Empowering Nurses to Provide Smoking Cessation Advice

Team Members:

Loyola Smoking Cessation Task Force

Opportunity for Improvement

One of the JCAHO Core Measures for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF) and Pneumonia patients states that hospitalized smokers (any patient who has smoked cigarettes in the last 12 months) must receive advice to stop smoking during their hospital stay. Initial results from AMI Core Measure Data showed that 58.3% of smokers were advised to quit smoking during their hospital stay.

Most Likely Causes

Hospital staff unaware of JCAHO definition of a smoker.Lack of a central location to document smoking status or advice given.Many staff nurses not comfortable in discussing smoking cessation with patients and unaware of smoking cessation resources available for patients.Smoking cessation patient education materials not readily accessible on nursing units.

Solutions Implemented

Nursing Database changed to accurately collect smoking history information.Screens added to LUCI to document smoking history. This information prints on the Patient Care Summary to alert all staff.Patient Education Record revised to include a section on smoking cessation counseling.

Solutions Implemented

“Quit for Good” patient educational pamphlet developed and available on all nursing units and in the EMR.

Hospital-wide nursing inservices conducted to educate nurses on JCAHO requirements and smoking cessation counseling strategies.

Automatic referral for smoking cessation counseling for all smokers added to standard orders for AMI, CHF and pneumonia patients.

Results

Year-to-date, the rate of smoking cessation advice given to hospitalized smokers who have had an MI has shown steady improvement.

Results from all solutions implemented will be reflected in data from Quarter 2, 2004.

JCAHO Core Measure Data Acute Myocardial Infarction - Smoking Cessation Advice

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Per

form

ance

Rat

e

LUMC Observed Rate % 58.3% 61.5% 79.3% 84.6% 89.5%

UHC Mean Rate % 59.8% 65.2% 68.7% 68.3% 71.0%

National Mean Rate % 56.9% 60.9% 66.4% 67.1%

CY02-Q3(N=12)

CY02-Q4(N=13)

CY03-Q1(N=29)

CY03-Q2(N=26)

CY03-Q3(N=19)

Recommendations for Further Action

Educate physicians on the JCAHO recommendations on delivering smoking cessation advice to all LUHS patients.Develop a standard order set for nicotine replacement therapy and bupropion use.Develop a campus-wide campaign to increase patient and staff awareness of the health risks of smoking and benefits of quitting.Expand the smoking cessation program to Loyola ambulatory sites.