Smoking remains a chief avoidable cause of morbidity and mortality in the US. Healthcare organizations should be in the vanguard of efforts to develop smoking cessation programs. Inpatient smoking cessation programs (ISCPs) are often more effective than those in the ambulatory setting. One year abstinence rates as high as 70% have been reported for cardiac patients enrolled in ISCPs. We report our experience with initiation of an ISCP at our institution.
Our 450 bed, university-affiliated hospital is in northwest Brooklyn. The goal was to provide cessation advice to all hospitalized smokers (smoked within the past twelve months) without new hires. Three staffers, all with other primary responsibilities (Asthma Center coordinator, Adult CF Nurse Coordinator, bronchoscopy RN) were trained as counselors using the 1996 US DHHS guideline. The 5Rs (Relevance, Risks, Rewards, Roadblocks, Repetition) and 5As (Ask, Advise, Assess, Assist, Arrange) were the key concepts learned and the focus for patient counseling. Understanding nicotine replacement therapy (NRT) and the use of buproprion were emphasized. A roster of newly admitted smokers is created by the hospital’s case managers each AM and faxed to the Smoking Cessation Center (SCC). Counselors see patients that day. Patients accepting, receive 5-10 minutes of counseling and written materials. Those declining, receive materials. Charts are stamped, documenting smoking cessation counseling. Physicians are encouraged to prescribe NRT and/or bupropion. Nursing staff are informed of the intervention. Monthly contacts via phone or email are attempted for patients agreeing to follow-up.
The ISCP began 7/04. Outcomes through 3/05 are shown in the table. The project has been publicized widely and has enjoyed broad support from clinical leadership, providers and administration.
Our experience suggests that ISCPs can be implemented without additional hires. Success requires broad institutional support, staff commitment based on an understanding of, and passion for, the task, and creative scheduling.
Wide-scale development of ISCPs could reduce tobacco use in the US especially benefiting those with smoking-related illnesses resulting in hospital admission.
ISCP 9 Month OutcomesTotal patients seen635Committed to quit458 (72.1%)Agreed to follow-up270 (42.5%)Contacted ≥1 times139 (51.5%)Abstinent @ 1-9 mos75 (54.0%)
Kathy Garrett-Szymanski, None.