2003 OPEN FORUM Abstracts
OUTCOMES OF A COMPUTERIZED TOBACCO DOCUMENTATION PROGRAM
Nanette Sorensen BS RRT, Vrena Flint MBA RRT, Stephen Howe MBA, Gaylene Anderton RN, Gary Melville BS CS, Maureen Davies BS, Curt Calder RD CD, Jan Orton RN MS, Respiratory/ Cardiovascular/Information Systems Departments, Intermountain Health Care (IHC) Hospitals, Salt Lake City, Utah.
Background: Tobacco Cessation Guidance & Education is a Board Goal Measurement for IHC. The goal was to provide tobacco advice/counseling to > 50% of current or recent (quit within one year) smokers in Respiratory Care (RC) & Cardiovascular program (CV), (2003 > 70%). Three methods were utilized in an attempt to provide optimal results.
1. Pharmacy & Registered Nurse (RN) notified the Respiratory Care Practitioner (RCP) of the patient's tobacco history.
2. Respiratory Care web-based query of the patient tobacco history.
3. Computerized inpatient tobacco use identification/documentation, involving all health care providers.
The first two methods were successful in identifying patients but were not capturing the full patient subset. It was agreed across the sites that computer programming be done for tobacco cessation in support of this major initiative.
Method: Tobacco use evaluation included reviewing patient charts daily. In the beginning of the process, the Pharmacy & the RN notified the RCP of the patient's tobacco history. Even though it was a great improvement, it was not time or cost efficient.
1. A RC web-based program was designed to query patient histories. Respiratory Care Practitioners scanned medical histories daily, for key highlighted words, like "smoke", "tobacco", "chew", etc. to identify the tobacco users. The assessment team then contacted the patients & educated them for options & resources available to stop tobacco use.
2. A group representing different sites within IHC formed a "Think Tank" to propose an electronic solution that would benefit all Urban IHC hospitals. The ideas include computer applications designed to identify, document & measure all inpatients 10 years of age & older. The measurement reports include an aggregate & detailed review for quality management & data collection.
RESULTS: We were ecstatic with our findings! From Step 1 to Step 3, the results progressively increased. In Step 1, the RN & Pharmacy notified the RCP, resulting in 11 patients identified per month. We realized we were still not capturing the inpatient arena. Step 2, the web-based program, was designed to query the patient history for tobacco use on a daily basis, resulting in 22 patients identified per month. However, we still were not capturing the full inpatient audience. Step 3, the computer identification application was installed to elicit the help of all health care providers & to notify the RCPs of the tobacco status of all inpatients. This resulted in a four-fold increase of 101 tobacco users identified per month.
CONCLUSION: Tobacco Cessation is a Board Goal Measurement for IHC. The data acquired reflects that using computerized tobacco identification & documentation surpasses the traditional methods, (Step 1 and Step 2) & will enable us to increase the patient identification & the tobacco cessation percentages.