Hospitalised and pre-operative smoking patients
Planned admissions
Stopping smoking before an operation decreases the risk of wound infection, delayed wound healing and post-operative pulmonary and cardiac complications. It can often mean a shorter stay in hospital. This is therefore a good opportunity for a successful intervention.
A recent Cochrane review reported that delivering stop smoking services to in-patients has a positive impact. Trials found that programmes begun during a hospital stay, and which included follow-up support for at least one month after discharge, are effective.
Recommendations
All patients should receive brief intervention advice in advance of any surgical intervention and be referred for more intensive support from their local NHS Stop Smoking Service.
Patients who do not intend to stop smoking prior to surgery should be advised of the hospital’s Smokefree policy. As smokers are likely to experience withdrawal symptoms during a period of enforced abstinence, pharmacotherapy should be offered to assist withdrawal management and provided through primary care.
Unplanned admissions
It is thought that people are more receptive to health advice and support while they are in hospital, and particularly following an unplanned admission. This therefore offers a prime opportunity to offer stop smoking advice, using the period of heightened motivation to stop smoking, encourage Smokefree compliance and highlight any need for withdrawal management.
Recommendations
If the patient wishes to stop smoking following admission to hospital they should be given brief intervention and referred for intensive support.
All smokers’ nicotine dependency scores should be assessed following admission and NRT provided as soon as possible.
Patients should not have to wait for their local NHS Stop Smoking Service (either provided internally or externally) to assess them before receiving NRT.
NHS Stop Smoking Services should be prepared to support patients who have stopped smoking in hospital once they return to the community. Discharge information from the hospital will need to be communicated to the service via a locally agreed system.
Stop smoking interventions in secondary care
The DH Tobacco Policy Team, with the aid of an expert working group, is currently working on a guide that will help NHS Stop Smoking Services develop planned and unplanned stop smoking support across acute settings. The stop smoking interventions in secondary care guidance is based on the premise that planned and unplanned admissions to hospital provide ideal opportunities to support people in stopping smoking. It is planned to be available via regional performance managers (RPMs) and on the extranet in early 2009.
commissioning tool
In addition, NICE is currently developing a tool to help NHS Stop Smoking Services demonstrate the financial and clinical impact of pre-operative stop smoking support services in acute settings to both acute and primary care commissioners. It should be published some time in 2009.
