SMOKING CESSATION PILOT

1. SMOKING CESSATION PILOT NEWSAM CENTRE WARD 2 AND 3 FORENSIC SERVICES Helen Hartley Michael Dixon Mark Lester Denise Hobson

2. 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)

3. 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)

4. 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

5. 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 Being giving nrt on picu for years before going smoke-free with no increased problemsBeing giving nrt on picu for years before going smoke-free with no increased problems

6. 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

7. 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

8. 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

9. 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 Offered advice and support to staff and patientsOffered advice and support to staff and patients

10. 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

11. 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

14. 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%

15. 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

16. 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%

17. 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% Forensic beds � 35 (20 ward 2, 15 ward 3) Day hospital places - 20 Forensic beds � 35 (20 ward 2, 15 ward 3) Day hospital places - 20

18. 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%

19. 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 Did sheet which transfers to smoking cessation service on dischargeDid sheet which transfers to smoking cessation service on discharge

20. 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

21. 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��!