The Clinical Specialist Midwife worked collaboratively with the smoking cessation midwife in the Colchester Hospital maternity unit at East Suffolk and North Essex NHS Foundation Trust (ESNEFT) to lead on the development and implementation of a smoking cessation service for pregnant women. This programme of work has led to improved outcomes, experiences and use of resources locally.
Where to look
NICE (2010) purport health and social care practitioners in all acute, maternity and mental health services, including community services, drug and alcohol services, outpatient and pre-admission clinics must take steps to support people using their services to stop smoking. The guidance goes on to highlight that helping pregnant women who smoke to quit involves communicating in a sensitive, client-centred manner, providing evidence based interventions. Midwives should make onward referrals as well as continue to assess needs and tailor support throughout the women’s care.
At East Suffolk and North Essex NHS Foundation Trust, the clinical specialist midwife identified unwarranted variation in practice. Eighteen percent of pregnant women were reporting they smoked at the point of using delivery services. This provided the midwifery team with an opportunity to review current service provision and consider other options available to women using their services to address the unwarranted variation.
What to change
East Suffolk and North Essex NHS Foundation Trust (ESNEFT)was formed through the merger of Colchester Hospital University NHS Foundation Trust and The Ipswich Hospital NHS Trust. The midwives undertook a review of women delivering babies at the Trust and identified that at the initial midwife appointment 100% were offered carbon monoxide monitoring as per guidance as well as the opt out referral to smoking cessation services, only 1 in 9 women engaged with the external smoking cessation service provider. This posed a risk to both the women’s health as well as the health of their child before and after birth.
How to change
The midwives worked with their local Public Health Department and an external smoking cessation provider to establish a new offer for women at the Trust. This included redevelopment of referral pathways so that the midwife could provide nicotine replacement therapy as part of a ‘one stop’ service.
When women book with the maternity service, the smoking cessations midwife contacts women by telephone to offer early smoking cessation advice. The midwife offers an appointment to combine with their first scan (one stop) appointment, or earlier if as per the woman’s preference. At this appointment, the midwife can provide a voucher for smoking cessation. This streamlined the pathway of care, making it easier for women to receive support to stop smoking.
The smoking cessation midwife makes an ongoing, individualised care plan with the women. This includes agreeing type, frequency and place of ongoing support or contact which is aimed at seeing women when they are already attending the hospital for other reasons (consultant appointments, scan, screening test) combined with telephone support to meet the women’s needs. It is anticipated that engagement is also increased as this midwife-led service means women can be supported with all pregnancy concerns in a streamlined fashion.
Better outcomes – Following the implementation of the improved clinical pathway for pregnant women, engagement with smoking cessation services across the Trust has significantly improved. Figures suggest this has shifted from 11% to 69% which has led to a marked improvement in women taking up offers of smoking cessation therapies and options. The Trust’s smoking at delivery rates have also significantly reduced from 18.47% to 11.70% which will have several health benefits for new mums and babies at the Trust.
Better experience – Women have been extremely positive about the new pathways and ‘one stop service’ as this means support is available where and when they need it in a way that is useful to them. In fact, team have anecdotally seen an increase in women seeking out the smoking cessation midwife and asking at appointments for referral onwards which is positive.
Better use of resources – This new pathway has transformed engagement rates and identified opportunities to Make Every Contact Count. It is anticipated that this new approach will support women to make healthy choices earlier, leading to less health complications and use of NHS services for these women and their babies.
Challenges and lessons learnt for implementation
A focused approach to improvement with dedicated time to test change works well.
Ask service users what they need, don’t assume.
As a leader of change, being passionate about the topic and having the ability to influence others to make changes is essential.
For more information contact
Clinical Specialist Midwife
East Suffolk and North Essex NHS Foundation Trust