An audit of the prevalence of recorded nicotine dependence treatment in an Australian psychiatric hospital

Abstract

Objectives: To investigate the prevalence of recorded smoking status, nicotine dependence assessment, and nicotine dependence treatment provision; and to examine the patient characteristics associated with the recording of smoking status. Method: A retrospective systematic medical record audit was conducted of all psychiatric inpatient discharges over a six‐month period (1 September 2005 to 28 February 2006), at a large Australian psychiatric hospital, with approximately 2,000 patient discharges per year. A one‐page audit tool identifying patient characteristics and prevalence of recorded nicotine dependence treatment, and requiring ICD‐10‐AM diagnoses coding was used. Results: From 1,012 identified discharges, 1,000 medical records were available for audit (99%). Documentation of smoking status most frequently occurred on the admission form (28.8%) and diagnoses summary (41.6%). Documentation of nicotine dependence was not found in any record, and recording of any nicotine dependence treatment was negligible (0‐0.5%). The rate of recorded smoking status on discharge summaries was 6%. Patients with a diagnosis of alcohol, cannabis, sedative use disorders or asthma were twice as likely to have their smoking status recorded compared to those who did not have these diagnoses. Conclusions: Mental health services, by failing to diagnose and document treatment for nicotine dependence, do not conform to current clinical practice guidelines, despite nicotine dependence being the most commonly diagnosed psychiatric disorder. Implications: Considerable system change and staff support is required to provide an environment where a primary prevention approach such as smoking care can be sustained.

Smoking Cessation Care for People with a Mental Illness: Family Carer Expectations of Health and Community Services

“…Such findings emphasise the need to better consult with, inform, and educate family carers regarding the rationale for, and implementation of smoking bans; a desire expressed by family carers (Missen et al, 2013). In addition, these findings may be influenced by the inconsistent implementation of smoke-free policies within mental health settings (Missen et al, 2013;RCP&RCP, 2013;Wye et al, 2010a;Wye et al, 2014), reducing the likelihood of intended benefits being achieved and hence experienced by carers.…”

“…Despite the existence of guidelines, the literature indicates that smoking cessation care is not routinely provided to smokers with a mental illness in inpatient (Prochaska et al, 2004;Wye et al, 2010a) or community (Anderson et al, 2013;Bartlem et al, 2015;Bartlem et al, 2014) mental health services and smoking cessation supports such as Quitline referral and nicotine replacement therapy are not routinely provided (Anderson et al, 2013;Bartlem et al, 2015;Bartlem et al, 2014). In GP, suboptimal smoking cessation care has been reported to be provided to both general and mental health patients (Holmberg et al, 2014;Lord et al, 2010;McKayBrown et al, 2008).…”

“…The delivery of smoking cessation care to people with a mental illness is consistently reported to be suboptimal in inpatient facilities (Prochaska, Gill, & Hall, 2004;Stockings et al, 2015;Wye et al, 2010a), community mental health services (Bartlem et al, 2014;Greening, 2005), and by GPs (Lord, Malone, & Mitchell, 2010;McKay-Brown et al, 2008). For example, a survey of 97 smokers in an Australian inpatient psychiatric facility with a smoke-free policy identified that only 36.1% received brief advice to quit smoking and just 19.8% received brief advice and optimal nicotine replacement therapy .…”

What carers of family members with mental illness say, think and do about their relative's smoking and the implications for health promotion and service delivery: a qualitative study

“…The need for health services, particularly mental health services, to do more to address smoking for people with mental illness and adopt a smoke-free policy within their care environments is now an internationally recognised imperative (NICE, 2013;RCP, 2013).This includes the need for consistent diagnosis, documentation and treatment of nicotine dependence to conform to established clinical practice guidelines (Wye, et al, 2010c). This response needs to occur across the full spectrum of community and inpatient care environments to ensure consistent support and to comprehensively address the cultural reinforement of smoking within this sector (Lawn & Campion, 2010).…”

Smoking: time for the mental health system to confront its own ambivalence

“…Nearly all NSW inpatient mental health units now adhere to a smoke-free policy and provide NRT. However, there is inconsistent enforcement, with leave passes to smoke, illicit smoking 16 and limited targeted follow-up on discharge. This is by no means atypical of similar facilities throughout the country.…”