Hospital treatment Hospital provides teachable moment Inpatient treatment + follow-up has demonstrated efficacy Team approaches demonstrate more effectiveness.

Two Fold Purpose of the Tobacco Use Intervention Protocol 1.To assure patient comfort, while he or she is hospitalized by offering nicotine patch therapy to current smokers 2.To offer behavioral counseling, education, and support. With a goal of ongoing abstinence Providing a graduated intensity in treatment from brief support from the bedside nurse to consult and discharge planning from a tobacco treatment specialist Determined by patient preference.

Hospital In-Patient treatment JCAHO Core Measures, must assess and advice/counsel if –Myocardial Infarction (MI) –Congestive Heart Failure (CHF) –Community Acquired Pneumonia (CAP) Nursing protocol – all patients who use tobacco: –Allows nurse to… Order consult Provide behavioral/education intervention Order medication for withdrawal

Step 1 Has patient ever used any tobacco products? Yes – proceed to next question. No – protocol does not apply. Has tobacco use been within the last 12 months? Yes – proceed to assessment section. No – protocol does not apply. Assessment Section: (US cigarette pack = 20 cigarettes; Canada cigarette pack = 25 cigarettes) Cigarettes per day _________ Spit/smokeless tobacco (can/pouch per week) _________ Pipe/cigar (number per day) _____________________ Not currently using, date patient reported stopped tobacco use:

Step 2 Behavioral Intervention Section: Registered Nurse recommends to end tobacco use or continue with abstinence. Give patient education pamphlet: “Help for Stopping Tobacco Use in the Hospital” (MC ). Step 3 Exclusion Criteria for nicotine patch therapy: (select all that apply) Patient has a known allergy to Nicotine patch. Patient is already on Nicotine replacement product. Patient self reports complete tobacco abstinence for 30 days or more. Patient self reports to be pregnant. Patient using pipe or cigar only. If any checked, Nicotine patch therapy is not indicated. Proceed to Step 4. If none of the boxes are checked, proceed to Step 5.

Step 4 Patient consents to Nicotine Dependence Center (NDC) consult only. sign protocol and send electronic referral to NDC. Patient refuses NDC consult. Sign protocol and submit completed protocol (Part 2) Step 5 Consent: (Select one) A Patient consents to NDC consult and Nicotine patch. If checked, proceed to medication intervention and send referral to NDC. B Patient refuses NDC consult, but consents to Nicotine patch. If checked, proceed to medication intervention section to begin patch therapy. C Patient refuses Nicotine patch, but consents to NDC consult. Send electronic referral to NDC. D Patient refuses referral and treatment.

Step 6 Medication Intervention Section: Cigarettes (select one) Less than 20 cigarettes per day: 14 mg patch 20 – 30 cigarettes per day: 21 mg patch 31 – 40 cigarettes per day: 35 mg patch More than 40 cigarettes per day: 42 mg patch Spit/smokeless tobacco Less than one can/pouch per week: 14 mg patch 1 can/pouch per week: 21 mg patch 2 cans/pouches per week: 35 mg patch 3 cans/pouches or greater per week: 42 mg patch