- 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 As 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 5As 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) 8. (CDC, 2014) 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)
14. Pharamacotherapy Nicotine Replacement: lozenges; gum;
transdermal; nasal spray; inhaler Bupropion: potentiates dopamine;
norepinephreine. Contraindicated if h/o of seizure Varenicline:
partial agonist at nicotine receptor; reduces withdrawal; reduces
reward. (Rennard & Daughton, 2014) 15.
http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf 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. The5AsofTobaccoCessation 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.
The5AsofTobaccoCessation 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) 28. Help for the Busy Nurses 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 32. NJQuitline Fax Form 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 Providers 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., &
OMalley, 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
