Improving Hospital Based Smoking Cessation

[Scott Crespy]

Telephonic interviews were conducted with staff members who represent 14 out of 18 hospitals that presented (i.e., at a workshop, on a conference call) their tobacco control/smoking cessation processes of care during the recent IPRO Smoking Cessation Collaborative. Notes from these discussions were taken and integrated. At regular installments we will be posting on JENY various topics that summarize the lessons learned shared by these facilities. Please share your experience by posting a message reply. Thanks.

Scott Crespy

How can my organization obtain leadership buy-in?

According to those interviewed, leadership buy-in was very important and often a critical element to successfully moving their hospital smoking cessation efforts forward - as one interviewee noted, it: “opens many doors” and assists in the allocation of appropriate levels of resources. Ideally, involve as high a level of administrative support as possible and then form a multidisciplinary committee with high-level decision makers.

Several hospitals with leading smoking cessation programs reported that they had leadership buy-in from the start. A strong involvement with core measures; QI or public reporting was found to help in making an easy transition to focusing on smoking cessation. Highly motivated leadership coupled with tobacco control being a priority, often paves the way to the development and institution of organizational policy.

Here are some strategies that have been useful in obtaining leadership buy-in:

Engage a board member or other high level of administration in early tobacco control/smoking cessation planning efforts (e.g., participation in grant writing). This person can later engage/lobby other board members to support these efforts.
Leverage support from members of administration who have supported previous quality improvement efforts. They will likely more readily appreciate the need for focusing on this topic.
Work with an administrative member of who has relevant clinical experience (i.e., knows the deleterious effects of tobacco). This person will likely be able to speak to other members of administration on both a clinical and a financial level. Also, If CEO or other high level member was an ex-smoker; he or she may be a very strong advocate.
Highlight when insurance company contracts provide financial initiatives for meeting clinical measure goals.
Highlight the point that smoking cessation is both a JCAHO and CMS quality indicator for three core measures.
Human resource administrators can emphasize how smoking impacts on the number of company healthcare dollars spent on employee health.
Emphasize the important role that physicians’ advice and support play in the success of smoking cessation efforts.
Remember; even if a high level of support exists for tobacco control/smoking cessation, providing the necessary structure, organization will still be needed.

We invite you to share your comments on this message board. Thanks.

Scott Crespy, PhD

[Scott Crespy]

In our second installment, our focus is on successfully assembling a planning or quality improvement team.

Most of the hospitals reported that having a multidisciplinary team was very important to the success of their tobacco control/smoking cessation efforts. To obtain maximum buy-in, early inclusion of representatives from each of the disciplines is necessary. This was seen to be very helpful in coordinating activities and ensuring high quality care across all departments (e.g., ED, ambulatory, and primary care). Some hospitals reported having long standing tobacco control teams - others long standing QI teams; however, most did not appear to have teams that combined the valuable experiences of both.

Here are some suggestions for assembling a smoking cessation team:

Explain the purpose and goals of the team to the leaders of each discipline and let them know exactly why their disciplines were critical to goal obtainment.
Top leadership buy-in and support is the surest way of assuring active participation from other key leaders (i.e., being able to use the name of the “higher-up” who is backing you). For example, “Mr. Smith (i.e., the CEO), has recommended you (high level departmental decision maker) to serve on the tobacco control committee, would you be interested in becoming involved? (It has been observed that almost no one ever declines when they know that the CEO has asked them to be involved.)
Combine existing tobacco control/smoking cessation team with core measures QI team (i.e., that focuses on Acute MI, CHF, Pneumonia).
Build from the experience and multidisciplinary membership of an already existing core measure team (add additional disciplines as needed), when no tobacco control/smoking cessation team exists.
Identify one person who will lead in organizing and coordinating the activities for the initiative. It was noted that, a QI leader can sometimes be very helpful in selecting and assembling the appropriate team members. Consider some of the following characteristics when determining the team’s composition: desired clinical expertise, strong agent of change, ability to procure needed resources, strong interest in the topic and represent department(s) that need improvement
Obtain broad departmental representation (e.g., employee health, managerial, administration, quality improvement, nursing, public relations, cardiac rehabilitation, business management - especially when insurance and other business contracts were involved, pharmacy and employees who interacted with external agencies - e.g., state grants, county sponsored activities).
Write a letter to prospective members to introduce the tobacco control initiative, outline the smoking prevalence and the impact that tobacco has on health outcomes of the community for which the hospital serves. If you have administrative buy-in, include how the smoking cessation initiatives are central to corporate strategic plans.
A large multidisciplinary team is not always feasible or necessary. One successful program in our collaborative that took place in a very small hospital. The cessation coordinator, “a one-man operation and quality improvement team all together,” demonstrated that a single person can conduct the counseling, track the information, perform and present the QI/PI reports to the Professional Activities Committee on a quarterly basis (so don’t despair).
We are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our third installment, our focus is on the importance of setting goals and/or outcomes to the success of tobacco control/smoking cessation effort. As one collaborator stated: “if you are not sure what you are looking at, you wont be able to achieve it”.

While many of the collaborators recognized that focusing on tobacco control/smoking cessation was important, often the major impetus came from needing to meet the standards of care set by external governmental (e.g., state grant), third-party payer (e.g., Medicare, insurance company) or regulatory agency (e.g., JCAHO). Goals developed often were set to meet or exceed these standards.

Clearly stating the purpose of the team up front helps in the process of defining the projects goals.
All members actively contribute toward the development and operationalization of the project goals. This increases buy-in and helps to ensure that the goals are more realistic.
Goal setting is easier when working with an established, cohesive team.
The QI/PI team brings valuable experience in outcome measurement and goal formulation.
Align facility goals with group collaborative goals. You can always broaden or modify the goals as needed (e.g., all inpatients, psychiatric patients, smoke free policy).
Limit initial goals to a sample patient population in order to build confidence, momentum, and expertise. These goals can be revised and broadened to as needed. For example, one facility started with CHF and critically ill patients and then quickly spread to looking at all inpatients identified as smokers.
Enhance processes for the measurement of goals. For example: at one facility, substantial systemic modifications were made to the electronic record system to create a process for identifying smokers that would be both universal and that could be sustained.
Goals need to be institutionalized and responsibility not just placed at the programmatic level. Institutional policy can be established to provide the guiding vision to establish smoking cessation as an institutional priority.
We are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our fourth installment, we focus on how data (e.g., concurrent, retrospective, etc.) can be used to strengthen smoking cessation quality improvement efforts.

Collaborators reported that the data collected from conducting chart reviews, was critical as it allowed them to determine how well they were accomplishing their goals. They also reported that the data helped them to trouble-shoot and identify areas that needed improvement. This allowed them to better focus their efforts to achieve their desired goals.

Here were some suggestions collaborators had for using data:

Publicly display comparative data. This can capitalize on the individual and departmental pride and can tap into the natural competitive spirit within the organization - using motivational processes (e.g., ”Gaming Theory" combined with cognitive dissonance) can positively influence institutional culture and norms by stimulating an increase of cessation activity hospital-wide. For example, provide physicians with the rates that they prescribe NRTs to their patients.
Tie results back to the medical staff. Present data results during mandatory staff education (e.g., nursing) on smoking related care performance levels can play an important part in educating and motivating staff (e.g., it was noted that the staff “really love it when you can show them improvement.”)
Present data at team meetings, departmental meetings, medical staff meetings, and/or board meetings.
Present data results to site visitors from accreditation agencies (e.g., JCAHO).
Simplify presentation of data (run-charts and/or bar graphs were preferred).
Use both concurrent and retrospective data collection methods. Use retrospective chart reviews to identify areas that need improvement then conduct concurrent reviews to improve those identified areas.
Transition to unit staff conducting concurrent chart reviews. This can be a powerful method for them to self-monitor care provided and get feedback about how well they are meeting goals set. This allows them to recognize and make changes to their processes of care as needed.
Start with smaller, more manageable patient populations (e.g., on a limited number of units). This allows changes to be made quicker; it is then easier to roll out the efforts more broadly once "the kinks [are] out of the system.”
Carefully define the questions in the medical records to improve upon the accuracy and usefulness of the data.
Electronic charts provide easier data access. They allow for faster feedback and facilitate rapid cycle changes.
As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our fifth installment, we focus on how rapid-cycle methodology (e.g., plan, do, check, act) can be used to improve QI efforts.

Many hospitals reported that they use some form of Rapid-Cycle Methodology (RCM) as a system for making improvements once an area of interest has been identified. Several hospitals indicated that they use Plan, Do, Check, Act cycles regularly in both their QI and other departmental work. Some reported a great familiarity in this process and full embracement of this model.

The PDCA model uses information gained from data to focus attention on areas that need improvement. It helps to direct energies toward relevant interventions, and it provides the framework for reassessing the effectiveness of changes made, which can then lead to further refinements.

Here are some specific suggestions made by collaborators:

Needs assessment analysis obtained from chart-reviewed data can determine the current status of cessation care.
Focus attention on the weaker areas in order to close existing service gaps.
Use data from multiple sources when evaluating and reevaluating performance. This provides information that can otherwise be overlooked.
“Tweak” and improve processes of care through trial and error methods.
After initial limited population focus (e.g., with CHF and PNE populations), generalize and transition to other units (e.g., nursing-led self-management).
Real time (concurrent) chart audits with identified patients are useful in maintaining gains. Look at charts on a daily basis to help guarantee that patients received proper care.
The modified medical model (clarify opportunity-assessment; cause analysis-diagnosis; counter-measures-plan and implement; consolidate improvement-follow-up and evaluation) to guide processes was offered a useful alternative.
Learn more about designing a rapid-cycle-change quality improvement project for smoking cessation at your facility. (http://jeny.ipro.org/showthread.php?t=59)
It was noted that experienced QI professionals tend to recognize the importance of RCM and PDCA and are likely to have it well integrated in their everyday work. It was also noted that the Check and Act steps much easier when electronic charts (i.e., ease of data access) are used.

As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our sixth installment, we focus on using systems and/or multidisciplinary approach (e.g., coordinated effort between units, community resources, etc.) to enhance tobacco control efforts.

A systems and/or multidisciplinary approach focuses on the fact that a hospital is system and that it is a part of the larger community system as well. Recognition and consideration of systemic issues is important in being able to capitalize on potential resources while limiting many possible barriers; it recognizes that change is more apt to occur through the coordination of efforts across internal (i.e., multiple departments) and external stakeholders. Creating systemic change (e.g., through changing company policy) helps to maintain gains in the face of staff turnover.

Here are some suggestions by our collaborators to promote systems change:

Conduct a review of the existing hospital smoking cessation systems.
Tobacco control/smoking cessation hospital policies developed with administration support promote systems change. Policies that address both employees and patients issues (e.g., smoke-free hospital campus) can affect system change all the way from grounds keeping on up.
Involve all clinical departments and leaders that focus on patient care.
Physically situate smoking cessation services in the medical facility, not in behavioral health or stand-alone structures. Integration with medical services better reaches patients and fosters easier communication with the medical staff.
Integrate cessation staff into regular routines on medical units (e.g., ER, inpatient units). For example, hospital intervention team carries smoking cessation materials when responding to chemical dependency. If seen as a separate service (e.g., as behavioral health), it tends to become less integrated and therefore less utilized.
Create internal integrated information systems. For example, work closely with MIS department to create integrated electronic medical records, reports, order entry system, etc.
Develop a community presence and partner with external organizations. Keep close communication and conduct outreach programs with local universities, elementary schools and other institutions as well as partner with local organizations (e.g., IPRO, county, state, ACS, etc.). Use media (e.g., TV, radio) to capitalize on the fact that smoking cessation is a hot topic.
As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our seventh installment, we focus on identifying current or recent smokers in the context of a paper medical record system.

Most hospitals use paper medical records for their inpatient population (as of April 2005, there appears to be a trend towards hospitals transitioning to electronic medical records – which, usually tends to begin in outpatient services). For hospitals using paper medical records, the most common and consistent place for identifying patients’ current and/or recent smoking history appears to be in a nursing admission history form. This form is usually either reviewed by or completed by a nurse upon admission.

Here are some suggestions offered by interviewees for identifying patients:

Combine identification and brief intervention in one step upon admission (structure after the Public Health Services (PHS) 5As model). ASK all patients if they have smoked any cigarettes in the past 12 months; ADVISE the patient to quit; provide a self-ASSESSment tool (Readiness to Change Ruler), tool has self-help information to ASSIST them make a quit attempt and ARRANGE for them to discuss this information with in-house interventionist staff.
Use admission to “set the stage” for a successful patient quit attempt.
Prepare patient for being smoke-free while in the hospital.
Staff to function as patient advocate and encourage/facilitate use of NRTs to enhance patient comfort.
Pave the way for follow-up consult by interventionist staff.
Provide smoking cessation information.
Document these interactions.
Assess for any tobacco use in the past 12 months. Many patients who reported that they quit had their last cigarette on the way to the hospital.
Provide a place on the nursing admission form to document that patient was given information and that a referral for cessation counseling was made.
Use pre-admission visits as opportunity to prepare patient for being smoke-free, encourage them to consider a quit attempt and provide them with cessation information (e.g., quit card- business sized card with quit-line and local cessation resources)
Identify smoking history on any "short stay" forms (less than 24 hours) as well.
Develop physician standing orders for NRT use.
As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our eighth installment, we focus on identifying current or recent smokers in the context of an electronic medical record system.

A few of the hospitals have reported that they are currently using electronic medical records, many others have indicated that they are either considering, planning or have begun to transition to using medical records. In addition to incorporating all of the cessation processes involved in a paper medical record system, an electronic medical record system offers many more features that assist in consistently identifying, facilitating and documenting cessation efforts.

Here are ways electronic medical records are used to identify current or recent smokers to enhance cessation efforts:

Nurse or physician use electronic system to conduct admission interview and/or history and physical
Make tobacco use inquiry mandatory (can't move onto the next screen with out discussion tobacco)
Additional screen(s) can drop down with follow-up questions for patients with a positive current or recent history (e.g., patients’ stage-of-change for making quit attempt, formulary for NRT quantity and type, etc.)
Order sheet for NRT can be automatically produced based on patient consumption level
Build in process to follow-up with those patients who can't communicate upon admission
Advantages of having NP or MD diagnose the patients smoking history:
(1) Fosters buy-in and increases use of cessation services
(2) Orders/requests for counseling and/or pharmacotherapy are made real-time (facilitates cessation follow-up).
(3) Physicians manage any potential drug-drug interactions (NRTs with other meds)
Allows for printing patient educational information individually tailored to patients needs (e.g., cessation information and quit-lines for smokers)
Tracks and provides daily report of smokers requiring cessation consult
Can link with other electronic systems (e.g., ER, patients not admitted)
Can facilitate telephonic post-discharge follow-up
Case management can include cessation module in clinical software program (e.g., MIDAS) that can interact with hospital admission electronic records
As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our ninth installment, we focus on other processes to facilitate identification (e.g., standing orders, clinical pathways, etc.).

Interviewees indicated several other processes that facilitate identification of smokers:

Include smoking cessation in clinical pathways (e.g., pneumonia, CHF, and COPD). Facilitate physicians’ prescription of pharmacotherapy NRTs increases use of other options on the patients’ treatment plan.
Incorporate standing orders for a cessation counseling consult (e.g., RT) for patients interested in quitting.
Provide automatic cardiac rehabilitation referral through standing order for patients with particular diagnoses (e.g., AMI). Cardiac rehabilitation consults generally which includes cessation assessment/intervention.
Physicians either use a standardized order set or write own orders for smoking cessation consult. Consider incentives to promote using standardized orders.
As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our tenth installment, we focus on the processes related to notifying disciplines that provide cessation services when these services are needed.

Based on discussion with interviewees, there are many different disciplines that provide hospital-based cessation counseling (e.g., nursing, respiratory therapy, case management, discharge planning, addictions counselors, psychologists and physicians). Nursing and respiratory therapy appear to provide a large share of these services.

Some hospitals provide a brief cessation intervention (e.g., provide information) upon admission to either all patients (regardless of smoking history) or for all current or recent smokers (which then is followed up by a more intensive in-house consult). This multi-step intervention process is conducted to both provide patients with early assistance during their hospitalization and for documenting that all patients receive minimal cessation services.

When paper medical charts are in use, some interviewees described linking the smoking cessation consult to a single common process of care already in place that every patient is likely to receive.

Have one identified hospital staff position (e.g., charge nurses) that is already responsible for reviewing admission assessments make a referral for cessation consult. For example, charge nurse adds the names of all current or recent smokers or just those who are interested in quitting on a list (e.g., ”Cessation Sheet") or enter onto a computer database, to be shared with interventionist staff (e.g., RT, clinical nurse, social work, psychologist).
Train hospital staff (e.g., case-management, discharge planners) who already conduct daily chart reviews of new admissions to provide cessation services to every current or recent smoker.
Interviewees described other communication strategies to notify cessation interventionists of when consult is needed.

Nurse referral or physician order for consults
Nursing care coordinator enters cessation consult into clinical software package and/or computerized order system and produces a list that prints out in cessation provider department (e.g., RT)
Nurse provides psychological staff with list during rounds
List of patients prescribed pharmacological medications for smoking cessation
Daily electronic reports of standardized orders. Referrals from each of the standardized orders are brought together in one database in one centralized place - reports are printed daily and the patients are divided up between the cessation specialists
Cessation provider obtains and reviews admission list each morning
As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our eleventh installment, we focus on incorporating the PHS clinical guidelines (e.g., 5As and 5Rs) into cessation services.

The hospital staff indicated two major ways that the 5As and 5Rs are incorporated into the cessation services that are provided:

Formally integrate 5As into the processes of care provided by the admitting nurse. ASK all patients if they have smoked any cigarettes in the past 12 months; ADVISE the patient to quit; provide a self-ASSESSment tool (e.g. "Readiness to Change Ruler (http://jeny.ipro.org/attachment.php?attachmentid=707)"), tool has self-help information to ASSIST them make a quit attempt and ARRANGE for them to discuss this information with in-house interventionist staff.
Distribute information and train staff using the 5As and 5Rs and allow them to inform interventions provided
More information about incorporating the 5As/5Rs into hospital-based cessation counseling. (http://jeny.ipro.org/showthread.php?t=219)
As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our twelfth installment, we focus on incorporating Motivational Interviewing into cessation services.

According to several of the interviewees, Motivational Interviewing (MI) techniques were being used in the cessation counseling provided at their facility. Some mentioned the use of the book "lifestyle change" and others reported that their staff received training focused on the use of MI techniques.

According to one program coordinator, “the centerpiece of the motivational work is to determine what the things are that motivate each individual patient and it is critical to know the types of things that are important to each patient in order to maximally have an impact on them.” For example, asking, “How would your life be different if you did not use tobacco?”

Here are some ways that MI was being incorporated in the cessation counseling:

Invite patient to discuss their smoking (most agree to talk)
Learn about where the patients stands with their smoking
Use of open ended questions
Assess interest/willingness to quit
Identify barriers to quitting
“Planting the seed with patients regarding quitting”
An emphasis on moving patients forward
Visit our on-line Motivational Interviewing library (http://jeny.ipro.org/showthread.php?t=60)
More information about applying Motivational Interviewing techniques (http://jeny.ipro.org/showthread.php?t=105)
As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our thirteenth installment, we focus on additional counseling strategies and/or techniques incorporated into cessation services.

Several hospitals indicated that they try to take advantage of the higher receptivity that patients have due being hospitalized with an acute physical problem. One interviewee referred to this as “Event Motivated Behavioral Change,” (patients that have certain diagnosis or conditions, e.g., AMI, pregnancy, are likely to have higher level of motivation to make lifestyle changes, such as quitting smoking).

Here are some techniques that interviewees reported using with their patients:

Establish a rapport with the patient
Empathize with the patient about not being able to smoke in the hospital and function as their advocate in order to help them to feel comfortable (e.g., NRT use for nicotine withdraw). Inquire about how patients are managing without the cigarettes (use open-ended questions).
Provide support, encouragement and use a non-threatening approach
Make the connection between their smoking and reason for their hospitalization
Assess smoking stages of change and provide appropriate intervention for that stage.
Assess level of addiction (e.g., Fagerstrom Test for Nicotine Dependence)
Discuss pharmacotherapy options
Inquire about previous quit attempts
Provide information for dealing with urges
Identify coping strategies to deal with relapse triggers (e.g., driving, tobacco company advertisements)
Determine and help develop external supports at home
Create an action plan for discharge
Provide list and contacts for community resources (e.g., NYS quitline)
Describe any inpatient or outpatient cessation classes offered
As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our fourteenth installment, we focus on strategies for documenting smoking cessation advice/counseling.

Several strategies were noted for documenting that cessation counseling services were provided, which included:

Placing a smoking cessation counseling sticker or stamp onto the progress note to document the cessation intervention. Medical record departments reportedly found this method easier to determine whether the intervention was conducted.
Documenting cessation intervention on a nursing assessment, intervention sheet, treatment planning, or discharge planning sheet
Placing NRT recommendations in front of chart or in physicians progress note
Some specialties (e.g., psychology, respiratory therapy) document on their own progress notes
Document on a multidisciplinary patient education teaching tool/teaching form
At some facilities, cessation counselors also enter information of the intervention into a computer. A few facilities primarily utilize a computerized system and document on electronic care notes or patient education forms.

As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our fifteenth installment, we focus on assessment of patient’s readiness to make a quit attempt (e.g., use of stages of change – precontemplation, contemplation, etc.).

Many facilities assess the degree to which patients are interested and/or ready to make a quit attempt. Some hospitals use a more formal process of assessing patients’ level of readiness to make a quit attempt, others are seek to determine whether a patient is interested in making a quit attempt.

Here are some suggestions for formally incorporating stages-of-change in smoking cessation processes of care:

Provide staff with training on the stages-of-change model
Place readiness levels to change on cessation counselor intake form or patient educational area
Assess patients readiness-to-change (e.g., precontemplative, etc.)
Provide patients with a stages-of-change self-assessment and informational tool (e.g., "a ruler") upon admission. Review with patient during cessation intervention.
Document patient readiness to change in chart.
Other facilities tend to simply ask patients if they are interested in quitting and tend to limit interventions to those patients that indicate an interest. Results of interactions are then documented. Patients are provided with assistance if they are interested in making a quit attempt, and for those patients who refuse these services – documentation is noted in the chart.

As always, we are very interested in your thoughts about the suggestions offered by your peers in our collaborative. Please post a reply and share you thoughts and reactions today.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager

[Scott Crespy]

In our last installment, we focus on smoking cessation resource information and materials.

There is a wide variety of smoking cessation information and resources that hospitals provide to patients. Some of them are “home-grown” and others purchased from external organizations. These materials provide patients with useful information regarding making a successful quit attempt. Hospitals also have a heavy reliance on the NYS quitline in addition to in-house cessation services.

Here were some suggestions:

Provide community resources for quitting including the NYState Quitline
Information about various NRTs
Phone numbers for both in-house and external resources
Information about smoking as a cardiac risk factor (for cardiac patients only).
In addition to the typical information offered to patients, one hospital provides patients who are interested in quitting with a Relaxation CD

We hope that you found these suggestions from your peer to be helpful and would greatly value your feedback.

P.S. As the person who conducted the phone interviews with the 14 centers across the state, I would like to note that it was wonderful getting to know such outstanding professionals as well as the many others across the state throughout the collaborative. I am grateful for this opportunity.

Scott Crespy, PhD
IPRO Smoking Cessation Project Manager