Training & education in smoking cessation

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Training education in smoking cessation

• gary.bickerstaffe_at_bolton.nhs.uk

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• Gary Bickerstaffe
• Health Improvement Specialist
• (Health Promoting Hospitals)

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• Gary Bickerstaffe
• Smoking Cessation Specialist - Hospitals

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Gary Bickerstaffe

• Brad Pitts Stunt Double!

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The role of a Smoking Cessation
Specialist/Advisor?

• Explain NRT to people
• Give vouchers for NRT
• Send letters to GPs
• pharmacies
• Offer cessation hints tips
• Input data
• Design put up posters
• Hand out leaflets
• Attend meetings/conferences

• Some strategy work?
• Tell people to get a grip and just stop
  smokingits bad for you!
• Sorrythats the doctors
• Training

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We are nice with people and supportive with
people
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Most of the time!
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Who delivers stop smoking advice services?

• SSS Staff
• GPs/Practice Nurses
• Assistant Practitioners
• HCAs
• Pharmacists
• Pharmacy counter Assistants

• Physiotherapists
• Dieticians
• Acute nurses
• Community nurses
• Midwives
• Health Visitors
• Health Trainers
• AND

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Some other qualified people!
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• TRAINING

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Standards For Training In Smoking Cessation
Treatments HDA 2003
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Smoking interventions

• Two levels of service developed in hospital
• Level I (Brief Interventions)
• signposting for inpatients outpatients
• Level II (Intermediate intervention)
• inpatient stop smoking assessment

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Level I training Brief Interventions

• 3-hour training session
• Facts, statistics on smoking and information on
  local Stop Smoking Service.
• Essentially to make a case to the healthcare
  staff to encourage them to ask all patients about
  smoking the benefits of stopping and if further
  help is required referral made or leaflet given.

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Training Level I

• 3 hour powerpoint/interactive session
• Small support pack given (referral form, leaflet,
  copy of training)
• Certificates given
• Electronic database kept of people trained
• Delivered wherever (but usually at the hospital)
• Part of hospital education prospectus/embedding
  in usual doctor student nurse training
• Minimum of 6 people to attend?

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Level I training session is about..

• Information about the local SS Service
• Who smokes (national local) why people smoke
• Whats in a cigarette
• Harm caused by smoking
• Who/how many want to quit
• Advice to give using the 4 As - Ask Advise
  Assist Arrange
• How to record the intervention refer on

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Level II - intermediate

• To facilitate immediate stop smoking
  support/symptom relief for inpatients
• NRT limited to a specific support pathway
• Recorded assessment for risk/benefit motivation
  to quit dependence to nicotine standardised
  assessment form designed and used.
• To recommend or prescribe NRT
• Ensure continued support after discharge
• Any grade of staff can attend training assess

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Level II training is about..

• Basic concepts of addiction
• Models of change
• Basic concepts of motivational interviewing
• How to complete the dedicated assessment form
• What to do with the form when completed
• Nicotine replacement therapy in detail - products
  use

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Results Nov 2002 Nov 2006

• Level I (Brief Intervention) hospital referrals
• approximately 4500 over four years
• not for bad for a non-compulsory intervention
• mostly from pre-operative clinics
• referrals directed into usual SSS community
  services
• expected to achieve usual service quit rate (no
  tracking system to date)

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Results Level II Nov 2003 Aug 31 2007

• Total 477 inpatient assessments
• Cardiology 265 55.5
• Respiratory 122 25.5
• Med A Unit 27 6
• Orthopaedics 16 3
• Stroke 14 3
• Maternity 5 1
• Other 20 4
• Mental health 8 2 developments
  required!

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Results (NRT) Nov 03 Aug 07

• One weekly NRT Px as inpatient One full week Px
  on discharge
• Patch 232 49
• Inhalator 134 28
• Lozenge 33 7
• Gum 32 7
• Nasal spray 17 3.5
• Microtab 4 0.8
• Unknown 7 1.5
• no NRT 17 3.5
• Combination 1 0.2
• Total NRT cost to hospital 8,300

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Delivering training education

• Prepare to train small numbers
• Prepare for it to take forever!
• Pre-op out-patient clinics good start point
• The referrals start coming in
• ongoing training then maintains the momentum

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Training/education

• Generates inter-professional respect/status
• Contributes to NHS service innovation
  improvement
• Provides professional access for SS service to
  all grades of healthcare staff
• Makes a case for smoking cessation practices
• Helps the SSS service embed itself into
  healthcare settings

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Importance of training/education

• THE UPSHOT IS
• It is more difficult to replace a service that
  delivers training!
• Its not as difficult to replace a service that
  simply delivers stop smoking advice

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SSS staff training education - outstanding
issues

• No accepted SC qualification or training route
• If one appears will we, can we or must we all
  complete it?
• What is training? Is there an accepted format?
• Will training last? (Enough new employees?)
• Who trains the trainers?
• No professional body or affiliation (or have we?)

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Education-led developments

• Potentially successful template for other
  lifestyle interventions e.g. Public health/
  health promotion
• Promote SSS as part of wider public health
  initiative - not separate
• Develop service in key areas e.g. mental health,
  disadvantaged, difficult to reach groups

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THANK YOU

• Gary Bickerstaffe

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Recording interventions

• Standardise across the hospital setting
• Dont wait for the form to appear!
• Use a temporary sticker or other
• Audit regularly report findings
• What information to collect?

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Recording interventions

• What smoked cigs/roll tobacco/cigars/pipe?
• Avg number cigs per day or ounces tobacco?
• Chewing tobacco?
• Does patient want to stop?
• Brief advice given?
• Leaflet given?
• Level II requested?
• Referral to SSS?
• Name,date dept of staff

• Smoker ex-smoker never smoker?
• If ex how long? days/weeks/months?
• Age started?
• Age stopped?
• Smokers any quit periods gt12 months?

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Training Level II

• 6 hour Powerpoint/interactive session
• Must complete Level I first
• Certificates presented
• Database kept
• List of trained staff available on hospital
  intranet
• Motivational interviewing how to complete Level
  II form nicotine replacement therapy (NRT)

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Other qualified people!
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In an ideal world

• Higher priority for smoking cessation in hospital
• Success measured at 12 months (across all
  settings)
• Staff released (more readily) for training
• Time allowed for advice to patient any
  assessment
• Accredited national qualifications for SSS staff

• More investment in SSS staff to continue support
  after hospital discharge
• Home visits
• Solutions to mental health smoking cessation?
• More medications to choose from
• Standardised assessment tool across national NHS

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Level I Brief Interventions

• Within the three-hour training session
• Very brief advice (3-10 minutes) to any patient
  identified as a smoker. 4 As Ask, Advise,
  Assist, Arrange
• Concentrating on benefits of stopping
• RECORDING THE INTERVENTION, give a leaflet and/or
  referral form to Stop Smoking Services