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Poster presentation:
Hospital inpatient smoking cessation pathway
Gary Bickerstaffe
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Level I & Level II hospital inpatient smoking cessation pathways poster. Gary Bickerstaffe. Bolton PCT June 2006.
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Abstract
Hospital inpatients, identified as smokers and who wish to use their hospital stay as a time to attempt to quit smoking can be readily assessed for dependence to nicotine and level of motivation to quit. Patients, who simply want to refrain from smoking during their stay, can also be appropriately assessed for NRT to relieve any withdrawal symptoms.
This Level II assessment pathway ensures that NRT is only prescribed within a programme of motivational support beginning in the hospital and continuing after discharge.
A dedicated paper assessment tool has been developed and is used to ensure the patient is asked the appropriate questions and that only those who have received this assessment are prescribed NRT. NRT cannot be prescribed in the hospital independently of this level II assessment.
The form that is used encompasses both a patient note records and a discharge letter ensuring any inpatient prescribed NRT is discharged into the care of the local smoking cessation service.
The service then proactively continues the motivational support and ensures the patient receives a continuous supply of NRT back in the primary care setting.
All grades of healthcare staff are trained via Level I and level II training to carry out the assessments. This ensures continuity of service throughout the hospital.
This has been an active service for approximately 18 months and has resulted in 230 assessments including the provision of NRT in Coronary Care Unit and Maternity Units as the form provides specific evidence of risk/benefit assessment.
Biography
Gary Bickerstaffe has worked in smoking cessation since April 2000. Originally an Advisor he progressed to the role of Specialist for Hospitals in 2003. He is responsible for developing and embedding smoking cessation protocols into the secondary care setting.
Working closely with teams within the secondary care setting he has developed very effective systems for Brief Interventions and subsequent referral into specialist services. Information on this was presented at the National preoperative conference in 2004 and the first national smoking cessation conference in 2005. There was subsequently a high level of interest in the Level I developments, especially concerning pre-operative assessments. This work was recently highlighted in the CNO bulletin for England and Wales Dec 2005.
The development of a Level II pathway came as a logical next step. Again working closely with teams within secondary care, a system of assessment, appropriate prescribing of NRT and an effective discharge pathway which involves specialist smoking cessation services was the outcome. This assessment and treatment pathway for smokers has proved to be highly effective in ensuring that patients who wish to quit smoking whilst in hospital are not denied this excellent opportunity.
He is currently also working outside of the smoking cessation service on behalf of another NHS department to develop a standardised system of supported self care for patients with COPD. This also encompasses building working partnerships with local providers of leisure and sports facilities to facilitate a hospital-led pulmonary rehabilitation service.
Author 1: Gary Bickerstaffe
Smoking Cessation Specialist - Hospitals
Lever Chambers Health Centre
Ashburner Street
Bolton
BL1 1SQ
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