Could you outline your current role and responsibilities and why you enjoy doing it?
I offer inpatients and outpatients support to quit smoking or just to abstain during a hospital stay and arrange any pharmacotherapy products they wish to try. For those who quit smoking I also follow up on discharge. I enjoy being able to support those patients who are struggling with nicotine withdrawals, making their hospital stay a little easier, and giving them the opportunity to quit. I run education sessions for staff, so they know how and when to refer patients into the service and support staff to quit.
Can you tell us how the demographics of your local population impact how you plan and deliver a tobacco dependency service and why specific areas in your local population may need the service more than others?
We cover the whole of North Wales which includes 3 acute hospitals, community, and maternity. We live in a rural area so not everywhere has a stop smoking service or even a local pharmacy where people can access support there. They may be unable to travel to where the support is, due to mobility or transport issues. I think there is certain stigma attached to people who still smoke, they are embarrassed and when asked, may deny being a smoker. We have several deprived areas that we cover who may not be aware about access to free products, they see the price in the shops and say that smoking is cheaper.
Can you tell us the importance of providing this service within a hospital?
As we are promoting a smoke free site it is important to educate our patients that they shouldn’t be leaving the ward to smoke. Most hospital inpatients aren’t aware they can receive support and products to aid quitting. Once they are referred, we can provide specific education about stopping smoking and products/services available to them. It’s a good education opportunity as they are in front of us and important they’re not overlooked. All other patients with addictions are offered support therefore smokers should have the same treatment.
How do you feel the programme is benefitting the trust and most notably, patients with a tobacco dependency?
Patients who get referred into the service now get help with nicotine withdrawal and more staff are aware to refer. The patients who go on to quit are making the best decision about their health and are less likely to be readmitted to hospital. If they hadn’t been asked the question in hospital, they may never have gone on to quit smoking. Don’t they say all smokers want to be given the opportunity to quit?
Can you explain what you did within the first 3 months of your project launch?
I only covered 4 wards at the beginning and every day I went to each ward and note trawled to pick up any current smokers. I was then able to assess and get appropriate medications prescribed.
What were your main barriers/difficulties in the early stages of starting the programme and how did you overcome these?
I struggled getting staff to engage, I still do 4-5yrs down the line to be honest! It has been hard work trying to get the referrals in without trawling the wards asking every member of staff.
To engage with the wards, I approached all ward managers and explained what the service was and if it was possible for me to attend the ward daily and note trawl to begin with. I asked if I could put posters up on the ward so patients and staff could see my contact numbers. They were happy for me to note trawl with the medical notes. Once I get the medication prescribed, I order it from pharmacy and go back the next day to make sure the patient has received it and can use it properly. I have also set up education sessions within the practice development programme so staff can access the sessions which are currently held via TEAMS.
How did you manage to engage with all the ward managers - any training tips? - what could someone do other than ward trawl?
I went to see them all face to face. I am lucky in that I have worked in the hospital for over 20 years so I know many of the staff. I think unless you have an electronic referral system then you would have to trawl the wards. I also think it’s important to be visible to build rapport with the staff. It is annoying and some days I don’t want to do it but if I am going to keep the service going staff need to see me. I hope that once the new system comes into force and our referrals increase we will be on most wards, so visibility is still there but sitting in my office all day waiting for referrals to come in isn’t productive for the service.
Is there anything you would do differently if you had the opportunity to start from the beginning?
I think I should have somehow done a launch of the service; maybe got comms involved a bit more to put it on the hospital internet or maybe managers higher up.
Can you share tips on how to deal with these issues based on your experience?
I think you just have to remain visible so staff remember the service exists. We still struggle getting referrals in. I think staff are better at providing NRT but not necessarily referring to us. They do still let them leave the ward to smoke on some wards. Provide training/education at every opportunity to both patients and staff. Be consistent with visiting wards.
Get the managers of each ward involved in how best to refer into the service. Get training set up for staff members early, including Dr’s. Be prepared to still be trawling wards looking for referral’s years down the line.
Do you have any recommendations on how to maintain and sustain the programme to ensure it is embedded within the trust in the longer term?
Keep it going, even the days you feel like you are banging your head against the wall with staff and their lack of referrals, just keep looking for them. We just need to keep asking staff to ask their patients if they smoke, it’s that simple!