Tobacco-free
AOTEAROA Conference
Auckland 2010
Smokefree Practice in Action
Sue Marshall.
Smokefree Project Coordinator
Maternal, Child & Youth Service
Hawkes Bay District Health Board
Our Population
Pregnancy
Babies and Children
Exposure
Special Care Baby Unit APRIL 2010
(SCBU)
Families not smokefree 11/15 (73%)
Ref: Internal Audit Report, Smokefree Systems-Special Care Baby Unit (SCBU) Hawkes Bay District Health Board, 2010.
Exposure
Children's Ward APRIL 2010
Families not smokefree 12/21(57%)
Ref: Internal Audit Report, Smokefree Systems- Children's Ward Hawkes Bay District Health Board, 2010.
Approach
Systems First: model of organisational change
Systems First
Education
Evidence
Policy
Systems
Intervention
Roles
Patient
Policy
• Leadership
• Commitment
Systems
• Documentation
tools
• Care pathways
• NRT protocol
• Audit systems
Education
•
•
•
•
MOH ABC e learning tool
HBDHB Smokefree education
SmokeChange Education for Midwives
Baby Essentials
Roles
•
•
•
•
Link Champions
Dedicated Smokefree Midwife
Smokefree Project and team
Clarity about role
Interventions
• Focused ABC
• Provision NRT
Audit
• Process
• Data
• Findings
Maternity Services
•
•
•
•
•
ANTENATAL WOMEN
Screening
100% woman
77% partners
70% household
•
•
Interventions
61% (included NRT arranged or offered referral to a smokefree service arranged or offered).
•
•
•
•
•
POSTNATAL WOMEN
Screening
95%postpartum women
84%partners
84% household
•
•
Interventions
77% (included inpatient NRT arranged, offered or had NRT or referral to a smokefree service).
Ref: Internal Audit Report, Smokefree Systems & Performance Maternity Services Hawkes Bay District Health
Board, 2010.
Special Care Baby Unit
Prevalence of Smoking in Families of
SCBU Babies
• 73%
Screening
• 100%
Interventions
• 81%
Ref: Internal Audit Report, Smokefree Systems-Special Care Baby Unit (SCBU) Hawkes Bay District Health Board, 2010
Children's Ward
Screening
• 37%
Interventions
• 75%
Ref: Internal Audit Report, Smokefree Systems- Children's Ward Hawkes Bay District Health Board, 2010
In Action
screening
1st contact
contact
over time
electronic
discharge
summary
antenatal
clinics
embrace
whole family
smokefree midwife
role - safe sleep
discussions
motivational
tools
acknowledging
harm
free NRT for
parents and
caregivers
discussion of
benefits of
smokefree
motivational
time
Just Imagine
booklets
smokefree
NRT for inpatient
women
Women and their families
smokefree during pregnancy
referral to
smokefree
other health care support
service
professionals
midwife hat
and Quitcard
provider hat
smokefree
partners
A little and
often by many
over time
family
smokefree
household
NRT
smokefree
pregnancy
care pathway
In Action
brief advice
screening for
exposure
linking in
with other
providers
care
pathways
NRT for
parents and
caregivers
Quit cards
referral to
smokefree
support service
Parents and Caregivers of
Hospitalised Babies and
Children Smokefree
electronic
discharge
summary
smokefree Link
Champions
professional
support
discussion of
benefits of
smokefree
acknowledging
harm
smokefree
environment
providing opportunity
for practice to be
smokefree
Stories
Ruby
Rawiri
References
Cowan S & Smith D. Systems First – supporting smokefree leadership in New Zealand hospitals. Guidelines for district
health boards. Christchurch, NZ. Education for Change. August 2005.
Baby Essentials Online http://www.changeforourchildren.co.nz/safe_start_programme/baby_essentials_online
DiFranza,J., Aligne,C.A., WeitZman,M. (2004) Prenatal and postnatal environmental tobacco smoke exposure and
children's health. Pediatrics Vol.113.
Hofthuis,W., de Jongste,J.C.,Merkus,P..J. F.M. (2003) Adverse health effects of prenatal and postnatal tobacco smoke
exposure on children. Arch.Dis.Child 2003;1086-1090.