Smokefree Midwives Pack

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Smokefree MidwivesPack

• Jane Sunter
• Performance Improvement and Delivery Manager

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Objectives of the DH Campaign

• Reduce the percentage of women who smoke during
  pregnancy to 15 by 2010
• To motivate pregnant smokers to stop during and
  after pregnancy
• To drive responses through the NHS Pregnancy
  Smoking Helpline, Stop Smoking Services and
  Smokefree Website

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Objectives of the Toolkit

• To provide a standardisation in approach to
  engaging pregnant smokers
• To ensure partners are included in the
  intervention
• To encourage health care care professionals to
  undertake the 3 A on a more systematic basis

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Content of the toolkit

• The content of the toolkit has been developed
  in conjunction with academics, midwives and LSSS
  Advisors and includes
• - flash cards
• - QA booklet
• -Training guide
• - copies of consumer collateral

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Brief Interventions in Tobacco Control

• Offering advice and support to stop smoking is
  the single most cost effective and clinically
  proven preventative action that a practitioner
  can undertake
• Curbing the epidemic Government and the
  Economics of Tobacco Control. World Bank 1999

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• No other preventative action produces such a
  powerful health result with such a small
  investment in time.
• Boa, Duan et al. Is provider advice on
  smoking cessation better than no advice? Health
  Service Research 2006

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• If all healthcare providers gave empowering
  stop smoking messages to all smokers, the impact
  on smoking prevalence would be greater than
  doubling the price of cigarettes
• Boa,Duan et al, Is provider advice on
  smoking cessation better than no advice? Health
  Service Research 2006

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NICE GuidanceFor brief interventions and
referral for smoking cessation in primary care
and other settings.

• Gives 9 recommendations
• Everyone who smokes should be advised to quit
  unless there are exceptional circumstances
• People who smoke should be asked how interested
  they are in quitting.
• Advice to stop should be sensitive to the
  individuals preference.

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Recommendation 9

• Monitoring systems should be set up to ensure
  health professionals have access to information
  on the current status of their patients.
• This should include information on
• Most recent occasion on which advice was given
• Nature of advice offered
• Response to that advice

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Cochrane Reviews

• Training alone is not a useful investment, unless
  linked to organisational change
• a good system must be in place to support
  workers in putting skills into practice

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Department of Health recommendations

• Extensive research has concluded poor
  performance in smoking cessation is due primarily
  to inadequate systems.
• 85 of performance improvement lies with
  changing the system 15 with changing the
  individual.
• Dennings Rule.

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What is an adequate system?

• Senior level commitment
• Incentives
• Protocol
• Team work
• Training
• Supportive environment
• Resources
• Pharmaco-therapies
• Info on Stop smoking services
• Feedback

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Timescales

• When stop smoking messages are received from
  many health care professionals, motivation is
  increased.
• 30seconds (-3mins) brief advice
• 5-10 minute brief intervention
• Intensive support

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The 3 As

• ASK and record pregnant smokers/partners status
  (Smoker ex-smoker- non-smoker)
• ADVISE mum/partner on the health benefits the
  baby will gain from quitting smoking (4x more
  likely to quit with NHS support)
• ACT Build confidence, give information and
  refer (use NHS Pregnancy helpline and supporting
  leaflets)

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Practical models to support pregnant women in
brief intervention
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Trans-theoretical Model of Change
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Framework for Behaviour ChangeRollnick, Mason
and Butler (2007)

• Establish rapport
• Set agenda
• multiple single
• Assess importance and confidence (readiness)
• Explore importance and build confidence

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Establish rapport

• Use the clients name
• Make eye contact
• General chat
• Ensure privacy
• Create a pleasant environment
• Introduce other if present
• Identify pressing concerns
• Use a typical day

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The ingredients of the readiness to change

• Importance
• (Why should I change)
• (Personal values and expectations
• of the importance of change)
• 
  Readiness
• Confidence
• (How will I do it?)
• (self efficacy)

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Assessing importance and confidence

• Use scaling questions
• how important is it to you personally to give
  up smoking at the moment?
• If 0 was not important and 10 was very
  important what number would you give yourself?

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• If you decided right now to give up smoking,
  how confident would you feel about succeeding
  with this?
• If 0 was not confident and 10 was very
  confident, what number would you give yourself?

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A readiness to change continuum

• not ready unsure ready
• -----x------------------x---------------------x--
  ----

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• If a change feels important to you and you
  have the confidence to achieve it you will feel
  more ready to have a go.
• You are ready, willing and able
• Miller 2006

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Practitioners skills

• Asking open questions
• Reflective listening
• Summarising
• Affirming

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Contact details

• Jane Sunter
• Performance Improvement and Delivery Manager
• Tel [phone]
• Jane.Sunter_at_smokefreenorthwest.org.uk