25 August 2023
Zoe Ludgate, Early Intervention Midwife at Airedale General Hospital, tells us about the work being carried out by Airedale NHS Foundation Trust to reduce smoking in pregnancy and cut the smoking status at time of delivery (SATOD) rates.
Being the Smoking Cessation in Pregnancy Lead is just one of Zoe’s roles at the trust.
“Before I took on the role, there had never been a lead for smoking cessation in pregnancy,” explains Zoe. “After we’d completed audits of our smoking in pregnancy rates for the years before I started in this role it soon became apparent that this was an enormous change project. Fortunately, I’ve had the full support of our management and obstetric teams to spur me on to make this a success!”
Given the scale and challenges faced, it was decided to take a phased approach and to tackle the highest smoking in pregnancy prevalence area first. This involved:
- Recognising the areas for change
- Identifying the women needing direct access to nicotine replacement therapy (NRT) at the time of booking
- Offering a 12-week programme with weekly behavioural support and offering a further supply of NRT
- Requesting IT changes, including a new template on the electronic patient record (EPR) to allow reporting on smoking status at time of booking; four weeks post quit date; at 36 weeks and at the time of delivery
- Making the National Centre for Smoking Cessation and Training (NCSCT) Very Brief Advice (VBA) smoking in pregnancy modules mandatory for the whole maternity team, including obstetricians, midwives and maternity support workers (MSWs)
- Level 2 smoke free practitioner training for midwives and maternity support workers
- Designing and implementing a smoke free pregnancy and care pathway guideline and patient group directions (PGD) staff training
Zoe says: “We also had to work closely with the community midwife manager to work out how our midwives and MSWs could deliver this service, with minimal impact on already busy workloads.
“This has been a huge project and one which has taken a lot longer than anticipated, made more complex with the additional pressures of the Covid-19 legacy,” says Zoe. “It’s been all hands on deck to cover clinical work but we got there eventually and began the first phase of our in-house stop smoking service on 24 July 2023.”
In the short time since the service went live, the team has already had 17 referrals with some great feedback.
“Those referred are saying that by offering this service we really are committed to the health of the women and their babies,” Zoe concludes.