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Mary Beth Ginn, RN, BSN, CCRN Georgetown University School of Nursing and Health Studies
THE COSTS Tobacco use costs $53$73 billion per year in medical bills
In-patient smoking cessation interventions can increase quit rates to as high as 74%
In-patient advice, education and behavioral counseling Nicotine Replacement Therapy Post-discharge follow-up
(Wolfenden, Campbell, Walsh & Wiggers, 2003)
43%
50%
Poor documentation
Solution
Solution
Education initiated with nursing and medical staff through multiple channels including: nurse managers, clinical educators, chief residents, pulmonary and cardiology fellows, hospitalists
Nurse Managers
April
May
June
July
Data collection Idea-generating meetings with nursing, medical and pharmacy staff Creation/revision of protocol
Pharmacy and Therapeutics Committee Approval Patient Care Services/Nursing Approval Forms Committee process begins Revisions to admission database
Hospital Practice Council creation and approval of standard of care for tobacco cessation Selection of patient education materials
Forms Committee Approval of Tobacco Orders! Hospital-wide announcements introducing protocol Tobacco protocol up and running effective JULY 15th!
Nurse Training:
Announcement/ presentation at PCS managers meeting In-services with nursing units Creation and distribution of nursing self-learning packet Involvement of Hospital Practice Council to create nursing standard of care for tobacco cessation
Strong hospital support of nurse-driven protocols Tremendous support from nursing staff, pharmacy director Geoff Cox and chief of cardiology Dr Richard Morrissey Research support and JCAHO teeth facilitated smooth approval process
Patient Care ALWAYS the PRIORITY Delays associated with summer vacations, edits to protocol Politics associated with revising hospital forms and asking nursing to undertake more initiatives
Next Steps
Three month postimplementation review Amendment of the physician admission intake packet to include assessment of readiness to quit and a prompt to initiate the tobacco cessation protocol. Presentation of protocol and tobacco cessation counseling tactics during Grand Rounds.
Next Steps
The Tobacco Cessation Network: Television Channel Respiratory Therapy Involvement On-Going Intensive Physician and Nursing Training In-Patient Group Counseling and Post-discharge Follow-up
A Special Thanks.
Janie Heath- for her guidance and for being the brainchild of this project!! Dr Geoff Cox- for his enthusiasm and support of nursing Dr Richard Morrissey- for his support Dr Sharon OBrien and Dr Anne ODonnell- for their editorial support Gail Thurkauf and Donna Sanford- my data gurus! The P&T and Forms Committee- there would not be a protocol without your approval Cristie Namata- to whom I am passing the tobacco torch- good luck!