Engaging Pregnant Women to Stop Smoking – Creating Effective Referral Pathways and Increasing Quit Rates By Hayley Bates and Catherine Sixsmith

Smoking in Pregnancy – Why is it important Women Quit?  Smoking tobacco during pregnancy incurs many risks to the mother and unborn child. Some of these risks include:  Miscarriage  Still birth  Cot death  Cleft lip / pallet  Behavioural problems  IUGR – baby is smaller as a result of oxygen / nutrient restriction  Despite the numerous negative health outcomes associated with smoking during pregnancy, historically it has been difficult to engage pregnant women with smoking cessation services

Background – Telford and Wrekin Telford and Wrekin is 4 th highest in the UK for pregnant women smoking during their pregnancy  The number of women smoking at time of delivery (SATOD) had not reduced for 7 years  Previously, Telford and Wrekin Stop Smoking Services were funded through NHS, however, funding shifted across to the local authority offering a change in commissioning and a chance for changes to be made to service delivery  In 2014, Quit 51 were awarded the pregnancy stop smoking service and aimed to bring about change to the delivery of this service with an overarching aim to reduce SATOD

Quit 51 Stop Smoking Service Aimed to: Key service components we wanted to implement:  Create an ‘Opt out’ system whereby women who are identified as smoking in pregnancy are automatically referred into our service  Engage women at as early as possible a time point in their pregnancy to have maximum effectiveness on cessation rates and reduce harm  Provide intensive behavioural support  Follow up pregnant women to allow for clear data to be collected

Quit 51 Stop Smoking Service Aimed to:  Increase knowledge of the service to health care professionals who come into contact with pregnant women and ensure they know how to refer patients to us  Encourage partners of pregnant women to quit to both aid cessation for the pregnant women and reduce risks presented by second hand smoke

Previous Service Provision – highlighting areas in need of improvement Analysis of current service provision highlighted areas for improvement;  Identified further training needs within midwifery team including brief advice training and CO monitor training  We identified that CO readings were not routinely been taken at booking appointments – This is crucial as it allows for women who are smoking to be identified early in their pregnancy  We provided free equipment, resources, and training  We also developed a ‘traffic light’ system to allow CO readings to be easily understood by both midwives and patients

Previous Service Provision - highlighting areas in need of improvement Build a relationship and have effective communications between the midwifery staff and Quit 51  We wanted to ensure encouraging women to quit smoking was a high priority  Had regular meetings with the midwifery staff keeping them informed on the level of referrals received  We leased closely with the midwifery management team to identify midwives who would benefit from further training to increase their confidence around discussing smoking cessation with patients to, in turn, increase referral rates

Treatment Pathway Patient referred to service contacted within 2 days of referral being made Patient accepts Service and appointment is arranged patient Quits at 4 / 12 / 26 weeks, and Delivery Support offered up to 3 months after delivery This could be a midwife, GP, Pharmacist, Health Visitor, Sonographer, etc. All referrals are contacted up to four times; morning, afternoon, evening (after 6pm) and Saturday. If no successful contact is made, a letter is sent offering our service. A patient at this stage will either accept or decline support to quit. If accepting the service, a number of accessible methods of support are offered We accurately record data from clients on their quitting journey. We also shared our data with the midwifery team as a way of cross referencing any women we have found to be QAD with hospital records We try and reengage any patients who have relapsed / who did not originally accept our service from the point of referral right up to delivery Support doesn’t halt at delivery, we are there for up to 3 months after to offer our support / keep patients on track

Engaging Pregnant Women Consultant Lead Clinic  Women who attend these clinics are doing so as they have additional risks to their pregnancy such as; diabetes, IUGR, or other health issues  We had a presence at these clinics as a way of reaching out to some of the most vulnerable women, their partners and families to provoke more thoughts about stopping smoking Parent Craft Sessions  We attended ‘Parent Craft’ a service to support young, teenage parents  We developed and delivered interactive and informative sessions about the dangers of smoking during pregnancy / second hand smoke with the aim to encourage more parents to consider quitting

Service Outcomes – Was our service effective? SATOD was reduced by 0.6% This is the first time SATOD has reduced in 7 years!  From 01/03/2014 – 31/03/2015 we received approximately 600 referrals from various sources (mainly maternity services) in Telford and Wrekin  Of these a total of 308 women registered to use our service  Of these women 213 set a quit date  99 women quit at 4 weeks (46%)  35 women quit at 12 weeks (16%)  And, most importantly, 27 women quit at delivery (13%)  Most importantly Quit 51 Stop Smoking Service has embedded a pathway to smoking cessation into maternity services in Telford and Wrekin  We anticipate SATOD to continue to fall with the changes that have been made to this service

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