Tobacco-free AOTEAROA ConferenceAuckland 2010Smokefree 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 (SCBU)

APRIL 2010

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.

ApproachSystems First: model of organisational change

Evidence Policy Systems

Education

Patient

Roles

Intervention

Systems First

Policy

• Leadership

• Commitment

• Documentation

tools

• Care pathways

• NRT protocol

• Audit systems

Systems

• MOH ABC e learning tool

• HBDHB Smokefree education

• SmokeChange Education for Midwives

• Baby Essentials

Education

• Link Champions

• Dedicated Smokefree Midwife

• Smokefree Project and team

• Clarity about role

Roles

• Focused ABC

• Provision NRT

Interventions

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

Women and their families smokefree during pregnancy

1st contact

screening embrace whole family

motivational tools

acknowledging harm

discussion of benefits of smokefree

Just Imagine booklets

smokefree pregnancy

care pathwayNRT

A little and often by many

over time

midwife hat and Quitcard provider hat

other health care professionals

antenatal clinics

contact over time

smokefree midwife role - safe sleep

discussions

NRT for inpatient women

free NRT for parents and caregivers

motivational time

smokefree family

smokefree household

smokefree partners

referral to smokefree

support service

electronic discharge summary

In Action

Parents and Caregivers of Hospitalised Babies and

Children Smokefree

screening for exposure

brief advice NRT for parents and caregivers

Quit cards

referral to smokefree

support service

professional support

discussion of benefits of smokefree

acknowledging harm

providing opportunity for practice to be

smokefree

smokefree environment

smokefree Link Champions

electronic discharge summary

care pathways

linking in with other providers

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.