MEASURING SMOKEFREE SUCCESS BEYOND THE HOSPITAL WALLSMEASURING SMOKEFREE SUCCESS BEYOND THE HOSPITAL WALLS

Penny ThompsonSmokefree Liaison NurseTotally Smokefree ProjectHawke’s Bay DHB

Project Team

Carleine Receveur Project Manager

Kate O’Brien Train the Trainer

Suzanne Marshall Coordinator for Maternal,

Child and Youth Workstream

Rebecca Missen Coordinator for Mental Health

and Addiction Workstream

Rangi Barcham Cessation Support

David Mitchell Cessation Support

Overview

• Background of HBDHB Totally Smokefree project

• DHB Policy

• Project Approach

• Health targets

• Moving outside the hospital walls

• What we found outside the hospital walls

Where we were just over 3 years ago

• Dedicated Smoking rooms

• Policy that focused on where not to smoke

• No dedicated team to support clinical practice

Burden of Tobacco in HB

Smoking prevalence (%) by single year of age- all gender New Zealand v Hawke's Bay

0%5%

10%15%20%25%30%35%40%45%

15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 +

Age

%

New Zealand Hawke's Bay DHB

Increasing Smokefree Understanding

Policy - Purpose

“To describe the HBDHB smokefree

strategy and systems to encourage and

support smokefree lifestyles for all”.

Policy Principles

HBDHB recognises:

- Level of harm of tobacco use- Leadership- Funder and provider- Best practice- Health promotion and protection

Policy Statements

100% of patients/clients will have their smokefree status identified.

100% of patients/clients identified as smoke exposed will have appropriate smokefree interventions.

Smokefree Best Practice: ABC Smokefree Best Practice: ABC

AA is for is for askask

BB is for is for brief advicebrief advice

CC is for is for cessation cessation supportsupport

ApproachSystems First: model of organisational change

Evidence Policy Systems

Education

Patient

Roles

Intervention

ApproachSystems First: model of organisational change

• Acknowledgement harm

• Impact harm

• Evidence of Treatment

Evidence

ApproachSystems First: model of organisational change

Describes• Purpose / Vision• Principles• Scope• Strategies / policy

statements• Roles and

responsibilities• Link to other

organisation policies

Policy

ApproachSystems First: model of organisational change

• Links policy to action

• Framework for accountability

• Guides interventions and strategies

• Provides shape to work

Systems

ApproachSystems First: model of organisational change

• Clarity

• Match education to specialty

• Confidence and competence in clinical practice

Education

ApproachSystems First: model of organisational change

Roles and Responsibilities

• Supportive role for everyone identified

• Roles align to purpose

• Establishes accountability for delivering clinical best practice

Role

ApproachSystems First: model of organisational change

• Clinical best practice becomes a reality

• The ABC’s A = AskB = Brief

AdviceC = Cessation Support

Intervention

ApproachSystems First: model of organisational change

• 100% of patients/clients will have their smokefree status identified.

• 100% of patients/clients identified as smoke exposed will have appropriate smokefree interventions.

Patient

ApproachSystems First: model of organisational change

Evidence Policy Systems

Education

Patient

Roles

Intervention

Data

• Data is the “currency” of systems

• Data has two primary purposes 1. To monitor performance

2. To inform understanding and future planning

• Types of Data1. Process data

2. Outcome data

Ministry of Health Target

By June 2010 80% By June 2010 80%

By June 2011 90% By June 2011 90%

By June 2012 95% By June 2012 95%

Hospitalised smokers will be provided with advice and

help to quit

Measuring Outside the Hospital Walls

Activities outside the hospital walls

• Mental Health and Addiction

Community services

• Public health nurses

• Dental Therapists

• Diabetes Clinics

• District Nurses

HBDHB and HBPHO

Auditing Framework

Audit Process–Executive Summary–Terms of Reference

Aims and ObjectivesScope

Audit Approach–Significant Findings

Risks

–Recommendations–Table of Corrective

Actions

Findings

- Transferability

- Service Specific

- Systems Approach

- Cessation Support Services

- Performance Feedback

- Measuring Success

Acknowledgements

• David Smith and Stephanie Cowan “Systems First” framework

• Hawkes Bay PHO

Sue Taaffe and Wendy Jacques

• Hawke’s Bay District Health Board

Totally Smokefree Project Team

References • Hodge P & Binnie V. Smoking cessation and periodontal health – a

missed opportunity? Evidence-Based Dentistry (2009) 10, 18–19

• Johnson NW, Bain CA. Tobacco and oral disease. British Dental Journal Vol. 189, no. 4, pp. 200-206. 26 Aug 2000

• Ellison J, Mansell C, Hoika L, MacDougall W, Gansky S, Walsh M. Characteristics of adolescent smoking in high school students in California. Journal of Dental Hygiene, Spring, 2006

• Micheal Fiore. Chair of the US Public Health Services 2000 Smoking Cessation Clinical Practice Guidelines Panel. Author of: Treating Tobacco Use and Dependence. August, 2003

Questions

Penny ThompsonSmokefree Liaison Nurse

Hawke’s Bay District Health Boardpenny.thompson@hawkesbaydhb.govt.nz