“You are just one click away from helping your patient”
Richa Singh, Mark Dukes and Myleen Bucsit from the respiratory team at The Royal London Hospital are pioneering a tobacco screening model which is seeing great success with their patients so far in terms of smoking cessation.
The Five Year Forward View emphasises a radical upgrade in preventative medicine. Now the respiratory team in Ward 13F at RLH are making it their daily habit to ask patients upon admission about their smoking and drinking habits.
Just by asking a simple question every time a new patient comes in, you can help a patient change their life.
Could you talk me through the screening programme and how it works for you at RLH/13F?
How does the real team approach work?
The medical and nursing teams have worked really hard together to make this a success. It’s not just the matter of the consultants discussing this during medical reviews, but it’s been the work of the nurses to ensure the screening is discussed and documented at several opportunities throughout a patient’s journey. We have also worked hard to highlight to the junior members of the respiratory team the importance of capturing this information at the beginning of a patient’s hospital stay, so we can treat patients more effectively.
It is easily captured – everyone across the team down to our junior members can offer brief advice and offer nicotine replacement options. It is a true example of a multi-disciplinary approach.
What is the clinical benefit to the patient? How has it helped work towards the CQUIN target?
For us, it’s about focusing on improving patient care and management and involving the right staff in a timely fashion, rather than the CQUIN target alone. Up to 50% of respiratory admissions are due to a smoking related illness – therefore it should be part of our routine daily management of the patient.
What would you say to other teams?
Even though it’s a particularly high priority for respiratory, ongoing smoking significantly affects other aspects of a patient’s overall health – including affecting wound healing times after surgery and worsening existing health conditions.
We can’t emphasise enough the importance of asking the questions and making it part of daily practice. It really is a multidisciplinary approach led by the nursing team and it has a huge effect on patient outcomes.
Once you begin doing it, it becomes a natural process and part of your day-to-day patient care. We have seen huge benefits to the patients who come in – having that nurse day-to-day contact to help them quit smoking is hugely helpful in the first stages of quitting. It’s about embedding the process within your team, particularly for ward managers and nursing staff who see the patients every day. It’s about finding what works best for your department as it’s not a one size fits all approach.
Does anyone decline the support?
Yes, we do get some patients who decline the support. However, it is important to give patients the opportunity to discuss the support that can be offered in a non-confrontational space.
Also with our younger in-patients, it’s an opportunity to talk to them before it goes too far. Some people find it frustrating to talk about it and have an element of guilt associated with it. We should consider this as another medical condition, as it is an addiction but treatable, and it’s important they have the opportunity to talk about it.
What are your future plans for shared learning?
We want to raise awareness across the Trust and highlight that after the questions are asked at the first point of contact, the whole team come together to help the patient recover and support them through the process.
It’s really about changing mind-set across the Trust that it’s a difficult thing to do – it’s not hard to incorporate into your daily practice and can make such a huge difference. It’s remarkable that you’re only one click away to help your patient.
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