Smoking Cessation Protocol

Practice Leads

  • Nurse: Chantelle Kerin (HCA), Rachael Tempest (HCA)

Date Reviewed

6th July 2016

Date of Next Review

September 2017

Aims of the service

To provide a dedicated smoking cessation service which is readily accessible to all smokers wanting to quit, thereby contributing towards the national targets for smoking cessation as laid down in the Government White Paper ‘Smoking Kills’ December 1998.  The DoH places a high priority on smoking cessation and has set targets for it.    Stopping smoking reduces the chances of a heart attack, stroke, COPD and many other conditions.

  • More than 20% of deaths in the UK are related to smoking (‘SMOKING’ Contract Quality Series, Doctor 2004)
  • Stopping people from smoking represent probably the best and most cost-effective way of improving their health (as above).[hr]

What will need doing

  • Record smoking status
  • Assess motivation to quit using the 30-second brief intervention
  • Refer to Smoking Cessation Clinic.
  • Record minimum data as outlined by the DoH on a quarterly basis - if this refers to the data you submit as part of your practice based stop smoking service then is should state monthly
  • Evaluate the effectiveness of the service.

Literature - The practice provides patients with self-help literature provided by staff and in the practice waiting room. Bradford Council commission the GP practice based stop smoking service and receive practice statistics on patient smoking outcomes on a monthly basis. Smoking status is recorded within SystmOne by either the GP’s or the Nurses and HCAs hence is seen as a clinical indicator. The practice achievement is shown in the SystmOne QoF targets record.

If patients are currently smoking, then they are offered smoking advice so they understand the health risks and access to either Ashcroft practice based stop smoking service or Bradford District Stop Smoking Service.

If a patient wishes to stop smoking from the NHS Smoking Cessation Service, then they should also be offered support by the Practice based Health Trainers.

Who does what?

The practice has Health Care Assistant who is trained and the lead of the Smoking Cessation Clinic, based at the practice. This is supported by:

  • GPs (brief intervention & smoking status)
  • Practice Nurses/HCA’s
  • Admin. team
  • DN’s & HV’s
  • Other HC professionals linked to Ashcroft i.e. midwife

NCSCT Very Brief Advice e-Learning tool

Staff may wish to do the NCSCT very brief advice eLearning – link below this will provide staff with the current evidence based knowledge and skills to carry out a stop smoking intervention in a GP practice setting.

OUR SMOKING CESSATION CLINIC PROTOCOL

Initial Appointment

  • Take brief details required by the DoH (see Appendix 3)
  • Record smoking status incl. age started, daily smoking intake and duration between waking and 1st cigarette – this can all be recorded on the SystmOne smoking template.
  • Discuss reasons for wanting to quit at this time – family situation, any external extra-stress factors i.e. moving house/divorce etc. also possible weight-increase concerns. Highlight the need for pt to set a quit date.
  • Inform pt re 4000 chemicals per cigarette (show bookmark) followed by the purpose of NRT, Zyban and Champix. Demonstrate all NRT products.
  • Take Carbon Monoxide reading and document on template.
  • Allow patient to choose own form of NRT or medication but reassure that this can be altered at anytime due to side effects occurring or simply not liking their chosen product. Explain method of use of chosen product in more detail outlining common possible s-effects.
  • Organise collection of script in 48hrs time.
  • Make review appt - every 2 weeks appts for approx 3 months in total.
  • Carbon Monoxide reading to be taken again at week 4 as per the DoH requirements and also to see patient’s progress.

Follow-up Appointments

  • Generally see how pt has been getting since quit date.
  • Any cigarettes smoked?
  • Happy with chosen product?
  • Any side effects?
  • How is the pt coping with cravings – reassurance & encouragement – lots!

Read-Coding

The practice records a patients smoking status and any advice given.   Smoking cessation is encompassed by many clinical areas of the PMS contract such as CHD, stroke, hypertension, diabetes, COPD and asthma.

Practices can gain PMS points across several clinical area and a further points for patient records etc.  Therefore smoking status of over 16 year olds must be routinely recorded at various opportunities as they occur.  The practice tries to match the best prescribed method within BRASS advice to achieve the best quit rates of patients.

Method of Acheiving Objectives

Where

  • Ashcroft Surgery
  • Home Visits

When

  • During all consultations – at any opportunity, where appropriate
  • NPHC’s
  • Chronic Disease Reviews
  • Family Planning/Cytology appts
  • Antenatal Clinic
  • Blood tests/ECG’s (to give questionnaire?)
  • Home visits undertaken by the District Nurses and/or Health Visitors

How

  • 30-second brief intervention + brief info leaflet
  • Routine GP consultation – agreed the GP can commence 1st prior to accessing the practice NHS SSC.
  • Smoking Cessation Clinic operated by a practiceHCA whom  appointments should be booked with via  reception.
  • BRASS – referrals are made to this specialist service if the patient is a frequent quitter (multiple attempts) or if they are pregnant. Patients can refer themselves directly if they choose not to wait for an appt at the surgery.

References

Most of the information on this webpage adapted from...

  • West R et al. Meeting Department of Health smoking cessation targets. Recommendations for PCT’s.London: Health Development Agency, 2003
  • The NHS Confederation. Investing in General Practice. The New General Medical Services Contract.
  • Croghan, Emma Smoking Cessation; Helping people Stop Smoking. Practice Nurse 25th Feb 2005

Further Notes