Driving Inpatient Smoking Cessation Through Respiratory Protocols

Abstract

Background:

In 2016 the respiratory department at the University of Utah Health (RT dept) partnered with the State of Utah health department to provide an organized and effective counseling program to inpatients. These patients (pts) were identified through the use of our existing respiratory protocols (RPs). Once identified, the pts were enrolled into the smoking cessation program (SCP). Through the SCP, pts received counseling and were encouraged to enroll in the quit line (QL). The goal was to enroll 40% of the SCP patients with the QL.

Methods:

Pts were evaluated using RPs approx 24 h after any respiratory therapy modality was ordered. If the pt was a current smoker or smoked in the last 6 months, they were assigned a quit score; 0) No desire to quit, do not want to talk about it, 1) Pt unavailable to answer at this time, 2) Don't really want to quit but I'm willing to talk about it, 3) Not sure if I want to quit, 4) Want to quit and interested in more information or 5) Already quit but need help to be successful. If pt scored 1-5, a SCP order was generated for the following day. Respiratory therapists trained in SCP visited with these patients and used the AAC (Ask, Advise, Connect) model with motivational interviewing. Pts were encouraged to sign up for the QL. Pt information was sent to the QL after discharge. The Utah QL faxes the results of their contact with the pt.

Results:

Jan 2017 — Apr 2018, 547 pts were identified, 309 pts were disqualified for being medically unable to participate (132), self-identifying as non-smokers (10), refusing counseling (65), or being discharged (102) prior to SCP. Of the remaining 238, 80 (33.6%) signed up for the QL with only 9 accepting services post discharge. The amount of pts who accepted services may be higher, not all states send pt. updates.

Conclusions:

Initially driving inpatient SCP with RPs provided a great way to identify potential pts for this program. However, after 15 months without many positive results an additional avenue will be explored. Starting in July 2018, current smokers upon admission will be identified and enrolled in SCP without the initial quit score. Plans are to pilot 2 acute care floors to auto populate into the SCP in addition to the current enrollment. It is possible that the percentage of pts enrolling in the QL will decrease but hopefully the number of pts accepting services once discharged will increase thus improving population health.