1. MEASURING SMOKEFREE SUCCESS BEYOND THE HOSPITAL WALLS MEASURING SMOKEFREE SUCCESS BEYOND THE HOSPITAL WALLS Penny Thompson Smokefree Liaison Nurse Totally Smokefree Project Hawke’s Bay DHB

2. 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

3. 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

4. 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

5. Burden of Tobacco in HB

6. Increasing Smokefree Understanding

7. Policy - Purpose “ To describe the HBDHB smokefree strategy and systems to encourage and support smokefree lifestyles for all”.

8. Policy Principles HBDHB recognises: -Level of harm of tobacco use -Leadership -Funder and provider -Best practice -Health promotion and protection

9. 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.

10. Smokefree Best Practice: ABC A is for ask B is for brief advice C is for cessation support

11. Approach Systems First: model of organisational change Evidence PolicySystems Education Patient Roles Intervention

12. Approach Systems First: model of organisational change Acknowledgement harm Impact harm Evidence of Treatment Evidence

13. Approach Systems First: model of organisational change Describes Purpose / Vision Principles Scope Strategies / policy statements Roles and responsibilities Link to other organisation policies Policy

14. Approach Systems First: model of organisational change Links policy to action Framework for accountability Guides interventions and strategies Provides shape to work Systems

15. Approach Systems First: model of organisational change Clarity Match education to specialty Confidence and competence in clinical practice Education

16. Approach Systems 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

17. Approach Systems First: model of organisational change Clinical best practice becomes a reality The ABC’s A = Ask B = Brief Advice C = Cessation Support Intervention

18. Approach Systems 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

19. Approach Systems First: model of organisational change Evidence PolicySystems Education Patient Roles Intervention

20. 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 Data 1.Process data 2.Outcome data

21. Ministry of Health Target By June 2010 80% By June 2010 80%  By June 2011 90%  By June 2012 95% Hospitalised smokers will be provided with advice and help to quit

22. Measuring Outside the Hospital Walls

23. Activities outside the hospital walls Mental Health and Addiction Community services Public health nurses Dental Therapists Diabetes Clinics District Nurses

24. HBDHB and HBPHO

25. Auditing Framework Audit Process –Executive Summary –Terms of Reference Aims and Objectives Scope Audit Approach –Significant Findings Risks –Recommendations –Table of Corrective Actions

26. Findings -Transferability -Service Specific -Systems Approach -Cessation Support Services -Performance Feedback -Measuring Success

27. 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

28. 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

29. Questions Penny Thompson Smokefree Liaison Nurse Hawke’s Bay District Health Board penny.thompson@hawkesbaydhb.govt.nz