Proposal: Georgetown University Hospital Smoking Cessation Action Plan

Rationale: 1. Tobacco use is the leading cause of preventable death in the United States. 2. Georgetown University Hospital compliance with JCAHO and CMS requirements for smoker identification and treatment is below the benchmark for CHF, AMI and CAP; since 2004, Georgetown has documented smoking cessation advice on ~40% of identified smokers admitted with CHF and CAP. (AMI has been excluded as those patients are sent to Washington Hospital Center) Goals: 1. Increase identification of current smokers and identify those who are ready to quit. 2. Improve documentation of smoking status and readiness to quit. 3. Initiate a nicotine replacement therapy protocol for all those who communicate readiness to quit (in targeted populations - AMI, CHF, PNA) and offer the quit hotline phone number for those who are not ready. Program Description: 1. Nursing staff will inquire at admission about patients smoking status and readiness to quit and document patient responses on the admission database. 2. If patient is ready to quit, RN must report to intern so that Nicotine Replacement Therapy (NRT) can be initiated. 3. Intern will fill out NRT protocol with patient to ensure most appropriate products are used, based on patients smoking history and quitting history. 4. Pharmacy will receive copy of NRT orders via fax and fill orders accordingly. Outcomes Measurement: Outcomes will be measured in Phase II of this project, beginning one quarter after protocol initiation, by Georgetown University SNHS students. Outcome measurements will include: 1. Identification of 90% of adult smokers on admission 2. Achieve a 90% compliance target for providing smoking cessation advice for AMI, CHF and PNA patients, as required by JCAHO. Necessary Resources: 1. New order forms for the NRT protocol. 2. Training time with current pulmonary and cardiac services and with incoming interns. (Training to be done by Mary Beth Ginn, RN, BSN) 3. Training time with nursing staff regarding new protocol and importance of screening all patients, especially AMI, CHF and PNA patients. 4. Adequate stock in pharmacy of NRT products