Welcome
to the summer edition of BTS Stop Smoking Champions Newsletter. There has been a lot going
on in the last few months from both the BTS Tobacco Specialist Advisory Group as well as nationally:
• Over the last few months we have finalised the BTS National Smoking Cessation Audit and have had a
great response to our call out for volunteer pilot sites to trial the Audit. Many thanks to those who have
volunteered. The pilot phase will begin on 1st June 2015 and will run until 31st July 2015. We hope to
have some preliminary results in time for the Stop Smoking Champions study day in September.
• Working with the Deborah Hutton campaign, BTS has sponsored the Cut Films schools project where
children create a short film to learn about the harms related to tobacco.
• University Hospitals Leicester and Leicester City Stop Smoking Service have produced a training video
called ‘Emily’s Story’. This video will be hosted on the BTS website. It is primarily for use by healthcare
professionals in smoking cessation teaching in hospitals to encourage colleagues to refer smokers to
the Stop Smoking Service. This video can be used alongside the BTS Educational slide set.
• To date we have recruited 155 Stop Smoking Champions in 131 sites across the UK, and are really
looking forward to our Stop Smoking Champions Day on 24th September 2015. More on this later in
the newsletter.
On a national level smoking rates continue to decline. The latest figures show an incidence of 17.9%. For
further information see “smoker’s toolkit” available via the following link
http://ash.org.uk/localtoolkit/
.
• New legislation banning smoking in cars with children is due to come into effect later this year.
• Plain packaging measures have been approved and judging by the Australian experience this should
have an impact on improving quit rates and reducing the uptake of smoking in children.
• Earlier this month, ASH launched their new tobacco plan ‘Smoking Still Kills’ that will hopefully be
adopted by the government over the next 5 years to reduce uptake and incidence of smoking further.
• New Public Health Bill launched by the Welsh Government June 2015, includes restrictions on use of
e-cigarettes in enclosed public spaces. This is expected to come into force in 2017.
We are delighted to have had a lot of interest to submit articles to the BTS Stop Smoking Champions
newsletter. It’s good to see so much great work going on around the country. We will also feature members
of our Tobacco SAG and this edition will introduce Dr John Hutchinson.
Finally I would like to encourage you to attend the BTS Summer Meeting and specifically the session on
the Friday morning which looks at the role of tobacco in TB, emergency admissions and Interstitial
Lung Disease.
Dr Sanjay Agrawal
Chair BTS Tobacco SAG
British Thoracic Society
Summer 2015
Contact BTS stop smoking champions at [email protected]
BTS Tobacco Specialist Advisory Group member profile
Dr John Hutchinson, Speciality Trainee Registrar Respiratory Medicine
I’m a Respiratory Specialist Registrar based in Nottingham. I’m currently taking time out of my clinical training to do a PhD, focussing on the epidemiology of Interstitial Lung Disease. Once completed I will then have a year left of clinical training in Nottingham before I qualify as a Consultant.
My interest in smoking cessation started early in my registrar training, when I repeatedly came across people with chronic respiratory disease who came to clinic breathless yet were still smoking. Despite numerous admissions to hospital with exacerbations, the smoking was never addressed (or at least not successfully). In an audit at one of my hospitals, current smokers just weren’t being asked about smoking on admission, despite being interested in stopping, and there were clearly missed opportunities to prescribe NRT or refer to local stop smoking services.
I found the BTS Case for Change document really helpful, and hope that during my time on the Tobacco Specialist Advisory Group we can contribute to similar work that will hopefully make it easier for hospital doctors to push forward smoking cessation efforts in their Trusts. Although much of this will involve system changes, I think there is a clear role for educating junior doctors, and hope that our updated educational slide set helps in this regard.
One of the random things I’ve enjoyed about the SAG has been the Cut Films project, where we have supported a competition where schoolchildren have the opportunity to make a film for their peers about the risks of smoking.
Musgrove Park Hospital, Taunton and Somerset
NHS Foundation Trust:
Lucy Rexworth, Innovation Support Office & Smokefree Lead, describes new initiatives to enforce the Smokefree site policy at Musgrove Park Hospital where they have recently launched the innovative ‘Push Button Smokefree Campaign’.
Musgrove Park Hospital is an entirely Smokefree site, meaning smoking is not permitted anywhere in the buildings or grounds. Despite initiatives and campaigns encouraging people not to smoke on site, the maternity unit in particular remained a hotspot for patients and visitors smoking.
Back in September 2014 the maternity department at Musgrove Park Hospital launched an innovative personal announcement system (funded by bid money won from Public Health England) operated by the receptionists to play out a pre-recorded Smokefree message.
When a smoker was seen to be smoking outside the main entrance of the maternity unit, a receptionist pressed a button to activate the PA device which then played out messages recorded by local school children that reinforce the Smokefree message.
Originally the idea for using children’s voices for the speaker system came after reading about the incredible response that Thompson airlines received when using children to play the actors in their safety video.
Following the very successful implementation of the system outside the maternity unit, the unanimous decision was made by the Smokefree team to drive this initiative forward to help tackle other smoking hot spots onsite. The team worked together to develop a business case which was quickly approved by the operational board and with approval, the team progressed with sourcing quotes from local contractors. The funding was sourced from a variety of charitable funds belonging to the different areas proposed to have the system
installed. In order to ensure that the project was implemented in a timely and professional manner the Smokefree team worked very closely with a number of internal stakeholders including contractors, estates, capital projects, signage committee and teams from the areas that would have access to the system.
The location of the activation buttons was very carefully considered and it was decided that in order to target the largest number of smokers, all main entrances to the hospital should be fitted with the system. In addition to this, it was also decided that as well as fitting the activation buttons on reception, they should also be accessible to the public to encourage them to engage with the hospital’s Smokefree policy.
Similar to the system in maternity, whenever someone is seen to be smoking on site, patients, visitor and staff can now push the blue ‘no smoking buttons’, which play 1 of 8 pre-recorded messages (on a loop) via a tannoy system, which were recorded by local school children.
After months of planning, the hospital was proud to finally launch the roll out of the new systems across the hospital site at
Hayley Stone, Smoking Cessation
Specialist Midwife
Describes the work in Maternity services where they have achieved the lowest SATOD (Smoking at time of delivery) results in the country.
Musgrove Park Hospital had a high prevalence of women smoking at time of delivery (SATOD) and by January 2013 this was noted to become an upward trend with over 17% of mothers smoking at time of delivery, which was well above the national government target set of 11% to be reached by 2015.
As a result of this, a specialist smoking cessation midwife post was created to provide a major service re-design of the smoking in pregnancy service pathways. This involved embedding intensive smoking cessation practice into routine antenatal care, and encouraging all staff members to welcome this change. The first big test of change was introducing carbon monoxide monitors whereby all women booked in for their first appointment with their midwife was offered a carbon monoxide screen. In 2013 only 1% of women were offered carbon monoxide screening but the compliance rate to date is now 82%. Carbon monoxide screening has enabled maternity services to identify women who smoke, allowing confidence in the accuracy of our data. This highlighted that a staggering 16% of women were smoking at conception in 2013/14.
The use of carbon monoxide monitors gave midwives an
opportunity to discuss with patients their smoking status and a brief overview of the harmful effects of smoking in pregnancy tailored to the individuals Carbon Monoxide screen result. This conversation then led them to complete a referral to the stop smoking service which became an opt-out programme. In 2013 the referral rate was 59% and the opt-out programme now has a referral compliance of 97% to date.
The partnership between the maternity service and the smoking cessation service became well established in January 2013, with smoking advisors visiting women at their homes to support them to quit smoking; from booking up to six months post-natal. This initiative has run alongside the incentive scheme of ‘Mums to be vouchers’ which reward women for setting a quit date, staying a non-smoker and remaining engaged with the service. Combined with the one to one support, evidence shows that more and more women are staying quit by the time of delivery.
In 2014, Musgrove established its very first risk perception clinic, whereby all women who were identified as smokers were seen on a one to one basis by the specialist smoking cessation midwife after their first ultrasound scan. Within this clinic the specialist smoking cessation midwife uses the ‘Risk Perception Tool’ and visual aids (including a ‘placenta teaching aid’ created by the specialist midwife in post), to demonstrate the harmful effects of smoking in pregnancy. This clinic is specifically aimed to engage the hard to reach women who are the least likely to engage with smoking cessation.
the beginning of May, inviting all those who participated in the project to celebrate the activation of the buttons.
Further campaign work involving the public is being planned for the summer, to continue to raise the profiles of the buttons and encourage public and staff to use them. It is hoped that this combination of work will raise the Smokefree status of the hospital and greatly decrease the number of smokers on site.
Contact BTS stop smoking champions at [email protected]
The placenta teaching aid in particular has been extremely useful in aiding the understanding of the anatomy, physiology, the role of the placenta and the damaging effects smoking has in pregnancy. The risk perception clinic has been incredibly valuable in engaging with those still smoking through pregnancy and has enabled the hospital to successfully integrate stop smoking services into routine antenatal care.
These smoking cessation pathways successfully in place, have resulted in the hospitals smoking rates improving dramatically. The proportion of pregnant smokers who set a quit date increased from 11% in 2013 to 38% in 2015, with a staggering 48% of women staying quit after four weeks from a mere 4% in 2013. These impressive figures mean on average a total of 50 babies per quarter are born smoke free with the help of the intervention scheme. This has lowered our current smoking at time of delivery SATOD data to 12.4% in quarter 4, 2014-2015 and this continues to fall today.
The hospitals current plans are to continue offering the carbon monoxide screening to all women at booking, to identify all women whom smoke with an opt-out referral to the smoking cessation service. This will continue the great one to one care community support by the smoking advisors alongside the incentive scheme. The risk perception clinic will also continue to run and help to engage those hard to reach women in the smoking cessation service and with the help of the placenta teaching aid to help women understand the risks of smoking in pregnancy.
Bristol Royal Infirmary:
Ros Badman, Clinical Nurse Respiratory Specialist gives a brief description of newly funded post for smoking cessation services “University Hospitals Bristol NHSFT (Bristol Royal Infirmary) working in partnership with Bristol City Council have secured funding for 12 months (fixed term post) to employ a part-time smoke free practitioner. We have recruited into this post and our new team member will start towards the end of June.
The job specification for this post is quite large with the main areas of focus:
• Enabling and supporting our patients, staff and visitors to remain smoke free whilst in our hospitals. • Circulation, understanding and compliance with our smoke free policy.
• Adherence to NICE PH48.
• Increasing awareness and providing brief intervention training to as many staff as possible (developing tools to enable this) • Improving all our patient information.
• Working with groups of patients and staff to develop best practice that we can ‘roll out’ and share.”
South London and Maudsley
NHS Foundation Trust
Implementing the NICE Guidelines for smoking cessation in secondary care: making it a reality in a mental health care setting.
Dr Debbie Robson, Mental Health Nurse & Senior Post Doc Researcher, Ann McNeill, Professor of Tobacco Addiction, Addictions Dept, KCL& Mary Yates, Modern Matron, South London & Maudsley NHS Foundation Trust
People who use mental health services in South London die on average up to 17 years earlier than people who don’t have a mental illness. Typically they die from potentially preventable cardiovascular and respiratory illnesses. For the first time in at least 80 years, the frequency of smoking in the general population is below 20%. In South London, around 60% of local services users with a psychosis and 88% who use local drug and alcohol services smoke. The South London and Maudsley NHS Foundation Trust (SLAM), the Addictions Department at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London and the South London CLAHRC are working together to implement the NICE guidelines for smoking cessation in secondary care to address this massive health disparity.
SLAM serves a diverse population of 2 million. Locally, we deliver mental health services to people living in the London boroughs of Croydon, Lambeth, Lewisham and Southwark; and substance misuse services for residents of Bexley, Lambeth, Greenwich, Southwark and Wandsworth. We also provide specialist services for people across the UK. The Trust has 4 hospital sites and treats approximately 5,300 inpatients a year. It also has over 200 community sites treating around 45,000 patients a year. We are part of King’s Health Partners Academic Health Sciences Centre, along with Kings College Hospital, Guys and St Thomas’ and Kings College London.
SLAM went completely smoke free on October 1st 2014, following several years of preparatory work and the successful piloting of a comprehensive smoke free policy in our forensic services. Service users and staff can no longer smoke in the hospital grounds and staff can no longer facilitate smoking. This is a huge culture change for people who work and receive treatment in a mental health setting. For decades, we have expected and accepted smoking in our hospitals. We have used cigarettes as a therapeutic tool to manage patient’s behaviour, whilst neglecting to treat tobacco dependence.
Engaging staff and services users in a new way of working has been challenging but largely successful. Getting the
balance right between the provision of tobacco treatment and enforcement of a smoke free policy takes a period of time. There are a number of initiatives that we put in place to assist this.
SLAM tobacco dependence treatment pathway
We have developed a new Trust-wide tobacco dependence treatment service. The Maudsley Smokers Clinic (which was first set up over 40 years ago by Professor Mike Russell), acts as a central service hub. Three posts have been created to support new hospital satellite services. For the first time in SLAM, there is a lead hospital tobacco dependence treatment advisor providing in-reach support to each of our hospital sites. These lead advisors provide specialist tobacco dependence treatment and advice to inpatient services and a bridging service between the ward and community specialist stop smoking services. Every patient admitted to an inpatient ward in SLAM can now expect to have their smoking status assessed, be offered advice about the evidence based support available and offered Nicotine Replacement Therapy (NRT) within 30 minutes of arriving on the ward. A new electronic referral system embedded with in the electronic health records allows inpatient and community staff to refer people for specialist support. Since we implemented the new referral system we have seen referrals for support steadily increase.
Improved access to NRT treatment
When making a quit attempt or temporarily abstaining from smoking, smokers need prompt access to NRT. We worked with our Pharmacy Department to add two new ways to access NRT. We developed a Patient Group Direction for NRT, which enables qualified nurses, with additional smoking cessation training, to administer a combination of two NRT products without a doctor’s prescription. Pharmacy also added a limited supply of NRT to the existing Trust Homely Remedies (Medicines Management) Policy. These two initiatives ensure that smokers can be offered NRT 24 hours a day without delay, and without a doctor’s prescription. Smokers have access to the full range of NRT products and we support combination use for those assessed as being heavily dependent smokers. We also encourage long term NRT use when clinically indicated to prevent relapse.
Electronic cigarette policy
We promote the use of licenced nicotine replacement products or stop smoking medications such as varenicline or bupropion as first line treatment. Electronic cigarettes (e-cigarettes) are a less harmful form of nicotine delivery and offer another choice for mental health smokers to manage temporary abstinence from tobacco use or who want to make a quit attempt. SLAM have taken a pragmatic decision to support the use of certain types of products within its hospital services. Disposable and pre filled rechargeable e-cigarettes are allowed on Trust premises. A policy outlining the safe use and management of e cigarettes includes recommending that their use is part of a smokers care plan, they cannot be used in communal places or during therapeutic activities. Risk assessments and management plans ensure that if required devices are charged by staff following the manufacturer’s guidance.
Staff training
The implementation of any new policy and treatment pathway requires a competent and engaged workforce. All frontline staff are encouraged to complete a 2 hour E Learning Course, specifically developed for mental health professionals. The aim of this course is to raise awareness of the scope of the problem of tobacco addiction in mental health settings and make the case that treating tobacco addiction is everyone’s business. Since 2012, a total of 1330 staff in SLAM have completed this training. Since July 2014, an additional 134 inpatient staff have completed 3 day classroom based training to deliver intensive stop smoking support or support for temporary abstinence. The evaluation of training has demonstrated positive outcomes with regards to knowledge, attitudes and confidence.
Supporting staff to stop smoking
The Maudsley Smokers Clinic and the site based tobacco dependence treatment advisors offers dedicated sessions for staff who smoke. The Trust supports staff to attend the treatment sessions during their contracted work hours. Since October 2014, 27 staff have engaged with the service and 12 have quit.
The NICE guidelines for smoking cessation in secondary care (NICE, 2013) have the potential to have a substantial impact on the physical health of people who use mental health services. There is much to do to change the hearts and minds of the mental health community about the value of providing support to stop smoking and creating smoke free hospital environments. The journey of a thousand miles begins with a single step……….
Contact BTS stop smoking champions at [email protected]
NICE Quality Standard [QS42] Smoking: reducing tobacco use: published March 2015
This NICE quality standard covers reducing tobacco use, including interventions to discourage people from taking up smoking, tobacco control strategies and smokefree policies. It covers all smoked tobacco products, including shisha, but does not cover smokeless tobacco or tobacco-free products such as e-cigarettes or shisha pens.
The QS is a concise set of prioritised statements
NICE quality standard Smoking: reducing tobacco use
1. Schools and colleges deliver combined interventions to stop children and young people taking up smoking by improving their social competence and awareness of social influences.
2. Schools and colleges do not allow smoking anywhere on their grounds and remove any areas previously designated for smoking.
3. Trading standards identify and take action against retailers that sell tobacco products to people under 18.
4. Employers allow employees to access evidence-based “stop smoking” support during working hours without loss of pay.
5. Healthcare services use contracts that do not allow employees to smoke during working hours or when recognisable as an employee.
6. Healthcare settings do not allow smoking anywhere in their grounds and remove any areas previously designated for smoking.
7. Secondary healthcare settings ensure that a range of licensed nicotine-containing products and stop smoking pharmacotherapies is available on site for patients, visitors and employees.
8. Local authorities use regional and local media channels to reinforce national tobacco campaigns. For further information visit: https://www.nice.org.uk/guidance/qs82
How do I start to get a tariff agreement in my acute trust for smoking cessation?
Firstly you will need to discuss with your Trust about becoming a ‘provider’ of NHS Stop Smoking Services. You will then need to contact your local community stop smoking service. They will be able to let you know who the local lead or Commissioner is, they are usually based in the Public Health department of the local Council. They will be able to advise you on how local commissioning structures operate within your area.
An option may be to set up a contract similar to the one local GP’s and Chemists have. You will be provided with an electronic system/date base to record all your patients notes/activity which in turn feeds into the finance department for payment. It is ususally best to have a patient group direction (PDG).
For more information go to the smoking cessation page on the BTS website.
www.brit-thoracic.org.uk/clinical-information/smoking-cessation/
Stop smoking Champions Study day programme details
The BTS Stop Smoking Champions study day will be held at the Clinical Education Centre at Glenfield Hospital in Leicester. It is specifically for BTS Stop Smoking Champions and we are delighted that we have received funding to enable us to offer the day free of charge to our Champions. Places are limited and we regret that only Stop Smoking Champions can attend. Delegates are expected to fund their own travel. The main aim of the study day is to enable BTS Stop Smoking Champions the opportunity to enhance their knowledge, share experiences, develop links, networks and support from colleagues.
The course includes an insight into the changing epidemiology of smoking tobacco policy and new developments, how to implement smoke free policies, discussion on E-cigarettes and management of difficult to treat smokers and pharmacology.
For further information in relation to registration will be available soon and an email sent to all BTS Stop Smoking Champions.
BTS and Cut films awards
BTS, working with the Deborah Hutton campaign, sponsored a Cut Films youth worker to go into schools and run a full one day tobacco education and filmmaking workshop with students, with the aim of completing at least 1 film in 16 schools. Schools were nominated by members of the BTS Tobacco SAG. 37 films were submitted from primary and secondary schools around the UK and were judged by a panel from BTS. The winning film will be announced at a reception at BAFTA HQ on 1st July, where they will be presented with an award. To find out more about the project go to www.cutfilms.org
Parliamentary Launch of “Smoking still kills report” 9th June 2015
ASH launched a new report ‘Smoking Still Kills’ at an event at the House of Commons on Tuesday 9th June. The report, funded by British Heart Foundation and Cancer Research UK, follows on from the ASH 2008 publication ‘Beyond Smoking Kills’ highlighting the main results/ conclusions/ recommendations for the next five years in relation to Health and Tobacco control.
The event was hosted by Bob Blackman MP, Secretary APPG on Smoking and Health,
The report calls for:
1. A new vision for the country with ambitious target of achieving 5% smoking rate by 2035
2. A new comprehensive five-year Government tobacco strategy for England
3. A new approach to funding, annual levy on tobacco companies to fund tobacco control
4. A comprehensive package of measures
