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Smokefree interventions in Emergency Care Are they working?

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

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Smokefree interventions in Emergency Care Are they working?

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  1. Smokefree interventions in Emergency CareAre 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%)

  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%)

  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

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