SMOKING CESSATION

1
SMOKING CESSATION

• SHARING BEST PRACTICES
• TELECONFERENCE
• 19 OCTOBER 2004
• MICHELE ACKER
• DIRECTOR CARDIOPULMONARY
• WAYNE HOSPITAL
• GREENVILLE, OHIO

2
HISTORY OF WAYNE HOSPITAL SMOKING CESSATION
EDUCATIONAL PROGRAM

• July 2001 - Wayne Hospital Smoke Stoppers Smoking
  Cessation Program established .
• July 2002- Inpatient smoking cessation education
  being tracked
• Respiratory therapy tasked with distributing
  pamphlets to patients who had a smoking history
  and were on respiratory treatments or oxygen.
• Nursing tasked with notifying respiratory if a
  patient was not on respiratory treatments.
• March 2003- Computerized charting began at Wayne
  Hospital
• Education section noted smoking cessation
  education given on respiratory treatment flow
  sheet
• Tracking of smoking cessation education performed
  by nursing staff and performance improvement
  coordinator.
• June 2003 -Performance improvement coordinator
  presented Keys to Success w/ Smoking Cessation
  Counseling to inpatient care committee- Ohio
  Kepro Article.
• July 2003- Work began for implementation of
  clinical pathways for CHF and Community acquired
  pneumonia- Trigger placed on pathway to call
  cardiopulmonary for smoking cessation education
  if patient had a smoking history.
• September 2003-
• Respiratory therapy began monitoring smoking
  cessation education documentation on respiratory
  patients.
• Clinical pathways approved for use
• June 23, 2004-Respiratory Therapists attended the
  Ohio Kepro Smoking Cessation Teleconference
• July 2004-Respiratory began working on ad hoc
  report to identify inpatients who smoked
• September 2004- daily ad hoc report generated
  from computer system identifying all patients in
  hospital who smoke
• October 2004- Use of clinical pathways made
  mandatory by medical staff.

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DISCIPLINES INVOLVED IN IDENTIFYING AND EDUCATING
PATIENTS WHO SMOKE

• Registration supplies the information of patient
  status, i.e.., inpatient, outpatient, or
  emergency department, when the patient is
  registered.
• Nursing identifies the patient as a smoker or
  nonsmoker with the initial patient assessment.
• Respiratory identifies the patient as a smoker or
  nonsmoker with initial assessment on patients
  receiving respiratory treatments or oxygen.
• Cardiopulmonary clerk prints out daily ad hoc
  report with a list on patients who smoke.
• Respiratory therapy presents the patient with a
  pamphlet from the American Cancer Society along
  with an insert describing the outpatient smoking
  cessation program and number to call to enroll.
• The telephone number for the Ohio Tobacco use
  prevention and control foundation quit line is
  printed on the insert.
• The dietician presents the class on healthy
  nutrition during the outpatient program.
• A section for physician smoking cessation
  education is present on the clinical pathway
  discharge orders.

4
TRENDING DATA

• CHF 3RD QUARTER 2002- AVERAGE 90
• 3RD QUARTER 2003-CAP 25, AMI 33
• 3RD QUARTER 2003 RESPIRATORY EDUCATION AVERAGE
  -65
• 4TH QUARTER 2003-AMI-NO APPLICABLE PATIENTS, CAP
  38, CHF-75
• 1ST QUARTER 2004
• AMI- NO APPLICABLE PATIENTS, CAP 44, TOTAL 9
  PATIENTS,
• CHF, 1 PATIENT WAS NOT COUNSELED.
• RESPIRATORY STATISTICS FOR 2004
• AVERAGE 43 FROM JANUARY-AUGUST
• SEPTEMBER -AD HOC REPORT-100

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IMPROVEMENTS ALONG THE WAY

• The initial process was too loosely defined.
  Nursing was supposed to hand out the pamphlets on
  patients not receiving respiratory treatments.
  Respiratory was supposed to hand out pamphlets to
  respiratory patients.
• Although the clinical pathways were implemented
  in September of 2003, many physicians did not
  utilize them. The trigger for education was not
  helpful because they were not being used.
  Clinical pathways have now been approved to be
  mandatory on acute myocardial infarction
  patients, community acquired pneumonia, and CHF.
• Respiratory therapists were not always notified
  of smoking patients.
• Initial assessments and education by respiratory
  was sporadic.
• Due to workload
• agency and resource use
• lack of buy in by the therapists
• After the teleconference from Ohio Kepro in June
  2003, more therapists bought into the importance
  of their role in the education process.
• The addition of the daily ad hoc report
  identified all patients who smoke.
• Pamphlets have been placed on all the nursing
  units as well as in the department where they are
  in sight and easily accessible.

6
EXPANSION OF THE PROGRAM

• With the implementation of the daily ad hoc
  report, we have identified a large population
  that was being missed before due to the
  identification process---- New mothers
• We have also provided the Pre admission testing
  nurse with pamphlets to distribute to pre
  surgical patients.
• Our goal at Wayne is to continue to reach out
  into the community to educate the public on
  smoking cessation and prevention. We have been
  doing this by attending various health fairs in
  the community and presenting information to the
  community.
• In April the plan is to team up with the Miami
  Valley Youth Health Improvement Coalition group
  from the High School to present an interactive
  booth on smoking prevention for the 5th grade
  health fair at our local fairgrounds. This
  should expose approximately 1000 5th graders to
  the dangers of smoking.
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

7
CONCLUSION

• Having been a smoking cessation facilitator for
  3 years and having seen the low statistics of
  attendance and relapse of people who quit
  smoking, I sometimes wonder if it is worth it.
• Then in the next class we get a couple who have
  smoked for 60 years and they quit together. .. Or
  the man who was going to have to go on disability
  but was able to continue working after quitting.
  Then I know, it is all worth it.
• We have to do it.. ONE PATIENT AT A TIME
  
  
• THANK YOU
• FOR QUESTIONS OR COMMENTS , PLEASE FEEL FREE TO
  CALL
• SHELLY ACKER AT 937-547-5943
• OR E-MAIL AT michele.acker_at_waynehospital.com