Monklands Hospital mental health services smoking cessation support

Mental health wards at Monklands District General Hospital have become smoke-free. Healthy lifestyle and smoking cessation support help service users succeed in efforts to quit, both in hospital and after discharge.

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How it started

Many mental health inpatients smoke, and some start smoking after they are admitted to hospital. The mental health unit was exempted from the 2006 smoking ban. There was a poorly ventilated smoking room, and inpatients could obtain cigarettes and tobacco easily. Until recently there was no coordinated approach in the mental health wards at Monklands District General Hospital to helping people quit smoking. There were concerns about:

  • passive smoking
  • the impact of toxins in cigarettes on the efficacy of medication
  • the perception among health professionals and patients that stopping smoking could add to mental health problems.

Partners

  • two mental health ward nurses trained to become smoking cessation liaison nurses
  • hospital smoking cessation services
  • Maudsley Training
  • ASH Scotland
  • Glasgow Caledonian University
  • ward staff trained in alternative therapies and relaxation techniques
  • GPs and consultants
  • community stopping smoking nurse specialist
  • community mental health teams and addiction services.

 

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Process

It took three years (2006-09) to make the mental health unit a smoke free environment. Several changes were made to the physical environment of the hospital. The smoking room was closed and a new smoke-free family room was opened. A smoke-free therapeutic garden was created solely for mental health patients, and inpatients are no longer permitted to smoke in hospital grounds. A programme of activity was carried out in preparation for the smoking ban:

  • smoking cessation training for ward staff, including prescribing Nicotine Replacement Therapy (NRT)
  • information on smoking cessation services is available on every ward
  • stopping smoking groups, including sessions on NRT and cessation services.

In 2011 the two trained ward nurses started an outpatient smoking cessation group, also open to inpatients. The group helps patients to address their general wellbeing, offering a service that may not be readily available in mainstream smoking cessation services. Patients are now encouraged to improve their overall physical health and tackle stress through more structured activity. Gym equipment, relaxation exercises and alternative therapies were all introduced, together with a series of health and wellbeing events for staff and patients.

 

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Outcomes

The hospital has seen an increase in referrals to mainstream exercise and healthy lifestyle activities and greater numbers of patient referrals to smoking cessation services. Staff are now more confident about encouraging smokers to quit. Another result of the new smoking cessation support is closer working between ward nurses and doctors. They now work together to monitor service users’ health and the impact of quit attempts on individuals’ medication.

Evaluation

The charge nurse and community coordinator are evaluating the outpatient smoking cessation group. This evaluation will include an assessment of whether the hospital is an appropriate venue Feedback from service users has been positive. Some individuals have quit after smoking for many years, leading to increased confidence and levels of social activity as well as improved health and fitness. There has also been a reduction in medication and hospital admissions.

 

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Lessons learned

  • patients need to be reassured by health professionals that stopping smoking will not have negative consequences, like agitation or anxiety
  • for the best results structured activities should be offered to patients alongside a smoke-free environment and encouragement to quit
  • mental health patients need extra help to maintain smoking cessation attempts in the community. Mainstream smoking cessation groups may not provide the necessary emotional support
  • many patients struggled after discharge, did not continue Nicotine Replacement Therapy (NRT), and returned to the wards frequently for advice.

 

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What's next for the project?

The hospital plans to offer assessment training to more ward staff. A charge nurse is now working with hospital smoking cessation services to give specialist support to mental health patients.

Related documents and links

‘Setting up a community stopping smoking group for mental health service users’ (PowerPoint presentation and notes)

Contact

Sharon Rankine, charge nurse or Emma Newall, staff nurse
Monklands District General Hospital
Monkscourt Avenue
Airdrie
ML6 0JS

Tel: 01236 748748
Email: sharon.rankine@lanarkshire.scot.nhs.uk or emma.newall@lanarkshire.scot.nhs.uk.

 

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