MENTAL HEALTH
EVIDENCE
COMMITMENT
SYSTEMS
EDUCATION
MONITORING
STRENGTHS
WEAKNESSES
Positive Australian experience –
close to home. Fears – unfounded.
Research supports policy. Health
benefits – live longer.
Not enough NZ research written
Lack evidence Pharmacotherapy –
clinical team. Smokefree
definitions. Availability of evidence.
Persistence of myths.
Lack of buy in
Staff that smoke and smoke in
grounds
Informal exemptions for patients
Moe Research through own
networks
Gate keepers
Staff
Conflicting evidence
Provide cessation support and
training for staff
Staff that smoke
No MoH support and clarity
Staff actively undermining policy
Consumer advisors
Acute admission not the time.
Smokefree definition of a Mental
Health Unit
Targets don’t reflect the
effectiveness of MHU being
Smokefree
No specialized cessation support
NGO sector Precursor to advocate
smokefree
Not being taken seriously
Health target covering up “real
picture”
Lack of priority by staff
Lack of opportunity to speak to
staff
Need cessation training
Reduced opportunities to attend
Lack reality and target outcomes
Reporting interpretations differ
with each DHB
Coding differences
Training for staff
Change mind set of staff/patients
Co-ordinators not seen as MH
experts
E-learning not marketed to specific
MH / academia
To standardize reporting
Audits
Can manipulate data
Need:
Committed Smokefree staff.
Champion
Policies
Service Manager and Charge
Nurse Manager who support
Smokefree initiatives
Sustainable – paper work
Electronic ABC
Management Backing
Reference Group
Mandatory e-learning
Mark Wallace Bell
Good education works
Right skill and confidence
Nursing / doctors / Allied Health
Electronic Documentation
Provides ability to improve
OPPORTUNITIES
THREATS
EXTRA COMMENTS:
POSITIVE MEASURES: Engage outside speakers / experts e.g. Sharon Lawn, train community workers, enlist Champions e.g. Psychiatrists, general amanger, dedicated
Smokefree Mental Health cessation practitioners, engage staff members in the change process.
MATERNITY
EVIDENCE
COMMITMENT
STRENGTHS
MONITORING
OPPORTUNITIES
THREATS
Harm of smoking to foetus,
Treatment models are present,
“Look at this placenta”, Increased
acceptance of ABC.
Poor evidence about OK use of
drugs, Ethical challenges re trail of
drugs.
Opportunities for NZ Research,
standardization of data collection,
is there UK evidence for national
frameworks
Everybody is measuring things
differently, people scared of safety
Pregnancy is a catalyst
Many relapse after birth, “softly,
softly” approach isn’t enough,
inconsistent training of midwives
Yet to be realized as MoH and all
service providers pull together,
increased leadership
Lack of leadership
Smoking status well recorded at
enrollment
Lack of national leadership,
inconsistencies, integration
between agencies, no resources
specific to hapu women, different
forms used by independent
agencies vs DHBs
Mltiple learning packages,
inconsistent messages, still a lack
of knowledge
Funding for Midwives as Quit
Coaches, Icentives, Can we do
ABC @ each encounter, free NRT
supply for midwives (Partner and
mother) MPSO?, Add Smokefree
clause to section 88 agreement
Midwives as SC coaches,
Increase midwifery training, add to
undergraduate training
AKP providers have a larger % of
males, need more female
providers.
Doubts about outcomes from AKP
services
Add ABC documentation to M/V
reporting to MoH docs
SYSTEMS
EDUCATION
WEAKNESSES
ABC on-line, Smokechange –
funded, STEPS - coming
Monitoring inpatients – is it useful?
EXTRA COMMENTS:
POSITIVE MEASURES: person to assist with transitioning of clients from maternity to community, build relationship with LMCs, specific pregnancy smoking cessation service.
EMERGENCY Dpt
EVIDENCE
COMMITMENT
STRENGTHS
WEAKNESSES
Population presenting to ED
contains a higher prevalence of
disadvantaged groups and
smokers, nicotine withdrawal
needs to be managed, 1 in 40
NNT for brief intervention still
applies
Lack of evidence to show that
there are +ve outcomes from
giving brief advice in the acutely
unwell population
Once protocols are set and clearly
explained nurses will apply them,
Champions who are recognized in
ED will be emulated
Difficulty getting buy in because of
busy department, large number of
staff, lack of cohesion in staff
group, smoking cessation is seen
as a community issue that should
happen outside of hospital
Developing systems takes time,
can be initially chaotic, requires
fiscal support, requires a change
in staff attitudes.
OPPORTUNITIES
Risks to individual going outside to
smoke when acutely unwell, fire
risks from smokers outside of ED,
managing nicotine withdrawal
keeps patient calm, ability to share
what works well in ED, ability to
reach target populations, engage
whanau
Senior Nurses have kpis to meet,
the current health target is putting
pressure on them
Accessibility, equitability, health
promotion
THREATS
The area is too busy, staff cannot
see the relevance, lack of skills in
giving brief advice
Smokefree is seen as an “add-on”,
ensuring sustainability of purpose,
the health target becomes the
driver rather than the well=being of
the individual, lack of ownership by
the department
Workload increased, Bureaucracy
increased.
SYSTEMS
Ensure: consistency,
sustainability, removes barriers,
enables auditing
EDUCATION
Patients are exposed to education,
staff acquire skills to improve
patient care.
Time constraints, non-receptive /
challenging patients; inappropriate
timing
More quit attempts, capitalize on a
teachable moment
Overestimating knowledge,
decreased referrals, decreased
follow-up
MONITORING
Enables feedback and
performance management
Big brother surveillance, micro
managing patient’s lives, just a
tick, problems of data integrity
Enables improvement in practice
Staff resent monitoring,
complacency, Focus too narrow.