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  • Policies, Procedures, Guidelines and Protocols

    Document DetailsTitle Protocol for the Supply of Pharmacotherapy for Smoking

    Cessation to School Age and Family Nurse PartnershipClients for Help 2 Quit

    Trust Ref No 2033-32314Local Ref (optional)Main points the documentcovers

    This policy details the protocols required to deliver smokingcessation intervention and nicotine replacement therapy toSchool Age and Family Nurse Partnership Clients for Help 2Quit

    Who is the documentaimed at?

    This policy is aimed for the Shropshire School Nursing Teamand Family Nurse Partnership

    Owner Kirsten Ellmore (School Nurse Team Leader) and Sarah Rock(Family Nurse Partnership Supervisor)

    Approval processApproved by(Committee/Director)

    Clinical Policies Group

    Approval Date 18/7/2016Initial Equality ImpactScreeningFull Equality ImpactAssessmentLead Director Steve Gregory- Director of Nursing and OperationsCategory ClinicalSub CategoryReview date 18/7/2019

    DistributionWho the policy will bedistributed to

    Shropshire School Nurse Team and Family Nurse Partnership

    Method Dissemination via Datix alerts to managers and available to allstaff via the trust website.

    Document LinksRequired by CQCRequired by NHLSAKeywords H2Q, Help to Quit, smoking, stop smoking, NRT, Nicotine

    Replacement Therapy, smoking cessation,Amendments History

    No Date Amendment1 June 2016 New Policy234

  • Shropshire Community Health NHS Trust

    Protocol for Smoking Cessation H2Q Page 1 Datix 2033-32314 July 2016

    Contents1 Introduction 22 Purpose 23 Definitions 24 Duties 24.1 Directors and Managers 2

    5 Protocol for the Supply of Pharmacotherapy for Smoking Cessation toSchool Age and Family Nurse Practitioner Clients for Help 2 Quit 36 Flow Chart of Activity 47 Giving Clients Choice 48 Safe Storage of Nicotine Replacement Therapy 49 Criteria for Inclusion 510 Nicotine Replacement Therapy 511 Record Keeping 512 Consultation 513 Dissemination and Implementation 514 Training 615 Review 616 Monitoring Compliance 617 References 618 Associated Documents 7Appendix 1: Protocol for the Supply of Pharmacotherapy for SmokingCessation in Help2Quit Error! Bookmark not defined.

  • Shropshire Community Health NHS Trust

    Protocol for Smoking Cessation H2Q Page 2 Datix 2033-32314 July 2016

    1 IntroductionShropshire Community Health Trust School Nurses and Family Nurse Partnership(FNP) provide smoking cessation services according to the Help2Quit pathway aspart of the Help2Changes service.The Trust provides services appropriate to the age and location of our serviceusers, delivering alternative service provision, to support existing provider, (Help 2Change) to maximize reach of difficult to engage clients.This document must be read in conjunction with the Protocol for the supply ofpharmacotherapy for smoking cessation in Help2Quit (Appendix 1) andoutlines the areas where our service provision differs.This document authorises and sets out the conditions under whichpharmacotherapy can be supplied to service users of Help2Quit, by namedindividuals working for Help2Quit and organisations contracted by them to provideStop Smoking Services under this Protocol. This service is an additional ServiceLevel Agreement between Help2Change and School Nurse Service and FamilyNurse Partnership.

    2 Purpose To safely deliver smoking cessation services to school age children and

    FNP clients

    To outline where service delivery to these clients differs from existing Help2Change service

    3 DefinitionsNRT Nicotine Replacement Therapy

    NCSCT National Centre for Smoking Cessation and Training

    CO monitoring Carbon Monoxide monitoring

    FNP Family Nurse Partnership

    H2Q Help2Quit

    SN School Nurse

    SLA Service level agreement

    GP General Practitioner

    4 Duties

    4.1 Directors and ManagersDirectors and Managers of Services are responsible for ensuring the safe andeffective delivery of services they manage; this includes securing and directingresources to support the implementation of this best practice guidance protocol.They must ensure that:

    All staff must be made aware of and have access to this protocol

  • Shropshire Community Health NHS Trust

    Protocol for Smoking Cessation H2Q Page 3 Datix 2033-32314 July 2016

    Staff authorised to supply Nicotine Replacement Therapy under ServiceLevel Agreement with Help2Change must have NCSCT stop smokingpractitioner training and have completed Help2Quit Local Training

    5 Protocol for the Supply of Pharmacotherapy for Smoking Cessation toSchool Age and Family Nurse Practitioner Clients for Help 2 QuitPharmacotherapy is offered in line with the Protocol for the supply ofpharmacotherapy for smoking cessation in Help2Quit.The service utilises a number of treatment routes to make access and complianceas easy as possible. All products currently licensed as stop smoking medicines(Nicotine Replacement Therapy [NRT], Bupropion and Varenicline) are madeavailable as first-line treatments unless clinically contraindicated. Bupropion andVarenicline is prescribed via the General Practitioner (GP), so any young personeligible and requesting this treatment option will be signposted to the GP, thesetreatment options would not be given or recommended by the school nursingservice or family nurse partnership.Before prescribing a treatment, service users will be informed of the use, action,side effects, cautions, consideration and efficacy of all available treatments. Theindividuals preference, previous experience and medical history are taken intoaccount when discussing medications.The service will provide, and manage NRT according to the attached Appendix 1.The service will provide NRT through direct supply for service users exempt frompaying a prescription fee, simplifying access to the service by removing the needto visit a pharmacy.Service users required to pay a prescription fee (as deemed necessary by theDepartment of Health and NHS Business Services Authority) will be offered avoucher, please see Appendix 1, redeemable at all local pharmacies.Help2Quit will continue to work with all pharmacies and the Local PharmaceuticalCommittee to ensure a seamless service for service users. Permission is soughtfrom the service users GP, specialist or consultant where a caution is identified.Help2Quit has an annual contract for direct supply of NRT products, attractingdiscounts for bulk purchases over the contractual period. NRT products aresupplied to each advisor who keeps a locked supply for use at specific venues.Where transportation of NRT is needed, it is kept in a locked case, in a lockedvehicle out of sight. No medication is left in a vehicle parked overnight.The service has an audit trail set up to monitor the route of all NRT thought theservice. Training and mentoring is in place for advisors as well as continuingupdate and education run at 6 monthly intervals.

  • Shropshire Community Health NHS Trust

    Protocol for Smoking Cessation H2Q Page 4 Datix 2033-32314 July 2016

    6 Flow Chart of ActivityThe flowchart below outlines the process for Smoking Cessation support.

    Help 2 Quit provides training to Advisors so they can follow the protocol toprovide Nicotine Replacement Therapy Directly to clients.

    Help 2 Quit Advisor will, assess nicotine dependence, readiness to quit andensure inclusion criteria for the Stop Smoking Service is met and explain all

    pharmacotherapy options to the client.

    Help 2 Quit Advisor will complete a Pharmacotherapy assessment for eachclient and apply relevant actions i.e. GP notification

    Help 2 Quit Advisor will issue direct supply of Nicotine Replacement Therapyfree to the client.

    ORHelp 2 Quit Advisor will issue a voucher to be redeemed at the Pharmacy, which

    will incur prescription charges. This voucher will need to be returned to Help 2Quit for reimbursement.

    ORSignpost to the GP for consideration if Varenicline or Bupropion are requested.

    7 Giving Clients ChoiceClients will be offered this service as part of existing contacts, however they mayalso be offered alternative service delivery as appropriate across Shropshire.Clients must be given the choice of medications and decide with the advisor whichone is best for them.

    8 Safe Storage of Nicotine Replacement TherapyAll Nicotine Replacement Therapy (NRT) products MUST be:

    Kept out of the reach of children and animals

    Be transported to school settings in a lockable container

    If transported by car, must be in a locked boot out of sight.

    All NRT to be kept in a locked cabinet as per medicines managementpolicy

  • Shropshire Community Health NHS Trust

    Protocol for Smoking Cessation H2Q Page 5 Datix 2033-32314 July 2016

    9 Criteria for Inclusion Current smokers of tobacco products

    Tobacco users receiving support from Help2Quit

    Before medication is supplied, the client must first set a quit date.Practitioners to signpost to GP if under client is 12 years of age or meets exclusioncriteria as outlined in Appendix 1. GPs are informed of NRT prescriptions andongoing support via Help2Change

    10 Nicotine Replacement TherapyIndications and dose:

    School Nurses Family Nurse PractitionersNicQuitin fresh mint 2mg (medicatedchewing gum)

    NicQuitin fresh mint 2mg medicatedchewing gum

    Nicorette 15mg Inhalator Nicorette 15mg Inhalator

    NicQuitin 2mg lozenge NicQuitin 2mg lozenge

    NicQuitin Transdermal patch 25mg,15mg and 10mg/ 16hour

    NicQuitin Transdermal patch25mg,15mg,10mg / 16 hour

    NicQuitin Transdermal patch 21mg,14mg, 7 mg /24 hour

    Nicorette 500 micrograms/dose nasalspray

    Niquitin 2.5mg orodispersible film

    Link: British National Formularyhttps://www.medicinescomplete.com/