Smoking Cessation in the Inpatient
Setting
About The Smoking Cessation Project
The Smoking Cessation Project was a temporary consortium of hospitals
that studied
how hospitals could improve the performance of inpatient adult smoking
cessation projects.
The purpose was to improve the quality of care by developing and sharing
practice
strategies and innovations that assist patients with smoking cessation. The Colorado Clinical Guidelines Collaborative (CCGC)
The CCGC is a coalition of health plans, physicians, hospitals,
employers, government agencies, quality improvement
organizations and other entities. They work together to implement systems
and processes using evidence-based
clinical guidelines to improve healthcare in Colorado. The goal – to improve current hospital processes related to smoking cessation
counseling. Activities of this project in support of this goal included:
- presenting and discussing each hospital’s self assessment of and current
processes; related to smoking cessation counseling;
- reviewing relevant clinical practice guidelines and supporting scientific
evidence;
- discussion on process of improvement and barriers, both unique to
each
hospital and identified from other hospitals;
- development of an action plan to implement changes in your system;
and
- discussion of monthly data collection and submission.
Benefits of Participation
Participating in Colorado’s Smoking Cessation Project provided hospitals
an opportunity to:
- be a leading force in promoting interventions to free patients from
their destructive tobacco habit;
- receive data about your organization’s process and the changes you make;
- receive similar feedback on identified barriers and successful
strategies from up to 50 other hospitals;
- apply lessons learned to other systems changes for your hospital
(e.g., other quality indicators);
- improve quality of care; and
- improve compliance with national regulatory requirements.
Hospital personnel who contributed to the success of the project
included:
- Pulmonologists
- Hospitalists
- Addictologists
- Pharmacists
- Respiratory Therapists
- Quality Improvement Staff
- Nursing Staff
- Case Managers
- Discharge Planners
Participation Involved:
- signing a memorandum of understanding that details the tasks and
expectations of the project;
- offering perspectives and ideas;
- actively participating in meetings, discussions and decisions;
- sharing resources, knowledge, skills and expertise;
- communicating project activities within your organization;
and
- submitting data.
There are many components of a successful smoking
cessation counseling program in any health care setting. For
example, does your hospital currently:
- have a program in place to specifically address smoking cessation
counseling?
- have a system in place to routinely identify whether a patient smokes
or not?
- have a physician champion for a smoking cessation counseling program?
- have a multi-disciplinary team to dedicate time and responsibility to
a program of smoking cessation counseling?
- have upper level management support for a smoking cessation counseling
program?
- provide education and/or feedback to staff pertaining to smoking
cessation counseling and other treatments?
The treatment of tobacco use and dependence presents the best
opportunity for clinicians to improve the lives of millions of Americans
nationwide in a cost-effective manner. It is essential that clinicians
and healthcare delivery systems implement a system for consistent
identification and treatment of every tobacco user in a health care
setting. Tobacco dependence counseling, even if brief, is effective and
every patient who uses tobacco should be offered treatment. Previously Identified Barriers to Identification
- Smoking status not a priority at admission
- Patient unable to communicate
- Cardiac rehabilitation responsible for smoking cessation activities
- Deference to primary care physician
Previously Identified Barriers to Counseling
- No person responsible for counseling
- Pharmacy doesn’t carry desired nicotine replacement
- Smoking or counseling status not documented
- Concern with acute issues
- Lack of self-efficacy (knowledge/skills to provide counseling)
- Lack of time or reimbursement
- Competing Demands
Recommended Strategies to develop a successful system of smoking
cessation counseling
Implement a tobacco-user identification system in every clinic or
hospital
Provide education, resources and feedback to promote provider
intervention
Dedicate staff to provide tobacco dependence treatment and assess the
delivery
of this treatment in staff performance evaluations
Promote hospital policies that support and provide tobacco dependence
services
Include tobacco dependence treatments identified as effective
(counseling and pharmacotherapy)
as paid or covered services for all subscribers or members of health
insurance packages
Reimburse clinicians and specialists for delivery of effective tobacco
dependence treatments
and include these interventions among the defined duties of clinicians
* from evidence based strategies identified in:
Fiore MC, Bailey WC, Cohen SJ, et al: Treating Tobacco Use and
Dependence.
Clinical Practice Guidelines. Rockville, MD: US Dept. of Health and
Human Services.
Public Health Service. June 2000
Final Hospital Report (links open new
windows)
The following report is provided in Adobe Acrobat PDF format. If you
do not have Adobe Acrobat Reader, you can download it free of charge at
Adobe's Website.
Final Hospital Report
Questions?
For more information contact Michelle Mills at 303.695.3300 x3038,
or
mmills@coqio.sdps.org.
The Colorado Foundation for Medical Care (CFMC), the Medicare quality improvement organization for Colorado, prepared this material under
contract with the Centers for Medicare & Medicaid Services (CMS), an
agency of the U.S. Department of Health and Human Services. The contents
do not necessarily reflect CMS Policy.
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