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SMOKING CESSATION PILOT NEWSAM CENTRE WARD 2 AND 3 FORENSIC SERVICES Helen Hartley Michael Dixon Mark Lester Denise Hobson INTRODUCTION Studies show that of patients in mental health units: 70% smoke

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smoking cessation pilot

SMOKING CESSATION PILOT

NEWSAM CENTRE

WARD 2 AND 3 FORENSIC SERVICES

Helen Hartley

Michael Dixon

Mark Lester

Denise Hobson

introduction
INTRODUCTION
  • Studies show that of patients in mental health units:

70% smoke

50% are heavy smokers (smoking more than 20 cigarettes per day)

This compares to approximately 26% of the general population.

(Meltzer H. et al 2003)

leeds pft going smoke free
Leeds PFT going smoke-free
  • Leeds Partnerships NHS Foundation Trust went smoke-free January 2007
  • Route to go smoke-free:
  • Stopping smoking working group established inc estates, smoking cessation service, medics, pharmacy, nursing, TCCC, unions, risk management dept.
  • Smoking shelters
  • No smoking signs
  • CD on smoking literature produced
  • NRT available on all community and inpatient units (patches and gum)
perceived worries about going smoke free
Perceived worries about going smoke-free
  • Increased risk of violence
  • Fire hazard
  • Nursing time required for escorting patients
  • Impact on staff breaks
  • Lack of knowledge about NRT
  • Time required to speak to patients about quitting
and what actually happened
And what actually happened…..
  • No increased violence
  • occasions of smoking in bedrooms but no increase in fires
  • Escort patients at set times
  • Breaks –ask lynn?
  • Address with training & advice sort where needed
  • Time required to speak to patients
training of staff
Training of staff
  • lunchtime talk to doctors about prescribing NRT
  • Lunchtime talk to pharmacy
  • level 1 training – offered to wards but only taken up by 2 out of 4 sites
  • Level 2 training – 20 trained after running 2 course (4 offered)
  • Dissemination of NRT prescribing guidelines
  • Letter sent to all wards offering help of Leeds smoking cessation services
before csip pilot
BEFORE CSIP PILOT
  • Assessing smoking status put on standard admission form
  • Discussed with forensic directorate manager & ward managers
  • Discussion between Leeds stop smoking service and pharmacy
  • Involved level 2 advisor in forensic service
  • Identify link persons on respective wards and set up working group
  • Audit of ward staff about current stop smoking services offered
  • Wrote CSIP protocol
work of csip pilot group
Work of CSIP pilot group
  • Met on a weekly basis for a month
  • Poster display
  • Leaflets available on wards
  • Ward administrator responsible for upkeep of displays/leaflets
  • Advertised pilot to staff and patients
  • Level 1 training provided again for staff
csip pilot planning
CSIP PILOT - Planning
  • JANUARY 2008 – commenced a pilot drop in group at the Newsam Centre, on wards 2 and 3, forensic wards.
  • Offering smoking cessation advice and support
  • Using the Smoking Cessation In Practice document as a toolkit to deliver a sustainable system.
  • Involved one smoking cessation nurse, trained smoking advisor from forensic wards and one pharmacist
csip pilot planning10
CSIP Pilot - Planning
  • Pilot to run for 8 weeks then to be reviewed.
  • Same day, same time each week to promote familiarity .
  • Same advisors running group again to promote familiarity.
  • Tea, coffee and biscuits available.
  • Informal, relaxed environment
csip planning
CSIP Planning

Audit

Part 1 – numbers seen at drop-in group

- % quit at 4 weeks

Part 2 – audit of no. of patients who had smoking status assessed on wards before and after pilot

results 1
Results (1)

Part 1 - Forensics

  • 9 people
  • 6 service users
  • 3 staff
  • 3 people still on smoking cessation therapy (2 staff, 1 service user) – 33%
results 2
Results (2)
  • Reviewed pilot after 4 weeks and decided to extend it to an acute day hospital
  • Discussed with their team manager
  • Time split as follows:
  • 2-3pm – forensic drop-in
  • 3-4pm – day hospital drop-in
  • Ward staff informed smoking advisor about which people needed to be seen
results 3
Results (3)

Part 1 – Day Hospital

  • 8 people
  • 7 service users
  • 1 staff member
  • 4 people still on smoking cessation therapy (3 service users, 1 staff member) – 50%
results part 1
Forensics

9 people

6 service users

3 staff

3 people still on smoking cessation therapy (2 staff, 1 service user) – 33%

Day Hospital

8 people

7 service users

1 staff member

4 people still on smoking cessation therapy (3 service users, 1 staff member) – 50%

Results (Part 1)
results from wards part 2
January (before)

35 patients

Smokers 94%

Non-smokers 6%

Offered advice 74%

Given NRT 8%

April (after)

35 patients

Smokers 94%

Non-smokers 6%

Offered advice 82%

Given NRT 25%

Results from Wards (Part 2)
post pilot
Post pilot
  • To run level 1 smoking cessation course at Day Hospital
  • Provided CO monitors to 4 inpatient sites
  • To continue visits to forensics and day hospital on a Monday pm
  • To continue providing Level 1 & 2 training course
  • To provide yearly update courses for level 2
  • To try to keep any discharged patients in contact with Smoking Cessation Service
conclusions
Conclusions
  • Forensic patients – challenging group to get to stop smoking
  • Day Hospital patients may be more mentally well and ready to give up smoking
  • Future work will involve providing smoking cessation support to other day hospitals in the Trust using trained advisors
and today
AND TODAY………..
  • New planner designed and in use.
  • New posters.
  • Referral pads.
  • Level 2 training planned.
  • Update training available for advisors.
  • Level 1 training available for the trust.
  • Work to start with Learning Disabilities.
  • Working in partnership with Leeds PFT and the Nutritional and Physical Wellbeing Team.
  • And lots more……!