1. Tobacco-free AOTEAROA Conference Auckland 2010 Smokefree Practice in Action Sue Marshall. Smokefree Project Coordinator Maternal, Child & Youth Service Hawkes Bay District Health Board

2. Our Population

3. Pregnancy

4. Babies and Children

5. Exposure Special Care Baby Unit (SCBU) APRIL 2010 Families not smokefree11/15 (73%) Ref: Internal Audit Report, Smokefree Systems-Special Care Baby Unit (SCBU) Hawkes Bay District Health Board, 2010.

6. Exposure Children's Ward APRIL 2010 Families not smokefree12/21(57%) Ref: Internal Audit Report, Smokefree Systems- Children's Ward Hawkes Bay District Health Board, 2010.

7. Approach Systems First: model of organisational change Evidence PolicySystems Education Patient Roles Intervention Systems First

8. Policy Leadership Commitment

9. Documentation tools Care pathways NRT protocol Audit systems Systems

10. MOH ABC e learning tool HBDHB Smokefree education SmokeChange Education for Midwives Baby Essentials Education

11. Link Champions Dedicated Smokefree Midwife Smokefree Project and team Clarity about role Roles

12. Focused ABC Provision NRT Interventions

13. Audit Process Data Findings

14. Maternity Services ANTENATAL WOMEN Screening 100% woman 77% partners 70% household Interventions 61% (included NRT arranged or offered referral to a smokefree service arranged or offered). POSTNATAL WOMEN Screening 95%postpartum women 84%partners 84% household Interventions 77% (included inpatient NRT arranged, offered or had NRT or referral to a smokefree service). Ref: Internal Audit Report, Smokefree Systems & Performance Maternity Services Hawkes Bay District Health Board, 2010.

15. Special Care Baby Unit Prevalence of Smoking in Families of SCBU Babies 73% Screening 100% Interventions 81% Ref: Internal Audit Report, Smokefree Systems-Special Care Baby Unit (SCBU) Hawkes Bay District Health Board, 2010

16. Children's Ward Screening 37% Interventions 75% Ref: Internal Audit Report, Smokefree Systems- Children's Ward Hawkes Bay District Health Board, 2010

17. In Action Women and their families smokefree during pregnancy 1 st contactscreeningembrace whole family motivational tools acknowledging harm discussion of benefits of smokefree Just Imagine booklets smokefree pregnancy care pathway NRT A little and often by many over time midwife hat and Quitcard provider hat other health care professionals antenatal clinics contact over time smokefree midwife role - safe sleep discussions NRT for inpatient women free NRT for parents and caregivers motivational time smokefree family smokefree household smokefree partners referral to smokefree support service electronic discharge summary

18. In Action Parents and Caregivers of Hospitalised Babies and Children Smokefree screening for exposure brief adviceNRT for parents and caregivers Quit cardsreferral to smokefree support service professional support discussion of benefits of smokefree acknowledging harm providing opportunity for practice to be smokefree smokefree environment smokefree Link Champions electronic discharge summary care pathways linking in with other providers

19. Stories RubyRawiri

20. References Cowan S & Smith D. Systems First – supporting smokefree leadership in New Zealand hospitals. Guidelines for district health boards. Christchurch, NZ. Education for Change. August 2005. Baby Essentials Online http://www.changeforourchildren.co.nz/safe_start_programme/baby_essentials_online DiFranza,J., Aligne,C.A., WeitZman,M. (2004) Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics Vol.113. Hofthuis,W., de Jongste,J.C.,Merkus,P..J. F.M. (2003) Adverse health effects of prenatal and postnatal tobacco smoke exposure on children. Arch.Dis.Child 2003;1086-1090.