Developing and implementing a new approach to smoking at Kings College Hospital: a joined up approach for South Londoners

Dr Irem PatelConsultant Respiratory Physician/Smokefree Lead

Arran WoodhouseTobacco Liaison Specialistarranwoodhouse@nhs.net

London Respiratory Team 2012

1 in 5 deaths in Southwark and Lambeth are due to smoking related disease

King’s has approximately 6,500 smoking related admissions per year

King’s cares about the health of the population it serves

Planning a new approach

June 2013 Smokefree Strategy Group established

Chaired by a Respiratory Consultant and Smokefree Lead for the Trust

Wide membership including local Stop Smoking Services and Public Health Teams

Supported by Director of Strategy and Medical Director

Sick smokers Medical wards Olivier

Ward

Medical wards Mary

Ray

Medical wards Lons-

dale

Medical wards Twin-

ing

Medical wards Annie

Zunz

Surgical wards Cotton

Surgical wards Lister

Surgical wards Chris-tine Brown

KCH 0.406 0.4 0.238805970149254

0.666666666666667

0.175438596491229

0.560975609756098

1 0.261904761904764

0.539473684210526

National average

0.2 NaN NaN NaN NaN NaN NaN NaN NaN

London average

0.175 NaN NaN NaN NaN NaN NaN NaN NaN

5%25%45%65%85%

KCH Medical Wards KCH Surgical Wards

I really want to stop smoking

and intend to in the next month

I really want to stop smoking

and intend to in the next three

months

I want to stop smoking and hope to soon

I really want to stop smoking

but I don't know when I will

I think I should stop smoking

but don’t really want to

I don't want to stop smoking but will need help whilst in

hospital to avoid smoking

I don't know

Series1 23 6 15 8 8 7 16

Series2 15 3 3 14 8 5 4

2.5

12.5

22.5

Patients that want to stop smoking

No.

of

pati

ents

28%

29%

7%6%

18%

6%10%

27%

10% 15% 8%10%

19%

8%

64 % of patients said they want to stop smoking

Medical

Surgical

Prevalence of smokers at KCH, patient survey, August 2013

Have you been offered treatment for nicotine withdrawal in hospital?

Yes23%

No68%

n/a9%

Medical Wards

Yes31%

No56%

n/a13%

Surgical Wards

Yes13%

No81%

n/a6%

Significant numbers of local smokers needing treatment are in King’s – but not treated

No Not sure Maybe Yes probably Yes definitely Not answered or n/a

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

35%

3%

8%12%

29%

14%

81%

1% 3% 3%

7%4%

Have you been supported with information on how to access stop smoking support on discharge? Medical vs Surgical

Significant numbers of local smokers needing treatment are in King’s – but not supported

When would you like help to quit smoking?

King’s cares about what our patients want

Help includes providing an environment that supports smoking cessation

On admission During hospital stay At discharge None of them / not answered

0%

5%

10%

15%

20%

25%

30%

35%

40%

24.66%

34.25%

18.49%

15.07%

National Centre for Smoking Cessation Training Project

Developed through 2013-14

Link Trust referrals with national referral system

Very Brief Advice (VBA) e-learning module

Referral and screening via Electronic Patient Record (EPR)

Over 12,000 patients have had their smoking status recorded since the start of the smoking CQUIN

Smoking CQUIN

CQUIN agreed with Lambeth and Southwark CCG for 2014/15

Medical, surgical, renal and elective surgery wards only

Target 1 - Training of staff in VBA

Target 2 - Recording patient’s smoking status

Target 3 - Giving VBA to patients who smoke

Smoking CQUIN performance

Over 80% of in-patients on the CQUIN designated wards now have their smoking status recorded.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar0

10

20

30

40

50

60

70

80

90

100

Inpatient smoking assessments completed by month 2014-15

% Assessed% Target

Perc

enta

ge %

Smoking CQUIN performance

Over 85% of inpatients on CQUIN designated wards now receive VBA

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar0

10

20

30

40

50

60

70

80

90

100

Inpatient smokers given advice by month 2014-15

% Advised% Target

Perc

enta

ge %

Smoking CQUIN performance

Referrals to community services from King’s have more than doubled compared to 2013/14.

Q1 Q2 Q3 Q40

50

100

150

200

250

300

350

400

Referrals to Stop Smoking Services

2013-142014-15

Num

ber

of

refe

rrals

Smokefree Grounds Launch

In-house media utilised

Patient and staff events

Staff testimonials shared on the intranet

Removal of the smoking shelter and smoking bins

Smokefree ‘clean-up’

Smokefree signage installed, paid for by CQUIN funds

Challenges

Staff escorting patients outside to smoke

Concern about approaching smokers within the hospital grounds

Litter in residential streets adjacent to the hospital site

Next steps

Patient Group Direction (PGD) in development

3 year MECC CQUIN going ahead

CO pilot project on selected wards

Smokefree policy responsibility of all staff

Develop data metrics to show value

THANK YOUarranwoodhouse@nhs.net