31
Session 2 • How to reach and motivate tobacco user to quit? • How to motivate doctors and nurses to talk about quitting? • Good practice and challenges on ENSH Standard 3 and 4
Session 2
• How to reach and motivate tobacco
user to quit?
• How to motivate doctors and nurses
to talk about quitting?
• Good practice and challenges on
ENSH Standard 3 and 4
Using toolkits to support implementation of
tobacco cessation - Staff
• Focus on tobacco use as a clinical issue • Specialty specific presentations to the nursing
staff and healthcare assistants • “Doctors and Nurses – Procedure for dealing with
patients who smoke” – Poster – Pocket card
• Nurses’ patient care plan • Vignette training • Brief Intervention training
St. Vincent’s University Hospital
Using toolkits to support implementation of
tobacco cessation - Patients
St. Vincent’s University Hospital
Identification
Pharmacological
Treatment
Behavioural
support
Using toolkits to support implementation of
tobacco cessation - Nationally
• Significantly contributed to the development of a national toolkit for implementing a tobacco-free policy.
– National Tobacco-free campus policy
– Implementation plan
– Communications Plan
– Risk assessment for second-hand smoke
– Sample posters, leaflets & signage
• Attend regional, national and international events, workshops and conferences
• Papers
St. Vincent’s University Hospital
motivating hard core smokers
• computerized assessment of smoking status, medical
check, CO-measurement and FNT belong to the standard
intake assessment with every patient.
• routine brief intervention with every smoking patient as part
of the intake assessment
• mandatory lecture “Sir Walter Raleigh”
• 2 smoking cessation treatment groups (348 participants in
2012) based on CBT. 4 therapists guarantee continuous
supply of the groups.
• free NRT for participants of smoking cessation
• privileges for participants of smoking cessation
salus clinic Lindow
ENSH Gold Forum 2014
Pneumology wards: a
multidisciplinary intervention
programme
Hospital Clinic Barcelona
Program features
• Multidisciplinary intervention
• COPD patients
• Free pharmacological treatment
• Stages:
– Detection: Hospital (nurse)
– Intervention: Hospital (nurse+MD
pneumology ward)
– Follow-up (Tobacco Unit/Primary Care)
Pneumology Hospital Clínic
One Year Outcomes
• n = 81 patients
• 25% (oxygen therapy)
• Main cause of admission: exacerbation.
• 6-month abstinence: 60%.
• Those who quit smoking after
admission:
– Improvement in PaO2 and FEV1
– Less 6-month readmissions
Pneumology Hospital Clínic
ENSH Gold Forum 2014
Good Practice In Improving Services By
Reminder Systems In Patients Record
Kaohsiung Medical University
Chung-Ho Memorial Hospital
Hospital Support
2
Smoke Free Environment
Smoke-Free Web
Smoke-Free Zone
Smoke-Free Zone Line Public Sign
Smoke-Free Volunteer
Audit
2012 July Aug Sep Oct Nov
Bathroom 0 0 0 0 0
Stair 27 25 18 14 9
Hallway 172 180 146 150 139
Total 199 205 164 164 148
Patrol Inspection - Cigarette butts
ENSH Gold Forum 2014
Good pratice on intergrating staff in
implementation by reminder system
Kaohsiung Medical University
Chung-Ho Memorial Hospital
Education
Category No.
Nurse 59
Medical Personnel 29
Administrative Personnel 7
Tobacco Control Education (Gov.)
Category No.
Physician 12
Smoking Cessation Clinic (Gov.)
Year No. of employee trainees
2013 4666
Tobacco Related Education (Hosp)
Smoking Quit Health Education
& Transfer Competition
Process of Smoking Free Intervention
Detect behavior of
smoking
Transfer to smoking cessation
health education
clinic
Smoking cessation
clinic
Management
and monitoring
Picture of Detect Behavior
Picture of Behavior in Ward
Picture of Monitor
ENSH Gold Forum 2014
Specialised Hospital Coswig GmbH
Teaching Hospital of the University of Dresden
Prof. Dr. med. habil. A. Rolle
Centre for Pneumology, Allergology, Respiratory and
Intensive care, Sleep medicine and Thoracic surgery
interior view exterior view to the
Hospital in 1920
1930
Thoracic operating theatre,
annex to the main building
www.fachkrankenhaus-coswig.de
• 3. Renewal Certification ISO 9001:2008, seal of quality for clinic management
• Certification as Centre for Thoracic surgery
• Certification as Centre for Lung cancer treatment
• International Thoracic Laser Centre
• Gold Forum Membership
Centre for Pneumology, Allergology, Respiratory and Intensiv care, Sleep medicine and Thoracic surgery
Smoking status
Name, Firstname:
number of the case:
date of birth: 19.06.1965
active smoker: ex-smoker: nonsmoker:
number of cigarettes/day 20
age of beginning: 18
number of years of smoking 12
remarks:
wish to quit: yes no
Fagerström test
one year follow up history after consultation
by psychologist
n = 301 2010 / 2011
student program “Tobacco Parcours“
prevention, health risks, lung diseases and
symptoms of emphysema and COPD
ENSH Gold Forum 2014
Angered Hospital
- Action for a tobacco free
environment
A community hospital in a multicultural
urban setting
Angered Hospital
Mortality rates are higher than the rest of the country for a number of diseases: • Cardiovascular diseases
• COPD / Lung cancer
• Alcohol-related deaths
Also higher numbers for the following: • Obesity
• Daily smoking
• Physical inactivity
• Stress
Keys to success
The management of Angered
Hospital consider work with
tobacco issues very important.
Tobacco and health related
issues has been a main
concern and a mission for
Angered Hospital since the
start in 2007.
Angered Hospital
4. Identification and cessation support
• All new patients are asked if they smoke
Children – about passive smoking
• Patients scheduled for surgery are asked
about their smoking habits - Brief advice
- Counselling
- Advanced counselling
• Training course in motivational interviewing
techniques.
Angered Hospital
4. Identification and cessation support
Angered Hospital
OUR GOAL
Smoke free 6 weeks
before surgery
Tobacco
cessation
service
Guideline
Web based
education
0,00%
10,00%
20,00%
30,00%
40,00%
50,00%
Work is too busy No time to ask smoking status
and their willing to quit
Questionnaire for medical staff and smokers
about barriers of smoking cessation referral in 2012
Factors that stop medical staffs to help patients to quit
smoking
Doctors (N=55） No.(％) Nurses/Assistants
（N=54） No.(％)
Work is too busy 27
(49.09％)
Doctors don’t mention
about smoking cessation
34
(62.96％)
No time to ask smoking
status and their willing to
quit
18
(32.73％) No motivation
29
(53.70％)
Factors that reinforce smokers to quit smoking
Outpatient Smokers （N=704） No.（％）
Remind to quit smoking repeatedly 256
(36.47％)
Provide smoking cessation counseling and help me to realize
the disadvantages of smoking and the advantages of smoking
cessation
167
(23.79 ％)
0,00%
20,00%
40,00%
60,00%
80,00%
Doctors don’t mention about
smoking cessation
No motivation
Doctors
Nurses/Assistants
0,00%
10,00%
20,00%
30,00%
40,00%
Remind to quit smoking repeatedly Provide smoking cessation counseling
and help me to realize the
disadvantages of smoking and the
advantages of smoking cessation
Outpatient Smokers
27
Strategy 1
Emphasis the
importance of tobacco
free policy
Strategy 2
Reinforce doctors’
willingness to refer
patients
Strategy 3
Reinforce
nurses/ assistants’
willingness to refer
patients
Strategy 4
Set up referral SOP
Continuing education for staffs Announce the results at Hospital
Affairs Meeting every month
Lectures for outpatients Hospital website about smoking
cessation information
Referral incentives program
for nurses/assistants
Referral program and
referral sheet
28
Out-patient referrals for smoking cessation
2012 2013
health counseling smoking cessation
Outpatient Clinic total health counseling
smoking cessation
outpatient Clinic total
Medicine 163 31 194 137 89 137
Pulmonary 25 3 28 14 2 14
Endocrinology 18 2 20 7 1 7
In-patient referrals for smoking cessation
2012 2013
health counseling smoking cessation
Outpatient Clinic total health counseling
smoking cessation
Outpatient Clinic total
Orthopedics 9 6 15 39 8 50
Surgery 3 1 4 30 2 34
Pulmonary 12 4 16 15 7 27
29
Set up smoking cessation
referral SOP
Combine with smoking
cessation treatment if necessary
Medical staffs fill out the referral sheet
Smoking cessation educators
provide one-to-one counseling
All the SC activities will
record on the medical records
30
Participants of
smokers
Quit smoking
successfully
2010 1 0
2011 4 0
2012 2 1
2013 10 2
On-Site Smoking Cessation
Counseling Service For Staffs in 2013
Number of counseling 33
Number of people to receive SC
treatment 3
Decrease the amount of
smoking 1
Quit successfully 2
Smoking cessation class
31
