2006 OPEN FORUM Abstracts
A SYSTEMATIC APPROACH TOTOBACCO CESSATION INTERVENTION
Nancy
Ayers RRT, AE-C, Marsha Becker RRT, AE-C, Carole Dorr BS,
RRT,
Saralyn Foley BS, RRT, Pamela Rock BA, RRT, Suzanne Smith
MBA, BS, RRT, and Rick Wieand, BA, RRT.
Lehigh
Valley
Hospital
, CC & I78,
Allentown
,
PA
18105
Background: Tobacco
abuse imposes both health and financial burdens on the individual and the community.
Lehigh
Valley
Hospital
and Health Network (LVHHN) has developed a Tobacco
Cessation Initiative to provide assistance to meet these needs. The program
identifies patients who use tobacco products and offers advice and support for
cessation. Problem: Existing tobacco
intervention program and personnel were inadequate to meet the need for
inpatient tobacco cessation interventions. Documentation of completed and
missed consultations, referrals and outcomes were inconsistent. Purpose: A team of skilled clinicians
was developed to provide a systematic approach to tobacco cessation
intervention for the inpatient population. The Community Health sponsored
Tobacco Treatment Program (TTP) was developed to provide outpatient treatment
and counseling.
Method: A specialized team of Respiratory Care
Practitioners were trained to provide bedside tobacco cessation consultations.
Patients are identified by answering "Yes" to the question "Do you smoke or
have you smoked in the last 12 months?" on the hospital admission datasheet.
Additional patients are identified through the JCAHO Core Measures
program for AMI (acute myocardial infarction), CHF (congestive heart failure),
and Pneumonia. The medical professional staff is encouraged to provide advice
to quit and request formal Tobacco Cessation Consults. Bedside intervention by
the specialized team includes assessment of degree of nicotine dependence,
discussion of quitting strategies, and review of cessation programs available
in the area. Upon completion of the intervention, the consultation forms,
including those for patients who have refused intervention, are placed in the
patient's chart, and a copy is forwarded to the outpatient TTP for follow-up.
The TTP offers individual counseling including pharmacologic recommendations,
behavioral modifications, psychosocial support and follow-up for a 12 month
period.
Results: Documentation of
completed and missed consultations was inconsistent for 1998 and 1999, before
the specialized team was developed. Between 2000 and 2004, completed tobacco
cessation interventions increased more
than three-fold, from 320 to 1048
per year. Additionally, the implementation of JCAHO Core Measures increased the
number of interventions in 2005 to1816. A completion rate of 76% has been
achieved despite barriers of patient unavailability and early discharge. Outcomes: Before the formation of the
specialized team, the approach to inpatient tobacco cessation counseling was
inconsistent. Implementation and
expansion of the specialized team and greater priority placed on inpatient interventions
have resulted in a 5.7 fold increase in completed interventions with a 76%
completion rate. Of the 2397 ordered consults, 1816 were completed. Referral to
the outpatient Tobacco Treatment Program offers ongoing treatment, provides
accurate documentation of statistics, and tracks outcomes. The authors acknowledge the contributions of
Michelle Serfass, RRT and Bernhart
Hochleitner, RRT, AE-C.