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Facilitating organisational change: The Hunter New England Health Smoke-free story

Prepared by: Carolyn Slattery, Rebecca Wyse, Jenny Knight, Inga Kasch, Lorraine Paras, Megan Freund

HUNTER NEW ENGLAND POPULATION HEALTH 5 September 2007

2

Background

NSW Health directive to go Smoke-free

March 2006 Hunter New England (HNE) set smoke free date

History in HNE of smoking cessation pilot programs

Organisational change required

HNE Health went Smoke-free on October 31st 2006

Vision to Reality……..in 8 months

3

What did we want to achieve NSW Health mandates a comprehensive

approach to implementing a Smoke Free Health Service Policy:

– Patient support

– Staff cessation support

– Enforcement

– Communication

Focus of presentation is:

– Inpatient smoking care across all HNE facilities.

4

The Challenges … Challenges

– Large area (130,000 sq km)

– Large no of facilities (54)

– 15 000 staff

– Diversity – rural/remote/metro

– Limited resources

– No existing area-wide procedures

Base located

here

5

Method - Intervention 1. Local consensus

Inpatient working group formed and:

• Identified key smoking care practices

• Developed a clinical practice guideline

• Identified recording requirements

• Developed Nurse Initiated Medication Protocol – NRT

2. Systems change• Nicotine dependent care assessment form

• Incident Information Management System (IIMS)

• Supply of 3 day post discharge medication

3. Training/skill development• 2 nurse train the trainer sessions delivered

• Multiple planned telephone contacts with Nurse Unit Manager’s (NUM) and Senior Nurse Mangers (SNM)

• Medical officer’s information sheet

6

Method – Intervention cont’d

4. Communication• Staff eg staff newsletter, information sheets, website• Patient eg brochures, posters, Media, informed of the policy on

admission

5. Prompts • NUM and SNM contacted for compliance with implementation protocols

6. Management support• Telephone contact with NUM’s and SNM’s• Smoke-free email

7. Monitoring compliance and feedback• 4 x Telephone contacts with NUM’s • Area wide bedside audit• Results of above feed back to wards and Nurse Management• SNM’s and NUM’s provided Smoke Free team feedback

7

Method – Pre - Post test design

– Care provision data collected from NUMs

– Eligibility criteria

• Wards with smokers admitted since Oct 31st

• completed both (pre & post) telephone contacts

– Measures:

• % patients informed about SF policy

• % smokers recorded as smokers

• % smokers who had nicotine dependence assessed

• % nicotine dependent smokers offered NRT

– Response rate 100% (n=67)

8

Results

71 71

8791

0

10

20

30

40

50

60

70

80

90

100

Informed of SF Policy Recorded smoking status

Pro

po

rtio

n o

f Pa

tien

ts

pre

post

9

Results Cont’d

4551

8492

0

10

20

30

40

50

60

70

80

90

100

Assessed NicotineDependence

Offered NRT

Pro

po

rtio

n o

f Pa

tien

ts

pre

post

10

Summary Large improvement in smoking cessation care across HNE

facilities

Duplication of single facility results across a large Area Health Service (ie all patients in multiple facilities).

Validation data of self report from bed side audits currently being analysed

Intervention provides a feasible and effective way for facilitating change across a large, diverse area

Future Steps

• Succession plan

• Sustainable monitoring tool and system to facilitate sustainability of provision of smoking cessation care

11

Key Messages

Leadership required

– Top down

– Bottom up

Consultation

Tailored support

Problem solve on a daily basis

Be available!

12

Acknowledgements With grateful acknowledgements of:

– Jenny Knight,

– Rebecca Wyse

– Sue Green

– Christophe Lecathelinais,

– Lynn Francis,

– CATI interviewers

- Bev Parker

- Jenny Jackson

- Olga Peers

Hunter New England Population Health is a unit of the Hunter New England Area Health Service.

Supported by funding from NSW Health through the Hunter Medical Research Institute.

Developed in partnership with the University of Newcastle.