Setting

This audit took place on a general adult treatment ward but would be applicable to in-patient wards across all psychiatric specialties.

Background

It has been recognised for more than 10 years that smoking cessation interventions delivered through the National Health Service (NHS) are a cost-effective way of preserving life and reducing ill-health (West et al, 2000). Nicotine replacement therapy has been shown to double cessation rates in placebocontrolled trials (Luty, 2002). In line with smoking bans across the UK (March 2006 in Scotland, April 2007 in Northern Ireland and Wales, and July 2007 in England), most NHS trusts should have policies in place for psychiatric patients who smoke, and offer smoking cessation support as part of a package of care. In Nottingham (where this audit was conducted), training on smoking cessation with information about the health benefits, stages of change and available support as well as training in brief interventions is mandatory for all clinical staff who work within the trust.

Standards

Standards that are relevant to in-patients (in any hospital) were obtained from the updated Royal College of Physicians’ guidelines (West et al, 2000):

ᐅ Hospitals should maintain readily accessible records on the current smoking status of patients.

ᐅ In-patients who smoke should be advised to stop as early as possible in the admission and this should be recorded on a readily accessible form and repeated annually.

ᐅ Specialist cessation counsellors should provide behavioural support for hospital patients who want help to stop smoking.

ᐅ Smokers should be encouraged to consider nicotine replacement therapy, where appropriate, and assisted with this.

Method

Data collection

The medical notes, nursing notes and drug charts of all patients under the care of an in-patient ward were examined for documentation of the following:

ᐅ the patient's smoking status, recorded on admission

ᐅ type of tobacco and amount smoked

ᐅ for patients who smoke, any record that smoking cessation has been discussed

ᐅ for patients who express a wish to stop smoking or to cut down: