Can you tell us a little about how your hospital based stop smoking services is organised?
Our team consists of three Tobacco Dependence Specialists, a Team Administrator and Consultant Respiratory Physician who is our clinical lead. The aim of this team is to provide expert support to tobacco dependent patients as part of routine care during their acute admission and once they have left hospital, and to support our Trust smoke free policy, which includes ensuring staff are appropriately trained and we run a smoke free site.
We are an NHSE early implementer site for the Ottawa Model for Smoking Cessation and are currently running a pilot project on 4 wards, two acute medical wards and two surgical wards, with the aim of expanding this as we expand our clinical team.
Current smokers, identified by routine screening on admission to the ward, are seen as part of an opt out pathway of support by the Specialists, and choose either to make a quit attempt or maintain temporary abstinence with or without pharmacotherapy during their admission in line with the Trust Smokefree policy. We have an electronic patient record so can receive electronic referrals and link electronically to our local community smoking cessation teams.
The team is an integral part of the Integrated Respiratory Team (IRT) so referrals are received from team colleagues, as well as the wider respiratory team and other clinical specialities.
People will be very keen to know how COVID-19 has impacted your service. When did you stop face to face patient contact?
Due to the pandemic and associated guidelines we were unable to see COVID positive patients. Restrictions on aerosol generating procedures meant we could not carry out routine exhaled carbon monoxide tests on patients. At the end of March three wards in the pilot project were changed to COVID wards and two members of staff were working remotely from home. Whilst we extended our reach into other wards and continued face to face support, we were seeing fewer patients.
How were you able to maintain contact with patients?
As the pandemic progressed the role of telephone support became more important, particularly as some services provided by local Stop Smoking Services were disrupted. Responding to the situation meant adapting the support we offered. Fortunately we had a system in place for scheduled calls for our patients involved in the Ottawa Model project.
Can you tell us a little more about how patients were contacted and supported?
Calls were made to patients a few days after discharge to assess the patient’s smoking status and the support they required. If the patient’s local Stop Smoking Service was able to support the patient remotely the specialist would check to see that they had engaged with the service and offer a follow up call at a later date. If local support was not available the patient was offered scheduled follow up calls by one of our specialists and a request was made for ongoing stop smoking medication via the patient’s GP. Phone based behavioural support techniques were used by the specialists to support the patient in their quit attempt.
There will be a great many people working across the NHS to provide virtual clinics and appointments to patients. Are there any tips you can give to people starting to think about remote smoking services?
Good listening skills are required, particularly with phone support where you don’t have visual prompts.
Discuss convenient times for calls/sessions’ make sure there are no distractions for both parties.
Patient motivation to engage can fluctuate, especially during this pandemic. We have found that patients may accept support post-discharge after initial lack of interest when asked on the ward.
Offer consistent follow ups e.g. weekly at specified times.
Be aware of other pressures affecting patient’s wellbeing during these challenging times.
Are you finding that patients are keen to engage?
Patients have been very keen to engage with our service and have appreciated our calls. A follow-up call from the hospital Tobacco Dependence Team post-discharge ensures continuity of care and builds on the supportive relationship initiated on the ward by the specialist. Patients that smoke are worried about COVID-19 and how it may affect them, and as a result many are motivated to quit smoking to lower their level of risk. We know that the majority of smokers want to stop smoking, and probably have tried before to quit; the present situation is another important prompt to encourage them to get specialist support and be smokefree.
It would seem a great time to embed smoking cessation in to hospital and community settings. Do you think COVID 19 has presented an opportunity for people to innovate?
There is definitely an opportunity to increase our reach with patients, but this needs to be done collaboratively with community based support to ensure patient needs are best met and to prevent overlap. Our next steps are to offer online sessions with a Tobacco Dependence Specialist.