Authors: Dan Harley, Angela Cunningham, Corinne Love and Bernadette McCulloch,

MCQIC, Healthcare Improvement Scotland

www.scottishpatientsafetyprogramme.scot.nhs.uk/programmes/mcqic www.healthcareimprovementscotland.org www.nice.org.uk/guidance/ph26

Aims The Scottish Maternity and Children Quality Improvement Collaborative (MCQIC) aims to improve outcomes and reduce inequalities by providing a safe, high quality experience for all women, babies and families. MCQIC has three improvement aims related to smoking in pregnancy:

• offer 95% of women carbon monoxide (CO) monitoring at booking • refer 95% of women with a CO level of > 4pmm to smoking cessation services, and • provide a tailored package of care to 95% of women who continue to smoke during pregnancy.

Background There is evidence for the effectiveness of automatic/ ‘opt out’ referral pathways in increasing engagement of pregnant women and resulting in larger numbers quitting.

Methods Using the model for improvement, maternity units have been testing ‘opt out’ as a means to ensure referral to smoking cessation service (Figure 1).

Results Work conducted to date has resulted in:

• collection of data on the referral of women to smoking cessation services (Figure 2), and

• opportunities to identify how to improve referral processes to smoking cessation services.

Improving Scottish Antenatal Care Services for Women who Smoke During Pregnancy

Figure 1 – Model for Improvement Figure 2 – % women referred to smoking cessation services

Next steps • NHS boards continue to improve processes to refer pregnant women

who smoke to smoking cessation services.

• Focusing on supporting women who do not take up the referral to smoking cessation services.

• Continued collaboration with smoking cessation services and other national programmes to reduce the number of women who smoke during pregnancy.

• Continued co-operation with Scottish Government tobacco policy leads and NHS Health Scotland (Scotland's health improvement agency) to help improve MCQIC’s theory of change.

The science of quality improvement advocates the testing of change on a small scale, and capturing data to corroborate if the changes have led to an improvement. Maternity teams were given a range of tools to support measurement, including a clear operational definition, a sampling strategy and data recording tools to display data in time sequence. Teams shared their progress and their monthly data to accelerate learning and improvements.