Background Despite NICE guideline PH48 on smoking, documentation of patient smoking status, referral to smoking cessation services and staff engagement and awareness of smoking policy at the trust were poor. Enforcement and leadership for the smoke-free policy on site was lacking.

Aim Improving compliance with NICE Guideline PH48 and getting management and staff buy-in to improve longer term health outcomes for patients and staff using Croydon Health Services.

Methodology Spot audits of patient records, staff awareness of smoking cessation services and importance of documentation were conducted. Results were presented to management to make a case for change.

Result Individual meetings were held with management in appropriate departments and a detailed plan was drawn up with a timeline and target to make the trust compliant by 2020. A new policy was also drafted to this effect and submitted for approval. Educational events took place and feedback gathered. Awareness amongst frontline staff of the NICE guidelines increased significantly. A trust-wide launch event is scheduled for October and mandatory training for frontline staff is being rolled out. Software changes are also underway to ensure documentation of smoking status and referral pathways to cessation services are streamlined. Pharmacological support is being made more readily available and stocked in every ward to ease patient compliance with the no smoking policy.

Conclusion Implementing a change in culture and mindset requires significant dedication and time. Resistance to change is inevitable and management buy-in, together with a multidisciplinary team to turn ideas into action is paramount. Timelines need to be achievable and tailored to changing priorities and availability of resources. Most importantly, however, if a change is needed for better health outcomes for the population being served, then appropriate actions need to be taken and such initiatives should be encouraged.