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National Conference on Tobacco or Health December 2003
Changing the System
Smoking Cessation Supports for
Hospital Patients and Staff
Christina Krause MSc, Yvette Penman MEd,
Dawn McDonald RPh & Pat Reader BSc
Tobacco Reduction, Pharmacy & Chronic Disease ManagementCalgary Health Region
National Conference on Tobacco or Health December 2003
Need for Change
• Implementation of smoking restrictions on hospital property, including smoke-free buildings, grounds and parking lots
• Need to support patients and staff who smoke
• As a health care institution, have a responsibility to address tobacco use
most smokers [70-90%] visit health practitioners yearly, 30% report being asked about their smoking
Fiore et al, 2000
National Conference on Tobacco or Health December 2003
Process of Change
Calgary Health Region:• 4 acute care sites• Serving a population of over 1 million
Goals: • Increase supports for patients to address smoking while in hospital.• Change current practice within acute care settings to address patient smoking. • Increase supports for staff to take action on tobacco use.
National Conference on Tobacco or Health December 2003
Patient Supports: Process of Change
• Clinical Tobacco Intervention (CTI) education program for staff.
• Nicotine replacement products added to hospital formulary.
• Nicotine replacement therapy (NRT) algorithm developed and posted on inpatient units.
• “How to Assist Others to Quit Smoking” pocket card disseminated.
• Tobacco Use Assessment Form developed and disseminated.
• Smoking status and nicotine dependency questions added to regional Nursing Assessment and Respiratory Therapy forms.
• Thinking About Quitting Smoking? brochure disseminated (outlining cessation resources in region)
National Conference on Tobacco or Health December 2003
Patient Supports: Outcomes
From 2000 - 2003:
• 836 health care professionals trained in CTI
• Over 90,000 Thinking About Quitting Smoking? brochures disseminated in acute care
• Nicotine Replacement Therapy use by inpatients increased by 288%.
National Conference on Tobacco or Health December 2003
Inpatient Use of Nicotine Replacement Therapy
6,947 8,555
13,945
26,925
05000
1000015000
2000025000
30000
1999 2000 2001 2002
Fiscal Year
Uni
ts o
f NR
T
National Conference on Tobacco or Health December 2003
Challenges
Workloads of acute care staff • time to participate in in-services for CTI• time to address tobacco use
Staff Survey
Year 2003 Smoking Status
Agreement Questions 2001 2003 NS FS CS
1. It is important to talk with patients
about tobacco use as it relates to 88% 89% 92% 88% 59%
their health.
2. In my role, I am confident when
talking to patients about tobacco use 64% 59% 62% 58% 30%
as it relates to their health.
National Conference on Tobacco or Health December 2003
Challenges (continued)
Recent quality improvement project found:
• Inconsistent identification of smokers
• 17.4% of acute care patients were smokers (below provincial rate of 23%)
• 12.6% of smokers identified in acute care setting had an order for NRT support
neurology (28.6%) and geriatric rehab (29.4%) units had highest proportion of population with NRT order
National Conference on Tobacco or Health December 2003
Staff Supports: Process of Change
• Employee benefits coverage for smoking cessation products increased from a lifetime maximum of $200 to $3,000
• Financial assistance provided to attend a group smoking cessation program
• Self-help materials made available at no cost
National Conference on Tobacco or Health December 2003
Staff Supports: Outcomes
• maintenance of smoking prevalence (8%) from 2001 to 2003
• decrease in number of smokers who indicated no intentions of quitting
32% in 2001; 19% in 2003
• staff smoke fewer cigarettes at work in comparison with home and non-work days (Staff Survey, 2003)
Number of Cigarettes Work Days Non-Work Days Home1 – 10 74% 71% 46%11 – 25 3% 14% 39%26 or more 0% 0% 1%no response 3% 15% 14%
National Conference on Tobacco or Health December 2003
Staff Smoking Cessation Benefit Costs
0
5000
10000
15000
20000
25000
30000
Quarter
Cos
t in
Dol
lars
NRT Use
Zyban Use
Policy Implemented
Provincial tax Increase
National Conference on Tobacco or Health December 2003
Ongoing Challenges
• Confidence of staff to discuss tobacco use remains low
• Competing priorities for frontline care providers time
• Staff values/beliefs regarding tobacco use
• Inconsistent identification of smokers
• Conservative culture in province
National Conference on Tobacco or Health December 2003
Key Learnings
Patients• Flexibility is key - timing and length of CTI in-services
• Availability of NRT at no cost through hospital formulary offers opportunity for patients to try product without committing to quit
• Print resources for health professionals to act as “cues” increases likelihood tobacco use will be addressed
Staff• Increasing limit on benefits coverage likely increased use by removing fears of “using up” coverage without succeeding in quitting
National Conference on Tobacco or Health December 2003
Next Steps
• Continue to engage staff in Clinical Tobacco Intervention training (when they want, where they want and for as long as they want!)
• Dissemination of calendars for physician office and clinic wait rooms with information on smoking cessation
to take advantage of wait times of patients and opportunity to discuss with care provider
• Continue to build environment supportive of consistent and accurate patient smoking status and stage of change identification
National Conference on Tobacco or Health December 2003
Further Information
Website
www.calgaryhealthregion.ca/hecomm/tobacco
