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

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

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. 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)

18. 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)

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

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……!