For those people who would like to stop smoking, nurses can play a key role, with nurse prescribers helping deliver life-changing treatment.
In a recent audit carried out by the British Thoracic Society (BTS) (2022), nearly 80% of people were asked about their smoking status. However, only 45% were then given the briefest of advice, 15% were offered referral to a smoking cessation service, and 9% were seen by a smoking cessation practitioner. While in hospital, despite staff knowledge of their addiction, only 5% of patients were provided with the interventions recommended by the National Institute for Health and Care Excellence (NICE) (2022)—namely, nicotine replacement therapy, varenicline and vaping.
In order to improve the implementation of smoking cessation services in hospitals, and to share the responsibility with primary care, the BTS (2022) made several recommendations. These included:
- Assessing every patient's smoking status
- Appointing a specialist health professional to deliver a tobacco dependency treatment service
- Appointing an executive-level board member to support the service
- Introducing a data collection system of prescribing with relation to smoking cessation treatments to ensure NICE recommendations are followed
- Introducing a new training package to increase competence in staff for delivering effective smoking cessation advice
- Ensuring 90% of tobacco-dependent inpatients receive ‘very brief advice’
- Offering all tobacco-dependent patients a specialist tobacco dependency service referral within the hospital
- Establishing a system for monitoring those given very brief advice and those referred to tobacco cessation services.
According to the British National Formulary, smoking cessation interventions are cost-effective and can prolong life and should be offered as appropriate, alongside behavioural interventions (Joint Formulary Committee, 2022). The appropriate therapy can be given according to the person's likely commitment to certain therapies, including: availability of counselling and support; previous experience of smoking cessation treatments; consideration of appropriateness of pharmacotherapy in light of other medications they are taking or conditions they are living with; and the person's preference.
Nicotine replacement therapy is considered the lowest risk option. It introduces few new risks and can be stopped abruptly without losing its effectiveness. It can replace the nicotine the person was used to following abrupt smoking cessation and can help with cravings as well as reduce compensatory smoking.
There are multiple options and formulations for the application of this therapy, which increases the likelihood that there is something suitable for the patient. Patches are convenient due to their long duration and once-daily application, and a 24-hour patch is available for people with particularly strong cravings. Gum, lozenges, sublingual tablets, inhaler, nasal sprays and oral sprays can be used whenever someone feels the urge to smoke and can prevent cravings (Joint Formulary Committee, 2022). Someone who tried to stop smoking previously and used a product like this but went back to smoking and wants to stop again, may find a combination of therapies might suit them best.
The British Medical Journal (BMJ) (2018) provides a good summary of how to deliver brief advice for implementing best practice while delivering smoking cessation interventions. The five as recommended by the BMJ are: ask, advise, assess, assist, arrange follow-up (BMJ, 2018).
Firstly, systems should be established to identify the smoking status of every patient and practitioners should be able to ask this question and openly report this back to the consultant or doctor and specialists the patient is under. There should then be a personalised, open and reflective patient-centred discussion on how smoking cessation can assist a patient in achieving their goals (BMJ, 2018).
Next, the patient should be assessed: is the patient ready and willing to stop, and how confident are they about success? Assistance can then be offered; keep the conversation open for motivational communication if the patient does not yet wish to stop, so they feel they can easily come for advice and feel motivated to make that step. For those who are ready to stop, they should be provided an appropriate ‘menu’ of pharmacotherapies and counselling therapies, before then arranging a follow up. A counselling follow-up can be provided within a week of their stopping date through telephone counselling, face-to-face group or individual counselling, or with clinic visits or calls (BMJ, 2018).