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Using the 5A’s. SIDS Mid-Atlantic presents. SIDS Mid-Atlantic. 2700 S. Quincy St. Suite 220 Arlington VA 22206 703-933-9100 www.sidsma.org [email protected] Betty Connal, RN, MS, Director. Objectives. - PowerPoint PPT Presentation
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Using the 5A’s
SIDS Mid-Atlantic presents
Presented by Health Care Education & Training, Inc. 2Created March 2002
SIDS Mid-Atlantic
2700 S. Quincy St. Suite 220 Arlington VA 22206 703-933-9100 www.sidsma.org [email protected] Betty Connal, RN, MS, Director
Presented by Health Care Education & Training, Inc. 3Created March 2002
Objectives
To establish evidence-based, best practice prenatal smoking cessation interventions as a routine part of prenatal care by training health care providers in the Five A’s Method of Smoking Cessation
To assure that all pregnant women in Virginia are asked about their use of tobacco and that all pregnant smoking women in Virginia receive evidence-based treatments in smoking cessation
Presented by Health Care Education & Training, Inc. 4Created March 2002
Program Objectives
Describe the 5A prenatal smoking cessation method
Incorporate the 5A prenatal smoking cessation method into the standard protocol
Identify readily available smoking cessation resources
Presented by Health Care Education & Training, Inc. 5Created March 2002
Agenda
Introduction Ask Advise/Assess Assist/Arrange for follow-up Implementation issues and role play Resource identification Wrap-up
Presented by Health Care Education & Training, Inc. 6Created March 2002
Risks of Smoking in Pregnancy
Smoking remains the single most important preventable cause of poor birth outcome
20% low birth weight deliveries
8% pre-term births
5% perinatal deaths
Presented by Health Care Education & Training, Inc. 7Created March 2002
Risks of Smoking
Placenta previa Miscarriage Ectopic pregnancy Preterm Premature Rupture Of
Membranes Abruptio placenta
Presented by Health Care Education & Training, Inc. 8Created March 2002
Risks of Smoking
Low birth weight Small for gestational age Preterm delivery 3 to 4 times greater risk of Sudden
Infant Death Syndrome (SIDS) Stillbirths
Presented by Health Care Education & Training, Inc. 9Created March 2002
Smoking effects on the baby
Otitis media (ear infections) Asthma Bronchitis and pneumonia Wheezing and lower respiratory
illness
Presented by Health Care Education & Training, Inc. 10Created March 2002
Who is at Risk for Premature Birth?
The best predictor of having a preterm birth is a history of preterm labor/delivery or prior low birthweight
Presented by Health Care Education & Training, Inc. 11Created March 2002
Risk factors for premature birth
multifetal pregnancy—twins, triplets and more
maternal age (<17 and >35 years)
black race low SES unmarried previous fetal or neonatal
death 3+ spontaneous terminations uterine abnormalities incompetent cervix genetic predisposition
Presented by Health Care Education & Training, Inc. 12Created March 2002
Risk for premature birth
low pre-pregnant weight obesity infections bleeding anemia major stress lack of social supports tobacco use illicit drug use alcohol abuse folic acid deficiency
Presented by Health Care Education & Training, Inc. 13Created March 2002
Signs of Premature Labor
Contractions every 10 minutes or more Changes in vaginal discharge (leaking
fluid or blood from vagina) Pelvic pressure—baby pushing down Low dull backache Cramps that feel like a period Abdominal cramps with or without diarrhea
Presented by Health Care Education & Training, Inc. 14Created March 2002
Why use the Five A’s?
About 35% of women will quit smoking during pregnancy, benefiting themselves, their next pregnancy, their children and their families
Presented by Health Care Education & Training, Inc. 15Created March 2002
Cost of Complicated Births
Smokers average cost of birth $11,000
Non smokers average cost of birth $6500
Presented by Health Care Education & Training, Inc. 16Created March 2002
Cost Effectiveness of Smoking Cessation Intervention Cost per life year saved, in thousands of
dollars Smoking Cessation Intervention $2500 Mammography $50,000 Treatment of high cholesterol $100,000
Presented by Health Care Education & Training, Inc. 17Created March 2002
Timing of Health Benefits
1990 Surgeon General’s Report
20 minutesBlood pressure, heart rate return to
normal
8 hoursO2 level returns to normal; nicotine
and CO levels reduced by half
24 hoursCO is eliminated from body; lungs begin to eliminate mucus, debris
48 hoursNicotine eliminated from body; taste
and smell improve
72 hoursBreathing is easier; bronchial tubes
relax; energy levels increase
2 to 12 weeksCirculation improves
3 to 9 monthsLung function increases by up to
10%; coughing, wheezing, breathing problems reduced
1 yearHeart attack risk halved
10 yearsLung cancer risk halved
15 yearsHeart attack risk same as for someone who never smoked
Presented by Health Care Education & Training, Inc. 18Created March 2002
Intervention Works
Smoking cessation intervention by clinicians improves quit rates
Brief counseling (5 to 15 minutes total) is all that is needed to help many pregnant smokers quit
A woman is more likely to quit smoking during pregnancy than at any other time in her life
Presented by Health Care Education & Training, Inc. 19Created March 2002
The 5A approach
Ask about patient’s habits. Advise of consequence of
smoking. Assess willingness to quit. Assist with cessation plan
development. Arrange for follow-up
Presented by Health Care Education & Training, Inc. 20Created March 2002
Research
Conclusions1. Brief cessation counseling session can
improve cessation rates as compared to simple advice to quit
2. More intensive counseling has not been documented to increase cessation rates
3. Benefits of brief counseling effective in light to moderate smokers (less than a pack per day)
Presented by Health Care Education & Training, Inc. 21Created March 2002
Ask
A. I have NEVER smoked, or I have smoked less than 100 cigarettes in my lifetime.
B. I stopped smoking BEFORE I found out I was pregnant, and I am not smoking now.
Goal: Find out if patient smokes or has recently quit.
Presented by Health Care Education & Training, Inc. 22Created March 2002
Ask (cont)
C. I stopped smoking AFTER I found out I was pregnant, and I am not smoking now.
D. I smoke some now, but I cut down on the number of cigarettes I smoke SINCE I found out I was pregnant.
E. I smoke regularly now, about the same as BEFORE I found out I was pregnant.
Presented by Health Care Education & Training, Inc. 23Created March 2002
Advise
Goal is to either: 1) present compelling evidence about the
importance of quitting
2) encourage recent quitters to continue abstinence.
Message must be strong, clear, and relevant to specific patient’s concerns.
Presented by Health Care Education & Training, Inc. 24Created March 2002
Advise Examples
Appropriate:“Ms. Smith, it is important for you to quit smoking.
As your Resource Mother, I need you to know that quitting smoking increases your chances of having a healthy baby. Your health will also improve...”
Inappropriate: “Ms. Smith, you need to quit smoking.”
Presented by Health Care Education & Training, Inc. 25Created March 2002
Create an Advise Statement
Maria is 19-year old woman with two children. She has smoked since she was 16 years old. She has indicated that she smoked with her first two children and “they are fine.”
Presented by Health Care Education & Training, Inc. 26Created March 2002
Advise example for recent non-smoker “Ms. Smith, I want to congratulate you on
making such an important decision for your baby’s health. As your nurse, I need you to know that quitting smoking has greatly increased your chances of having a healthy baby. Your health will also improve….”
Presented by Health Care Education & Training, Inc. 27Created March 2002
Three patient types
Current smoker who wants to quit. Recent non-smoker Current smoker who does not want to quit.
Target of Assess step
Presented by Health Care Education & Training, Inc. 28Created March 2002
Assess Decision Flow
YesDoes patient
currently smoke?
Patient willing to quit?
Provide appropriate cessation
techniques (Step 4 of 5A approach)
Yes
No
Provide motivational
materials and counseling
Presented by Health Care Education & Training, Inc. 29Created March 2002
Assess Decision Flow (cont)
YesDoes patient
currently smoke?
Has patient smoked in the
past?
Assist with cessation
maintenance (Step 4 of 5A
approach)
No
Presented by Health Care Education & Training, Inc. 30Created March 2002
Dealing with the resistant patient
1. Find out why patient doesn’t want to quit.
2. Emphasize risks of smoking.
3. Point out the rewards of quitting.
4. Discuss roadblocks and ways to overcome them.
Presented by Health Care Education & Training, Inc. 31Created March 2002
Patients Who Decline to Quit: Using the 5 R’s
Relevance
Risks
Rewards
Roadblocks
Repetition
Presented by Health Care Education & Training, Inc. 32Created March 2002
Assist
Why people smoke: Addicted to nicotine Enjoyment
Common triggers: After eating Social situations
Presented by Health Care Education & Training, Inc. 33Created March 2002
Assist (cont)
Roadblocks: Friends all smoke Doesn’t really want to quit but feels should quit
Rewards: Clothes and breath will smell better Cough will go away
Presented by Health Care Education & Training, Inc. 34Created March 2002
Assist: Coping Strategies
Why people smoke: Addicted to nicotine/Drink lots of water Enjoyment/Do something else enjoyable
Common triggers: After eating/Eat breath mint Social situations/Avoid situations where there’s
smoke
Presented by Health Care Education & Training, Inc. 35Created March 2002
Assist: Coping Strategies (cont) Roadblocks:
Friends all smoke/Talk on phone instead of in person
Doesn’t really want to quit but feels should quit/Identify personal reasons to quit
Rewards: Clothes and breath will smell better/Wash all
clothing Cough will go away/Track number of coughing
bouts per day
Presented by Health Care Education & Training, Inc. 36Created March 2002
Smoking Cessation Plan
Step 1. Identify why, common triggers, and major roadblocks.
Step 2. Identify rewards.Step 3. Establish a quit date.Step 4. Identify cessation method and
coping strategies.Step 5. Provide resources.
Presented by Health Care Education & Training, Inc. 37Created March 2002
Arrange for follow-up
For patient who has remained smoke-free, offer congratulations.
For patient who has relapsed, return to Assist step in 5A approach.
Presented by Health Care Education & Training, Inc. 38Created March 2002
Relapse Questions
What was the trigger? When did the relapse occur? What was going on in your life at the time of
relapse? Did you have a support person there? What techniques did you try to help you work
through the craving? Would you like to set another quit date?
Presented by Health Care Education & Training, Inc. 39Created March 2002
Reimbursement
ICD-9-CM code 305.1 (tobacco use disorder, tobacco dependence)
AND CPT code 99401 (15-minute physician-provided
counseling) with modifier 25 as part of regular prenatal visit
OR CPT code 99211 (nurse counseling)
Presented by Health Care Education & Training, Inc. 40Created March 2002
Resources
SIDS Mid-Atlantic www.sidsma.org Go to ‘Professionals’ ‘Stop Smoking Stop SIDS Program’ Links to state and national info and
resourcesMarch of Dimes
www.marchofdimes.com
Presented by Health Care Education & Training, Inc. 41Created March 2002
Great Start 1-866-66StartInteractive Quitline for Pregnant Smokers
Presented by Health Care Education & Training, Inc. 42Created March 2002
Resources
Smoke Free Families www.smokefreefamilies.org
National Partnership to Help Pregnant Smokers Quit www.helppregnantsmokersquit.org
Presented by Health Care Education & Training, Inc. 43Created March 2002
Virginia Quit Line
1-800-QUIT NOW