Tobacco-free AOTEAROA Conference Auckland 2010 Smokefree Practice in Action

1. Tobacco-free AOTEAROA Conference Auckland 2010 Smokefree Practice in Action Sue Marshall. Smokefree Project Coordinator Maternal, Child & Youth Service Hawkes Bay District Health Board

2. Our Population

3. Pregnancy

4. Babies and Children

5. Exposure Ref: Internal Audit Report, Smokefree Systems-Special Care Baby Unit (SCBU) Hawkes Bay District Health Board, 2010.

6. Exposure Ref: Internal Audit Report, Smokefree Systems- Children's Ward Hawkes Bay DistrictHealth Board, 2010.

7. ApproachSystems First: model of organisational change Systems First Education Policy Systems Evidence Patient Intervention Roles

8. Policy • Leadership • Commitment

9. Systems • Documentation tools • Care pathways • NRT protocol • Audit systems

10. Education • MOH ABC e learning tool • HBDHB Smokefree education • SmokeChange Education for Midwives • Baby Essentials

11. Roles • Link Champions • Dedicated Smokefree Midwife • Smokefree Project and team • Clarity about role

12. Interventions • Focused ABC • Provision NRT

13. Audit • Process • Data • Findings

14. Maternity Services • ANTENATAL WOMEN • Screening • 100% woman • 77% partners • 70% household • Interventions • 61% (included NRT arranged or offered referral to a smokefree service arranged or offered). • POSTNATAL WOMEN • Screening • 95%postpartum women • 84%partners • 84% household • Interventions • 77% (included inpatient NRT arranged, offered or had NRT or referral to a smokefree service). Ref: Internal Audit Report, Smokefree Systems & Performance Maternity Services Hawkes Bay District Health Board, 2010.

15. Special Care Baby Unit Prevalence of Smoking in Families of SCBU Babies • 73% Screening • 100% Interventions • 81% Ref: Internal AuditReport, Smokefree Systems-Special Care Baby Unit (SCBU) Hawkes Bay District HealthBoard, 2010

16. Children's Ward Screening • 37% Interventions • 75% Ref: Internal Audit Report, Smokefree Systems- Children's Ward Hawkes Bay District Health Board, 2010

17. In Action embrace whole family motivational tools screening acknowledging harm 1st contact Women and their families smokefree during pregnancy smokefree midwife role - safe sleep discussions NRT for inpatient women free NRT for parents and caregivers contact over time discussion of benefits of smokefree electronic discharge summary motivational time antenatal clinics Just Imagine booklets smokefree family smokefree household referral to smokefree support service other health care professionals smokefree partners smokefree pregnancy care pathway midwife hat and Quitcard provider hat NRT A little and often by many over time

18. In Action brief advice NRT for parents and caregivers Quit cards referral to smokefree support service Parents and Caregivers of Hospitalised Babies and Children Smokefree screening for exposure linking in with other providers care pathways professional support electronic discharge summary discussion of benefits of smokefree smokefree Link Champions acknowledging harm smokefree environment providing opportunity for practice to be smokefree

19. Stories Ruby Rawiri

20. References Cowan S & Smith D. Systems First – supporting smokefree leadership in New Zealand hospitals. Guidelines for district health boards. Christchurch, NZ. Education for Change. August 2005. Baby Essentials Online http://www.changeforourchildren.co.nz/safe_start_programme/baby_essentials_online DiFranza,J., Aligne,C.A., WeitZman,M. (2004) Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics Vol.113. Hofthuis,W., de Jongste,J.C.,Merkus,P..J. F.M. (2003) Adverse health effects of prenatal and postnatal tobacco smoke exposure on children. Arch.Dis.Child 2003;1086-1090.