Maternity and child health clinicians adding value from every contact by treating tobacco dependence...
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Maternity and child health clinicians adding value from every contact by treating tobacco dependence Helping Pregnant Smokers Quit: London & South East
Maternity and child health clinicians adding value from every
contact by treating tobacco dependence Helping Pregnant Smokers
Quit: London & South East Tobacco & Pregnancy Network
Meeting 16 July 2015 Sin Williams Programme Consultant NHSE London
respiratory network & Clinical Senate Helping Smokers Quit
team
Slide 2
Slide 3
Treating tobacco dependency Greatest value proposition for NHS
today Long-term relapsing condition that starts in childhood Unique
role for healthcare professionals: every clinician should know
smoking status of every patient they see and Use established and
evidence based pathways to help them quit Collective leadership
Clinically led transformational change in healthcare provider
culture Helping smokers quit London Senate Programme 2014-15
Slide 4
Helping Smokers Quit in London Influencing Strategy 4 Sponsored
by London Clinical Senate Council Delivered by HSQ Delivery Team
chaired by Mike Gill Held to account by the HSQ Programme Board 2
specific deep dives: mental health and smoking in pregnancy
Delivery team are experts in clinical change, champions of smoking
cessation as treatment, influencers
Why is helping pregnant smokers quit important? Active maternal
smoking causes up to 5,000 miscarriages, 300 perinatal deaths,
2,200 premature singleton births and 19,000 babies to be born with
low birth weight in the UK each year these adverse effects are
entirely avoidable (1) Maternal overweight and obesity and smoking
are the most important potentially modifiable risk factors for
still births in high income country settings smoking cessation
programmes in pregnancy are effective and should be implemented as
part of routine care (2) 1.Tobacco Advisory Group (TAG) of the
Royal College of Physicians (RCP) 2. Lancets Stillbirth Series 2
deep dives: maternity and mental health
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And the problem doesnt stop at delivery 35% of caregivers
reported tobacco exposure, yet cotinine was detected in 56% of
serum samples and 80% of saliva samples. Among caregivers who
reported no exposure, serum and saliva cotinine levels were
detected in 39% and 70% of children, respectively.
Slide 8
And the problem doesnt stop at delivery 35% of caregivers
reported tobacco exposure, yet cotinine was detected in 56% of
serum samples and 80% of saliva samples. Among caregivers who
reported no exposure, serum and saliva cotinine levels were
detected in 39% and 70% of children, respectively.
Slide 9
Reframe the problem: influence clinicians mental model &
provide hope Maternity and child health clinicians adding value
from every contact by treating tobacco dependence Develop and
promote key messages: influence what clinicians do Deliver a
professional relations programme: influence the endorsement system
Publish claims: influence the reference structure
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Clinicians want to know the basis of the claims we make. What
are the most convincing references & data? May need several
elements pulled together Publish claims: influence the reference
structure NICE PH26, ASH and PHE, Challenge Group? Best real London
prevalence data? eg Haringey Public Health data 1 in 6 mothers
smoke Tobacco Control Collaborating Centre data using urine
cotinine testing at delivery? Outcomes data on smoking? RCP Tobacco
Advisory Group 2010? Best references on the benefits and successful
implementation? babyClear? What about paediatric community:
maternal smoking affects asthma and allergy and admissions for
wheeze: references and data?
Slide 11
Reframe the problem: influence clinicians mental model &
provide hope Maternity and child health clinicians adding value
from every contact by treating tobacco dependence Develop and
promote key messages: influence what clinicians do Deliver a
professional relations programme: influence the endorsement system
Publish claims: influence the reference structure
Slide 12
Deliver a professional relations programme: influence the
endorsement system Identify the people others listen to/read/want
to impress; meet them, get them on board. Assess how confident they
are and how important helping smokers quit is to them and help them
raise to 8/10. Ask them to publicise the messages: they are the
endorsers Prof Stanley Okolo, North Middlesex, Helping Smokers Quit
Programme Board Prof Donald Peebles and Donna Ockenden,
Co-directors NHS England (London), Sarah Dunsdon, Maternity
Strategic Clinical Network; Prof Jacqueline Dunkley-Bent, Wendy
Matthews and Diane Hamilton- Fairley NHS London Senate Council
Susan Bewley, Kings Penny Chew, Smoking in Pregnancy Network Alun
Lewis, London TC network Prof Jacqueline Dunkley-Bent, PHE,
Marilena Korkodilos, PHE Deputy Director and PHE C&YP lead,
Aideen Dunne, PHE London Health Improvement Manager: tobacco
control, Nike Arowobusoye PHE: prevention in the acute trust Teresa
Airley, Marian Gibbon BHRT and LBBD Sara Nelson, Child Health
Strategic Clinical Network
Slide 13
Reframe the problem: influence clinicians mental model &
provide hope Maternity and child health clinicians adding value
from every contact by treating tobacco dependence Develop and
promote key messages: influence what clinicians do Deliver a
professional relations programme: influence the endorsement system
Publish claims: influence the reference structure
Slide 14
Quit smoking is first element of stillbirth reduction care
bundle (draft) 1. All pregnant women who smoke should be referred
for help to quit 2. Identify and institute surveillance for
pregnancies with fetal growth restriction (FGR) 3. Implement best
practice for reduced fetal movement - RFM 4. Effective fetal
monitoring during labour Implementing the evidence is effective and
welcomed so dont be afraid to ask Women benefit from frank and
factual information from a trained health professional about the
harmful effects of carbon monoxide (CO), and evidence-based support
to quit (babyClear) Systematic CO testing (at booking and 36 weeks)
is a valuable motivational tool : Dont assume you can tell by
looking Use the test to begin the conversation Can highlight poorly
ventilated appliances, faulty exhausts and second-hand smoke
Promote Smokefree Hospitals Is NRT on the formulary? Do you ask
about smoking on admission? Is NRT sold in the shop? Reframe the
problem: influence clinicians mental model & provide hope
Slide 15
Maternity and child health clinicians adding value from every
contact by treating tobacco dependence Develop and promote key
messages: influence what clinicians do Deliver a professional
relations programme: influence the endorsement system Publish
claims: influence the reference structure
Slide 16
Develop and promote key messages: influence what clinicians do
http://www.tommysbabybe.org.uk/main.php
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Plan to learn from babyClear Counts real local prevalence using
CO screening Systematic training, briefing of HCPs Evidence-based
protocols and care pathways, opt out referral Advanced skills
training to support Stop Smoking Advisors to work effectively with
pregnant women Ways to reach out to those not engaged with the Stop
Smoking Services Administrative/call centre staff training to
increase number accepting appointments Awareness raising and
engagement with all HCPs involved with pregnant smokers A
performance management system Monitoring and evaluation of
effectiveness The midwives have certainly been won over from a very
skeptical start. Carol A. Mutton, Head of Midwifery/Service
Manager, James Paget University Hospitals NHS Foundation Trust
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Commit to CO4 to improve the health of women and their
children, knowing tobacco dependence is a chronic, relapsing
condition that starts in childhood Improving the health of
Londoners by building stop smoking clinical leadership and capacity
COnversation with every woman who smokes that gives them a
chance/opportunity to quit CO monitoring by clinicians COde the
intervention so we can evaluate effectiveness COmmission the system
to do this right: so right behaviours incentivised
systematically
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Enabling COnversations : Clinicians trained in smoking
cessation - so every patient who smokes is offered an opportunity
to quit
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Why I have and use a CO monitor on the ward and in clinic or
cotinine? CO (ppm) >20 Highly dependent Shisha smoker Cannabis
smoker Cheap ~ 150 Quick and easy to use Diagnostic: - Smoking as
contributing factor to illness - Tobacco dependence Motivational
tool Outcome measure 29 4 Do your clinical teams who provide care
for smokers have and use a CO monitor?
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Does your organisation have a dataset for all patients smoking
status & interventions? Source: Survey of London providers, NHS
England (London) September 2014
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What smoking cessation outcomes does your organisation measure?
Source: Survey of London providers, NHS England (London) September
2014
Slide 23
Do your organisation know how many of your staff smoke? Source:
Survey of London providers, NHS England (London) September
2014
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www.londonsenate.nhs.uk/helping-smokers-quit/
Slide 25
Sources of borough data on low birthweight and infant mortality
(as proxy if no hospital data provided) Source:
http://fingertips.phe.org.uk/profile/cyphof/data#page/0 London
datahttp://fingertips.phe.org.uk/profile/cyphof/data#page/0 25 Low
birthweight babies
Slide 26
Sources of borough data on low birthweight and infant mortality
(as proxy if no hospital data provided) Source:
http://fingertips.phe.org.uk/profile/cyphof/data#page/0 London
datahttp://fingertips.phe.org.uk/profile/cyphof/data#page/0 26
Slide 27
Sources of borough data on infant mortality (as proxy if no
hospital data provided) Source:
http://fingertips.phe.org.uk/profile/cyphof/data#page/0 London
datahttp://fingertips.phe.org.uk/profile/cyphof/data#page/0 27