Tobacco: treating dependence

Structure

Evidence of local arrangements to ensure that people who smoke have access to a hospital- or community-based smoking cessation service when admitted to hospital.

Data source: Data can be collected locally by provider organisations, for example from service specifications. The British Thoracic Society's national smoking cessation audit collects data on whether hospital trusts have a hospital-based smoking cessation service on the premises or access to a community-based smoking cessation service. It also collects data on whether there is a formal referral pathway to a hospital or community-based smoking cessation service and whether a hospital has a dedicated smoking cessation practitioner.

Process

a) Proportion of people who smoked on admission to hospital who receive stop-smoking pharmacotherapy.

Numerator – the number in the denominator who receive stop-smoking pharmacotherapy.

Denominator – the number of people who smoked on admission to hospital.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

The British Thoracic Society's national smoking cessation audit collects data from inpatient medical records of evidence that people who smoke were offered the use of licensed pharmacotherapy for tobacco addiction and the pharmacotherapy received (single nicotine replacement therapy [NRT], combination NRT, varenicline, bupropion, or decline of pharmacotherapy). NHS Digital's data collection on tobacco dependence collects data on whether current smokers aged 16 and over admitted for an overnight stay to a provider with an inpatient tobacco dependence treatment service had referral to an in-house tobacco dependence service, date of the referral, date of attendance at an in-house service, the tobacco dependence care plan which includes quit attempt with licensed medication and the type of pharmacotherapy received.

b) Proportion of people who smoked on admission to hospital who receive behavioural support within 24 hours of admission.

Numerator – the number in the denominator who receive behavioural support within 24 hours of admission.

Denominator – the number of people who smoked on admission to hospital.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

NHS Digital's data collection on tobacco dependence collects data on whether current smokers aged 16 and over admitted for an overnight stay to a provider with an inpatient tobacco dependence treatment service had referral to an in-house tobacco dependence service, date of the referral, date of attendance at an in-house service and the tobacco dependence care plan which includes quit attempt with behavioural intervention.

Outcome

Proportion of people who smoked on admission to hospital who are abstinent at 4 weeks after discharge.

Numerator – the number in the denominator who are abstinent at 4 weeks after discharge.

Denominator – the number of people who smoked on admission to hospital.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

NHS Digital's data collection on tobacco dependence collects data on tobacco care plan outcome at 28 days including carbon monoxide confirmed quit and self-reported only quit. This is measured at 28 days following the start of their agreed quit window (the date of discharge from hospital for most inpatients).

The British Thoracic Society's national smoking cessation audit collects data on whether patients are abstinent from smoking at 4 weeks after discharge (chemically validated or self-reported).

Treatment to stop smoking

Treatment includes:

People admitted to hospital who smoke should be offered behavioural support and stop-smoking pharmacotherapy to stop smoking during their inpatient stay. Behavioural support should be provided immediately, if necessary, or within 24 hours of admission for an inpatient. Stop-smoking pharmacotherapy should be provided immediately.

Consider nicotine replacement therapy alongside behavioural support to help women stop smoking in pregnancy and for young people aged 12 and over who are dependent on tobacco. Varenicline or bupropion should not be offered to pregnant or breastfeeding women or people under 18. [Adapted from NICE's guideline on tobacco, recommendations 1.12.3, 1.12.4, 1.14.5 to 1.14.11, 1.14.13, 1.14.15, 1.14.17, 1.20.6 and 1.20.11]

Hospital

All acute, maternity and mental health services inpatient admissions. It covers emergency care, inpatient care for severe mental illness in hospitals, psychiatric and specialist units and secure hospitals and planned specialist medical care or surgery. It also includes maternity care in hospitals and in maternity units. [Adapted from NICE's guideline on tobacco, section 1.14 and terms used in this guideline (secondary care)]