developing and implementing a new approach to smoking at kings college hospital: a joined up...
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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 [email protected]
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 [email protected]