Smoking in Pregnancy Our Improvement Journey in Somerset Stewart Brock, Public Health Specialist
SATOD Working Group In 2013 we set up a multi-agency group comprising Heads of Midwifery, Stop Smoking Service Manager, CCG Quality Improvement Manager, SCC Public Health Specialist. Strategic oversight as working towards the CCG Quality Premium Indicator and Health and Wellbeing Board Smoking in Pregnancy Key Priority.
Action Plan Based on National Pregnancy Challenge Group report and local intelligence, audits etc. Data collection and recording accuracy vastly improved at both booking and delivery by midwives. Specialist midwives (part time, CCG funded) act as champions for this agenda, providing training and support to colleagues and monitoring progress. Mandatory training for all Somerset midwives annually on smoking identification and referral.
Mums2B specialist smoking in pregnancy service rolled out countywide in 2014 (SCC funded) and incorporated into new contract with Solutions 4 Health (Smokefreelife Somerset) All midwives now have access to carbon monoxide (CO) monitors (CCG funded initially, ongoing by the Trusts), with an expectation that all women have their breath tested at first booking. Women with a positive CO reading are referred to the Mums2B stop smoking service, on an opt out basis.
These women are contacted promptly and those who respond are offered an intensive support programme with shopping vouchers provided throughout pregnancy and beyond, up to 200 total, contingent on CO breath tests showing continued abstinence from smoking. Women who are still smoking at the time of the 12 week scan are referred to a specialist midwife to discuss the impact of smoking on the woman and her unborn child, and again offered referral.
Checking compliance The specialist midwives have a quality improvement role. For example: Following up booking forms with missing CO screen Training includes an emphasis on CO checks and data accuracy Record forms changed and stickers used on handheld notes to reinforce
LA Name Number setting a quit date Number of successful quitters (selfreported) Number of successful quitters (self-reported), confirmed by CO validation 2 Bournemouth Borough Council (Unitary) 47 16 16 Bristol City Council 30 8 7 Cornwall Council 135 73 15 Devon County Council 87 61 45 Dorset County Council 30 10 10 Gloucestershire County Council 118 69 55 North Somerset District Council 44 20 13 Plymouth City Council (Unitary) 108 39 29 Somerset County Council 7 184 107 91 South Gloucestershire Council (Unitary) 42 16 16 Swindon Borough Council (Unitary) 47 35 19 The Council of the Isles of Scilly (Unitary) 0 0 0 Torbay Council (Unitary) 30 9 7 Wiltshire Council 31 11 3 Data source HSCIC Apr-Sep 2015
SATOD rates
Taunton 2014/15
Continuous Improvement The Somerset Maternity Services Forum is working to address remaining barriers to effective working, overseen by MSLC. Need to ensure that the identification of pregnant women who are smoking and the offer of support to quit is systematic and routine practice at both first booking and 12 week scan. Ensuring 12 week scan intervention attendance is maximised. Tackle misrecording / falsification of data. 36 week CO reading.
Upstream interventions Consistent messaging Children s Centre family support workers, fertility services, obstetricians, GPs, etc. Provide brief intervention training to upstream professionals Partner and household smoking need to develop and test interventions. Maintain focus on correct ascertainment and recording of smoking status at booking and delivery.
Remember Smoking is the single biggest modifiable risk factor for poor birth outcomes. Thankyou!