Abstract

There are over a billion smokers in the world and tobacco addiction is one of the biggest health treats for the world. Smoking tobacco kills half of its users and is estimated to cause up to one billion deaths in the 21^st century (WHO, 2010). There is a public health drive to provide behavioural and medication support to reduce the amount of current smokers and prevent future smokers. Respiratory clinicians have an opportunity to lead change and facilitate services closer to patients; smoke cessation is the key evidence based treatment for COPD that will delay progression of disease (NICE, 2010). 15% of smokers will be diagnosed with COPD and alters the immune system; there is a 2.5 increased risk of contracting pneumonia, quadrupled risk of contracting tuberculosis (Bernhard, 2011).

This case study identifies how a respiratory team have implemented a secondary care stop smoking service lead by a BTS Stop Smoking Champion. The service design is discussed, lessons learnt and results. An innovative model attracts tariff payment for in reach into schools, colleges and workplaces which in turn funds the inpatient service.

The service has been operational for 24 months and has treated over 700 patients. Respiratory nurses and AHP’s are fully qualified advisers and facilitate provision with the help of a full time co-ordinator. Support is available on wards and in outpatient with follow up for at least 12 weeks, nicotine replacement therapy available for inpatients 24 hours per day. All pre-op patients receive carbon monoxide testing with an opt our referral system. Referral systems in place from A/E to outpatients.

Evaluation has shown an average quit rate of 50%; 65% in COPD clinics with COPD CNS advisor. 14–18 year old complex smokers –20% quit rate and 85% in work place (routine and manual workers). NHS staff quit attempts have been consistently high (50%) with family groups also facilitated (80%).