published

Smoking in Pregnancy Project Report: June 2012
2.2 Piloting the system
For the purposes of the pilot the NCSCT focused on testing the feasibility of implementing
level three of the tiered model (see annex A). This included the implementation of an electronic
referral system with referral and feedback mechanisms for use by a number of health
professionals in a selected pilot site. The decision to concentrate on level three was based
upon the recognition that many areas had reported that they were already implementing level
one and that further testing in this area was already being undertaken through the UKCTCS
health inequality pilot. Level two would only test the addition of an electronic referral system
to level one and thus, to maximise the potential of the pilot, level three was chosen.
In practice, implementation of the third level of the model meant that:
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Every pregnant woman would be carbon monoxide (CO) tested by the midwife at booking
to identify whether they were a smoker. The midwifery team would refer all identified
pregnant smokers to the stop smoking service using an electronic referral system linked
into the service’s database
Whether the woman attended for her initial appointment would be recorded by the stop
smoking service on their database and the midwife or other health professional would
be able to access feedback regarding their referral using the electronic referral system
Where the appointment was not taken up, then following the normal pregnancy clinical
pathway and at their subsequent maternal health assessment, the woman would be
offered re-referral via the electronic referral system
Referral and re-referral would also be possible by other health care professionals (HCPs)
during the pregnancy enabling every contact to become an opportunity for revisiting the
client’s smoking status as appropriate
During the postnatal period the midwife and the health visitor would ask the woman
about smoking at appropriate postnatal visits. If the woman self-reported as a smoker,
the midwife and the health visitor would have the opportunity to refer her to the stop
smoking services from time of delivery up to two months postnatal using the electronic
referral system. This would therefore provide an opportunity for re-referral in the immediate
postnatal and neonatal period
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