babyClear

Implementing a regional approach to tackling smoking in pregnancy

Martyn Willmore

Performance Improvement Delivery Manager, Fresh

Hilary Wareing

 Director, Tobacco Control Collaborating Centre

2010 RCP report on “Passive smoking and children” states that:

“Each year in theUK, an estimated 3,000 to

5,000 miscarriages are caused by maternal

smoking”

The impact of maternal smoking

Smoking at time of delivery rates since 2006/07

How to stop smoking in pregnancy and

following childbirth NICE public health

guidance 26: Quitting smoking in pregnancy

and following childbirth

NICE Guidance

Key outcomes from research

- Four main issues identified following regional survey of North East midwives:

- Skills and training. How to make training standards consistent? Specific issues around using CO monitors

- Resources. Prompts/triggers to help midwives raise issue in a more structured way. Access to resources

- Carrying the message consistently. Ensure staff deliver same message every time

- Managing relationships. Need to defuse any concerns about negative reactions to discussing smoking

Following procurement process, we commissioned the TCCC to deliver babyClear:

•Systematic approach to CO monitoring at first booking appointment•Standardised referral process•“Risk Perception” intervention by midwife at time of dating scan clinic•Skills training for SSS (advisers and admin teams)•Supply of all related materials

Implementing a regional approach

Implementation

• Numerous meetings took place with a range of key partners:

– Heads of Midwifery/Midwifery Supervisors– SSS commissioners and providers– Public Health staff– Clinical Innovations Team for Maternity & Newborn

• We committed to fund roll-out of babyClear and all associated materials in year one

• Letter sent out to FT Chief Executives, outlining the rationale for this approach, and seeking strategic support

Aim: To enable participants to systematically identify smokers at time of first booking appointment by means of a carbon monoxide reading. To raise “concern” and automatically refer all smokers into NHS Stop Smoking Services

Standard midwifery booking intervention

Standard midwifery booking intervention

• Two-hour training for all staff who do booking appointments. Challenges include:

o Identify everyone who needs to attendo Organise dates/venues for trainingo Ensure relevant staff register and attendo Provision of localised materials and CO monitorso Manage the on-going provision of resourceso Ensure someone locally monitors/manages the

compliance with this processo Future training needs to be picked up locally

Booking intervention training numbers

Total number of midwives trained across all clusters 399

Total staff trained across all clusters 457

Total number of CO monitors issues across all clusters 380

Aim: To enable a cohort of trained midwives to intervene (at time of 12-week dating scan) with smokers who have previously declined offers of help, and ensure they fully understand the risks of continued smoking in pregnancy

Risk Perception Intervention

Risk Perception intervention

• All-day training for small cohort of nominated midwives. Challenges include:

o We specified it must be a midwife delivering this…..o Organising dating scan clinics around smokerso Having to repeatedly make the case for this “new”

interventiono Midwifery teams making appropriate staff availableo Ensure equipment is made availableo Monitoring the implementation/compliance

Risk Perception training

Trust Number trained

County Durham & Darlington 15Gateshead 5

South Tyneside 1Sunderland 3North Tees 8South Tees 2Northumbria 8Newcastle 2

Stop Smoking Services

• Concerns that not all smokers being identified at booking

• Even majority of those referred opt out of support. Of those that did set a quit date, success rates were low

• We committed to ensuring that NE SSS pregnancy services deliver highest quality support:

o One-day refresher training to existing advisorso Two-day full training to any new pregnancy advisorso One-day training for SSS admin teams on converting

“leads” into appointments attended

Stop Smoking Services

• Challenges of SSS training:

o Six NE SSS at time, all with different models of delivery, different data systems

o Changes to models midway through implementation

o Identifying preferred pregnancy advisors locally

o Potential big rise in number of referrals, and impact

o Significant role for SSS in helping to manage process and evaluate

SSS training

Stop Smoking Advisors 124

Healthy Living Pharmacies/pharmacist advisors

31

SSS Administrative staff 28

Evaluation

• Newcastle University agreed to carry out an independent evaluation of the project`s quantitative outcomes

• Teesside University will be evaluating qualitative outcomes

• Universities secured funding from School of Public Health Research to undertake this work

• Not expecting report until Spring 2015 at earliest

Initial Results (SSS throughput)

Quit dates set in April-September

2012/13

Quit dates set in April-September

2013/14

% change in quit dates set since last year

County Durham & Darlington 165 203 +23%

Gateshead, South Tyneside & Sunderland 164 216 +32%

Newcastle & North Tyneside 136 127 -7%

Northumberland 138 129 -7%

North Tees 266 212 -20%

South Tees 172 142 -17%

% change in quit dates set by pregnant women from Q1-3 2012/13 to 2013/14

Risk Perception

County Durham and Darlington(12th August – end of March)

Numbers % of eligible cohort

% of initial referrals

Accepted referral following RP 257

Engaged with the SSS 241 94%

Set a Quit Date 66 27% 26%

Quit at 4-weeks 37 56% 14%

Promising early results from Cluster One…..

At 2013 County Durham and Darlington FT staff awards. babyClear approach won:

•Public Health/Health Improvement Award•Chairman`s Quality Award

Trust recognition of progress…

Key Lessons Learnt

• Importance of senior manager buy-in from the start

• But also crucial to work with those delivering, to understand local challenges/systems, and be flexible

• Make sure new processes are embedded and formally commissioned (e.g. CQUINs) to help sustain work

• Understand and address the consequences of upscaling efforts (more equipment, more admin work, etc)

• It`s not enough to just provide the training and resources….

Any Questions?

hwareing@pmaresearch.co.uk

01926 490 111

info@freshne.com

0191 333 7140

www.freshne.com