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This map was published by MidCentral District. A printed version of this document is not controlled so may not be up-to-date with the latest clinical information.

Stop Smoking Support Medicine > Thoracic medicine > Stop Smoking Support

Hospital Inpatient Clinical Presentation RED FLAGS

Identified as a Current

Smoker

Identified as Ex-

Smoker

Identified as Never

Smoked

Provide brief advice

Provide stop smoking

AND pharmacological

support

Refer to stop smoking

support

Pharmacological

treatment

Te Ohu Auahi

Mutunga (TOAM) Nicotine Replacement

Therapy (NRT)

Other stop smoking

medication options

Practice based stop

smoking support Transdermal Patch Varenicline

Quitline Gum Bupropion

Lozenges Nortriptyline

Oral Spray

Inhalator

Care map

information Updates to this care

map

Information resources

for patients and carers

Resources for

providers

Hauora Māori Pasifika



1. Care map information

In scope:

• stop smoking management and advice for current and ex-smokers accessing medical advice in either a community or hospital

setting

• use of pharmacotherapy options for stop smoking support

• stop smoking support services

Whilst 15 years is considered the lower age limit for capture of a patient's own smoking status, it may still be worthwhile initiating the

conversation with children and teens of younger ages. For very young children, parents or caregivers should be asked about tobacco

use in the child's living environment.

Out of scope:

• cessation advice regarding drugs apart from tobacco

Background:

• smoking is New Zealand's single leading cause of preventable death

• smoking kills an estimated 5000 people in New Zealand every year

• smoking-related diseases are a significant opportunity cost to the health sector

• stopping smoking confers immediate health benefits on all people who smoke, even those who already have a smoking-related

disease

Most smokers want to quit, and the basis for The New Zealand Guidelines for Helping People to Stop Smoking continues to be the

memory aid - ABC - that can be routinely provided in both primary and secondary care.

Smoking cessation is a Ministry of Health priority area. The ABC prompts health care workers to:

• Ask about and document every person's smoking status

• give Brief advice to stop to every person who smokes (every patient, every time)

• strongly encourage every person who smokes to use Cessation support (a combination of behavioural support and smoking

cessation medicine works best) and offer them help to access it. Refer to, or provide, cessation support to everyone who

accepts that offer. A combination of behavioural support and smoking cessation medicine works best

Ministry of Health Target (July 2015):

• 95 percent of hospital patients who smoke and are seen by a health practitioner in a public hospital are offered brief advice and

support to quit smoking

• 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last

15 months

• 90 percent of pregnant women who identify as smokers upon registration with a DHB-employed midwife or Lead Maternity

Carer are offered brief advice and support to quit smoking

Within the target, a specialised identified group includes:

• progress towards 90% of pregnant women who identify as smokers at the time of confirmation of pregnancy in general practice

or booking with Lead Maternity Carer are offered advice and support to quit [4]

2. Information resources for patients and carers

Quitline resources [4]:

• Quitline website

• The Quit Book to support them on their journey to becoming non-smokers

http://www.quit.org.nz/https://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Smoking%20Cessation/The%20Quit%20Book.pdf



Māori language resources:

• Me Mutu Tatou - Let's all Quit (Quitline)

Samoan language resource:

• O lou malosiaga lea e te sa’oloto mai ai i le ulaula (Your strength lies in freedom from smoking)

• E fa‘apefea le fa‘aaogaina o fasi nikotini | E fa‘apefea le fa‘aaogaina o pulu po o lole (How to use patches, gum and lozenges)

Tongan language resources: • Ko ho malohinga’ ‘oku ma’u ia ‘i ho’o ‘ata’ata mei’ he ifi tapaka’ (Your strength lies in freedom from smoking)

• Founga hono ngaue’aki ‘o e palasita nikotini´ | Founga hono ngaue’aki ‘o e pululole´ pe lole´ (How to use patches, gum or

lozenges)

Other sources of information:

• Health navigator:

• smoking - reasons to quit

• smoking cessation providers by region

• health promotion agency

• smoking - Ministry of Health:

• health effects of smoking

• stop smoking

• tips for quitting

• Health Navigator resources in multiple languages

• stopping smoking - tips from the Heart Foundation

• medications to assist smoking cessation - patient flyer

• Manawatu Community Mental Health Directory

Quit Plans:

• download Quit Plan information for patients: preparation is key to a successful quit attempt

Te Ara Whānau Ora Brochure:

• Te Ara Whānau Ora Brochure

3. Resources for providers

The following courses are available online for staff free-of-charge:

• ABC online training (Ministry of Health)

• National Heart Foundation course - stop smoking training

Training for Stop Smoking Practitioners (cost associated, NZQA accredited):

• National Training Service Stop Smoking Practitioner Training (Inspiring Ltd)

Useful Websites:

• understanding smokers 'real needs'

• Quitline

• Action on Smoking and Health New Zealand (ASH)

• Cancer Society

• Toi Tangata

https://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Smoking%20Cessation/HE2383-Me_Mutu_Tatou_Let's_All-Quit.pdfhttps://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Smoking%20Cessation/qtl7399_pacific_resource_samoan.pdfhttps://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Smoking%20Cessation/Samoan%20Language%20Resource%20-%20E%20fa'apefea%20le%20fa'aaogaina%20o%20fasi%20nikotini.pdfhttps://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Smoking%20Cessation/qtl7399_pacific_resource_tongan.pdfhttps://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Smoking%20Cessation/Tongan%20Language%20Resource%20-%20Founga%20hono%20nqaue'aki'o%20e%20palasita%20nikotini'.pdfhttp://www.healthnavigator.org.nz/healthy-living/smoking/why-quit-smoking/http://www.smokefreecontacts.org.nz/search/filter/cessation-services/http://www.hpa.org.nz/what-we-do/tobacco-controlhttp://www.health.govt.nz/your-health/healthy-living/addictions/smokinghttp://www.health.govt.nz/your-health/healthy-living/addictions/smoking/health-effects-smokinghttp://www.health.govt.nz/your-health/healthy-living/addictions/smoking/stop-smokinghttps://quit.org.nz/en/staying-quit/tips-for-quittinghttp://www.healthnavigator.org.nz/healthy-living/smoking/quit-smoking-resources-multiple-languages/http://www.heartfoundation.org.nz/healthy-living/quitting-smokinghttp://www.healthhb.co.nz/wp-content/uploads/2015/08/Stop-Smoking-Medicines.pdfhttps://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Common%20Forms/Te%20Ara%20Whanau%20Ora%20Brochure_UPDATED%20MAY2013.pdfhttp://learnonline.health.nz/login/index.phphttp://www.heartfoundation.org.nz/programmes-resources/health-professionals/resource-centre/stop-smoking-traininghttp://nts.org.nz/traininghttp://whatsmokersreallywant.co.nz/http://www.quit.org.nz/http://www.ash.org.nz/https://cancernz.org.nz/http://toitangata.co.nz/



• General Practice Toolkit for 'More Heart and Diabetes Checks and Better Help for Smokers to Quit'


• the New Zealand Guidelines for helping people to stop smoking

• healthnavigator:




4. Updates to this care map

This Pathway was last reviewed and updated in October 2016.

Pathway review/update: November 2015 - view for more information on the update

Date of publication: May 2013.

This care map has been updated in line with consideration to evidenced based guidelines.

For further information on contributors and references please see the care map's Provenance.

5. Hauora Māori

Smoking rates among Māori aged 18 years or over are at 41% [5].

Key findings from the 2009 New Zealand Tobacco Use Survey [2].

In 2009 the current smoking rate for Māori females was more than three times that for non-Māori females: 48.3 percent compared

with 16.2 percent respectively.

Although the disparity was smaller for males, the current smoking rate for Māori males (39.3 percent) was still nearly twice as high

as that for non-Māori males (20.3 percent), a statistically significant difference [2].

Māori are a diverse people and whilst there is no single Māori identity, it is vital practitioners offer culturally appropriate care when

working with Māori whānau. It is important for practitioners to have a baseline understanding of the issues surrounding Māori health.

This knowledge can be actualised by (not in any order of priority):

• acknowledging Te Whare Tapa Wha (Māori model of health) when working with Māori whānau

• asking Māori clients if they would like their whānau or significant others to be involved in assessment and treatment

• asking Māori clients about any particular cultural beliefs they or their whānau have that might impact on assessment and

treatment of the particular health issue (Cultural issues)

• consider the importance of whānaungatanga (making meaningful connections) with their Māori client / whānau

• knowledge of Whānau Ora, Te Ara Whānau Ora and referring to Whānau Ora Navigators where appropriate

• having a historical overview of legislation that has impacted on Māori well-being

For further information:

• Hauora Māori

6. Pasifika

Pacific Cultural Guidelines (Central PHO) 6MB file

http://www.health.govt.nz/publication/general-practice-toolkit-more-heart-and-diabetes-checks-and-better-help-smokers-quithttp://www.health.govt.nz/publication/new-zealand-guidelines-helping-people-stop-smokinghttp://www.healthnavigator.org.nz/healthy-living/smoking/why-quit-smoking/http://www.smokefreecontacts.org.nz/search/filter/cessation-services/http://www.hpa.org.nz/what-we-do/tobacco-controlhttps://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Smoking%20Cessation/Stop%20Smoking%20Support%20pathway%20update%20summary%20table%20January%202016.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Hauora%20Maori%20Forms/Te%20Whare%20Tapa%20Wha.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Hauora%20Maori%20Forms/Cultural%20Issues.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Hauora%20Maori%20Forms/Wh%C4%81naungatanga.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Hauora%20Maori%20Forms/Whanau%20Ora%2C%20Te%20Ara%20Whanau%20Ora%20and%20Navigators.pdfhttps://www.centralpho.org.nz/node/688http://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Pacific%20Health%20Forms/Pacific%20Cultural%20Guidelines%20(Central%20PHO).pdf



Our Pasifika community:

• is a diverse and dynamic population:

• more than 22 nations represented in New Zealand

• each with their own unique culture, language, history, and health status

• share many similarities which we have shared with you here in order to help you work with Pasifika patients more effectively

The main Pacific nations in New Zealand are:

• Samoa, Cook Islands, Fiji, Tonga, Niue, Tokelau and Tuvalu

Acknowledging The FonoFale Model (pasifika model of health) when working with Pasifika peoples and families.

Acknowledging general pacific guidelines when working with Pasifika peoples and families:

• Cultural protocols and greetings

• Building relationships with your pasifika patients

• Involving family support, involving religion, during assessments and in the hospital

• Home visits

• Contact information

Pasifika Health Service - Better Health for Pasifika Communities:

• the Pasifika Health Service is a service provided free of charge for:

• all Pasifika people living in Manawatu, Horowhenua, Tararua and Otaki who have long term conditions

• all Pasifika mothers and children aged 0-5 years

• an appointment can be made by the patient, doctor or nurse

• the Pasifika Health Service contact details are:

• Palmerston North Office - 06 354 9107

• Horowhenua Office - 06 367 6433

• Better Health for Pasifika Communities brochure

Additional resources:

• Ala Mo'ui - Pathways to Pacific Health and Wellbeing 2014-2018

• Primary care for pacific people: a pacific health systems approach

• Tupu Ola Moui: The Pacific Health Chart Book 2004

• Pacific Health resources

• Central PHO Pasifika Health Service

7. Hospital Inpatient

Stop smoking services are available within MidCentral Health. This includes visits with patients while they are in hospital.

Te Ohu Auahi Mutunga Referral Form

Refer directly to Te Ohu Auahi Mutunga (TOAM). This is the DHB funded provider for stop smoking services.

Hospital in-patients can be prescribed nicotine inhaler or spray if patient fulfil the HML restrictions (any of the following):

• for perioperative use in patients who have a 'nil by mouth' instruction; or

• for use within mental health inpatient units; or

• acute use in agitated patients who are unable to leave the hospital facilities

http://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Pacific%20Health%20Forms/Fonofale%20model.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Pacific%20Health%20Forms/Cultural%20Protocols%20and%20Greetings.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Pacific%20Health%20Forms/Building%20relationships%20with%20pacific%20patients.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Pacific%20Health%20Forms/Family%20support_Religion_Healing_Hospital.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Pacific%20Health%20Forms/Home%20visits.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Pacific%20Health%20Forms/Contact%20info.pdfhttp://apps.centralpho.org.nz/Permalink/MoM/General%20Documents/MoM/Published/Pacific%20Health%20Forms/Pasifika%20Health%20Service%20-%20Better%20Health%20for%20Pasifika%20Communities%20Brochure.pdfhttp://www.health.govt.nz/publication/ala-moui-pathways-pacific-health-and-wellbeing-2010-2014http://www.health.govt.nz/publication/primary-care-pacific-people-pacific-and-health-systems-approachhttp://www.health.govt.nz/publication/tupu-ola-moui-pacific-health-chart-book-2004http://www.health.govt.nz/our-work/populations/pacific-health/pacific-health-resourceshttps://www.centralpho.org.nz/node/480https://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Smoking%20Cessation/Te%20Ohu%20Auahi%20Mutunga%20Referral%20Form.pdf



8. Clinical Presentation

ASK smoking status.

Document whether:

• current smoker - defined as someone who smoked within the last 30 days

• ex-smoker - defined as:

• not smoked for 30 days but 12 months

• never smoked

ALWAYS document in the patient notes.

Read Codes:

• 137R - current smoker

• 137S - ex-smoker

• 1371 - never smoked

ALWAYS update Dashboard© or lifestyles tab on PMS.

9. RED FLAGS!

Red flags include:

• Māori

• Pacific Island

• maternal smoking / whānau smoking

• low decile

10. Identified as a Current Smoker

Defined as someone who smoked within the last 30 days.

Read Code:

• 137R - current smoker

General practice - ALWAYS update Dashboard© or lifestyles tab on PMS.

At every admission to hospital, document their response in their clinical records by completing the appropriate Smokefree

Screening forms.

11. Identified as Ex-Smoker

Defined as:

• not smoked for 30 days but 12 months

If not smoked for 30 days but



• what they used [1]

• provide:

• positive feedback to patient for doing well

• appropriate written materials on the benefits of stopping smoking

• options for additional support i.e. referrals, texts, telephone calls to strengthen their new ex-smoker status

• reaffirm their commitment

• identify relapse prevention strategies

If not smoked > 12 months:

• provide positive feedback to patient for doing well

• reaffirm their commitment

• provide brief advice and support

General practice -ALWAYS update Dashboard© or lifestyles tab on PMS.


Screening forms.

12. Identified as Never Smoked

ALWAYS document in the patient notes.

Read Code:

• 1371 - never smoked

General practice - ALWAYS update Dashboard© or lifestyles tab on PMS.


Screening forms.

13. Provide brief advice

For all people who smoke, advise them to stop smoking by offering support to stop (e.g. a referral to a stop smoking provider

- TOAM and/or Quitline) with a prescription for a smoking cessation medicine - this will prompt more people to make a stop

smoking attempt than just advising them to stop.

Advice to stop can be personalised, e.g.:

• COPD - stopping smoking is the best treatment for your lung disease and will help you breathe easier

• pregnancy - stopping smoking will decrease your risk of harm to your baby and your pregnancy

• cost of smoking - stopping smoking will save you a lot of money

Follow advice with an offer of treatment:

• "I'd really like to help you stop smoking, and can refer you now"

• "I'd really like to help you stop smoking and would like to refer you to a stop smoking service. This is a great way to increase

your changes of stopping"

• "I know someone like yourself that managed to stop smoking using the help of a local service or Quitline. I highly recommend

them. I can make a referral now and give you a stop smoking card"

• "By using stop smoking services, you will be much more likely to stop smoking than trying to stop smoking on your own"

• "The Quitline has a great website where you can sign up for their online and text support programme"



Read Codes:

• @ZPSB.10 - brief smoking cessation advice given

• @ZPSC.10 - refer to smoking cessation support

• @ZPSC.20 - prescribed med

• @ZPSC.30 - provided cessation

• @ZPSC.90 - declined cessation

General practice - ALWAYS update Dashboard© or lifestyles tab on PMS and document advice given in the patient notes.


Screening forms.

15. Refer to stop smoking support

Read Codes:

• @ZPSC.10 - referral provided

General practice - ALWAYS update Dashboard© or lifestyles tab on PMS and document advice given in the patient notes.


Screening forms.

16. Pharmacological treatment

Consider comorbidities when choosing treatment option.

Read Codes:




General practice - ALWAYS update Dashboard© or lifestyles tab on PMS and document pharmacological treatment provided in the

patient notes.

At every admission to hospital, document pharmacological treatment prescribed in patient clinical records and complete the

appropriate Smokefree Screening forms.

17. Te Ohu Auahi Mutunga (TOAM)

Te Ohu Auahi Mutunga (TOAM) is a FREE local stop smoking service (purchased by the DHB).

Available to all, including high risk groups i.e:

• pregnant women (Stop Smoking Support Midwife available)

• Māori

• Pacific Island (Pasifika Stop Smoking Support Coach available)

• rural communities (rurally based Stop Smoking Support Coach available)

Available to assess & refer onto all available stop smoking services in MDHB & across NZ:



• intensive, supportive Whānau centred approach (use Te Ara Whānau Ora journey)

• visit where appropriate - at home, in clinic, group work, email, phone or text, competitions & Quitline

• provide nicotine replacement therapy & subsidised quit card for ongoing supply

• able to refer to other services e.g. budgeting, Whānau Ora Navigators, green prescription

• aligned to and operating within some general practices within the region

For further information please call 06 357 3426.

Medtech users:

• TOAM referral is connected to dashboard© and/or on Medtech outbox doc, type in SMOKE, choose TOAM referral

Non-Medtech users:

• referral can be faxed or emailed:

• fax: 06 357 3425

• email: [email protected]

• Te Ohu Auahi Mutunga Referral Form

18. Nicotine Replacement Therapy (NRT)

Nicotine Replacement Therapy:

• transdermal patch

• gum

• lozenges

• oral spray (unsubsidised)

• inhalator (unsubsidised)

Hospital in-patients can be prescribed nicotine inhaler or oral spray if patient fulfil the HML restrictions (any of the following):




19. Other stop smoking medication options

Read Codes:




General practice - ALWAYS update Dashboard© or lifestyles tab on PMS and document pharmacological treatment provided in the

patient notes.

At every admission to hospital, document pharmacological treatment prescribed in patient clinical records and complete the

appropriate Smokefree Screening forms.

20. Practice based stop smoking support

Some GP practices may offer nurse-led stop smoking support. This varies practice-to-practice.

mailto:[email protected]://thinkhauorawebsite.blob.core.windows.net/websitepublished/CCP/Resources/Smoking%20Cessation/Te%20Ohu%20Auahi%20Mutunga%20Referral%20Form.pdfhttp://www.nzf.org.nz/nzf_2853.html



The following courses are available online for staff free-of-charge:

• ABC online training (Ministry of Health)

• National Heart Foundation course - stop smoking training

Useful Websites:

• understanding smokers 'real needs'

• Quitline

• Action on Smoking and Health New Zealand (ASH)

• Cancer Society

• Toi Tangata

• General Practice Toolkit for 'More Heart and Diabetes Checks and Better Help for Smokers to Quit'


• the New Zealand Guidelines for helping people to stop smoking

• Health Navigator:




21. Transdermal Patch

TRANSDERMAL PATCH:

NB: Patches should be applied on waking to dry, non-hairy skin on the hip, trunk, or upper arm and held in position for 10–20

seconds to ensure adhesion; remove old patch and place next patch on a different area and avoid using the same site for several

days:

• may be used in combination with faster acting nicotine replacement therapy in patients who experience breakthrough cravings

or who have failed with single treatment

• adult over 18 years - 24 hour patch:

• apply 21 mg patch once daily for 3–4 weeks

• then 14 mg patch once daily for 3–4 weeks

• then 7 mg patch once daily for 3–4 weeks

• however, individuals who smoke less than 20 cigarettes daily should:

• apply 14 mg strength patch daily for 3–8 weeks

• then 7 mg patch for 3–4 weeks

• adult over 18 years - 16 hour patch:

• apply 15 mg patch for 16 hours each day for 8 weeks

• then 10 mg patch for 16 hours each day for 2 weeks

• then 5 mg patch for 16 hours each day for 2 weeks

• note: maintaining or increasing the dose may be necessary if abstinence is not achieved or if withdrawal symptoms are

experienced

• child 12–18 years:

• dose as for adult; do not extend treatment beyond 16 weeks

22. Varenicline

Varenicline

• adult starting usually 1–2 weeks before target stop date

http://learnonline.health.nz/login/index.phphttp://www.heartfoundation.org.nz/programmes-resources/health-professionals/resource-centre/stop-smoking-traininghttp://whatsmokersreallywant.co.nz/http://www.quit.org.nz/http://www.ash.org.nz/https://cancernz.org.nz/http://toitangata.co.nz/http://www.health.govt.nz/publication/general-practice-toolkit-more-heart-and-diabetes-checks-and-better-help-smokers-quithttp://www.health.govt.nz/publication/new-zealand-guidelines-helping-people-stop-smokinghttp://www.healthnavigator.org.nz/healthy-living/smoking/why-quit-smoking/http://www.smokefreecontacts.org.nz/search/filter/cessation-services/http://www.hpa.org.nz/what-we-do/tobacco-controlhttp://www.nzf.org.nz/nzf_2856.html



• initially 500 micrograms once daily for 3 days, increased to 500 micrograms twice daily for 4 days, then 1 mg twice daily for 11

weeks (reduce to 500 micrograms twice daily if not tolerated)

• 12-week course can be repeated in abstinent individuals to reduce risk of relapse

• there are funding restrictions for the drug. To learn more go to the pharmaceutical schedule website

23. Gum

GUM:

Chew the gum until the taste becomes strong, then rest it between the cheek and gum; when the taste starts to fade, repeat this

process. 1 piece of gum lasts for approximately 30 minutes. If using in combination with nicotine patches, 2 mg strength gum should

be used up to a maximum of 12 pieces daily:

• adult over 18 years:

• use 1 piece of 2 mg strength gum when the urge to smoke occurs

• individuals who smoke more than 20 cigarettes each day or who are unsuccessful with the 2 mg strength gum, should use

the 4 mg strength; maximum 40 mg daily (20 pieces of 2 mg strength gum or 10 pieces of the 4 mg strength gum)

• note: if attempting smoking cessation, treatment should continue for 3 months before reducing the dose; discontinue when

dose reduced to 1–2 pieces daily


• dose as for adult; maximum duration of treatment 16 weeks

24. Bupropion

Bupropion

• adult start 1–2 weeks before target stop date

• initially 150 mg daily for 3 days then 150 mg twice daily (maximum single dose 150 mg, maximum daily dose 300 mg; minimum

8 hours between doses)

25. Quitline

The Quit Group (which operates as Quitline) is an incorporated charitable trust that grew out of the national Quitline, established in

1999.

The Quit Group is committed to helping all New Zealanders stop smoking, with a particular focus on Māori, Pacific peoples and

pregnant woman.

Their free services is funded by the Ministry of Health. Quitline works in partnership with other stop smoking services i.e. a patient

can receive support from two or more agencies at the same time.

Smokers can access support via telephone, text or online:

• phone support - 0800 778 778

• online support - sign up online:

• quit stats

• quit plan

• quit blogs

• text support (Txt2Quit):

• sign up online or call Quitline

Quitline's phone service is available in 44 languages.

If your first language is not English, you can use the Language Line service via Quitline to get support to quit smoking in your native

http://www.pharmac.govt.nz/patients/PharmaceuticalSchedule/Schedule?osq=vareniclinehttp://www.nzf.org.nz/nzf_2841.htmlhttps://quit.org.nz/en/register



tongue. Forty-four languages are covered including, Samoan, Cook Island Māori, Tuvaluan, Tongan, Tokelauan, Mandarin and

Hindi. This service is available from Monday to Friday 9am - 6pm.

To access the service:

• 1. Call Quitline on 0800 778 778

• 2. When the call is answered, clearly say “Language line” and the language you wish to speak in

• 3. It may take several minutes before an interpreter is available

• 4. Once the interpreter is available, the normal Quitline support call will begin

• 5. All subsequent support calls will be delivered through the Language Line interpreter

26. Lozenges

LOZENGES:

Note: Slowly suck the lozenge until the taste becomes strong, then rest it between the cheek and gum; when the taste starts to fade,

repeat this process. One lozenge lasts for approximately 30 minutes.

If using in combination with nicotine patches, 1 mg strength lozenges should be used up to a maximum of 12 lozenges daily:

• adult over 18 years:

• use 1 mg strength lozenge when the urge to smoke occurs\

• individuals who smoke more than 20 cigarettes each day or who are unsuccessful with the 1 mg strength lozenges, should

use the 2 mg strength; maximum 25 of the 1 mg strength lozenges daily, or 15 of the 2 mg strength lozenges daily

• note: if attempting smoking cessation, treatment should continue for 3 months before reducing the dose; discontinue when

dose reduced to 1–2 lozenges daily


• dose as for adult; maximum duration of treatment 16 weeks

27. Nortriptyline

Nortriptyline

• adult over 18 years start 10–28 days before target stop date

• initially 25 mg daily

• increased gradually (over 10 days to 5 weeks) to 75–100 mg for up to 3–6 months

• taper dose slowly on discontinuation

28. Oral Spray

ORAL SPRAY - not funded in the community:

1mg/inhalation:

• the oral spray should be released into the mouth, holding the spray as close to the mouth as possible and avoiding the lips

• the individual should not inhale while spraying and avoid swallowing for a few seconds after use

Adult over 18 years:

• use 1–2 sprays in the mouth when the urge to smoke occurs or to prevent cravings

• should not exceed 2 sprays per episode (up to 4 sprays every hour), and a maximum of 64 sprays daily

• if using in combination with nicotine patches, 1–2 sprays can be used at a time (up to 2 sprays every hour), up to a maximum

of 32 sprays per day

Child 12–18 years:

• same as adults

http://www.nzf.org.nz/nzf_2260.html



FIrst use:

• if using the oral spray for the first time, or if unit not used for 2 or more days, prime the unit before administration

Hospital in-patients can be prescribed nicotine inhaler or oral spray if patient fulfil the HML restrictions (any of the following):




29. Inhalator

INHALER CARTRIDGES - not funded in the community:

• maximum of 12 cartridges of 10 mg strength daily OR

• 6 cartridges of 15 mg strength daily if using in combination with nicotine patches

Use:

• insert the cartridge into the device and draw in air through the mouthpiece:

• a single 10 mg cartridge lasts for approximately 4 sessions of 20 minutes

• a single 15 mg cartridge lasts for approximately 7 sessions of 40 minutes

The amount of nicotine from 1 puff of the cartridge is less than that from a cigarette, therefore it is necessary to inhale more often

than when smoking a cigarette.

If attempting smoking cessation, treatment should continue for 3 months before reducing the dose; discontinue gradually over 6–8

weeks.

Adult:

• use when urge to smoke or to prevent cravings

• usually 6–12 cartridges of the 10 mg–strength or 3–6 cartridges of the 15 mg–strength are used daily

Child 12–18 years:

• same as adults

Hospital in-patients can be prescribed nicotine inhaler or spray if patient fulfil the HML restrictions (any of the following):






Stop Smoking Support

Provenance Certificate

Overview

Overview | Editorial methodology | References | Contributors | Disclaimers

This document describes the provenance of MidCentral District Health Board’s Stop Smoking Support Pathway. This pathway is regularly updated to include new, quality-assessed evidence, and practice-based knowledge from expert clinicians. Please see the Editorial Methodology section of this document for further information.

This localised pathway was last updated in October 2016.

For information on changes in the last update, see the information point entitled ‘Updates to this care map’ on each page of the pathway.

One feature of the “Better, Sooner, More Convenient” (BSMC) Business Case, accepted by the Ministry of Health in 2010, was the development of 33 collaborative clinical pathways (CCP).

The purpose of implementing the CCP Programme in our DHB is to:

• Help meet the Better Sooner More Convenient Business Case aspirational targets, particularly the following:

o Reduce presentations to the Emergency Department (ED) by 30%

o Reduce avoidable hospital admissions to Medical Wards and Assessment Treatment and Rehabilitation for over-65-year-olds by 20%

o Reduce poly-pharmacy in the over-65-year-olds by 10%

• Implement a tool to assist in planning and development of health services across the district, using evidence-based clinical pathways.

• Provide front line clinicians and other key stakeholders with a rapidly accessible check of best practice;

• Enhance partnership processes between primary and secondary health care services across the DHB.

This pathway complements the Ministry of Health smoking cessation targets:

• 95 percent of patients who smoke and are seen by a health practitioner in public hospitals and 90 percent of patients who smoke and are seen by a health practitioner in primary care are offered brief advice and support to quit smoking. Within the target a specialised identified group will include:

o Progress towards 90 percent of pregnant women who identify as smokers at the time of confirmation of pregnancy in general practice or booking with Lead Maternity Carer are offered advice and support to quit

To cite this pathway, use the following format:

Map of Medicine. Medicine. MidCentral District View. Palmerston North: Map of Medicine; 2014 (Issue 1).



Editorial methodology

This care map was based on high-quality information and known Best Practice guidelines from New Zealand and around the world including Map of medicine editorial methodology. It has been checked by individuals with front-line clinical experience (see Contributors section of this document).

Map of Medicine pathways are constantly updated in response to new evidence. Continuous evidence searching means that pathways can be updated rapidly in response to any change in the information landscape. Indexed and grey literature is monitored for new evidence, and feedback is collected from users year-round. The information is triaged so that important changes to the information landscape are incorporated into the pathways through the quarterly publication cycle.

References

This care map has been developed according to the Map of Medicine editorial methodology. The content of this care map is based on high-quality guidelines and practice-based knowledge provided by contributors with front-line clinical experience. This localised version of the evidence-based, practice- informed care map has been peer-reviewed by stakeholder groups and the CCP Programme Clinical Lead.

1 Contributors representing the Smoking Cessation Collaborative Clinical Pathway Working Group – MidCentral DHB (2013)

2 Ministry of Health. 2010. Tobacco Use in New Zealand: Key findings from the 2009 New Zealand Tobacco Use Survey. Wellington: Ministry of Health.

3

Ministry of Health (2013) Health targets website. Retrieved from: http://www.health.govt.nz/new- zealand-health-system/health-targets/2012-13-health-targets/health-targets-2012-13-better-help- smokers-quit

4 Quitline website Retrieved from: http://www.quit.org.nz/

5 Smoking cessation – helping patients stick with it, until they quit. Best Practice Journal (BPJ), Issue 71 October 2015. http://www.bpac.org.nz/BPJ/2015/October/smoking.aspx

Contributors

MidCentral DHB’s Collaborative Clinical Pathway editors and facilitators worked with clinical stakeholders such as front-line clinicians and pharmacists to gather practice-based knowledge for its care maps.

The following individuals contributed to the update of this care map – Oct 2016:

• Fay Selby-Law, Kaiarahi, Te Ohu Auahi Mutunga, Te Wakahuia Manawatu Trust Hauora (Primary Care Clinical Lead)

• Charity PNG, Pharmacist, MidCentral Health (Secondary Care Clinical Lead)

• Caroline Clark, Clinical Quality Facilitator – Team Leader, Central PHO

• Nicola Russell, Service Improvement Leader, CPHO

• Kerry Metcalfe, Smoking Cessation Coordinator, CPHO

• Alaina Glue, Project Assistant, CPHO (Facilitator)

• Eve Williams, Team Administrator, CPHO (Editor)

http://www.health.govt.nz/new-http://www.quit.org.nz/http://www.bpac.org.nz/BPJ/2015/October/smoking.aspx



The following individuals contributed to the update of this care map – Dec 2015:

• Fay Selby-Law, Kaiarahi, Te Ohu Auahi Mutunga, Te Wakahuia Manawatu Trust Hauora (Primary Care Clinical Lead)

• Charity PNG, Pharmacist, MidCentral Health (Secondary Care Clinical Lead)

• Angela Verhoeven, Project Manager, Central PHO

• Caroline Clark, Clinical Quality Facilitator – Team Leader, Central PHO

• Kerry Metcalfe, Smoking Cessation Coordinator, CPHO

• Alaina Glue, Project Assistant, CPHO (Facilitator/Editor)

The following individuals contributed to the original development of this care map:

• Fay Selby-Law, Kaiarahi, Te Ohu Auahi Mutunga, Te Wakahuia Manawatu Trust Hauora (primary care clinical lead)

• Charity PNG, Pharmacist, MidCentral Health (secondary care clinical lead)

• Jane Cullen, Service Improvement Leader, Central Primary Health Organisation

• Ashleigh-Kate Araroa, Quit Coach, Central PHO

• Wendy Blair, Nurse Educator Lead Practice Development, MidCentral Health

• Shirley-Anne Gardiner, Project Director, Map of Medicine, Health Care Development (pathway editor)

• Mark Beale, Clinical Director, Medicine, MidCentral Health

Disclaimers

Clinical Board Central PHO, MidCentral DHB

It is not the function of the Clinical Board Central PHO, MidCentral DHB to substitute for the role of the clinician, but to support the clinician in enabling access to know-how and knowledge. Users of Map of Medicine are therefore urged to use their own professional judgement to ensure that the patient receives the best possible care. Whilst reasonable efforts have been made to ensure the accuracy of the information on this online clinical knowledge resource, we cannot guarantee its correctness and completeness. The information on Map of Medicine is subject to change and we cannot guarantee that it is up-to-date.