1. Smokefree interventions in Emergency Care Are they working? Courtney Rouse Smokefree Specialist- Inpatient Services, MMH

2. Why target Emergency Care patients? MOH Health Target – 90% of all admitted patients who smoke must be given support and advice to quit byJuly 2011and 95 percent by July 2012. High traffic area – 7500 to 8500 patients are seen at MMH EC each month Higher Prevalence rate in EC – 33.1% vs. 21.8% (Lynch & Quigley, 2010) Harder to reach population- lack of presence in primary care

3. Implementing the Smokefree ABC’s- Training December 2009 - Smokefree training for nurses began July 2010 – 143 (85%) EC nurses received training and became quit card providers 58 ( 40.5%) of these became certified to chart Nicotine Replacement Therapy (NRT) Sustainability – Two EC R/N’s were trained to carry out opportunistic smokefree training with new staff

4. Implementing the Smokefree ABC’s Documentation December 2009 – To improve documentation a smokefree assessment sticker was included in all EC assessment forms May 2010 - Smokefree assessment information was added to the EDS

5. Implementing the Smokefree ABC’s- Training From December 2009 to July 2010 Smokefree support in emergency care increased from 18% to 62%.

6. Are the interventions working? Who: All patients presenting to EC between 26/07/2010 - 29/08/2010 who: discharged directly from EC were ≥ 18 yrs. of age identified as currently smoking coded as having received a smokefree intervention during their presentation

7. Are the interventions working? Who: 354 patients (21.3%) were identified as currently smoking during this period 241 (68%) actually received support during the 5 week period 200 (56%) were coded as having received support during the study’s time constraints.

8. Are the interventions working? Identified and supported patients N= 200 Age ranged from 19 – 82 with a m= 38.30 Females = 91 (45.5 %), Males = 109 (54.5%) EthnicityNo. of participants % of participants European5628.0% Māori6130.5% Pacific6231.0% Asian157.5% Other63.0%

9. Are the interventions working? Contacted patients N= 104 Age ranged from 19 – 82 with a m= 40.2 Females = 54 (51.9 %) Males = 50 (48.1%) EthnicityNo. of participants % of participants European3533.7% Māori2524.0% Pacific3028.8% Asian87.7% Other65.8%

10. Are the interventions working? Exclusions 16 contacted patients were excluded in total: stated they were non-smokers at the time of presentation admitted on to a ward smoked marijuana only could not recall receiving support or stated that no support was received Only 8 patients could not recall receiving support

11. Are the interventions working? Self-reported Results After your ED admission did you think about stopping smoking? 74 (86%) thought about quitting after their ED presentation. 12 participants (14%) found the support did not encourage them to think about quitting N= 86 - exclusions: patients who could not recall receiving support or stated that no support was received

12. Are the interventions working? Self-reported Results Did you attempt to quit smoking? 51 (59.3%) were prompted to make a quit attempt following their presentation. 13 of those were unable to stay smokefree, but went on to reduce the number of cigarettes they smoked by an average of 13.8, sd =12.15 15 (min 1 - max 30). N= 86 - exclusions: patients who could not recall receiving support or stated that no support was received

13. Are the interventions working? Self-reported Results Have you reduced the number of cigarettes you smoke? 17 participants did not attempt to quit smoking completely, but stated they purposefully cut down following their EC intervention. On average they reduced by 12.27 cigarettes, sd = 8.64 ( min 2 – max 25). N= 86 - exclusions: patients who could not recall receiving support or stated that no support was received

14. Are the interventions working? Self-reported Results Did you find the smokefree support helpful? 67 patients (77.9%) found receiving brief advice in EC helpful. “Everyone should be told this. They should all get on board.” – 50 yrs, CI MA Male N= 86 - exclusions: patients who could not recall receiving support or stated that no support was received

15. Are the interventions working? Self-reported Results Smokefree at four weeks 26 of 51 patients (50.09%) who tried to quit after receiving a smokefree intervention in EC were successfully smokefree at four weeks! N= 86 - exclusions: patients who could not recall receiving support or stated that no support was received

16. Are the interventions working? Self-reported Results Behavioural Change 68 of the 86 patients (79.07 %) who received or recalled some form of support went on to change their behaviour following their presentation. N= 86 - exclusions: patients who could not recall receiving support or stated that no support was received

17. Are the interventions working? Where to from here: Further data analysis – 3 month follow ups, presentations/ diagnosis Ethics approval to audit unsupported patients who currently smoke Poster campaign to boost staff morale

18. Special Thanks Dr. Vanessa Thornton – Clinical Head of Emergency Medicine Dr. Stuart Jones – Respiratory Specialist Dr. Keng Ong – Emergency Medicine Joanne Aickin – Charge Nurse Emergency Medicine