ADAPT: Smoking cessation clinical adaptation (2)

We’re working with 11 FNP sites and Dartington Social Research Unit to co-design adaptations to the FNP programme which we will put through rapid-cycle testing over the next year. The ADAPT project (Accelerated Design and Rapid Programme Testing), is part of FNP Next Steps.

ADAPT sites have developed clinical innovations to test in their area and are finalising their plans for implementation. The roll-out of clinical adaptations in sites has begun and will continue in 2017.

In the third of our blog series about ADAPT adaptations, Jane Buckley, Supervisor for Cheshire East, talks about the smoking cessation intervention developed by her team, clients and local stakeholders.

We know that "Stopping smoking is the most important thing a pregnant woman can do to improve her baby's health, growth and development and reduce unnecessary pregnancy complications."(Dr David Richmond, President of the Royal College of Obstetricians and Gynaecologists, 2016). So the disproportionately high numbers of parents on the programme who smoke here in Cheshire East has been a concern since day one.

Site data and lessons learnt from training from the National Centre for Smoking Cessation and Training (NCSCT) helped to shape our interest in developing a clinical adaptation to improve quit smoking rates in pregnancy and postnatally. Prior to ADAPT, we’d already joined forces with our local ‘Kick Start’ team. As well as undertaking local research into smoking rates and barriers to quitting, they supported us on training and provided us with carbon monoxide (CO) monitors and Nicotine Replacement Therapy (NRT) prescription pads. Supporting parents’ quit attempts proved successful in a number of cases, but this has not been statistically significant.

Our aim is for young parents to stop smoking and, if they lapse, to be supported in stopping again. We also want to help clients’ close family and friends to quit smoking because of the influence they can have on young parents’ lifestyle choices. Our current site data indicates that 8% of young mothers quit smoking during pregnancy and 52.9% of smokers reduce the amount of cigarettes they smoke in pregnancy. However, this change is not maintained, and by the time their baby is 12 months old, most mothers will have resumed their original smoking pattern.

What does the clinical adaptation look like?

We plan to provide resources in a range of formats giving young parents, their family and friends clear information about the effects of smoking on the foetus, baby and child up to two years.

Midwives will ask parents if they smoke at the point of notification to FNP and we will record this to agenda match our first visits. Parents will then be reassessed by the family nurse at their first pregnancy visit and offered a CO reading, and we’ll also ask about close family and friends who smoke. For pregnant FNP clients, we’ll offer a ‘quit programme’ including access to relevant NRT materials. For their friends and family we’ll offer an e-cigarette starter pack and NRT materials. We’ll also encourage the use of Facebook for peer support, allowing clients to share challenges and solutions and celebrate milestones together.

Family nurses will use their communication and agenda-matching skills to individualise the quit support for each client. In addition to the current FNP programme, family nurses will revisit smoking cessation at the third visit in pregnancy, when discussing the antenatal checklist, and again after the baby is born, to link with prevention of Sudden Infant Death Syndrome (SIDS) and safer sleep.

We’ll also offer stress reduction techniques (such as mindfulness), and tools for clients to manage smoking triggers and challenging times.

In order to prepare for the delivery of this clinical adaptation, family nurses have received enhanced training in the use of:

  • CO monitors
  • NRT materials
  • E-cigarettes
  • Advanced communication skills
  • Mindfulness.

What has been the journey for developing Cheshire East’s clinical adaptation?

The family nurses in Cheshire East are tenacious and motivated and felt they wanted to offer young parents more help to stop smoking. Nurses were already using FNP programme materials and could see how they could be enhanced to provide bespoke smoking cessation advice to parents and their families. Coupled with a decline in the local Smoking Cessation Service supporting Maternity Services, we knew that ADAPT was a golden opportunity to redesign our approach in an evidenced-based, outcomes focused way. We also wanted to benefit from the expertise of the ADAPT FNP Co-production team!

Assembling our Co-Production Team was our first task. Alongside current FNP nurses, our provider lead and commissioners, we’ve also been joined by a parent currently on the programme, a local midwife and Smoking Cessation Lead and our Public Health Consultant, who has been keen to support the project.

Our first meetings provided a wealth of ideas for resources, equipment and evidence. Our parent kept us firmly focused on looking at the challenge of quitting through a young person’s eyes and had some great ideas for materials and incentives.

The process of producing logic models with the Dartington Social Research Unit helped us organise and firm up our ideas, which were then put into production through the FNP National Unit. Site visits, conference calls, meetings and group sessions have been invaluable in building our clinical adaptation.

How were clients involved in development work?

The young parent from our Co-Production Team brought a fresh approach and new ideas to the project. She has started a blog on our Facebook page with the aim of increasing the number of followers in preparation for our clinical adaptation launch. We hope that Facebook can offer flexible, timely and age appropriate support for people who are quitting smoking.

Exploration of triggers leading to lapses in quitting has been particularly helpful, especially in view of the site data which indicates most parents return to smoking by the time their baby is 12 months old. Our young parent was able to describe why this is the case and strategies for preventing lapses, managing lapses and re-quitting.