Appendix 1 - Nicotine Replacement Therapy (NRT)

Does the patient want to stop smoking?

If the patient does want to stop smoking then refer them to the Quit Your Way - Hospital Service (preferred method of referral is via TrakCare or see Appendix 6 for contact details). The Stop Smoking advisor will:

1. Assess patient's motivation to stop smoking.
2. Assess nicotine dependence.
3. Monitor carbon monoxide (CO) level.
4. Discuss suitability for NRT or varenicline and initiate via prescribing staff.
5. Continue to monitor and support patient for length of hospital stay.
6. Arrange follow-up support by referring to community stop smoking advisor and linking to community pharmacy service for NRT or varenicline for up to 12 weeks.
7. All patients on stop smoking programme prescribed and supplied with 2 weeks NRT for hospital use and on discharge.

If the patient does not want to stop smoking then assess whether they need symptomatic relief for acute nicotine withdrawal.

• If symptomatic relief is not required then advise patient regarding the health risk of continued smoking and the benefits of stopping smoking. Also give Quit Your Way Services information and leaflet and the Quit Your Way Scotland telephone number (see Appendix 6 for contact details).
• If symptomatic relief is required then prescribe Nicotinell^® patch:
  • If >20 cigarettes/day smoked – 21mg patch
  • If <20 cigarettes/day smoked – 14mg patch

  The manufacturer recommends 24 hour use of the patch to avoid morning cravings but it can be used for 16 hours to avoid sleep disturbance. Endorse Kardex "For Acute Withdrawal only" and review need daily.

• Discontinue prescription on discharge. If patient wishes to make a quit attempt, refer to the Quit Your Way - Hospital Service before discharge (preferred method of referral is via TrakCare or see Appendix 6 for contact details)

N.B. All pregnant women should be referred to Quit Your Way - Pregnancy Service (see Appendix 6 for contact details).

Guideline reviewed and content updated August 2020