This quality improvement project looks at the smoking cessation process among parents attending the neo natal intensive care unit (NICU) at John Hunter Children’s Hospital. The goal is to try to improve the rates of:
- offers of screening
- provision of screening
- uptake of smoking cessation counselling and nicotine replacement therapy in the parents of babies admitted to the NICU.
The aim of this study was to improve screening of parents of babies admitted to the NICU, to determine if they were smokers. If they were smokers, the aim was to:
- to increase the smoking cessation counselling rates with the identified smokers
- increase their uptake of nicotine replacement therapy as a result of this process.
- Increased staff awareness of smoking cessation process.
- Increased staff confidence with screening and counselling for smoking cessation.
- Parents who are smokers are offered support while their baby is in the NICU, to aid them in quitting smoking.
- This provides a possible knock-on effect for the babies to go home to a smoke free environment.
The need for a quality improvement project was confirmed when an audit was conducted over an eight week period. It found that 40% of the NICU parents said they smoked.
Given that 1100 babies on average are admitted to John Hunter Children’s Hospital NICU in any year, around 440 parents would be expected to be recorded as smokers every year. However, the 2017 database recorded only 86 parents were smokers, and in 2018 just 100 parents were identified as smokers. This illustrates that many parents who smoked were being missed and therefore not offered support, counselling and nicotine replacement therapy.
- smoking cessation screensavers at all of the bedside computers
- development of a one page information sheet for parents highlighting the risks of smoking to their baby and the interventions available
- staff education on the screening and counselling process
- making nicotine replacement therapy available in the unit which was easily accessible and free for parents for two weeks
- writing and implementing a guideline on the screening and counselling process.
Implementation - The initiative is ready for implementation, is currently being implemented, piloted or tested.
John Hunter Children’s Hospital NICU
Since the introduction of some of the interventions mentioned the smoking screening rate has improved from 90% to 100%. Smoking cessation counselling and nicotine replacement therapy uptake has also increased significantly, but there is still room for improvement as the project is ongoing.
The need for more than one person running the education sessions for staff about the changes being implemented. If that one person gets busy it holds up the project and the associated changes.
- Nahmias J, Doben A, Poola S, et al. Implementation of a quality improvement project on smoking cessation reduces smoking in a high risk trauma patient population. World J Emerg Surg. 2016;11:15. Published 2016 Apr 26. doi:10.1186/s13017-016-0072-7
- Winickoff JP, Buckley VJ, Palfrey JS, et al. Intervention with parental smokers in an outpatient pediatric clinic using counseling and nicotine replacement. Pediatrics. 2003 Nov;112(5):1127-33.
- Phillips RM, Merritt TA, Goldstein MR, et al. Prevention of postpartum smoking relapse in mothers of infants in the neonatal intensive care unit. J Perinatol. 2012 May;32(5):374-80. doi: 10.1038/jp.2011.106. Epub 2011 Aug 11.
Neonatal Fellow/ Neonatal Intensive Care Unit
John Hunter Children's Hospital
Hunter New England Local Health District