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Smoking in Pregnancy Project Report: June 2012 2.2.1 Benefits of the proposed approach One of the intended key benefits of implementing this level of the tiered model was the potential for maximising opportunities for referral along the various stages of pregnancy and into the postnatal period by a number of health care professionals. This provided further opportunities for referral and re-referral and was based upon the premise that utilising a common health assessment and referral framework in regard to smoking during pregnancy and postpartum by a number of health professionals, would provide a systems based integrated service model for pregnant smokers. The intention was to provide a seamless, more efficient and effective referral system from the referrer to the stop smoking service provider. The development of an electronic referral system had the potential to provide the local area with the opportunity to capture data that would inform local planning for service provision in the future. 2.2.2 The electronic referral system To support the pilot an electronic referral system was developed by AN Computing called the National Pregnancy Referral System (NPRS). This system is a web based data management tool that registered users can use to refer pregnant women, partners and other family members to the local stop smoking service(s). The system was also designed to include a feedback mechanism so that referrers could receive notification of the referral outcome. From a user perspective, referring a client involved little more than completing the client’s details and submitting the referral. In addition, as the pilot site (see below) used the Quit Manager (QM) database, additional development work was carried out to ensure that the two systems would recognise and work together, so that referrals made via the NPRS system would be successfully received directly into the QM database. 2.2.3 The pilots In July 2011, a request for expressions of interest for pilot areas was disseminated to the services that had responded to the NCSCT smoking in pregnancy survey (see 1.5.2), alongside an eligibility criteria checklist (see annex B). Based upon responses to the checklist a pilot site, Central and Eastern Cheshire Primary Care Trust (PCT), was chosen. In 2010, Central and Eastern Cheshire had a smoking rate of 20.1%. The local prevalence of smoking in pregnancy is measured by the smoking at time of delivery data provided by two Maternity Units within the PCT, Leighton Hospital Maternity Unit and Macclesfield District Hospital. At the time of the pilot the reported smoking rate was 18% in Leighton and 13% in Macclesfield. 16
Smoking in Pregnancy Project Report: June 2012 Both Leighton and Macclesfield Maternity units reported being compliant with NICE guidance actions for identifying smoking in pregnancy by midwives. All pregnant women were offered carbon monoxide screening at booking and identified smokers were offered a referral to the stop smoking service. Referrals were completed on a dedicated paper form, which was faxed across to the service. The Macclesfield Maternity Unit had commissioned support for their pregnant smokers and this was provided by a smoking in pregnancy midwife specialist. Within the unit, following referral, follow up was proactive and support was provided onsite, whilst follow up and support for Leighton Maternity Unit’s pregnant smokers was provided by the stop smoking service. In addition to implementing level three of the tiered model, the pilot site were keen to investigate the use of CO testing upon admission to a labour ward in order to improve the recording of smoking at time of delivery (SATOD) data and as a result it was agreed to also include this within the pilot. To support the planning and implementation of the model, a working group was established, chaired by the local stop smoking service manager, which included representation from midwives, health visitors, pharmacists and practice nurses. In line with the tiered model, other HCPs were also included within the pilot, although due to the short timescales, the working group decided that this could only be managed on a small scale. Therefore in total, one GP practice and two pharmacies were approached and agreed to become involved. The pilot ran from 17 January to 31 March 2012. 2.2.4 Pilot adaptations During the pilot planning phase, a number of adaptations had to be made. 2.2.4.1 Feedback mechanism It was found that the feedback mechanism from the stop smoking service database (QM) to the electronic referral system (NPRS) could not be developed within the anticipated timescales for the system to go live in the pilot site. Therefore the scope of the testing had to be reduced to testing the feasibility of implementing the NPRS referral system and importing of the referral to the stop smoking service only. 17
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