P127 Improving smoking cessation advice through the implementation of a quality improvement intervention

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Abstract

Background

Smoking remains the main cause of preventable morbidity and premature death in England (DH data) and is estimated to cost the NHS £1.5 billion a year. Smoking counselling beginning during hospitalisation and including support after discharge increases smoking cessation rates (Rigotti et al 2008).1 Health professionals in the hospital are expected to offer cessation advice. An audit was carried out in the acute medical unit of 118 consecutive medical patients which demonstrated that only 1/25 current smokers received any cessation advice. In July 2010, driven by a quality improvement project carried out locally in patients admitted with community-acquired pneumonia, key indicators of high quality care were established, one of which was to clearly document and offer smoking cessation advice to current or recently-quit smokers. Despite being a requirement, documentation regarding smoking cessation advice was poor. In the respiratory wards, only seven patients were referred to existing smoking cessation services over 6 months. Several interventions were planned to increase awareness. No additional resource was required and members of the multidisciplinary team were employed in a variety of roles. An educational programme was established, including presentations to key specialities (acute and respiratory medicine) and key ward nursing staff. An in-reach programme was developed by the smoking cessation lead nurse, targeting wards where high rates of smoking were identified. Several foundation trainees were employed as “smoking champions,” raising awareness among their peers.

Results

Since initiation of the interventions, documented cessation advice has steadily risen from 0% to 68% of patients with a smoking history (see Abstract P127 figure 1). On the respiratory wards, 77 patients over 6 months (cf seven prior to intervention) were referred to the service. Four-week cessation rates in the patients referred to the cessation service was 82% and of these patients 70% had still ceased to smoke at 6 months.

Conclusions

Low cost, easily-deliverable interventions can act as important drivers to improve awareness and delivery of smoking cessation advice. We have demonstrated that simple strategies can be highly cost effective, of particular importance in this financial climate.

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