National Conference on Tobacco or Health December 2003 Changing the System Smoking Cessation Supports for Hospital Patients and Staff Christina Krause MSc, Yvette Penman MEd, Dawn McDonald RPh & Pat Reader BSc Tobacco Reduction, Pharmacy & Chronic Disease Management Calgary Health Region

National Conference on Tobacco or Health December 2003 Need for Change Implementation of smoking restrictions on hospital property, including smoke-free buildings, grounds and parking lots Need to support patients and staff who smoke As a health care institution, have a responsibility to address tobacco use  most smokers [70-90%] visit health practitioners yearly, 30% report being asked about their smoking Fiore et al, 2000

National Conference on Tobacco or Health December 2003 Process of Change Calgary Health Region: 4 acute care sites Serving a population of over 1 million Goals: Increase supports for patients to address smoking while in hospital. Change current practice within acute care settings to address patient smoking. Increase supports for staff to take action on tobacco use.

National Conference on Tobacco or Health December 2003 Patient Supports: Process of Change Clinical Tobacco Intervention (CTI) education program for staff. Nicotine replacement products added to hospital formulary. Nicotine replacement therapy (NRT) algorithm developed and posted on inpatient units. “How to Assist Others to Quit Smoking” pocket card disseminated. Tobacco Use Assessment Form developed and disseminated. Smoking status and nicotine dependency questions added to regional Nursing Assessment and Respiratory Therapy forms. Thinking About Quitting Smoking? brochure disseminated (outlining cessation resources in region)

National Conference on Tobacco or Health December 2003 Patient Supports: Outcomes From : 836 health care professionals trained in CTI O ver 90,000 Thinking About Quitting Smoking? brochures disseminated in acute care Nicotine Replacement Therapy use by inpatients increased by 288%.

National Conference on Tobacco or Health December 2003 Inpatient Use of Nicotine Replacement Therapy

National Conference on Tobacco or Health December 2003 Challenges Workloads of acute care staff time to participate in in-services for CTI time to address tobacco use Staff Survey Year2003 Smoking Status Agreement Questions NS FS CS 1. It is important to talk with patients about tobacco use as it relates to 88%89%92%88%59% their health. 2. In my role, I am confident when talking to patients about tobacco use 64%59%62%58%30% as it relates to their health.

National Conference on Tobacco or Health December 2003 Challenges (continued) Recent quality improvement project found: Inconsistent identification of smokers 17.4% of acute care patients were smokers (below provincial rate of 23%) 12.6% of smokers identified in acute care setting had an order for NRT support  neurology (28.6%) and geriatric rehab (29.4%) units had highest proportion of population with NRT order

National Conference on Tobacco or Health December 2003 Staff Supports: Process of Change Employee benefits coverage for smoking cessation products increased from a lifetime maximum of $200 to $3,000 Financial assistance provided to attend a group smoking cessation program Self-help materials made available at no cost

National Conference on Tobacco or Health December 2003 Staff Supports: Outcomes maintenance of smoking prevalence (8%) from 2001 to 2003 decrease in number of smokers who indicated no intentions of quitting  32% in 2001; 19% in 2003 staff smoke fewer cigarettes at work in comparison with home and non-work days (Staff Survey, 2003) Number of Cigarettes Work Days Non-Work Days Home 1 – 10 74% 71% 46% 11 – 25 3% 14% 39% 26 or more 0% 0% 1% no response 3% 15% 14%

National Conference on Tobacco or Health December 2003 Policy Implemented Provincial tax Increase

National Conference on Tobacco or Health December 2003 Ongoing Challenges Confidence of staff to discuss tobacco use remains low Competing priorities for frontline care providers time Staff values/beliefs regarding tobacco use Inconsistent identification of smokers Conservative culture in province

National Conference on Tobacco or Health December 2003 Key Learnings Patients Flexibility is key - timing and length of CTI in-services Availability of NRT at no cost through hospital formulary offers opportunity for patients to try product without committing to quit Print resources for health professionals to act as “cues” increases likelihood tobacco use will be addressed Staff Increasing limit on benefits coverage likely increased use by removing fears of “using up” coverage without succeeding in quitting

National Conference on Tobacco or Health December 2003 Next Steps Continue to engage staff in Clinical Tobacco Intervention training (when they want, where they want and for as long as they want!) Dissemination of calendars for physician office and clinic wait rooms with information on smoking cessation  to take advantage of wait times of patients and opportunity to discuss with care provider Continue to build environment supportive of consistent and accurate patient smoking status and stage of change identification

National Conference on Tobacco or Health December 2003 Further Information Website