Hospital treatment

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

2. Two Fold Purpose of the TobaccoUse Intervention Protocol • To assure patient comfort, while he or she is hospitalized by offering nicotine patch therapy to current smokers • 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.

3. 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

4. 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:

5. 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” (MC2065-41). • 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.

6. 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.

7. 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