2025 Inpatient Prospective Payment System (IPPS) Proposed Rule
Nurses' Smoking Cessation Guide
1. SMOKING CESSATION INTERVENTION
FOR NURSES TO USE IN
CLINICAL PRACTICE
SEMINAR
Tamieka Bugam
Ricardo Lim
Julia Strong
MSN 7741
Wilmington University
2. Objectives
At the end of the session, participants will be
able to identify the 5 A’s of smoking
cessation.
At the end of the session, participants will be
able to identify the 3 quick interventions for
nurses.
At the end of the session, participants will be
able to name the 5 stages of change.
3. .Seminar Outline
I.Topic: Smoking Cessation Intervention: For Nurses to
Use in Clinical Practice
A.Tobacco Use
1. Adolescent Smokers
2. Patients with Mental Illness who smoke
3. Elderly Smokers
B. Nurses role
1. Efficacy of Advice to Quit
2. What works
3. Support/Counseling
4. Pharmacotherapy
II. Stages of Change
A.The 5A’s ofTobacco Cessation
1. 1-800-QUIT-NOW and State Quit Lines
2. Strategies for Providers
3. Help for the busy Nurses
4 How to Refer
5. Quit line outlines report
6. Reminder for Nurses
III. Learning More/CE Options
4. TobaccoUse
“Tobacco use remains the leading cause
of preventable morbidity and mortality
in the nation and is a major contributor
to excess medical care costs.”
(Quinn, V. P., 2008)
5. Tobacco Use
“Smoking rates remain
unsatisfactorily high, 20% among
adolescents and 21% in adults,
compared with Healthy People
targets of 16% and 12%,
respectively.”
(Jonathan E. Fielding, 2012)
6. AdolescentSmokers
Teens prefer smoking cessation messages
from peers
Prefer to hear about what they will gain
from smoking cessation: health and social
benefits
Celebrities and athletes are preferred
sources of messages
(Latimer et al., 2012)
7. Patientswith MentalIllnessWho
Smoke
Patients successfully quit smoking when
they receive adequate support
Pharmacologic treatment and nicotine
replacement therapy can be effective
Cessation does not lead to psychiatric
decompensation
(Parker, McNeill & Ratschen, 2012; Prochaska, 2011)
9. ElderlySmokers
The elderly are less likely to think smoking is
harmful
Smoking is the cause of 1 in 5 U.S. deaths
Smoking causes 90% COPD deaths; 80-90%
of lung cancer deaths
Increased risk: coronary heart disease;
stroke; dementia; cataracts
Cessation has benefits even at a late age.
(www.lung.org)
10. NursesRole
Nursing is the largest group of health care
professionals and have tremendous potential
role in smoking cessation interventions. Healthy
People 2020 goal for adult Tobacco use will be
achieved if every nurse helps one smoker per
year to quit smoking.
Nursing world, Tobacco Free Nurses.
http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/TobaccoFree.html
11. EfficacyofAdvicetoQuit
Abstinence Rate %
No advice 7.9
Physician, Nurses Advice 10.2
and other Health Care
Patients expect healthcare providers to ask about
tobacco use and advise them to quit
Source:TreatingTobacco Use and Dependence, USDHHS, Public Health Service, 2000
12. WhatWorks
Behavioral Counseling Support
Treats the psychological and
habit aspects
Pharmacotherapy
Treats nicotine addiction
Works best when combined
13. Support/Counseling
Group counseling programs: lecture;
exercises; tapering; build coping skills
Cognitive BehavioralTherapy
Cognitive and behavioral strategies are effective
in prevention of relapse
20-week follow-up was more effective that brief
intervention.
(Killen et al., 2008)
16. StagesofChange
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)
17. The5A’sofTobaccoCessation
TreatingTobacco Use and Dependence
Clinical Practice Guidelines: 2008 Update -
U.S. Department of Health and Human
Services, Public Health Service
A brief evidence-based tobacco cessation
intervention
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)
18. The5A’sofTobaccoCessation
Ask about tobacco use
Advise patient to quit
Refer (1-800-QUIT-NOW or local program)
Assess readiness to quit
Assist in quit attempt
Arrange follow-up
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)
19. 1-800-QUIT-NOW
1-800-Quit-Now is a national number which
accepts callers from throughout the nation,
directing them to the appropriate state quitline.
20. StatesQuit Lines
Alabama
1-800-QUIT NOW
Alaska
1-888-842-QUIT
Arizona
1-800-556-6222
Arkansas
1-866-NOW-QUIT
1-866-669-7848
California
1-800-NO-BUTTS
Colorado
1-800-QUIT NOW
Connecticut
1-866-END-HABIT
Delaware
1-866-409-1858
Florida
1-877-U-CAN-NOW
Georgia
1-877-270-STOP
Idaho
1-800-QUIT NOW
Illinois
1-866-QUIT-YES
Indiana
1-800-QUIT NOW
Iowa
1-800-QUIT NOW
Kansas
1-866-KAN-STOP
Kentucky
1-800-QUIT NOW
Louisiana
1-800-QUIT NOW
Maine
1-800-207-1230
Massachusetts
1-800-TRY-TO-
STOP
Michigan
1-800-480-7848
Minnesota
1-888-354-PLAN
Quitlines. (2010).
21. StatesQuit Lines(Continue)
Mississippi
1-800-QUIT NOW
Montana
1-866-485-QUIT
Nevada
1-888-866-6642
New Hampshire
1-800-548-8252
New Jersey
1-866-NJ-STOPS
New Mexico
1-800-4-CANCER
NewYork
1-866-NY-QUITS
Ohio
1-800-934-4840
Oklahoma
1-866-PITCH-EM
Oregon
1-877-270-STOP
Pennsylvania
1-877-724-1090
Rhode Island
1-800-TRY-TO-
STOP
South Dakota
1-866-SD-QUITS
Texas
1-877-YES-QUIT
Utah
1-800-QUIT NOW
Vermont
1-877-YES-QUIT
Virginia
1-800-QUIT NOW
Washington
1-877-270-STOP
Washington, DC
1-800-399-5589
Wisconsin
1-877-270-STOP
Wyoming
1-866-WYO-QUIT
Quitlines. (2010).
22. Ask
Ask about tobacco use at every visit
Systematically identify all tobacco users
Make identification/documentation a vital
sign
Create a universal identification system
(stickers, computer reminders, etc.)
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)
23. Createa ReminderSystem
Include tobacco use in other medical / dental advice
Use an identification system
Stamp, Sticker, EMR
Tobacco Use and Exposure
Tobacco Use: (circle one): Current Former Never
Secondhand Smoke Exposure: YES NO
Vital Signs: Blood Pressure: ________ Pulse: _____ Temp: _____ Resp: _____
Nicotine Patch: __________ mg daily Date Started: _____________________
.
24. Advise
Clear, Strong, Direct
“Quitting smoking ...
Employ the teachable moment:
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)
25. Assess
Smokers who want to quit in the
next 30 days
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)
26. Assist
Develop a quit plan
STAR:
- Set a quit date (within 2 weeks)
- Tell family, friends, coworkers
- Anticipate challenges to quitting
- Remove tobacco products from
environment
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)
27. Arrange
Schedule follow-up
in person
via telephone
Use Quitline
Evaluate pharmacotherapy use/problems
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)
29. Ifyouonlyhavetwo minutes
Ask every patient about tobacco use
Advise to quit with a clear, strong, personalized
message
Refer to
Tobacco Use Quitline
1-800-QUIT-NOW (1-800-784-8669)
Other resources as appropriate
Prescribe
Get NRT order from Physicians/Nurse
Practitioner
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)
30. REFER
Consider fax referral
For patients ready to quit within 30 days
Consider cessation medications
Provide Quitline number to all patients,
even those not ready to quit
Other resources such as Become An Ex
Follow-up at every visit
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)
31. NewJersey TobaccoUseQuitline
NJ Quitline- 1-866-NJSTOPS (1-866-657-8677)
Free telephone cessation counseling and free
two week supply of nicotine patches.
http://njquitline.org/
Mom's Quit Connection- 1-888-545-5191
Free telephone or face to face cessation
counseling for pregnant and parenting
women and families.
Fax Referral
33. QuitlinecanAssess,Assist,Arrange
Quit coach helps set Quit Date, and
Develop quit plan
Make follow-up calls
Discuss pharmacotherapy
Mail targeted resources
Patients can call the Quitline anytime
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)
34. Fax ReferraltoQuitlinefacilitate
Referral to effective cessation resources
Provider’s limited time and resources
Nurses referral to a cessation program has a
higher rates of participation than simply
telling patients they should stop using
tobacco
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)
35. HowFaxReferralWorks
1. Patient has been identified as a tobacco user
2. Patient educated on smoking cessation
3. Patient wants to quit tobacco use within 30 days
4. Patient consent to a quit coach to call at time/date
they select
5. HCP completes Provider Information, including
Hospital-Clinic Name, Contact Name and Number.
6. Patient completes Patient Information and signs
consent for HCP to release information
7. Quitline can provide Fax Referral Outcomes Report:
8. Quitline will begin contact attempts to enroll patient
in program based on time and date provided by
patient.
(Brief Tobacco Cessation Counseling For physicians and other providers and healthcare professionals to use in
clinical practice, 2009)
36. QuitlineOutcomesReport
Tool to follow patient progress with your
advice to quit / utilize Quitline services
Most useful in clinic setting with dedicated
fax machine/staff to retrieve reports
Outcomes Report information includes:
Accepted services
Declined services
Unreachable
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)
37. ReminderforNurses
Brief cessation counseling is effective
Longer cessation counseling is more effective
Pharmacotherapy can double quit rates
Pharmacotherapy should be offered to all
- few exceptions
Evidence-based resources are available
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)
38. For more patient cessation
resources, view Cessation
Resources at:
www.njquitline.org
39. LearningMore/CEOptions
Medscape:TreatingTobacco Use and Dependence
http://www.medscape.com/viewarticle/570604
Free
Approved for 1hour CE
AMA PRA Category 1 Credit(s)™
Requires registration to Medscape
TobaccoFreePatients.com
http://www1.tobaccofreepatients.com/TopicReq?
Based on NCI educational program
Available free for study and review
$15 per credit hour / letter of completion
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)
40. References
BriefTobacco Cessation Counseling For physicians
and other providers and healthcare professionals
to use in clinical practice. (2009, June). North
Carolina.
Fielding, J., (2012). Health Reform and Healthy
People Initiative. AmericanJournal of Public
Health.
Killen, J., Fortmann, S., Schatzberg,A., Arredondo,
C., Murphy, G., Hayward, C., Celio, M., Cromp,
D., Fong, D., & Pandurangi, M. (2008).
Extended cognitive behavior therapy for
cigarette smoking cessation. Addiction,
103,1381-1390.
41. References
Latimer, A., Krishnan-Sarin, S., Cavallo, D., Duhig, A.,
Salovery, P., & O’Malley, S. (2012).Targeted Smoking
Cessation Messages for Adolescents. Society for
Adolescent Health and Medicine, 50, 47-53.
CDC. (2014). New CDCVital Signs: Smoking among
those with Mental Illness. Retrieved June 21, 2014 from
http://www.cdc.gov/media/dpk/2013/dpk-vs-adult-
smoking-mental-illness.html
Parker, C., McNeill, A., & Ratschen, E. (2012).
Tailored tobacco dependence support for
mental health patients: a model for inpatient and
community services. Addiction, 107, 18- 25.
Prochaska, J. (2011). Smoking and mental Illness—
breaking the link. The New England Journal of
Medicine, 365, 196-198.
42. References
Quinn,V.P., (2008). Effectiveness of the 5-As
Tobacco CessationTreatments in Nine HMOs.
Journal General Internal Medicine.
Quitlines. (2010). Retrieved from Smoking Cessation
Leadership Center:
http://smokingcessationleadership.ucsf.edu/Quit
lines.htm
Rennard, S., & Daughton, D. ( 2014). Smoking
cessation. Clinical Chest Medicine, 35, 165-
176.
Retrieved from www.cdc.gov
Retrieved from www.lung.org