Going Smoke-Free in an inpatient mental health setting Mary Yates, Modern Matron, SLaM and Dr Shubulade Smith, Consultant Psychiatrist and Clinical Senior Lecturer, SLaM and IoP (KCL)
Smoking and physical health Smoking is the most important factor contributing to morbidity (Brown et al 2000) People with SMI die 15-20 years earlier than the general population Mainly due to CVS and respiratory disorders Significant contribution of lifestyle factors SMOKING is one of the main culprits (Brown et al 2000) 75% of people with schizophrenia smoke (Diaz et al 2009) 21% of general public smoke (H&SC 2010) Cessation does not exacerbate symptoms (Lawn & Pols 2005) Quitting is clinically & cost effective (Raw et al, 2005)
The Setting BDP CAG of SLAM NHS Foundation Trust Patients in medium and low secure, open units, forensic, neurodevelopmental disorders and LD services.
AIMS Equal access to smoking cessation services for our client group Improved health promotion and wellbeing within CAG Achieve CQUIN targets High Faluting Aims Increase patient satisfaction Reduce admissions/transfers to local general hospital Skill development in staff long-term reduction in physical health problems
Drivers to Change Our core value: everything we do is to improve the experience of people using our services, and to promote mental health and well-being for all Smoke Free Strategy 2010-2015 Smoke Free Policy June 2012 Moral & ethical reasons THERAPEUTIC NIHILISM Reducing incidents CQUIN targets MONEY!
Pre-March smoking audit Staff 11% smoked 30% completed smoking cessation training 58% were regularly assessing the smoking status of their patients Nurses spent 90 mins/shift facilitating smoking Wards All advertised smoking 2 wards had open access for smoking in the garden 2 wards had facilitated access to the garden for smoking 8 wards had designated smoking breaks (6-13 per day) Copious amounts of cigarette waste No smoking cessation groups on any of the wards
Pre-March 2013 70% of staff wanted to ban smoking 58% of patients had previously quit 78% of our forensic patients smoked 20% of our LD patients smoked 22% of patients who smoke wanted to ban smoking 62% of non-smokers wanted to ban smoking All patients transferred from Broadmoor had previously quit
% patients smoking in each ward 1 8% 15% 27% 38% 87% 91% 85% 69% 79% 77% 92% 80% 89% 0% 20% 40% 60% 80% 100%
Staff Experience 11% of our staff smoke 30% of staff have completed training 58% of staff regularly assess smoking status of their patients
Implementation lots of planning Advertising Individuals plans - CPA Ward plans Boredom Busters Building plans Community Meetings Champions Physical health Risk management plans Smoking cessation groups GP and practice nurse Dietician/Exercise Workers Smoking Cessation Adviser Motivational interviewing approach
Smoking cessation care pathway during inpatient stay Does the person smoke? NO YES Have they ever smoked? How many cigarettes do they smoke a day? Would they like support to stop smoking? YES NO NO YES Congratulate on success Reinforce decision to quit Review benefits of quitting Discuss strategies for prevention of relapse during inpatient stay Offer brief advice and brief intervention Repeat every month Refer to a level 2 stop smoking counsellor Write care plan with patient to prevent [re] starting smoking on the ward Write care plan with patient to minimise harm from tobacco whilst on the ward Write care plan with patient to devise a quit plan Record each stage in EPJS
Smoking breaks per ward Sept 12 14 No. Of Smoking Breaks 12 10 8 6 4 2 0
Smoke Free Day 13 th March 2013 Celebration Event Publicity Activity Risk Management plans Staffing
Smoking-related Incidents 300 SLaM incidents in 2009 were related to smoking, resulting in violence, fire and absconsions 15% of physical intervention use was associated with smoking related behaviours 18 16 14 12 10 8 6 4 2 0 Dec '12 Jan '13 Feb '13 March '13 April '13 May '13
Key changes that made all the difference Focus groups to get ideas for continuous quality improvement Monitoring incidents and taking prompt actions Smoke free planning meeting Equipment and resources Instilling hope Recovery Model Individual care planning Staff training and supervision Groups NRT & E-cigarettes
Future Plans Investigate the effectiveness of e-cigarettes Site based smoking cessation group Supervision group for staff Review reduction in medication Weight management groups More staff training
If you build it, they will come!! THANK YOU!