Helping to build a healthier east London | #TeamBartsHealth blogs

Alcohol misuse and smoking are among the most significant risk factors contributing to ill health, but are highly preventable. Barts Health is currently taking part in a new national initiative – preventing ill health by risky behaviours – which aims to identify and support inpatients who are drinking alcohol at increasing or higher levels of risk, and to support inpatients who smoke.

There are 5 main components of this project:

1. Tobacco screening – asking and recording smoking status of patients. This can be done on an AdHoc form on PowerChart, and takes no more than 30 seconds. Whilst this information is frequently recorded as part of admissions clerking, filling in this proforma allows us to capture data over time and have an easily-accessible documented smoking status for each patient – for this reason, this is a key component of the CQUIN, as part of which the Trust aims to have smoking status electronically documented for 90% of new admissions.
2.  Tobacco Very Brief Advice – a  short, face-to-face intervention that can be carried out by any healthcare professional, and has been shown to significantly improve rates of smoking cessation among patients. Prompts from healthcare providers are the second most common reason cited for quitting or cutting down on smoking (after encouragement from family/friends): there is thus every reason to continue to engage with patients regarding their smoking, particularly since patients often require encouragement on multiple occasions in order to make a decision about smoking behaviour change.
3. Referral to stop smoking services, and offer of nicotine-replacement medication to inpatients: a referral is now made automatically upon filling in an AdHoc form documenting a patient’s smoking status, which means less work for healthcare professionals. For those working in the Trust who are prescribing medications, it is vital to ensure that nicotine replacement therapy is prescribed for patients who are nicotine-dependent: not only will this make the patient more comfortable whilst in hospital, but it will also help to prevent them engaging in smoking around the hospital site, as well as introducing them to the concept of nicotine replacement.
4. Alcohol screening – asking and recording patients’ alcohol consumption. Many patients may not be aware that they are drinking at levels of increasing risk; even for those who are, repeated prompts by health professionals have been demonstrated to impact upon patient’s behaviour, and can act as a gentle encouragement to cut down alcohol consumption where they are able, or to reach out to support services if they are struggling to do so.
5. Alcohol brief advice/referral: advising patients who are consuming alcohol at increasing/higher risk levels on the benefits of reducing their alcohol intake, and referring potentially alcohol-dependent patients to further support services.

Implementing the Preventing Ill Health project is expected to have a big impact upon the outcomes of our patients. With good support from healthcare providers across the Trust, we can expect to see reduced future hospital admissions; reduced longer term risk of heart disease, stroke, and cancer; and improved chronic disease management. There is also significant financial reward: for each patient referred to a stop smoking service, the Trust will receive £13; for each patient receiving alcohol brief advice, £27.

Improving patient outcomes, reducing the burden of smoking- and alcohol-related disease, and generating much-needed revenue for the Trust:  all with a few simple steps!

Lotte Elton

FYI, Surgery