COPD Secondary Care Audit Good Practice Repository – Smoking Version 1: June 2018
Introduction The National Asthma and COPD Audit Programme (NACAP) have collated a series of case studies which highlight good practice in both audit data collection and entry, and in provision of quality COPD care. This document aims to provide teams with learning to implement locally, and with ideas on how local practice could be improved.
Do you have any questions? If you have any questions about any of the content, or would like more detail about any of the case studies, please contact the NACAP team on 020 3075 1526 or via email ([email protected]).
For further information on NACAP, please visit www.rcplondon.ac.uk/nacap.
Contents
Royal Sussex County Hospital (Brighton and Sussex University Hospitals NHS Trust) ...... 2 Colchester Hospital (Colchester Hospital University NHS Foundation Trust) ...... 3 Luton and Dunstable University Hospital (Luton and Dunstable Hospital NHS Foundation Trust) ...... 3 Southend University Hospital (Southend University Hospital NHS Foundation Trust ...... 4
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The national 75th percentile for prescription of smoking cessation pharmacotherapy to current smokers is 34%. (Calculated February 2017)
Royal Sussex County Hospital (Brighton and Sussex University Hospitals NHS Trust)
Has a higher than average percentage of recorded current smokers prescribed stop-smoking pharmacotherapy. For the period April 2017 to As part of Brighton and Hove NHS Smoking Cessation Service the October 2017 the Royal Sussex city public health department funded a full-time Smoking County Hospital has on average Cessation Service Lead (Anna Fairhurst) initially for 3 years been prescribing smoking (October 2014 to October 2017) which has been extended for a cessation pharmacotherapy to further 2 years. 52% of current smokers compared Anna aims to see all patients admitted to RSCH who are current smokers to give stop smoking advice. She ensures stop-smoking pharmacotherapy is prescribed and is at theto acorrect national dose average for the of patient’s 25%. need.
All patients who are ready to quit will receive cessation advice and behavioural support. These patients then receive telephone support post discharge and are invited in to smoking cessation (SC) outpatient department (OPD) clinic to have their carbon monoxide validated. Those who are not able to attend hospital OPD will be sign posted them to the appropriate community stop smoking service. This includes a domiciliary service for housebound patients. Anna’s presence around our acute medical unit (AMU), A&E and wards raises the profile of smoking cessation in the trust and is a reminder of the importance of prescribing stop-smoking pharmacotherapy. She accepts on-line referrals for patients she has not been able to see, contacts them post discharge so that they can be seen by her in outpatients or alternatively refers them on to other appropriate stop- smoking services. Anna reports her KPIs quarterly: o Number of patients seen: 76 (In Q4 2016 – 2017) o Number of patients set a quit date: 76 o Number of patients quit at 1 month: 60 remained quit at 4 weeks (63% CO validated) All our cardiac rehabilitation specialists have received level 2 Intermediate SC training and support cardiac patients as these patients appear highly motivated following their shock cardiac event. A&E doctors are also trained at Brief Intervention and offer very effective SC advice. “Training is the key to appropriate Brief Intervention training sessions are actively referrals being made. Doctors advising promoted on an on-going/rotational basis to cover all on the importance of smoking cessation new nursing staff, doctors and other healthcare have also played a key role in our professionals. success.”
To find out more, contact details for Royal Sussex County Hospital can be obtained from the COPD audit team.
Good Practice Repository – Smoking | Version 1: June 2018 National Asthma and COPD Audit Programme [email protected] | 020 3075 1526 | www.rcplondon.ac.uk/nacap
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Colchester Hospital (Colchester Hospital University NHS Foundation Trust)
The trust has a consistently higher than national average prescription of smoking cessation to current smokers. 100% of patients admitted for an exacerbation of their COPD are asked about their smoking history. 62.7% of those still smoking are willing to uptake further smoking cessation. The success rate of them stopping has been high. On further admissions 62.2% of patients remain an ex-smoker. The trust became smoke-free within the ground in March 2017. Since this time all current smokers have been offered nicotine replacement therapy (NRT) on admission.
100% of current smokers at Colchester Hospital were prescribed smoking cessation in April 2017. Since this time the trust continues to offer smoking cessation consistently higher than the national average.
Smoking cessation is addressed via the COPD care bundle prior to discharge from hospital. All COPD patients are seen by the COPD clinical nurse specialist (CNS) and offered smoking cessation treatment and further counselling to help them to quit. Those patients that require further support are referred to the community smoking cessation team.
To find out more, contact details for Colchester Hospital can be obtained from the COPD audit team.
Luton and Dunstable University Hospital (Luton and Dunstable Hospital NHS Foundation Trust)
In order to improve smoking cessation support we set up a stop smoking executive board which included both primary and On average 34% of current secondary health and care professionals. smokers at Luton and We promote smoking cessation in the hospital via posters that Dunstable Hospital were contained referral information. prescribed smoking cessation We initiate a twice weekly ward round by smoking specialists in between March and and run ad-hoc outpatient smoking cessation clinics. December 2017. This is in line In addition we have devised a local smoking cessation guideline with the national 75th which includes the initiated prescribing of NRT as inpatients. percentile for prescription of smoking cessation.
Good Practice Repository – Smoking | Version 1: June 2018 National Asthma and COPD Audit Programme [email protected] | 020 3075 1526 | www.rcplondon.ac.uk/nacap
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Southend University Hospital (Southend University Hospital NHS Foundation Trust
Every weekday the respiratory clinical nurse specialists In March 2017 just over 18% of current team identify and review all patients admitted with smokers at Southend Hospital were COPD. All patients are asked about smoking status and referrals are made to the stop smoking advisor. The prescribed smoking cessation. By referral slip is left in chest clinic. December 2017 this figure had has risen A full time smoking cessation advisor is located within to 60% of current smokers. Southend Hospital to respond swiftly to inpatients. Current smokers are also provided with the smoking cessation team contact details. On the respiratory unit, all current smokers are identified on the white board. A stop smoking advisor attends the wards daily to identify these patients. Leaflets about smoking cessation and the contact details for the smoking cessation team are widely available in the trust. All current smokers have a ‘current smoker’ stamp “A dedicated smoking cessation group within the medical notes on admission. has been established and regular All patients Heart and Chest clinic are asked at each meeting and reviews of the processes are appointment they attend about their smoking status, if held.” current smokers they are offered smoking cessation.
To find out more, contact details for Southend University Hospital can be obtained from the COPD audit team.
Good Practice Repository – Smoking | Version 1: June 2018 National Asthma and COPD Audit Programme [email protected] | 020 3075 1526 | www.rcplondon.ac.uk/nacap
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