Smokefree interventions in Emergency Care

Are they working?

Courtney Rouse

Smokefree Specialist- Inpatient Services, MMH

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

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

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

Implementing the Smokefree ABC’s- Training

From December 2009 to July 2010 Smokefree support in emergency care increased from 18% to 62%.

ED smoking prevalence (%) and advice given to smokers (%)

0%5%

10%15%20%25%30%35%40%45%50%55%60%65%70%75%80%

Jul-08

Aug-0

8

Sep-0

8

Oct-08

Nov-0

8

Dec-0

8

Jan-0

9

Feb-0

9

Mar-

09

Apr-

09

May-0

9

Jun-0

9

Jul-09

Aug-0

9

Sep-0

9

Oct-09

Nov-0

9

Dec-0

9

Jan-1

0

Feb-1

0

Mar-

10

Apr-

10

May-1

0

Jun-1

0

Jul-10

Aug-1

0

Sep-1

0

Month-Year

%

Smoking prevalence Advice / Support

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

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.

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%)

Ethnicity No. of participants

% of

participants

European 56 28.0%

Māori 61 30.5%

Pacific 62 31.0%

Asian 15 7.5%

Other 6 3.0%

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%)

Ethnicity No. of participants

% of

participants

European 35 33.7%

Māori 25 24.0%

Pacific 30 28.8%

Asian 8 7.7%

Other 6 5.8%

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

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

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

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

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

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

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

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

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