Emergency Nurse-initiated Brief Smoking Cessation Intervention
Darlie Simerson, DNP, FNP-BC, CEN; Diana Hackbarth, PhD, RN, FAAN
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Session C presented Thursday, September 14, 2017
Purpose: Smoking is the single most avoidable risk factor for many health problems. The ED provides care for many patients who smoke. Patients identifying as smokers and discharged from the ED do not customarily receive smoking cessation information. Emergency nurses routinely ask patients about their smoking status and are uniquely positioned to give smoking cessation advice and treatment referral for those patients who smoke. The objective of this project was to educate ED nurses about a brief smoking cessation intervention and have them initiate it for all adult ED patients who identify as smokers.
Design: This was an evidence based practice improvement project.
Setting: The setting was a suburban adult emergency department designated as a level II trauma center.
Participants/Subjects: The nurse participants were a convenience sample of 83 ED nurses working in the adult ED over a 6 month period. Patient participants were all ED patients 19 years and older that identified as smokers during a 12 week period. Excluded were those categorized as critical. Exempt status was obtained from the hospital IRB. All patient data was in aggregate and de-identified. Nurse surveys and documentation were anonymous to the researcher.
Methods: Retrospective ED patient smoking rates were measured to estimate the potential impact of the intervention. An ED nurse needs assessment survey was developed and administered to identify nurse smoking cessation education needs. A brief evidence based ask, advice, refer protocol was selected for the patient intervention. Nurses received protocol training and were surveyed post-education on knowledge obtained. Data was collected on nurse use of the patient intervention. Descriptive and t-test statistical analysis was performed on smoking rates, comparisons of two ED nurse surveys, and nurse use of the smoking cessation intervention. ED nurse demographics were obtained as well.
Results/Outcomes: Retrospective 12-month data revealed an ED patient smoking rate of 17.6% with no patient documented as having received smoking cessation information. The ED nurse needs assessment survey indicated limited prior smoking cessation training but nurses were comfortable talking with patients about quitting. The ED nurse post-education survey indicated significant knowledge gains in smoking cessation intervention delivery. The 12 week intervention smoking rate for 1488 ED patients was 19.9%. ED nurses documented advising all smokers to quit; 6.3% of patients accepted smoking cessation referrals. Nurse assessment of smoking status improved by 57%.
Implications: Emergency nurses felt competent to perform the smoking cessation intervention after training based on needs assessment results. Patients were consistently advised by ED nurses to quit smoking indicating that the ED setting can be used for this practice. Problems identified were inconsistencies in EMR prompts that could be corrected to better reflect nursing actions. Outcomes from this project can be used to encourage and guide future efforts by ED nurses to provide a brief smoking cessation intervention for the many ED patients that smoke and do not customarily receive help to quit.
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