1. SMOKING CESSATION INTERVENTION
FOR NURSES TO USE IN
CLINICAL PRACTICE
SEMINAR
Tamieka Bugam
Ricardo Lim
Julia Strong
MSN 7741
Wilmington University

2. Objectives
 At the end of the session, participants will be
able to identify the 5 A’s of smoking
cessation.
 At the end of the session, participants will be
able to identify the 3 quick interventions for
nurses.
 At the end of the session, participants will be
able to name the 5 stages of change.

3. .Seminar Outline
 I.Topic: Smoking Cessation Intervention: For Nurses to
Use in Clinical Practice
 A.Tobacco Use
1. Adolescent Smokers
2. Patients with Mental Illness who smoke
3. Elderly Smokers
 B. Nurses role
1. Efficacy of Advice to Quit
2. What works
3. Support/Counseling
4. Pharmacotherapy
 II. Stages of Change
 A.The 5A’s ofTobacco Cessation
 1. 1-800-QUIT-NOW and State Quit Lines
 2. Strategies for Providers
 3. Help for the busy Nurses
 4 How to Refer
 5. Quit line outlines report
 6. Reminder for Nurses
 III. Learning More/CE Options

4. TobaccoUse
“Tobacco use remains the leading cause
of preventable morbidity and mortality
in the nation and is a major contributor
to excess medical care costs.”
(Quinn, V. P., 2008)

5. Tobacco Use
“Smoking rates remain
unsatisfactorily high, 20% among
adolescents and 21% in adults,
compared with Healthy People
targets of 16% and 12%,
respectively.”
(Jonathan E. Fielding, 2012)

6. AdolescentSmokers
 Teens prefer smoking cessation messages
from peers
 Prefer to hear about what they will gain
from smoking cessation: health and social
benefits
 Celebrities and athletes are preferred
sources of messages
(Latimer et al., 2012)

7. Patientswith MentalIllnessWho
Smoke
 Patients successfully quit smoking when
they receive adequate support
 Pharmacologic treatment and nicotine
replacement therapy can be effective
 Cessation does not lead to psychiatric
decompensation
(Parker, McNeill & Ratschen, 2012; Prochaska, 2011)

8. (CDC, 2014)

9. ElderlySmokers
 The elderly are less likely to think smoking is
harmful
 Smoking is the cause of 1 in 5 U.S. deaths
 Smoking causes 90% COPD deaths; 80-90%
of lung cancer deaths
 Increased risk: coronary heart disease;
stroke; dementia; cataracts
 Cessation has benefits even at a late age.
(www.lung.org)

10. NursesRole
Nursing is the largest group of health care
professionals and have tremendous potential
role in smoking cessation interventions. Healthy
People 2020 goal for adult Tobacco use will be
achieved if every nurse helps one smoker per
year to quit smoking.
Nursing world, Tobacco Free Nurses.
http://www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/TobaccoFree.html

11. EfficacyofAdvicetoQuit
Abstinence Rate %
 No advice 7.9
 Physician, Nurses Advice 10.2
and other Health Care
 Patients expect healthcare providers to ask about
tobacco use and advise them to quit
Source:TreatingTobacco Use and Dependence, USDHHS, Public Health Service, 2000

12. WhatWorks
 Behavioral Counseling Support
Treats the psychological and
habit aspects
 Pharmacotherapy
Treats nicotine addiction
Works best when combined

13. Support/Counseling
 Group counseling programs: lecture;
exercises; tapering; build coping skills
 Cognitive BehavioralTherapy
 Cognitive and behavioral strategies are effective
in prevention of relapse
 20-week follow-up was more effective that brief
intervention.
(Killen et al., 2008)

14. Pharamacotherapy
 Nicotine Replacement: lozenges; gum;
transdermal; nasal spray; inhaler
 Bupropion: potentiates dopamine;
norepinephreine. Contraindicated if h/o
of seizure
 Varenicline: partial agonist at nicotine
receptor; reduces withdrawal; reduces
reward.
(Rennard & Daughton, 2014)

15. http://www.surgeongeneral.gov/tobacco/treating_tobacco_use.pdf

16. StagesofChange
 Pre-contemplation
 Contemplation
 Preparation
 Action
 Maintenance
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)

17. The5A’sofTobaccoCessation
 TreatingTobacco Use and Dependence
Clinical Practice Guidelines: 2008 Update -
U.S. Department of Health and Human
Services, Public Health Service
 A brief evidence-based tobacco cessation
intervention
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)

18. The5A’sofTobaccoCessation
 Ask about tobacco use
 Advise patient to quit
 Refer (1-800-QUIT-NOW or local program)
 Assess readiness to quit
 Assist in quit attempt
 Arrange follow-up
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)

19. 1-800-QUIT-NOW
1-800-Quit-Now is a national number which
accepts callers from throughout the nation,
directing them to the appropriate state quitline.

20. StatesQuit Lines
 Alabama
1-800-QUIT NOW
 Alaska
1-888-842-QUIT
 Arizona
1-800-556-6222
 Arkansas
1-866-NOW-QUIT
1-866-669-7848
 California
1-800-NO-BUTTS
 Colorado
1-800-QUIT NOW
 Connecticut
1-866-END-HABIT
 Delaware
1-866-409-1858
 Florida
1-877-U-CAN-NOW
 Georgia
1-877-270-STOP
 Idaho
1-800-QUIT NOW
 Illinois
1-866-QUIT-YES
 Indiana
1-800-QUIT NOW
 Iowa
1-800-QUIT NOW
 Kansas
1-866-KAN-STOP
 Kentucky
1-800-QUIT NOW
 Louisiana
1-800-QUIT NOW
 Maine
1-800-207-1230
 Massachusetts
1-800-TRY-TO-
STOP
 Michigan
1-800-480-7848
 Minnesota
1-888-354-PLAN
Quitlines. (2010).

21. StatesQuit Lines(Continue)
 Mississippi
1-800-QUIT NOW
 Montana
1-866-485-QUIT
 Nevada
1-888-866-6642
 New Hampshire
1-800-548-8252
 New Jersey
1-866-NJ-STOPS
 New Mexico
1-800-4-CANCER
 NewYork
1-866-NY-QUITS
 Ohio
1-800-934-4840
 Oklahoma
1-866-PITCH-EM
 Oregon
1-877-270-STOP
 Pennsylvania
1-877-724-1090
 Rhode Island
1-800-TRY-TO-
STOP
 South Dakota
1-866-SD-QUITS
 Texas
1-877-YES-QUIT
 Utah
1-800-QUIT NOW
 Vermont
1-877-YES-QUIT
 Virginia
1-800-QUIT NOW
 Washington
1-877-270-STOP
 Washington, DC
1-800-399-5589
 Wisconsin
1-877-270-STOP
 Wyoming
1-866-WYO-QUIT
Quitlines. (2010).

22. Ask
 Ask about tobacco use at every visit
 Systematically identify all tobacco users
 Make identification/documentation a vital
sign
 Create a universal identification system
(stickers, computer reminders, etc.)
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)

23. Createa ReminderSystem
Include tobacco use in other medical / dental advice
Use an identification system
Stamp, Sticker, EMR
Tobacco Use and Exposure
Tobacco Use: (circle one): Current Former Never
Secondhand Smoke Exposure: YES NO
Vital Signs: Blood Pressure: ________ Pulse: _____ Temp: _____ Resp: _____
Nicotine Patch: __________ mg daily Date Started: _____________________
.

24. Advise
 Clear, Strong, Direct
“Quitting smoking ...
 Employ the teachable moment:
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)

25. Assess
 Smokers who want to quit in the
next 30 days
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)

26. Assist
 Develop a quit plan
 STAR:
- Set a quit date (within 2 weeks)
- Tell family, friends, coworkers
- Anticipate challenges to quitting
- Remove tobacco products from
environment
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)

27. Arrange
 Schedule follow-up
 in person
 via telephone
 Use Quitline
 Evaluate pharmacotherapy use/problems
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)

28. Help for the Busy
Nurses

29. Ifyouonlyhavetwo minutes
 Ask every patient about tobacco use
 Advise to quit with a clear, strong, personalized
message
 Refer to
 Tobacco Use Quitline
1-800-QUIT-NOW (1-800-784-8669)
 Other resources as appropriate
 Prescribe
 Get NRT order from Physicians/Nurse
Practitioner
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)

30. REFER
 Consider fax referral
 For patients ready to quit within 30 days
 Consider cessation medications
 Provide Quitline number to all patients,
even those not ready to quit
 Other resources such as Become An Ex
 Follow-up at every visit
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)

31. NewJersey TobaccoUseQuitline
 NJ Quitline- 1-866-NJSTOPS (1-866-657-8677)
Free telephone cessation counseling and free
two week supply of nicotine patches.
http://njquitline.org/
 Mom's Quit Connection- 1-888-545-5191
Free telephone or face to face cessation
counseling for pregnant and parenting
women and families.
Fax Referral

32. NJQuitline
Fax Form

33. QuitlinecanAssess,Assist,Arrange
 Quit coach helps set Quit Date, and
 Develop quit plan
 Make follow-up calls
 Discuss pharmacotherapy
 Mail targeted resources
 Patients can call the Quitline anytime
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)

34. Fax ReferraltoQuitlinefacilitate
 Referral to effective cessation resources
 Provider’s limited time and resources
 Nurses referral to a cessation program has a
higher rates of participation than simply
telling patients they should stop using
tobacco
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)

35. HowFaxReferralWorks
1. Patient has been identified as a tobacco user
2. Patient educated on smoking cessation
3. Patient wants to quit tobacco use within 30 days
4. Patient consent to a quit coach to call at time/date
they select
5. HCP completes Provider Information, including
Hospital-Clinic Name, Contact Name and Number.
6. Patient completes Patient Information and signs
consent for HCP to release information
7. Quitline can provide Fax Referral Outcomes Report:
8. Quitline will begin contact attempts to enroll patient
in program based on time and date provided by
patient.
(Brief Tobacco Cessation Counseling For physicians and other providers and healthcare professionals to use in
clinical practice, 2009)

36. QuitlineOutcomesReport
 Tool to follow patient progress with your
advice to quit / utilize Quitline services
 Most useful in clinic setting with dedicated
fax machine/staff to retrieve reports
 Outcomes Report information includes:
 Accepted services
 Declined services
 Unreachable
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)

37. ReminderforNurses
 Brief cessation counseling is effective
 Longer cessation counseling is more effective
 Pharmacotherapy can double quit rates
 Pharmacotherapy should be offered to all
- few exceptions
 Evidence-based resources are available
(Brief Tobacco Cessation Counseling For physicians and other providers
and healthcare professionals to use in clinical practice, 2009)

38. For more patient cessation
resources, view Cessation
Resources at:
www.njquitline.org

39. LearningMore/CEOptions
 Medscape:TreatingTobacco Use and Dependence
http://www.medscape.com/viewarticle/570604
 Free
 Approved for 1hour CE
 AMA PRA Category 1 Credit(s)™
 Requires registration to Medscape
 TobaccoFreePatients.com
http://www1.tobaccofreepatients.com/TopicReq?
 Based on NCI educational program
 Available free for study and review
 $15 per credit hour / letter of completion
(Brief Tobacco Cessation Counseling For physicians and other providers and
healthcare professionals to use in clinical practice, 2009)

40. References
 BriefTobacco Cessation Counseling For physicians
and other providers and healthcare professionals
to use in clinical practice. (2009, June). North
Carolina.
 Fielding, J., (2012). Health Reform and Healthy
People Initiative. AmericanJournal of Public
Health.
 Killen, J., Fortmann, S., Schatzberg,A., Arredondo,
C., Murphy, G., Hayward, C., Celio, M., Cromp,
D., Fong, D., & Pandurangi, M. (2008).
Extended cognitive behavior therapy for
cigarette smoking cessation. Addiction,
103,1381-1390.

41. References
 Latimer, A., Krishnan-Sarin, S., Cavallo, D., Duhig, A.,
Salovery, P., & O’Malley, S. (2012).Targeted Smoking
Cessation Messages for Adolescents. Society for
Adolescent Health and Medicine, 50, 47-53.
 CDC. (2014). New CDCVital Signs: Smoking among
those with Mental Illness. Retrieved June 21, 2014 from
http://www.cdc.gov/media/dpk/2013/dpk-vs-adult-
smoking-mental-illness.html
 Parker, C., McNeill, A., & Ratschen, E. (2012).
Tailored tobacco dependence support for
mental health patients: a model for inpatient and
community services. Addiction, 107, 18- 25.
 Prochaska, J. (2011). Smoking and mental Illness—
breaking the link. The New England Journal of
Medicine, 365, 196-198.

42. References
 Quinn,V.P., (2008). Effectiveness of the 5-As
Tobacco CessationTreatments in Nine HMOs.
Journal General Internal Medicine.
 Quitlines. (2010). Retrieved from Smoking Cessation
Leadership Center:
http://smokingcessationleadership.ucsf.edu/Quit
lines.htm
 Rennard, S., & Daughton, D. ( 2014). Smoking
cessation. Clinical Chest Medicine, 35, 165-
176.
 Retrieved from www.cdc.gov
 Retrieved from www.lung.org