2006 OPEN FORUM Abstracts
A SYSTEMATIC APPROACH TOTOBACCO CESSATION INTERVENTION
Ayers RRT, AE-C, Marsha Becker RRT, AE-C, Carole Dorr BS,
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.