Standard Operating Procedure 1 (SOP 1) Clinical Guidelines for Prescribing Nicotine Replacement Therapy In Smoking Cessation

Transcription

1 Standard Operating Procedure 1 (SOP 1) Clinical Guidelines for Prescribing Nicotine Replacement Therapy In Smoking Cessation Background Smoking kills 50% of lifetime smokers through causing cancer, heart disease, and lung diseases. The high rates of smoking in people with mental health problems is the main reason that people in this group die years younger than other people. National guidelines issued to all mental health trusts in 2013 said that all mental health trusts should support their patients who smoke in the same way that general hospitals do, and should provide access to support to help people to abstain from smoking, should remove all smoking areas, and stop all facilitated smoking breaks. We have a duty of care to support our service users to improve their health, and we will offer effective support, to enable our service users to abstain from smoking while using our services, or to stop altogether. Overarching Policy The Trust Smokefree Policy should be read in conjunction with this Standing Operating Procedure Review of the policy This policy will be reviewed 3 years from the date of ratification. Group Inpatients Community Locations Mental Health Services all Learning Disabilities Services all Children and Young People Services all GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

2 Contents 1. Clarification of terminology Introduction General approach Admission prescribing flowchart Medications available on Trust formulary Guidance on prescribing NRT Nicotine Replacement Therapy Using combinations in nicotine replacement therapy Choice of formulation Prescribing individual doses of NRT Prescribing e-cigarettes Adverse effects of NRT Overdose Special medical considerations Medicines that require review on smoking cessation Reviewing periods (leave, medication, smoking status) Location of site in community for referrals Dissemination and implementation arrangements Training requirements Monitoring / review of this procedure References Associated Trust documents Equality Impact Assessment Data Protection Act and Freedom of Information Act GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

3 1. Clarification of terminology. Smoking cessation advisors - Smoking cessation advisors are staff members trained by local specialist smoking cessation services to provide smoking cessation advice, and use motivational interviewing techniques to support behavioural change. All the advisors will be registered with their local smoking cessation service provider and on their database. Advisors will be expected to attend an annual update after accreditation in order to remain an accredited advisor. Quit attempt (complete abstinence) Smokers who are motivated to stop smoking and are willing to work with a smoking cessation advisor to achieve lasting abstinence. Temporary abstinence Smokers who need NRT to manage the symptoms of nicotine withdrawal for the duration of the admission but do not wish to quit smoking 2. Introduction As of January 2019 all Trust buildings and grounds will be smoke-free. This means that no-one is permitted to smoke on Trust premises. These prescribing guidelines should be read in conjunction with the Trust Smokefree Nicotine Management Policy. All nicotine replacement therapy (NRT) products are licenced for reduction as well as smoking cessation and are safe and effective for supporting abstinence between opportunities to smoke. Offering support to quit, rather than merely asking a smoker if they are interested in stopping, or telling them they should stop, leads to more people making a quit attempt. As well as providing advice and information on smoking cessation, pharmacological support as described in this guidance will be made immediately available when needed. Licenced nicotine-containing products and other stop smoking pharmacotherapies help people to stop smoking and reduce craving, and using NRT increases the rate of quitting by 50-70%. 3. General approach All clinical staff and consultants with responsibilities under the Smokefree Policy will: Obtain the smoking status of each patient in their care. Determine the clinical significance of any potential interaction between medication and NRT products. Monitor efficacy and side effects Adjust dose if necessary Monitor smoking status and advise patients to seek advice from doctor if smoking status is to change During smoking cessation: Find out what medicines the patient is taking Determine clinical significance of any potential interaction Monitor for side effects and check blood plasma levels Adjust dose if necessary. The most important medicines to consider in those who smoke, or who are trying to quit, include theophylline, olanzapine, clozapine, caffeine, and warfarin. On discharge: Nurse in charge should refer service user to the appropriate community service GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

4 4. Admission prescribing flowchart Ask all new admissions about smoking - if YES Working day Out of hours Admitting medic to assess using Admitting Doctor assessment in appendix to assess 1 of patient using Nicotine Management assessment in Policy - does appendix the 1 of patient Nicotine want to stop Management or reduce smoking? Policy - does the patient want to stop or reduce smoking? No Support temporary abstinence: Support temporary Prescribe NRT for abstinence: containment of withdrawal Prescribe NRT for symptoms during use containment of of smokefree withdrawal service symptoms Medical during team to use of smokefree reassess weekly service Medical team to reassess weekly Please see Section 9 of this guideline for further information on medicines that require review on smoking cessation. Patients prescribed these medicines must be reviewed within 48hrs of admission Yes Support Quit Attempt: Prescribe NRT and refer to a local level smoking cessation advisor for motivational work and monitoring Admitting nurse to assess using assessment in appendix 1 of Nicotine Management Policy and start Admitting NRT Nurse patch and/or inhalator To using assess suitability for patient group NRT using NRT protocol. direction Start as required. NRT patch, lozenge Duty doctor and/or to inhalator using prescribe NRT ongoing protocol as required. NRT during Up to clerking. 2 NRT products can MDT to review be used ASAP together for up to and action 24 to support hours via the NRT temporary or total protocol. abstinence Admitting nurse to assess using Admitting doctor to assessment in prescribe ongoing appendix 1 NRT of during clerking. Nicotine Management MDT to review ASAP Policy and and start action NRT to support patch and/or temporary or total inhalator using abstinence patient group direction as required. Duty doctor to prescribe ongoing NRT during clerking. On MDT Discharge, to review ASAP and action to support For patients who wish to continue with a Quit Attempt, Nurse in charge should temporary refer service or totalnce user to the local community smoking cessation service. NRT will only be supplied on discharge for a Quit Attempt. In order for NRT to be supplied on discharge the prescriber should clearly document Quit attempt on the discharge summary/leave prescription in order for pharmacy make a supply. Pharmacy will supply up to 14 days of NRT. GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

5 5. Medications available on Trust formulary Table 2: NRT formulations Route of administration Transdermal (patch) Oral (lozenge, gum or spray) Nasal Spray Inhaled Medication available Nicotine patches 7mg, 14mg, 21mg (24 hours) Nicotine patches 10mg, 15mg, 25mg (16 hours) Nicotine lozenges 1mg, 2mg Nicotine gum 2mg, 4mg Nicotine spray 1mg/metered dose (150 doses) Nicotine nasal spray 500mcg (add to formulary) Nicotine inhalator 15mg (36 cartridge starter pack) 6. Guidance on prescribing NRT Nicotine replacement therapy should be offered to all inpatient smokers. Please note that Varenicline and Bupropion are not on the Trust formulary. Varenicline should not be prescribed to breast feeding or pregnant women but it can be used with caution in people with mental health problems. 6.1 Nicotine Replacement Therapy Therapy Performance Preparation long-acting Nicotine transdermal patches Lozenges, inhalator, gum, nasal spray, and oral spray Short-acting nicotine preparations used whenever the urge to smoke occurs or to prevent cravings. available in 16 hour form, and in 24 hour form. 6.2 Using combinations in nicotine replacement therapy Using a combination of NRT products to control withdrawal symptoms is 35% more effective than a single preparation alone. Combination therapy should be offered to all highly dependent patients (>10 cigarettes per day), and to patients who have found single forms of NRT inadequate in the past. Combination therapy would usually be a transdermal patch combined with an intermittent formulation for relief of breakthrough symptoms. Each preparation can be prescribed in a dose up to 100% of the BNF limit, even when two preparations are used in combination. GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

6 Evidence suggests that due to higher degrees of nicotine dependence, people with mental health problems often need higher doses of NRT, and for longer periods than smokers in the general population. One of the key aims of providing NRT in inpatient sites is to support abstinence by adequately managing dependency, and therefore timescales for reducing doses over time as provided below are for general guidance only, and may be premature for some of our patients. 6.3 Choice of formulation Choice of formulation will be influenced by patient preference and experience, as well as their medical history. Capacity to understand how to safely use NRT, and an assessment of the potential for misuse, or accidental or deliberate overdose should also be considered, especially with oral and nasal sprays, where devices contain comparatively large quantities of nicotine. 6.4 Prescribing individual doses of NRT Service users receiving NRT in inpatient settings will need to have individual doses administered by nursing staff. Therefore, when prescribing short acting preparations in inpatient units please consider treatments where administration of individual doses can be monitored by nursing staff, in the following order of preference:- 1. Inhalator 2. Patches 3. Lozenges 1 st Line NRT products Product Advice & Warnings Administration Patches 1. A 24 hour patch should be chosen when the patient smokes first thing in the morning and last thing at night, or wakes during the night to smoke. 2. Patches should not be used for people who do not smoke every day, and are generally not suitable for those with chronic skin conditions (e.g. psoriasis, chronic dermatitis or urticaria). Patches can cause skin reactions and should be stopped if severe. In the event of sleep disturbance from a 24 hour patch, a switch to the 16 hour preparation may be required. 24 hour patch - >20 cigarettes / day: use 21mg patch daily for 3-4 weeks then 14mg patch for 3-4 weeks, then 7mg patch for 3-4 weeks. - If <20 cigarettes / day, start with 14mg patch. - Patch should be applied each morning to dry, non-hairy skin on the hip, trunk or upper arm and held in place for seconds. Sites should not be reused for several days. 16 hour patch 25mg patch suitable start for those smoking >10 cigarettes / day. Patch should be applied as above and removed before bed. GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

7 Inhalator 1st Line NRT products (cont d) 1. Cartridge is inserted into device and patients inhale through the mouthpiece when relief required. Absorption is oral mucosal, not pulmonary, so advise to inhale into mouth to reduce gastrointestinal side effects. 2. Mild local reactions like cough and irritation of the throat and mouth may occur. Dose: Initially use a maximum of 6 x 15mg cartridges per day for up to 8 weeks then reduce gradually over 4 weeks. Lozenge 1. Similar to gum, except lozenge should be sucked and not chewed until taste becomes strong, then rest between cheek and gum, occasionally moving lozenge from one side of mouth to other. 2. Adverse effects are similar to those for gum. Dose: 1 lozenge should be used every 1-2 hours (usually 8-12, max 15 / 24 hours) for 6 weeks, then 1 every 2-4 hours for 3 weeks, then 1 every 4-8 hours for 3 weeks, then withdraw gradually over 3 months. Nasal Spray Oral Spray 2 nd Line NRT Products 1. Oral and nasal sprays are popular with heavily dependent smokers, as are perceived to have a rapid action, and also maintain plasma levels comparable to 4mg gum. 2. Nasal irritation, running nose, nose bleed, sneezing and watery eyes can occur. Advise not to use if driving. 1. Oral and nasal sprays are popular with heavily dependent smokers, as are perceived to have a rapid action, and maintain plasma levels comparable to 4mg gum. 2. Tingling lips, hiccups and a strong taste can occur Dose: Use one spray in each nostril as required, up to twice every hour for 16 hours daily, maximum 64 sprays per day, for up to 8 weeks then reduce over 4 weeks. Notes Use on wards likely to be limited due to number of doses that may be administered per day Dose: Use one or two sprays every minute. Max 2 sprays at a time, 4 sprays per hour, 64 sprays per day. Notes Use on wards likely to be limited due to number of doses that may be administered per day GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

8 Gum 2 nd Line NRT Products (cont d) 1. Gum comes in different flavours. It should be chewed until the taste becomes strong, then rested between the cheek and gum to allow nicotine absorption through the cheek, and process repeated when the taste fades. 2. People may experience wind, hiccups, sore mouth or throat, jaw ache and nausea, uncommonly urticaria and erythema and rarely, allergic reactions including angioedema Dose: If smoking >20/day, one piece 4mg gum chewed for about 30 minutes when urge to smoke. Max 15 pieces per day. Reduce gradually over 12 weeks, stopping when daily use reaches 1-2 pieces. If smoking <20/day, use 2mg gum in the same way. Notes Use on wards likely to be limited due to issues with disposal and hygiene. E-cigarettes Non-medicinal products Must be of single use not rechargeable and not refillable vaping devices Not currently prescribable GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

9 6.5 Prescribing e-cigarettes At present, e-cigarettes are NOT prescribable, being covered by general product safety legislation which changed in May 2016 with the introduction of new regulations under the revised European Union Tobacco Products Directive (TPD). Under the TPD e- cigarettes will either be licensed as medicines or, if unlicensed, will be subject to new quality and safety standards, packaging and labelling requirements, and restrictions on advertising. The new regulations include specification of ingredients, limits on nicotine concentration and on the size of tanks and refills, and child and tamper proof containers The Trust in line with Public Health England recommendations will offer support to people who are using or want to use e-cigarettes in a quit attempt. (Refer to smoke free policy) Recommendations for practice 1. Be open to e-cigarette use in people keen to try them; especially in those who have tried and failed to stop smoking using licensed stop smoking medicines. 2. Provide advice on e-cigarettes that includes: E-cigarettes provide nicotine in a form that is much safer than smoking. Some people find e-cigarettes helpful for quitting, cutting down their nicotine intake and/or managing temporary abstinence. There is a wide range of e-cigarettes and people may need to try various types, flavours and nicotine dosages before they find a product that they like. E-cigarette use is not like smoking and people may need to experiment and learn to use them effectively (e.g. longer drags may be required and a number of short puffs may be needed initially to activate the vaporiser and improve nicotine delivery). They may also need to recognise when atomisers need replacing. People previously using e-cigarettes while smoking (e.g. to reduce the number of cigarettes that they smoke) may need to consider changing devices and/or nicotine concentrations when making a quit attempt. Although some health risks from e-cigarette use may yet emerge, these are likely, at worst, to be a small fraction of the risks of smoking. This is because e-cigarette vapour does not contain the products of combustion (burning) that cause lung and heart disease, and cancer. Note: Clients of stop smoking services who are using an e-cigarette and who also want to use NRT can safely use the two in conjunction. They do not need to have stopped using the e-cigarette before they can use NRT. Source of information: Electronic cigarettes: A briefing for stop smoking services 2016 National Centre for Smoking Cessation and Training (NCSCT) GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

10 7.0 Adverse effects of NRT As well as the more localised effects associated with the above, there are some general side effects associated with NRT. These can be difficult to separate with the symptoms of nicotine withdrawal and include headache, dizziness, coughing, and gastrointestinal disturbances (nausea, vomiting, heartburn, and hiccups). Palpitations may occur, and rarely allergic reactions (including angioedema) and reversible atrial fibrillation (very rare) have been reported. 7.1 Overdose Nicotine overdose is rare in smokers. Cigarettes offer greater yields of nicotine to users than e-cigarettes and NRT, with the average smoker taking 2mg of nicotine from each cigarette. The risk of accidental nicotine overdose is low even with multiple forms of administration, i.e.: dual use. The minimum lethal dose of nicotine in a non-tolerant person is estimated at 500mg-1000mg8. Nicotine consumption tends to be self-limiting even in heavily dependent smokers due to nausea/vomiting induced by low level overdose, and the short half-life of nicotine in the body. 8.0 Special medical considerations It is widely accepted that there are no circumstances where it is safer to smoke than to use NRT, however in some circumstances it is preferable to quit without the aid of NRT: Condition Cardiovascular disease considerations In patients with stable cardiovascular disease, NRT is less of a risk than continuing to smoke. For dependent smokers with MI, severe dysrhythmia or recent CVA the advice is to stop smoking with nonpharmacological aids, with limited evidence on safety of NRT in this group.9 In the unlikely event of a patient this acutely unwell being managed on a psychiatric ward, specialist advice from cardiology should be sought on the use of NRT. Diabetes Mellitus Nicotine releases catecholamines which can affect carbohydrate metabolism. Blood glucose levels should be monitored daily for insulin dependent diabetics when starting NRT as an inpatient, as insulin doses may need to be decreased. Recording and reporting should be completed in accordance with operational clinical policies and procedures. Renal or hepatic impairment Pregnancy Patients should be monitored for adverse effects of NRT, as clearance of nicotine and its metabolites may be decreased in patients with moderate/severe hepatic impairment and / or severe renal impairment NRT risks and benefits should be discussed. NRT should be used if smoking cessation without NRT fails or patients express a clear wish to receive NRT, in which case professional judgement should be exercised. Intermittent forms of NRT are preferable (liquorice flavoured products are contraindicated) but patches can be used, though should be provided in 16 hour form. GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

11 Breastfeeding Patches Nasal spray Again, intermittent formulations are preferable (can be adjusted to allow maximum time between administration and feeding) and the amount of nicotine infant exposed to in breast milk less hazardous than second hand smoke they may otherwise be exposed to. Caution should be exercised with people who have experienced a previous reaction to patches, or are suffering a chronic generalised skin disease such as psoriasis, chronic dermatitis, and urticaria. Exercise caution for people with chronic nasal disorders such as vasomotor rhinitis, perennial rhinitis, and polyposis. 9. Medicines that require review on smoking cessation Cigarette smoke interacts with some medicines, mostly due to polycyclic aromatic hydrocarbons in cigarette smoke that stimulate cytochrome P450 enzymes, particularly CYP1A2; some medicines are therefore more rapidly metabolised in smokers. The enzyme inducing effect is removed when people stop smoking, potentially giving rise to higher plasma levels. Nicotine (NRT) has no effect on this process. As a precaution, patients who stop smoking on admission to an inpatient unit may need to have the doses of certain medications reduced. Similarly, on discharge from an inpatient unit, if the patient is likely to resume smoking the dose may need to be increased. The table below provides guidance on dose modification for common drugs. However, each case must be considered individually. The extent to which doses are reduced will depend upon the most recent plasma level (where available), the number of cigarettes the patient regularly smokes, the patient s mental state, and how well the patient tolerates the prescribed dose. Please refer to the references given for further information and guidance for other drugs. All patients admitted using the medicines in the following tables must have their prescribing reviewed within 48 hours of admission GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

12 Table 3: Common psychotropic drugs affected by smoking status Medication Clozapine Olanzapine Effect of smoking cessation may increase by up to 50%. May be more in patients taking valproate. may increase by up to 50%. Action required on stopping smoking Patients on stable dose: Take plasma levels before stopping smoking. - -On stopping smoking, reduce dose by 25% over a week. -Repeat plasma level after one week. Anticipate further dose reductions. If admitted for retitration of clozapine dose from the community; plasma levels should be taken 2 weeks into titration. Final treatment dose of clozapine may be less than treatment dose if smoking cessation is maintained on discharge. Particularly look out for tachycardia, hypersalivation & increased drowsiness On stopping, reduce dose by 25% over a week. Adjust dose according to response or tolerability. Action required on discharge from hospital/ re-starting smoking Take final plasma level before leaving hospital for all patients on clozapine. For patients who have a change in their smoking status on discharge take another clozapine assay two weeks after discharge. If patient re-starts smoking team to consider that there may need to be an increase in dose. Dose could be increased to previous dose over one week and repeat plasma level. Increase dose to previous smoking dose over one week. Chlorpromazine may increase. (Consider plasma levels in patients on high doses of Olanzapine or significant comorbidities at baseline and after one week.) Monitor closely, consider dose reduction Monitor closely, consider restarting previous smoking dose GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

13 Medication (cont d) Haloperidol Effect of smoking cessation may increase by around 20%. Action required on stopping smoking Reduce dose by 10%. Adjust dose according to response and tolerability. Action required on discharge from hospital/ re-starting smoking Increase dose to previous smoking dose. Fluphenazine may increase by up to 50% On stopping, reduce dose by 25% over a week. Monitor carefully for 4-8 weeks. Increase dose to previous smoking dose. Consider further dose reductions. Carbamazepine may increase, extent unknown Adjust dose according to response and tolerability. Monitor plasma levels. Adjust dose accordingly Duloxetine may increase by up to 50% Adjust dose according to response and tolerability. Increase dose to previous smoking dose. Fluvoxamine may increase by up to a third. Trazodone Around 25% increase in Tricyclic antidepressants plasma levels may increase by up to 25-50% Adjust dose according to response and tolerability. Monitor for increased sedation. Consider dose reduction Consider reducing dose by 10-25% over one week. Adjust dose according to response and tolerability. Increase dose to previous smoking dose. Monitor closely. Consider dose increase Increase dose to previous smoking dose Benzodiazepines may increase by up to 50% Monitor closely, consider dose reduction by up to 25% over one week Monitor closely, consider restarting previous smoking dose GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

14 Medication (cont d) Methadone Effect of smoking cessation may increase by an unknown quantity Action required on stopping smoking Monitor closely for signs of opiate toxicity If titrating a patient on methadone be cautious with dose and aware they may need a lower dose then previously If patient on stable dose of methadone this may need to be reduced Liaise with patient s consultant Action required on discharge from hospital/ re-starting smoking On discharge liaise with patient s consultant and inform of smoking status change and inform them of current dose of methadone Smoking and therefore smoking cessation may have effects on the metabolism of other medications commonly used on inpatient wards. Patients should be carefully monitored for adverse effects. If changes in observed adverse effects is noticed, seek advice from pharmacy and consider adjusting dosage appropriately. Take particular care with patients on the following medication: Medication What it does What you need to do Re-titrating clozapine Exercise caution when retitrating clozapine, in patients who are smokers immediately prior to admission. If the patient is no longer smoking, a lower target dose may be required to control symptoms and to avoid possible toxicity. Insulin Methadone Insulin helps to keep blood sugar level from getting too high (hyperglycaemia) or too low (hypoglycaemia). Clozapine plasma levels should only be taken after target dose has been administered for at least 5-7 days. monitor BMs and seek advice from diabetic team seek advice from patient s substance misuse service GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

15 Medication (cont d) Warfarin Theophylline & Aminophylline What it does Warfarin is an anticoagulant (blood thinner). It reduces the formation of blood clots and used to treat or prevent blood clots in veins or arteries, which can reduce the risk of stroke, heart attack, or other serious conditions. Aminophylline and theophylline are considered to be respiratory smooth muscle relaxants, but also have other pharmacologic actions. What you need to do Liaise with anticoagulation clinics at Hospitals within Wolverhampton, Sandwell and Dudley. monitor plasma levels and seek medical advice 10. Reviewing periods (leave, medication, smoking status) To review smoking status and the possible effects on medication when leave is introduced or changed, as the effect of smoking on the medication metabolism is nonlinear, with metabolism disproportionately increased by light smoking. Smoking as few as 7-12 cigarettes per day can significantly increase clozapine and olanzapine metabolism. It is also important to ensure that follow-up arrangements are in place for review of any medicines which may be affected by the patient s smoking status. 11. Location of site in community for referrals Table 1: Service Wolverhampton Stop Smoking Service is a NHS service Dudley Group NHS Foundation Trust Contact details ext E Tettenhall Rd, Wolverhampton WV1 4SA Dudley Stop Smoking Service Pharmacies that provide a service (Brierley Hill, Pensnett & Quarry Bank) Asda Pharmacy Merry Hill Centre, Brierley Hill McArdle High Street, Brierley Hill. DY5 3AP Murrays Pharmacy /38 High Street, Quarry Bank. DY5 2AA GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

16 Pharmacies within the Dudley area Boots the Chemist Market Place, Dudley. DY1 1PJ Priory Community Pharmacy Priory Road, Dudley. DY1 4EH Co-op Pharmacy Maple Green, Dudley. DY1 3QZ Pharmacies within the Halesown area Asda Pharmacy The Cornbow Shopping Centre, Queensway Mall, Queensway, Halesowen B63 4AB Boots the Chemist Peckingham Street, Halesowen. B63 3AW Boots the Chemist Ryemarket, Stourbridge. DY8 1AT Sandwell smoking cessation services Sandwell Stop Smoking Service (NHS Service) High Street West Bromwich West Midlands Linkway Medical Practice Lyng Centre for Health and Social Care, Frank Fisher Way, West Bromwich, West Midlandds, West Midlands, B70 7AW Some services are only available for people living within the local area. There may be a one off charge for a 12 course of treatment for those who pay prescription charges The following are stop smoking Advisors who offer support to staff and if requested to patients. SANDWELL Health Exchange Ex Ext: 232 Covers:Tipton, Wednesbury, West Bromwich (Wolverhampton & Walsall?) Trust sites: Delta, Hallam St, Heath Lane, Edward St Quit Covers: Oldbury, (Walsall?) Trust Sites: Quayside, (Orchard Hills) WOLVERHAMPTON ( / ) Healthy Lifestyles Covers: Wolverhampton GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

17 Trust sites: Penn Hospital, Steps to Health, Pond Lane, Brooklands DUDLEY / ) Workplace Health & Wellbeing Trust sites: Ridgehill, BrierleyHill Health & Social Care Centre 12. Dissemination and implementation arrangements This policy will be available on the Trust s intranet website. Paper copies will be distributed to all doctors in their induction programme. For clarification or support in relation to any aspect of this policy, please contact the Executive Director of Nursing. 13. Training requirements For training requirements please refer to the Smokefree Management Policy. 14. Monitoring / review of this procedure Regular audits will be conducted on an annual basis to ensure that prescribing in smoking cessation for adult inpatients is conducted in line with this Standing Operating Procedure. The audits will aim to ensure that patients are appropriately assessed and prescribed accordingly and that the process follows the guideline in this policy. The results will be reported to the Trust s Quality Safety Steering Group and the Helath and Safety committee. Learning from the audit will be shared with staff. 15. References 1. Royal College of Physicians of London & Royal College of Psychiatrists. Smoking and mental health: a joint report. (Royal College of Physicians : Royal College of Psychiatrists, 2013). 2. National Institute for Health Care and Excellence. Smoking cessation in secondary care: acute, maternity and mental health services. (2013). 3. NICE Clinical Knowledge Summary. Smoking cessation - NICE CKS. (2014). at 4. Joint Formulary Committee. British National Formulary. (BMJ Publishing Group Ltd and Pharmaceutical Press, 2014). at 5. Medicines and Healthcare Products Regulatory Agency. New advice on use of nicotine replacement therapy (NRT): wider access in at-risk populations. (2012). at andmessagesformedicines/con UK Medicines Information pharmacists for NHS healthcare professionals. What medicines need dose adjustment when a patient stops smoking? (2012). At 7. Taylor, D. & South London and Maudsley NHS Trust. The Maudsley prescribing guidelines in psychiatry. (John Wiley & Sons, 2012). GUI Prescribing Nicotine Replacement Therapy Version 1.0 November

18 8. South London and Maudsley NHS Foundation Trust. Medicines Bulletin. (2014). 9. Robson, D. & Potts, J. Smoking Cessation and Mental Health: A briefing for frontline staff. (2014). 10. Camden and Islington NHS Foundation Trust Guidlines for Prescribing in Smoking Cessation (2015) 15. Associated Trust documents These guidelines should be read in conjunction with: 1. Smokefree Management Policy 2. Health and Safety Policy 16. Equality Impact Assessment Please refer to overarching policy 17. Data Protection Act and Freedom of Information Act Please refer to overarching policy Standard Operating Procedure Details to be completed by Corporate Governance Unique Identifier for this SOP is State if SOP is New or Revised BCPFT-HS-SOP-12-1 New Policy Category Executive Director whose portfolio this SOP comes under Policy Lead/Author Job titles only Committee/Group Responsible for Approval of this SOP Month/year consultation process completed Review and Amendment History - to be completed by Corporate Governance Version Date Description of Change Health & Safety, Fire, Security Executive Director of Nursing Head of Health and safety Health and Safety Committee November 2018 Month/year SOP was approved December 2018 Next review due December 2021 Disclosure Status B can be disclosed to patients and the public 1.0 Sept 2018 New SOP for BCPFT to support Smokefree Policy GUI Prescribing Nicotine Replacement Therapy Version 1.0 November