Quality standard

Quality statement 7: Healthcare settings: nicotine-containing products and stop-smoking pharmacotherapies

Quality statement 7: Healthcare settings: nicotine-containing products and stop-smoking pharmacotherapies

Quality statement

Secondary healthcare settings ensure that a range of nicotine-containing products and stop-smoking pharmacotherapies is available on site for patients, visitors and employees.

Rationale

Secondary healthcare services have a duty of care to protect the health of people who use or work in their services and promote healthy behaviour among these groups. Most secondary and tertiary healthcare settings already have a smokefree policy in place, which includes smokefree grounds. Facilitating abstinence (long term or temporary) among patients, visitors and employees (including contractors and volunteers) will help ensure compliance with smokefree policies.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to ensure that stop-smoking pharmacotherapies and medicinally licensed nicotine-containing products are stocked by pharmacies within secondary healthcare services.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that a range of nicotine-containing products is available for sale within secondary healthcare services for visitors and employees.

Data source: Local data collection

Process

a) Proportion of secondary healthcare settings that stock stop-smoking pharmacotherapies and medicinally licensed nicotine-containing products.

Numerator – the number in the denominator that stock stop-smoking pharmacotherapies and medicinally licensed nicotine-containing products.

Denominator – the number of secondary healthcare settings in the specified geographic area.

Data source: Local data collection.

b) Proportion of secondary healthcare settings that sell nicotine-containing products to visitors and employees.

Numerator – the number in the denominator that sell nicotine-containing products to visitors and employees.

Denominator – the number of secondary healthcare settings in the specified geographic area.

Data source: Local data collection.

What the quality statement means for different audiences

Directors and senior managers of secondary care services or their representatives ensure that compliance with a smokefree policy is facilitated by a range of nicotine-containing products and stop-smoking pharmacotherapies being available on site for patients, visitors and employees.

Commissioners ensure that their contracts with secondary healthcare settings facilitate compliance with a smokefree policy by including on-site provision of nicotine-containing products and stop-smoking pharmacotherapies for patients, visitors and employees.

People who work in secondary healthcare services (including contractors and volunteers) are helped to stick to the smokefree policy by being able to obtain a range of nicotine-containing products and stop-smoking pharmacotherapies on site.

Patients in secondary healthcare services can obtain a range of nicotine-containing products and stop-smoking pharmacotherapies on site at all times. This helps them follow the smokefree policy within the healthcare grounds.

Visitors in secondary healthcare services can obtain a range of nicotine-containing products on site at all times. This helps them follow the smokefree policy within the healthcare grounds.

Source guidance

Tobacco: preventing uptake, promoting quitting and treating dependence. NICE guideline NG209 (2021, updated 2023), recommendations 1.14.25, 1.14.26 and 1.22.14

Definitions of terms used in this quality statement

Secondary healthcare settings

All publicly funded secondary and tertiary care facilities, including buildings, grounds and vehicles. It covers drug and alcohol services in secondary care, emergency care, inpatient, residential and long-term 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, maternity units, outpatient clinics and in the community. [NICE's guideline on tobacco, terms used in this guideline; secondary care]

Nicotine-containing products

Products that contain nicotine but do not contain tobacco and so deliver nicotine without the harmful toxins found in tobacco. This currently includes nicotine replacement therapy which has been medicinally licensed for smoking cessation by the Medicines and Healthcare products Regulatory Agency (MHRA) and nicotine-containing e-cigarettes. Currently there are no licensed nicotine-containing e-cigarettes on the market. Nicotine-containing e-cigarettes on general sale are regulated under the Tobacco and Related Product Regulations by the MHRA. For further details see the MHRA website. Different forms of nicotine replacement therapy include:

  • transdermal patches

  • gum

  • inhalation cartridges

  • sublingual tablets

  • lozenges

  • mouth spray

  • nasal spray.

[Adapted from NICE's guideline on tobacco, terms used in this guideline; nicotine-containing products and nicotine replacement therapy]

If alternative nicotine-containing products (such as e-cigarettes) gain licensing authorisation in the future, this quality statement will be reviewed.

Stop-smoking pharmacotherapies

This covers medication licensed for smoking cessation such as varenicline or bupropion, as well as nicotine-replacement therapy. In November 2021, varenicline was unavailable in the UK. See the MHRA alert on varenicline. [NICE's guideline on tobacco, terms used in this guideline; pharmacotherapies]

Equality and diversity considerations

People whose drug treatment is affected by smoking may need to have the dosage of their drugs adjusted. This is particularly important for people with mental health problems taking antipsychotic medication.