Transcript Document

babyClear
Implementing a regional approach to
tackling smoking in pregnancy
Martyn Willmore
Performance Improvement Delivery Manager, Fresh
Hilary Wareing
Director, Tobacco Control Collaborating Centre
The impact of maternal smoking
2010 RCP report on
“Passive smoking and
children” states that:
“Each year in the
UK, an estimated 3,000 to
5,000 miscarriages are
caused by maternal
smoking”
Smoking at time of delivery
rates since 2006/07
NICE Guidance
How to stop smoking
in pregnancy and
following childbirth
NICE public health
guidance 26: Quitting
smoking in pregnancy
and following childbirth
Key outcomes from research
- Four main issues identified following regional
survey of North East midwives:
- Skills and training. How to make training standards
consistent? Specific issues around using CO monitors
- Resources. Prompts/triggers to help midwives raise
issue in a more structured way. Access to resources
- Carrying the message consistently. Ensure staff
deliver same message every time
- Managing relationships. Need to defuse any concerns
about negative reactions to discussing smoking
Implementing a regional approach
Following procurement process, we
commissioned the TCCC to deliver babyClear:
•Systematic approach to CO monitoring
first booking appointment
•Standardised referral process
•“Risk Perception” intervention by
midwife at time of dating scan clinic
•Skills training for SSS (advisers
admin teams)
•Supply of all related materials
at
and
Implementation
• Numerous meetings took place with a range of key partners:
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Heads of Midwifery/Midwifery Supervisors
SSS commissioners and providers
Public Health staff
Clinical Innovations Team for Maternity & Newborn
• We committed to fund roll-out of babyClear and all
associated materials in year one
• Letter sent out to FT Chief Executives, outlining the rationale
for this approach, and seeking strategic support
Standard midwifery
booking intervention
Aim: To enable participants to systematically identify smokers
at time of first booking appointment by means of a carbon
monoxide reading. To raise “concern” and automatically refer
all smokers into NHS Stop Smoking Services
Standard midwifery
booking intervention
• Two-hour training for all staff who do booking
appointments. Challenges include:
o
o
o
o
o
o
Identify everyone who needs to attend
Organise dates/venues for training
Ensure relevant staff register and attend
Provision of localised materials and CO monitors
Manage the on-going provision of resources
Ensure someone locally monitors/manages the
compliance with this process
o Future training needs to be picked up locally
Booking intervention
training numbers
Total number of midwives trained across all clusters
399
Total staff trained across all clusters
457
Total number of CO monitors issues across all clusters
380
Risk Perception Intervention
Aim: To enable a cohort of trained midwives
to intervene (at time of 12-week dating scan) with smokers
who have previously declined offers of help, and ensure they
fully understand the risks of continued smoking in pregnancy
Risk Perception intervention
• All-day training for small cohort of nominated midwives.
Challenges include:
o We specified it must be a midwife delivering this…..
o Organising dating scan clinics around smokers
o Having to repeatedly make the case for this “new”
intervention
o Midwifery teams making appropriate staff available
o Ensure equipment is made available
o Monitoring the implementation/compliance
Risk Perception training
Trust
Number trained
County Durham & Darlington
15
Gateshead
5
South Tyneside
1
Sunderland
North Tees
3
8
South Tees
2
Northumbria
Newcastle
8
2
Stop Smoking Services
• Concerns that not all smokers being identified at booking
• Even majority of those referred opt out of support. Of
those that did set a quit date, success rates were low
• We committed to ensuring that NE SSS pregnancy
services deliver highest quality support:
o One-day refresher training to existing advisors
o Two-day full training to any new pregnancy advisors
o One-day training for SSS admin teams on converting
“leads” into appointments attended
Stop Smoking Services
• Challenges of SSS training:
o Six NE SSS at time, all with different models of delivery,
different data systems
o Changes to models midway through implementation
o Identifying preferred pregnancy advisors locally
o Potential big rise in number of referrals, and impact
o Significant role for SSS in helping to manage process
and evaluate
SSS training
Stop Smoking Advisors
124
Healthy Living
Pharmacies/pharmacist advisors
31
SSS Administrative staff
28
Evaluation
• Newcastle University agreed to carry out an independent
evaluation of the project`s quantitative outcomes
• Teesside University will be evaluating qualitative outcomes
• Universities secured funding from School of Public Health
Research to undertake this work
• Not expecting report until Spring 2015 at earliest
Initial Results (SSS throughput)
Quit dates
set in AprilSeptember
2012/13
Quit dates % change in
set in April- quit dates
September
set since
2013/14
last year
County Durham & Darlington
165
203
+23%
Gateshead, South Tyneside & Sunderland
164
216
+32%
Newcastle & North Tyneside
136
127
-7%
Northumberland
138
129
-7%
North Tees
266
212
-20%
South Tees
172
142
-17%
% change in quit dates set by pregnant
women from Q1-3 2012/13 to 2013/14
Risk Perception
Promising early results from Cluster One…..
County Durham and Darlington
(12th August – end of March)
Numbers
% of eligible % of initial
cohort
referrals
Accepted referral following RP
257
Engaged with the SSS
241
94%
Set a Quit Date
66
27%
26%
Quit at 4-weeks
37
56%
14%
Trust recognition of progress…
At 2013 County Durham
and Darlington FT staff
awards. babyClear
approach won:
• Public Health/Health
Improvement Award
• Chairman`s Quality
Award
Key Lessons Learnt
• Importance of senior manager buy-in from the start
• But also crucial to work with those delivering, to understand
local challenges/systems, and be flexible
• Make sure new processes are embedded and formally
commissioned (e.g. CQUINs) to help sustain work
• Understand and address the consequences of upscaling
efforts (more equipment, more admin work, etc)
• It`s not enough to just provide the training and resources….
Any Questions?
[email protected]
01926 490 111
[email protected]
0191 333 7140
www.freshne.com