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Integrated Care Pathway for the
Management of Nicotine
Addiction
18.04.2013
Jacqueline MacDonald
Stop Smoking Specialist Nurse
Hairmyres Hospital
Coathill Cluster
Community
Stop Smoking
Service
Monklands Hospital
Stop Smoking
Service
Hairmyres Hospital
Stop Smoking
Service
Wishaw Cluster
Community
Stop Smoking
Service
Wishaw Hospital
Stop Smoking
Service
Udston Cluster
Community
Stop Smoking
Service
NHS Lanarkshire Stop Smoking Service
Pharmacies
Seamless
Service
Integrated Care Pathway
‘‘Integrated care pathway (ICP) determines
locally agreed multidisciplinary practice based
on guidelines and evidence where available
for a specific patient/client group. It forms all
or part of the clinical record, documents the
care given, and facilitates the evaluation of
outcomes for continuous quality
improvement.’’ National Pathways Association,1998
ICP would support National
and Local Guidelines Smoking Cessation Guidelines (2010)
CEL(1) Health Promoting Health Service :
Action into Hospital Settings (2012)
Creating A Tobacco-Free Generation: A
Tobacco Control Strategy for Scotland (2013)
Quality strategy(2010)
The need for effective health care services through reducing inappropriate
variation and practices and ensuring that the most appropriate treatments,
interventions, support and services are provided at the right time to
everyone who could benefit.
Preparation ICP Group (multidisciplinary)
Project Initiation Document (PID)
• Pilot
• Identified 3 key areas: Coronary Care Unit
Respiratory Ward
Ward Emergency Care
• Senior/Ward managers
• Link Nurses
• Training
• Pharmacy
• Document
• Resources
Outcomes Improve patient comfort
• Appropriate referrals
• Patient choice
• Equity and consistency of care
• Increase in quit attempts and successful four week quits
• Lower incidence of patients smoking within acute sites (as part of the Smoke Free Policy work)
• Increased staff knowledge
• Increased availability of NRT
Example of Admission Documentation
How we planned to evaluate
Referrals
Quits made
Patient survey
Staff survey
Referrals 2 months pilot period(2012) in comparison to previous
year (2011)
12-53
Pilot Area
47-111
Hospital overall
Staff Survey
(36 completed survey)
• Raised Awareness - 29
• Increased confidence -21
• Requesting further training-19
• Access to NRT -33
• Made a difference to patient comfort -23
Staff Feedback
“Would like
more training”
“Recognise
Nicotine withdrawal
symptoms”
“Feel more confident
To discuss stopping
smoking with
Patient”
“Understand
Nicotine addiction”
Findings From Patient Survey
100 ICP Completed /53 patients contactable
• Unaware of service -34
• Asked on admission – 42
• Prescribed NRT- 31
• Quit - 49
• Health reasons - 32
• Policy - 28
• Very satisfied/satisfied - 53
• More at ease coming into hospital - 51
• Recommend service - 51
Patient’s Feedback
“NRT helped”
“Would recommend”
“Great Service”
“Felt more relaxed”
“Stopped because
help was offered”