Implementation and Effectiveness of Inpatient Nicotine Replacement Treatment Program in an Academic Setting

Background:

The Joint Commission on Accreditation of Healthcare Organizations requires U.S. hospitals to have policies prohibiting smoking. Despite hospital policies, many patients continue to smoke while hospitalized. Smoking in the hospital has adverse health consequences for the patient, exposes other patients and staff to second‐hand smoke, and for patients using oxygen, significantly increases the risk of fire.

Many hospitals do not regularly assess how often in‐hospital smoking occurs, and do not have formal programs in place to minimize its occurrence.

Purpose:

The University of Michigan Hospitals has a smoke‐free environment to promote health and safety, yet from January 1st through June 29th 2005, there were 26 inpatient smoking occurrences recorded in the university hospital.

We performed an inpatient smoking cessation program including a hospital policy to decrease smoking during hospitalization, address withdrawal symptoms, and provide bedside counseling by health care providers to minimize inpatient smoking related events during the hospital stay.

Method:

A multidisciplinary team including hospitalists, nursing, and pharmacy developed a coordinated plan to address the problem. The intervention consisted of three key elements: 1) Identification of all patients who had smoked at any time during the year prior to admission, 2) Development of a nicotine replacement treatment (NRT) order set, 3) Bedside counseling by a trained RN initiated within 24 hours of the admission to provide the patient a letter stating the hospital smoking policy, describe the options for nicotine replacement, and facilitate completion of the NRT order set by the patient's care providers.

Summary of Results:

A pilot trial was performed in the cardiac care unit and one general medical floor for three months. Pre and post‐implementation data on inpatient smoking occurrences were compared using security services data. All inpatient smoking incidents are reported to security, and thus their database provided a reliable and easy method to track events. Patient satisfaction with the intervention was assessed by a discharge survey.

Statement of Conclusions:

Interventions to facilitate smoking cessation for hospitalized patients are needed to minimize the potential hazards related to inpatient smoking, boost a smoker's motivation to ultimately quit smoking, and comply with federal regulations. Multiple factors influence the implementation of a successful comprehensive inpatient nicotine treatment program. Critical to the success of any program is identifying all inpatients at risk of smoking, informing them of hospital policy against smoking, describing the risks, and importantly, having a formal nicotine replacement program in place that can initiated by non‐physician providers. Using data from security services is a novel and effective method for tracking all inpatient smoking events.

Author Disclosure Block:

Y. Murad, None; S. Flanders, None; J. Dammeyer, None; B. Land, None; A. Richter, None.