{"text_format":"1","workbook":"xlsx","n_sheets":8,"sheets":["Overview","System","Communication","Training","Treatment","Scores","All questions","Full list NICE recommendations"],"not_rendered":{"charts":1,"images":1,"macros":1,"external_links":0,"defined_names":0,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Overview","index":0,"n_rows":4,"n_cols":3,"rows_kept":4,"cut":false,"hidden":false,"merged":[]}
[]
[]
[]
[null,null,"This self-assessment model supports the NICE guidance on Smoking cessation in secondary care (PH48) by providing a framework to help acute trusts to develop local action to reduce smoking prevalence and the use of tobacco within secondary care settings. \nThe four domains of the model are broken down into a number of related sections. Every section has a small number of questions, asking whether you can demonstrate a particular attribute or practice.\n\nConsider whether or not you can demonstrate this practice in your organisation. \n• If not, tick no evidence of achievement. \n• If you have some evidence of achievement and recognise that there is room for improvement or development, tick some evidence of achievement. \n• If you believe that your area is delivering and at the appropriate level so you would stake your professional reputation on it, tick strong evidence of achievement.\n\nAnswer the questions as honestly as you can, in consensus with your partners if possible. Where you select “some evidence” or “strong evidence” make a note of examples you would use to illustrate your point in the comments and references column.\n\nAs well as completing the self-assessment for your organisation as a whole, you may wish to use extracts from the self-assessment to work up action plans for individual treatment areas.\n"]

{"sheet":"System","index":1,"n_rows":35,"n_cols":10,"rows_kept":35,"cut":false,"hidden":false,"merged":[[1,3,1,5]]}
[]
[null,1,"Systems of delivery and implementation","Evidence"]
[null,null,"Partner organisations","None","Some","Strong","Comments","Actions","Original NICE recommendation referrence"]
[null,1.1000000000000001,"Do the NHS standard contract and local authority contract include smokefree strategies?",null,null,null,null,null,"Recommendation 16 - Commission smokefree secondary care services",1]
[null,"1.2","Does your local joint strategic needs assessment consider the impact of smoking on particular groups of people at high risk, such as those who are pregnant, those with chronic respiratory and circulatory conditions?",null,null,null,null,null,"Recommendation 15 - Ensure local tobacco control strategies include secondary care ",1]
[null,"1.3","Does it identify expected numbers of pregnant women who smoke, the proportion reached by services and the numbers who successfully stop smoking?",null,null,null,null,null,"Recommendation 15 - Ensure local tobacco control strategies include secondary care ",1]
[null,"1.4","Does it identify expected numbers of patients with chronic conditions related to smoking who smoke, the proportion reached by services and the numbers who successfully stop smoking?",null,null,null,null,null,null,1]
[null,"1.5","Does the local tobacco control strategy communicate key messages about tobacco-related harm to everyone who use secondary care services?",null,null,null," ",null,"Recommendation 15 - Ensure local tobacco control strategies include secondary care ",1]
[null,null,"Leadership","None","Some","Strong","Comments","Actions","Original NICE recommendation referrence"]
[null,"1.6","Have you assigned a clinical or medical director to lead on stop smoking support for people who use, or work in, secondary care services?",null,null,null,null,null,"Recommendation 16 - Commission smokefree secondary care services",1]
[null,"1.7","Can the designated lead ensure that:\n\nThe organisation has an annual improvement programme for stop smoking support given to people who use, or work in, secondary care services?",null,null,null,null,null,"Recommendation 16 - Commission smokefree secondary care services",1]
[null,"1.8","The quality of stop smoking services continues to improve?",null,null,null,null,null,null,1]
[null,"1.9","Progress and outcomes in each clinical area are monitored, for example, recording of individual smoking status (including at the time of giving birth), the number of referrals, uptake of interventions, prescribing of stop smoking pharmacotherapies, 4-week quit rates, training of staff?",null,null,null,null,null,null,1]
[null,"1.10","Performance monitoring and feedback on outcomes is provided to all staff?",null,null,null,null,null,null,1]
[null,null,"On site","None","Some","Strong","Comments","Actions"]
[null,"1.11","Does your organisation encourage everyone who smokes to stop smoking completely and if necessary provide immediate access to licensed nicotine-containing products or other pharmacotherapies when appropriate?",null,null,null,null,null,"Recommendation 2 - Identify people who smoke and offer help to stop ",1]
[null,"1.12","Is there a requirement within service specifications and service level agreements that all staff are trained to deliver advice on stopping smoking and to make a referral to intensive support?",null,null,null,null,null,"Recommendation 16 - Commission smokefree secondary care services",1]
[null,"1.13","Are all stop smoking pharmacotherapies included in secondary care formularies?",null,null,null,null,null,"Recommendation 16 - Commission smokefree secondary care services",1]
[null,"1.14","Do all hospitals have an on-site stop smoking service?",null,null,null,null,null,"Recommendation 10 - Provide leadership on stop smoking support ",1]
[null,"1.15","Are services commissioned to provide a range of stop smoking pharmacotherapies?",null,null,null,null,null,"Recommendation 16 - Commission smokefree secondary care services",1]
[null,"1.16","Are sufficient resources in place, to enable secondary care providers to maintain smokefree policies?",null,null,null,null,null,"Recommendation 16 - Commission smokefree secondary care services",1]
[null,"1.17","Are systems in place to monitor and audit the implementation and impact of the recommendations in NICE guidance 48?",null,null,null,null,null,"Recommendation 16 - Commission smokefree secondary care services",1]
[null,"1.18","Are all secondary care buildings and grounds smokefree?",null,null,null,null,null,"Recommendation 16 - Commission smokefree secondary care services",1]
[null,"1.19","Have you removed shelters or other designated outdoor smoking areas?",null,null,null,null,null,"Recommendation 11 - Develop smokefree policies",1]
[null,null,"Policy","None","Some","Strong","Comments","Actions"]
[null,"1.20","Was your smokefree policy, developed in collaboration with staff and people who use secondary care services, or their representatives?",null,null,null,null,null,"Recommendation 11 - Develop smokefree policies",1]
[null,"1.21","Are all staff are aware of the smokefree policy and do they comply with it?",null,null,null,null,null,"Recommendation 10 - Provide leadership on stop smoking support ",1]
[null,"1.22","Does your policy protect staff from tobacco smoke when they are visiting the homes of people using secondary care services?",null,null,null,null,null,"Recommendation 11 - Develop smokefree policies",1]
[null,"1.23","Are support systems in place for services users, staff, carers who experience problems arising from the smoking restrictions?",null,null,null,null,null,"Recommendation 11 - Develop smokefree policies",1]
[null,"1.24","Do you facilitate compliance with, and resolve immediately, any breaches of smokefree policies, including a process for staff to report incidents?",null,null,null,null,null,"Recommendation 11 - Develop smokefree policies",1]
[null,null,"Records","None","Some","Strong","Comments","Actions"]
[null,"1.25","Is a robust system in place (preferably electronic) to ensure continuity of care between secondary care and local stop smoking services for people moving in and out of secondary care?",null,null,null,null,null,"Recommendation 9 - Put referral systems in place for people who smoke",1]
[null,"1.26","Are discussions and decisions related to stop smoking advice, referrals or interventions recorded in the person’s records (preferably computer-based)?",null,null,null,null,null,"Recommendation 2 - Identify people who smoke and offer help to stop ",1]
[null,"1.27","Are systems for consistently recording and maintaining records of people’s smoking status in place and do these;\n- provide a prompt for action (including the referral of people to stop smoking support) \n- ensure smoking status is consistent in all patient records\n- be stored for easy access and audit?",null,null,null,null,null,"Recommendation 9 - Put referral systems in place for people who smoke",1]
[null,"1.28","Are systems in place to alert the person’s healthcare providers and prescribers to changes in smoking behaviour because other drug doses may need adjusting?",null,null,null,null,null,"Recommendation 3 -  Provide intensive support for people using acute and mental health services",1]

{"sheet":"Communication","index":2,"n_rows":16,"n_cols":10,"rows_kept":16,"cut":false,"hidden":false,"merged":[[1,3,1,5]]}
[]
[null,2,"Communication","Evidence"]
[null,null,"Communicating change of policy","None","Some","Strong","Comments","Actions"]
[null,2.1,"Have you communicated with directors and senior managers of publicly-funded secondary care services or their representatives (including the communications team, occupational health services and estates management)?",null,null,null,null,null,"Recommendation 12 - Communicate the smokefree policy",1]
[null,2.2000000000000002,"Does your communications strategy include all the information required by people who use secondary care services and their parents or carers, staff and visitors, and the wider local population?",null,null,null,null,null,"Recommendation 12 - Communicate the smokefree policy",1]
[null,null,"Communicating the policy","None","Some","Strong","Comments","Actions"]
[null,2.2999999999999998,"Are all staff provided with information about the smokefree policy and instructions about their roles and responsibilities in maintaining a smokefree work environment?",null,null,null,null,null,"Recommendation 14 -  Provide stop smoking training for frontline staff",1]
[null,2.4,"Does your organisation provide everyone with verbal and written information and advice about the smokefree policy before their appointment, procedure or hospital stay?",null,null,null,null,null,"Recommendation 1 - Provide information for planned or anticipated use of secondary care",1]
[null,2.5,"Do you provide information for relatives, carers, friends and other visitors explaining why the hospital is smokefree and giving information about local stop smoking services?",null,null,null,null,null,"Recommendation 1 - Provide information for planned or anticipated use of secondary care",1]
[null,2.6,"Do you provide information that explains to visitors that smoking is not allowed on the premises and provides advice about the benefits of stopping smoking and how to contact local stop smoking services?",null,null,null,null,null,"Recommendation 2 - Identify people who smoke and offer help to stop ",1]
[null,null,"Communicating benefits and risks","None","Some","Strong","Comments","Actions"]
[null,2.7,"Do you discuss the potential to reduce the dose of some drugs when stopping smoking with secondary care users and their carers, advising them to seek medical advice if they notice any side effects of changing smoking behaviour?",null,null,null,null,null,"Recommendation 7 - Adjust drug dosages for people who have stopped smoking",1]
[null,2.8,"Do you provide clear information and advice about the risks of smoking and secondhand smoke during contact with partners, parents, other household members and carers of people using mental health services and offer people who want to stop or reduce smoking a referral to a hospital or local stop smoking service, as appropriate?",null,null,null,null,null,"Recommendation 5 - Provide information and advice for carers, family, other household members and hospital visitors ",1]
[null,2.9,"Does this information include advice not to smoke near the patient; this includes not smoking in the house or private vehicle?",null,null,null,null,null,"Recommendation 5 - Provide information and advice for carers, family, other household members and hospital visitors ",1]
[null,"2.10","Do you emphasise that nicotine is not the major cause of damage to people’s health from smoking tobacco, and that any risks from using licensed nicotine-containing products or other stop smoking pharmacotherapies are much lower than those of smoking?",null,null,null,null,null,"Recommendation 6 - Advise on and provide stop smoking pharmacotherapies",1]
[null,2.11,"Do doctors pharmacists, health and social care practitioners in mental health services who advise on or prescribe pharmacotherapies, provide information about types of intensive behavioural support available, the different types of stop smoking pharmacotherapies and how to use them?",null,null,null,null,null,"Recommendation 3 -  Provide intensive support for people using acute and mental health services",1]

{"sheet":"Training","index":3,"n_rows":8,"n_cols":10,"rows_kept":8,"cut":false,"hidden":false,"merged":[[1,3,1,5]]}
[]
[null,3,"Training","Evidence"]
[null,null,null,"None","Some","Strong","Comments","Actions"]
[null,3.1,"Do relevant curricula for frontline staff include the range of interventions and practice to help people stop smoking, as outlined in this guidance?",null,null,null,null,null,"Recommendation 14 -  Provide stop smoking training for frontline staff",1]
[null,3.2,"Are all frontline staff trained to deliver advice around stopping smoking and referral to intensive support? They should know what local and hospital-based stop smoking services offer and how to refer people to them. ",null,null,null,null,null,"Recommendation 14 -  Provide stop smoking training for frontline staff",1]
[null,3.4,"Are all frontline staff trained to talk to people in a sensitive manner about the risks of smoking and benefits of stopping?",null,null,null,null,null,"Recommendation 14 -  Provide stop smoking training for frontline staff",1]
[null,3.5,"Are all staff who deliver intensive stop smoking support trained to the minimum standard described by the NCSCT, with additional training that is relevant to their clinical specialism?",null,null,null,null,null,"Recommendation 14 -  Provide stop smoking training for frontline staff",1]
[null,3.3,"Do you ensure online training can be completed and updated annually as part of NHS mandatory training (for example, training provided by the NCSCT)?",null,null,null,null,null,"Recommendation 14 -  Provide stop smoking training for frontline staff",1]

{"sheet":"Treatment","index":4,"n_rows":32,"n_cols":10,"rows_kept":32,"cut":false,"hidden":false,"merged":[[1,3,1,5]]}
[]
[null,4,"Treatments","Evidence"]
[null,null,"System ","None","Some","Strong","Comments","Actions"]
[null,4.0999999999999996,"Do your pharmacies stock varenicline, bupropion and a range of licensed nicotine-containing products (including transdermal patches and a range of fast-acting products) for patients and staff (see recommendations 6 and 13)?",null,null,null,null,null,"Recommendation 8 - Make stop smoking pharmacotherapies available in hospital",1]
[null,4.2,"Are a range of licensed nicotine-containing products available for sale in hospital to visitors and staff?",null,null,null,null,null,"Recommendation 8 - Make stop smoking pharmacotherapies available in hospital",1]
[null,4.3,"Have you taken action in line with NICE guidance on workplace interventions to promote smoking cessation (NICE public health guidance 5): \n- advise all staff who smoke to stop?\n- offer staff in-house stop smoking support?\n- provide contact details for community support if preferred?\n- allow staff to attend stop smoking services during working hours without loss of pay?",null,null,null,null,null,"Recommendation 13 - Support staff to stop smoking",1]
[null,null,"Before admission","None","Some","Strong","Comments","Actions"]
[null,4.4000000000000004,"Before a planned or likely admission, do you work with the person to include the management of smoking on admission or entry to the secondary care setting in their personal care plan?",null,null,null,null,null,"Recommendation 1 - Provide information for planned or anticipated use of secondary care",1]
[null,null,"On admission","None","Some","Strong","Comments","Actions"]
[null,4.5,"During the first face-to-face contact, do staff ask everyone if they smoke or have recently stopped smoking and record smoking status and the date they stopped, if applicable, in the person’s records (preferably computer-based) and any hand-held notes?",null,null,null,null,null,"Recommendation 2 - Identify people who smoke and offer help to stop ",1]
[null,4.5999999999999996,"Do you advise people who smoke that licensed nicotine-containing products and other stop smoking pharmacotherapies can help them to stop smoking and reduce cravings?",null,null,null,null,null,"Recommendation 6 - Advise on and provide stop smoking pharmacotherapies",1]
[null,4.7,"Do you offer and, if the person agrees, arrange for them to receive intensive behavioural support, either during their current outpatient visit or during their inpatient stay?",null,null,null,null,null,"Recommendation 2 - Identify people who smoke and offer help to stop ",1]
[null,4.8,"Do other staff offer and, if accepted, arrange a referral to a local stop smoking service?",null,null,null,null,null,"Recommendation 2 - Identify people who smoke and offer help to stop ",1]
[null,4.9000000000000004,"Do you provide the same for people receiving secondary care services in the community or at outpatient clinics and during pre-operative assessments?",null,null,null,null,null,"Recommendation 2 - Identify people who smoke and offer help to stop ",1]
[null,"4.10","Do you follow recommendation 8 in NICE guidance on tobacco: harm-reduction approaches to smoking (NICE public health guidance 45), encouraging the use of licensed nicotine-containing products for anyone who does not want, is not ready or is unable to stop completely?",null,null,null,null,null,"Recommendation 3 -  Provide intensive support for people using acute and mental health services",1]
[null,null,"Care delivery","None","Some","Strong","Comments","Actions"]
[null,"4.11","Is a personal stop smoking plan developed and provision for appropriate pharmacotherapies made as part of the health and wellbeing review?",null,null,null,null,null,"Recommendation 3 -  Provide intensive support for people using acute and mental health services",1]
[null,"4.12","Do you offer measurements of exhaled carbon monoxide during each contact, to motivate and provide feedback on progress?",null,null,null,null,null,"Recommendation 3 -  Provide intensive support for people using acute and mental health services",1]
[null,"4.13","Do you ensure that people who use drugs that are affected by smoking (or stopping smoking) are monitored, and the dosage adjusted if appropriate?",null,null,null,null,null,"Recommendation 7 - Adjust drug dosages for people who have stopped smoking",1]
[null,"4.14","When people are discharged from hospital do you ensure they have sufficient stop smoking pharmacotherapy to last at least 1 week or until their next contact with a stop smoking service?",null,null,null,null,null,"Recommendation 6 - Advise on and provide stop smoking pharmacotherapies",1]
[null,"4.15","Do you provide immediate support if necessary, and otherwise within 24 hours of admission to people admitted to a secondary care setting?\nProviding support (delivered in the setting) as often and for as long as needed during admission?",null,null,null,null,null,null,1]
[null,"4.16","In addition, for people receiving secondary care services in the community or at outpatient clinics (including pre-operative assessments):\nDo you provide immediate support in the outpatient setting?",null,null,null,null,null,null,1]
[null,"4.17","Do you offer weekly sessions, preferably face-to-face, for a minimum of 4 weeks after discharge. If it is not possible to provide this support after discharge, arrange a referral to a local stop smoking service?",null,null,null,null,null,null,1]
[null,"4.18","Do you recommend and offer licensed nicotine-containing products (usually a combination of transdermal patches with a fast-acting product such as an inhalator, gum, lozenges or spray) to all people who smoke, or varenicline or bupropion as sole therapy as appropriate?\n\nDo not offer varenicline or bupropion to pregnant or breastfeeding women or people under the age of 18.\n\nVarenicline and bupropion can be used with caution in people with mental health problems",null,null,null,null,null,null,1]
[null,"4.19","Do you encourage people who do not want (or do not feel able) to stop smoking completely (including pregnant or breastfeeding women) to use licensed nicotine-containing products to help reduce cravings to smoke during their stay or visit?",null,null,null,null,null,null,1]
[null,"4.20","Do you ensure that people using nicotine replacement therapy (NRT) patches should remove them 24 hours before microvascular reconstructive surgery and surgery using vasopressin injections?",null,null,null,null,null,null,1]
[null,"4.21","Do staff who are trained to provide intensive behavioural support, offer and provide support to people using secondary care services in a community setting?",null,null,null,null,null,"Recommendation 2 - Identify people who smoke and offer help to stop ",1]
[null,"4.22","Do you advise staff who do not want, or are not ready or able to stop completely to use licensed nicotine-containing products to help them abstain during working hours?",null,null,null,null,null,"Recommendation 13 - Support staff to stop smoking",1]
[null,"4.23","Do you offer and provide intensive behavioural support to maintain abstinence from smoking during working hours?",null,null,null,null,null,"Recommendation 13 - Support staff to stop smoking",1]
[null,null,"Additional actions for midwives","None","Some","Strong","Comments","Actions"]
[null,"4.24","Midwives should follow recommendation 1 in NICE guidance on quitting smoking in pregnancy and following childbirth (NICE public health guidance 26). This recommends that, in addition to the actions covered here, midwives should[2]:\n\nassess the woman's exposure to tobacco smoke through discussion and use of a carbon monoxide (CO) assessment\n\nrefer all women who smoke (including those who smoke lightly or infrequently), have stopped in the last 2 weeks or have a CO reading indicative of smoking[3], to stop smoking services.",null,null,null,null,null,"Recommendation 8 - Make stop smoking pharmacotherapies available in hospital",1]
[null,"4.25","Midwives should help women who do not smoke but register CO levels of 3 parts per million (ppm) or more to identify the source of CO and take further action as\nappropriate[4].",null,null,null,null,null,"Recommendation 8 - Make stop smoking pharmacotherapies available in hospital",1]

{"sheet":"Scores","index":5,"n_rows":27,"n_cols":9,"rows_kept":27,"cut":false,"hidden":false,"merged":[[1,3,1,5]]}
[]
[null,1,"Systems of delivery and implementation","Evidence"]
[null,null,null,"Max","Total","Review"]
[null,null,"Partner organisations",10,{"$f":"SUM(System!J4:J8)-5","v":0},null,null,{"$f":"SUM(E4/D4)","v":0},{"$f":"SUM(F4/D4)","v":0}]
[null,null,"Leadership",10,{"$f":"SUM(System!J10:J14)-5","v":0}]
[null,null,"On site",18,{"$f":"SUM(System!J16:J24)-9","v":0},null,null,{"$f":"SUM(E6/D6)","v":0},{"$f":"SUM(F6/D6)","v":0}]
[null,null,"Policy",10,{"$f":"SUM(System!J26:J30)-5","v":0},null,null,{"$f":"SUM(E7/D7)","v":0},0]
[null,null,"Records",8,{"$f":"SUM(System!J32:J35)-4","v":0},null,null,{"$f":"SUM(E8/D8)","v":0},0]
[null,null,"Total for section",{"$f":"SUM(D4:D8)","v":56},{"$f":"SUM(E4:E8)","v":0},{"$f":"SUM(F4:F8)","v":0}]
[null,2,"Communication"]
[null,null,null,"Max","Total","Review"]
[null,null,"Communicating change of policy",4,{"$f":"SUM(Communication!J4:J5)-2","v":0},null,null,{"$f":"SUM(E12/D12)","v":0},0]
[null,null,"Communicating the policy",8,{"$f":"SUM(Communication!J7:J10)-4","v":0},null,null,{"$f":"SUM(E13/D13)","v":0},0]
[null,null,"Communicating benefits and risks",10,{"$f":"SUM(Communication!J12:J16)-5","v":0},null,null,{"$f":"SUM(E14/D14)","v":0},0]
[null,null,"Total for section",{"$f":"SUM(D12:D14)","v":22},{"$f":"SUM(E12:E14)","v":0},{"$f":"SUM(F12:F14)","v":0}]
[null,3,"Training"]
[null,null,null,"Max","Total","Review"]
[null,null,"Training",10,{"$f":"SUM(Training!J4:J8)-5","v":0},null,null,{"$f":"SUM(E18/D18)","v":0},0]
[null,null,"Total for section",{"$f":"SUM(D18)","v":10},{"$f":"SUM(E18)","v":0},{"$f":"SUM(F18)","v":0}]
[null,4,"Treatments"]
[null,null,null,"Max","Total","Review"]
[null,null,"System ",6,{"$f":"SUM(Treatment!J4:J6)-3","v":0},null,null,{"$f":"SUM(E22/D22)","v":0},0]
[null,null,"Before admission",2,{"$f":"SUM(Treatment!J8)-1","v":0},null,null,{"$f":"SUM(E23/D23)","v":0},0]
[null,null,"On admission",12,{"$f":"SUM(Treatment!J10:J15)-6","v":0},null,null,{"$f":"SUM(E24/D24)","v":0},0]
[null,null,"Care delivery",26,{"$f":"(SUM(Treatment!J17:J29)-13)","v":0},null,null,{"$f":"SUM(E25/D25)","v":0},0]
[null,null,"Additional actions for midwives",4,{"$f":"SUM(Treatment!J31:J32)-2","v":0},null,null,{"$f":"SUM(E26/D26)","v":0},{"$f":"SUM(F26/D26)","v":0}]
[null,null,"Total for section",{"$f":"SUM(D22:D26)","v":50},{"$f":"SUM(E22:E25)","v":0},{"$f":"SUM(F22:F25)","v":0}]

{"sheet":"All questions","index":6,"n_rows":88,"n_cols":4,"rows_kept":88,"cut":false,"hidden":false,"merged":[]}
[]
[null,1,"Systems of delivery and implementation"]
[null,null,"Partner organisations","Original NICE recommendation referrence"]
[null,1.1000000000000001,"Do the NHS standard contract and local authority contract include smokefree strategies?","Recommendation 16 - Commission smokefree secondary care services"]
[null,"1.2","Does your local joint strategic needs assessment consider the impact of smoking on particular groups of people at high risk, such as those who are pregnant, those with chronic respiratory and circulatory conditions?","Recommendation 15 - Ensure local tobacco control strategies include secondary care "]
[null,"1.3","Does it identify expected numbers of pregnant women who smoke, the proportion reached by services and the numbers who successfully stop smoking?","Recommendation 15 - Ensure local tobacco control strategies include secondary care "]
[null,"1.4","Does it identify expected numbers of patients with chronic conditions related to smoking who smoke, the proportion reached by services and the numbers who successfully stop smoking?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,"1.5","Does the local tobacco control strategy communicate key messages about tobacco-related harm to everyone who use secondary care services?","Recommendation 15 - Ensure local tobacco control strategies include secondary care "]
[null,null,"Leadership","Original NICE recommendation referrence"]
[null,"1.6","Have you assigned a clinical or medical director to lead on stop smoking support for people who use, or work in, secondary care services?","Recommendation 16 - Commission smokefree secondary care services"]
[null,"1.7","Can the designated lead ensure that:\n\nThe organisation has an annual improvement programme for stop smoking support given to people who use, or work in, secondary care services?","Recommendation 16 - Commission smokefree secondary care services"]
[null,"1.8","The quality of stop smoking services continues to improve?","Recommendation 3 -  Provide intensive support for people using acute and mental health services"]
[null,"1.9","Progress and outcomes in each clinical area are monitored, for example, recording of individual smoking status (including at the time of giving birth), the number of referrals, uptake of interventions, prescribing of stop smoking pharmacotherapies, 4-week quit rates, training of staff?","Recommendation 3 -  Provide intensive support for people using acute and mental health services"]
[null,"1.10","Performance monitoring and feedback on outcomes is provided to all staff?","Recommendation 10 - Provide leadership on stop smoking support "]
[null,null,"On site","Original NICE recommendation referrence"]
[null,"1.11","Does your organisation encourage everyone who smokes to stop smoking completely and if necessary provide immediate access to licensed nicotine-containing products or other pharmacotherapies when appropriate?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,"1.12","Is there a requirement within service specifications and service level agreements that all staff are trained to deliver advice on stopping smoking and to make a referral to intensive support?","Recommendation 16 - Commission smokefree secondary care services"]
[null,"1.13","Are all stop smoking pharmacotherapies included in secondary care formularies?","Recommendation 16 - Commission smokefree secondary care services"]
[null,"1.14","Do all hospitals have an on-site stop smoking service?","Recommendation 10 - Provide leadership on stop smoking support "]
[null,"1.15","Are services commissioned to provide a range of stop smoking pharmacotherapies?","Recommendation 16 - Commission smokefree secondary care services"]
[null,"1.16","Are sufficient resources in place, to enable secondary care providers to maintain smokefree policies?","Recommendation 16 - Commission smokefree secondary care services"]
[null,"1.17","Are systems in place to monitor and audit the implementation and impact of the recommendations in NICE guidance 48?","Recommendation 16 - Commission smokefree secondary care services"]
[null,"1.18","Are all secondary care buildings and grounds smokefree?","Recommendation 16 - Commission smokefree secondary care services"]
[null,"1.19","Have you removed shelters or other designated outdoor smoking areas?","Recommendation 11 - Develop smokefree policies"]
[null,null,"Policy","Original NICE recommendation referrence"]
[null,"1.20","Was your smokefree policy, developed in collaboration with staff and people who use secondary care services, or their representatives?","Recommendation 11 - Develop smokefree policies"]
[null,"1.21","Are all staff are aware of the smokefree policy and do they comply with it?","Recommendation 10 - Provide leadership on stop smoking support "]
[null,"1.22","Does your policy protect staff from tobacco smoke when they are visiting the homes of people using secondary care services?","Recommendation 11 - Develop smokefree policies"]
[null,"1.23","Are support systems in place for services users, staff, carers who experience problems arising from the smoking restrictions?","Recommendation 11 - Develop smokefree policies"]
[null,"1.24","Do you facilitate compliance with, and resolve immediately, any breaches of smokefree policies, including a process for staff to report incidents?","Recommendation 11 - Develop smokefree policies"]
[null,null,"Records","Original NICE recommendation referrence"]
[null,"1.25","Is a robust system in place (preferably electronic) to ensure continuity of care between secondary care and local stop smoking services for people moving in and out of secondary care?","Recommendation 9 - Put referral systems in place for people who smoke"]
[null,"1.26","Are discussions and decisions related to stop smoking advice, referrals or interventions recorded in the person’s records (preferably computer-based)?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,"1.27","Are systems for consistently recording and maintaining records of people’s smoking status in place and do these;\n- provide a prompt for action (including the referral of people to stop smoking support) \n- ensure smoking status is consistent in all patient records\n- be stored for easy access and audit?","Recommendation 9 - Put referral systems in place for people who smoke"]
[null,"1.28","Are systems in place to alert the person’s healthcare providers and prescribers to changes in smoking behaviour because other drug doses may need adjusting?","Recommendation 3 -  Provide intensive support for people using acute and mental health services"]
[null,2,"Communication"]
[null,null,"Communicating change of policy","Original NICE recommendation referrence"]
[null,2.1,"Have you communicated with directors and senior managers of publicly-funded secondary care services or their representatives (including the communications team, occupational health services and estates management)?","Recommendation 12 - Communicate the smokefree policy"]
[null,2.2000000000000002,"Does your communications strategy include all the information required by people who use secondary care services and their parents or carers, staff and visitors, and the wider local population?","Recommendation 12 - Communicate the smokefree policy"]
[null,null,"Communicating the policy","Original NICE recommendation referrence"]
[null,2.2999999999999998,"Are all staff provided with information about the smokefree policy and instructions about their roles and responsibilities in maintaining a smokefree work environment?","Recommendation 14 -  Provide stop smoking training for frontline staff"]
[null,2.4,"Does your organisation provide everyone with verbal and written information and advice about the smokefree policy before their appointment, procedure or hospital stay?","Recommendation 1 - Provide information for planned or anticipated use of secondary care"]
[null,2.5,"Do you provide information for relatives, carers, friends and other visitors explaining why the hospital is smokefree and giving information about local stop smoking services?","Recommendation 1 - Provide information for planned or anticipated use of secondary care"]
[null,2.6,"Do you provide information that explains to visitors that smoking is not allowed on the premises and provides advice about the benefits of stopping smoking and how to contact local stop smoking services?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,null,"Communicating benefits and risks","Original NICE recommendation referrence"]
[null,2.7,"Do you discuss the potential to reduce the dose of some drugs when stopping smoking with secondary care users and their carers, advising them to seek medical advice if they notice any side effects of changing smoking behaviour?","Recommendation 7 - Adjust drug dosages for people who have stopped smoking"]
[null,2.8,"Do you provide clear information and advice about the risks of smoking and secondhand smoke during contact with partners, parents, other household members and carers of people using mental health services and offer people who want to stop or reduce smoking a referral to a hospital or local stop smoking service, as appropriate?","Recommendation 5 - Provide information and advice for carers, family, other household members and hospital visitors "]
[null,2.9,"Does this information include advice not to smoke near the patient; this includes not smoking in the house or private vehicle?","Recommendation 5 - Provide information and advice for carers, family, other household members and hospital visitors "]
[null,"2.10","Do you emphasise that nicotine is not the major cause of damage to people’s health from smoking tobacco, and that any risks from using licensed nicotine-containing products or other stop smoking pharmacotherapies are much lower than those of smoking?","Recommendation 6 - Advise on and provide stop smoking pharmacotherapies"]
[null,2.11,"Do doctors pharmacists, health and social care practitioners in mental health services who advise on or prescribe pharmacotherapies, provide information about types of intensive behavioural support available, the different types of stop smoking pharmacotherapies and how to use them?","Recommendation 3 -  Provide intensive support for people using acute and mental health services"]
[null,3,"Training"]
[null,null,null,"Original NICE recommendation referrence"]
[null,3.1,"Do relevant curricula for frontline staff include the range of interventions and practice to help people stop smoking, as outlined in this guidance?","Recommendation 14 -  Provide stop smoking training for frontline staff"]
[null,3.2,"Are all frontline staff trained to deliver advice around stopping smoking and referral to intensive support? They should know what local and hospital-based stop smoking services offer and how to refer people to them. ","Recommendation 14 -  Provide stop smoking training for frontline staff"]
[null,3.4,"Are all frontline staff trained to talk to people in a sensitive manner about the risks of smoking and benefits of stopping?","Recommendation 14 -  Provide stop smoking training for frontline staff"]
[null,3.5,"Are all staff who deliver intensive stop smoking support trained to the minimum standard described by the NCSCT, with additional training that is relevant to their clinical specialism?","Recommendation 14 -  Provide stop smoking training for frontline staff"]
[null,3.3,"Do you ensure online training can be completed and updated annually as part of NHS mandatory training (for example, training provided by the NCSCT)?","Recommendation 14 -  Provide stop smoking training for frontline staff"]
[null,4,"Treatments"]
[null,null,"System ","Original NICE recommendation referrence"]
[null,4.0999999999999996,"Do your pharmacies stock varenicline, bupropion and a range of licensed nicotine-containing products (including transdermal patches and a range of fast-acting products) for patients and staff (see recommendations 6 and 13)?","Recommendation 8 - Make stop smoking pharmacotherapies available in hospital"]
[null,4.2,"Are a range of licensed nicotine-containing products available for sale in hospital to visitors and staff?","Recommendation 8 - Make stop smoking pharmacotherapies available in hospital"]
[null,4.3,"Have you taken action in line with NICE guidance on workplace interventions to promote smoking cessation (NICE public health guidance 5): \n- advise all staff who smoke to stop?\n- offer staff in-house stop smoking support?\n- provide contact details for community support if preferred?\n- allow staff to attend stop smoking services during working hours without loss of pay?","Recommendation 13 - Support staff to stop smoking"]
[null,null,"Before admission","Original NICE recommendation referrence"]
[null,4.4000000000000004,"Before a planned or likely admission, do you work with the person to include the management of smoking on admission or entry to the secondary care setting in their personal care plan?","Recommendation 1 - Provide information for planned or anticipated use of secondary care"]
[null,null,"On admission","Original NICE recommendation referrence"]
[null,4.5,"During the first face-to-face contact, do staff ask everyone if they smoke or have recently stopped smoking and record smoking status and the date they stopped, if applicable, in the person’s records (preferably computer-based) and any hand-held notes?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,4.5999999999999996,"Do you advise people who smoke that licensed nicotine-containing products and other stop smoking pharmacotherapies can help them to stop smoking and reduce cravings?","Recommendation 6 - Advise on and provide stop smoking pharmacotherapies"]
[null,4.7,"Do you offer and, if the person agrees, arrange for them to receive intensive behavioural support, either during their current outpatient visit or during their inpatient stay?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,4.8,"Do other staff offer and, if accepted, arrange a referral to a local stop smoking service?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,4.9000000000000004,"Do you provide the same for people receiving secondary care services in the community or at outpatient clinics and during pre-operative assessments?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,"4.10","Do you follow recommendation 8 in NICE guidance on tobacco: harm-reduction approaches to smoking (NICE public health guidance 45), encouraging the use of licensed nicotine-containing products for anyone who does not want, is not ready or is unable to stop completely?","Recommendation 3 -  Provide intensive support for people using acute and mental health services"]
[null,null,"Care delivery","Original NICE recommendation referrence"]
[null,"4.11","Is a personal stop smoking plan developed and provision for appropriate pharmacotherapies made as part of the health and wellbeing review?","Recommendation 3 -  Provide intensive support for people using acute and mental health services"]
[null,"4.12","Do you offer measurements of exhaled carbon monoxide during each contact, to motivate and provide feedback on progress?","Recommendation 3 -  Provide intensive support for people using acute and mental health services"]
[null,"4.13","Do you ensure that people who use drugs that are affected by smoking (or stopping smoking) are monitored, and the dosage adjusted if appropriate?","Recommendation 7 - Adjust drug dosages for people who have stopped smoking"]
[null,"4.14","When people are discharged from hospital do you ensure they have sufficient stop smoking pharmacotherapy to last at least 1 week or until their next contact with a stop smoking service?","Recommendation 6 - Advise on and provide stop smoking pharmacotherapies"]
[null,"4.15","Do you provide immediate support if necessary, and otherwise within 24 hours of admission to people admitted to a secondary care setting?\nProviding support (delivered in the setting) as often and for as long as needed during admission?","Recommendation 3 -  Provide intensive support for people using acute and mental health services"]
[null,"4.16","In addition, for people receiving secondary care services in the community or at outpatient clinics (including pre-operative assessments):\nDo you provide immediate support in the outpatient setting?","Recommendation 3 -  Provide intensive support for people using acute and mental health services"]
[null,"4.17","Do you offer weekly sessions, preferably face-to-face, for a minimum of 4 weeks after discharge. If it is not possible to provide this support after discharge, arrange a referral to a local stop smoking service?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,"4.18","Do you recommend and offer licensed nicotine-containing products (usually a combination of transdermal patches with a fast-acting product such as an inhalator, gum, lozenges or spray) to all people who smoke, or varenicline or bupropion as sole therapy as appropriate?\n\nDo not offer varenicline or bupropion to pregnant or breastfeeding women or people under the age of 18.\n\nVarenicline and bupropion can be used with caution in people with mental health problems","Recommendation 6 - Advise on and provide stop smoking pharmacotherapies"]
[null,"4.19","Do you encourage people who do not want (or do not feel able) to stop smoking completely (including pregnant or breastfeeding women) to use licensed nicotine-containing products to help reduce cravings to smoke during their stay or visit?","Recommendation 6 - Advise on and provide stop smoking pharmacotherapies"]
[null,"4.20","Do you ensure that people using nicotine replacement therapy (NRT) patches should remove them 24 hours before microvascular reconstructive surgery and surgery using vasopressin injections?","Recommendation 6 - Advise on and provide stop smoking pharmacotherapies"]
[null,"4.21","Do staff who are trained to provide intensive behavioural support, offer and provide support to people using secondary care services in a community setting?","Recommendation 2 - Identify people who smoke and offer help to stop "]
[null,"4.22","Do you advise staff who do not want, or are not ready or able to stop completely to use licensed nicotine-containing products to help them abstain during working hours?","Recommendation 13 - Support staff to stop smoking"]
[null,"4.23","Do you offer and provide intensive behavioural support to maintain abstinence from smoking during working hours?","Recommendation 13 - Support staff to stop smoking"]
[null,null,"Additional actions for midwives","Original NICE recommendation referrence"]
[null,"4.24","Midwives should follow recommendation 1 in NICE guidance on quitting smoking in pregnancy and following childbirth (NICE public health guidance 26). This recommends that, in addition to the actions covered here, midwives should[2]:\n\nassess the woman's exposure to tobacco smoke through discussion and use of a carbon monoxide (CO) assessment\n\nrefer all women who smoke (including those who smoke lightly or infrequently), have stopped in the last 2 weeks or have a CO reading indicative of smoking[3], to stop smoking services.","Recommendation 8 - Make stop smoking pharmacotherapies available in hospital"]
[null,"4.25","Midwives should help women who do not smoke but register CO levels of 3 parts per million (ppm) or more to identify the source of CO and take further action as\nappropriate[4].","Recommendation 8 - Make stop smoking pharmacotherapies available in hospital"]

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