It’s Not That Simple: Tobacco Use Identification and Documentation in Acute Care

Abstract

This environmental telephone interview scan was designed to identify: (1) how hospitals in one Canadian province incorporated tobacco use identification/documentation systems into practice; and, (2) challenges/issues with tobacco identification/documentation. Participants included 36/139 hospitals previously identified to offer cessation services. Results showed hospitals aided by researchers monitored and tracked tobacco use; those not aligned with researchers did not. The wording of tobacco items most commonly included use within the last 6-months (42%), 30-days (39%), or 7-days (33%), or use without reference to time (e.g., “Do you smoke?”; 39%); wording sometimes depended on admitting form space limitations. The admission process determined where the tobacco item appeared, which differed by hospital—75% included it on an admitting form (75%) and/or nursing assessment (56%); the item sometimes varied by unit. There were also different processes by which the item triggered delivery of cessation interventions; most frequently (69%), staff nurses were triggered to provide an intervention. The findings suggest that adding a tobacco use question to a hospital’s admitting process is potentially not that simple. Deciding on the purpose of the question, when it will be asked and by whom, space allotted on the form, and how it will trigger an intervention are important considerations that can affect the question wording, form/location, systems required, data extraction, and resources.

Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment

“…Research suggests that integrating tobacco screenings into standardized clinical procedures encourages routine screening and intervention; an example of such practice is the implementation of hard-stop alerts in patients’ electronic health records (EHR), which prevents clinicians from further modifying the EHR without an entry about tobacco use status or a manual override [ 24 , 36 , 37 , 44 , 45 ]. However, hard stops are not ubiquitous within EHR systems, and some settings where tobacco-using patients are routinely seen are still utilizing paper charts for clinical encounters [ 46 , 47 ]. This may especially be the case in states like Texas where, according to data collected in 2016, only 58.4% of mental health treatment centers and 70.2% of substance use treatment centers were screening patients for tobacco use [ 24 ].…”

Identifying Best Implementation Practices for Smoking Cessation in Complex Cancer Settings

“…Our findings show that the two RCCs with the highest Tobacco Screening Rates used a centralized screening process [ 27 ] administered by clerical staff, while the remaining twelve RCCs used a decentralized screening process that was either patient-initiated, initiated or run by nurses or health care aides ( Table 2 ). With centralized screening, all new patients were registered and subsequently screened for smoking status at a single location.…”

“…With centralized screening, all new patients were registered and subsequently screened for smoking status at a single location. With decentralized screening [ 27 ], patients were admitted to a specific clinic, and were often screened for smoking status during the nursing assessment. The question remains as to whether the high screening rates are due to the centralized screening process, the staffing model, or a combination of both.…”

Improving patient education about tobacco withdrawal and nicotine gum use by registered nurses in inpatient psychiatry: A feasibility study

“…All patients were adults age 18 and older who were hospitalized on the unit during the pre‐intervention or post‐intervention phases and had used a tobacco product within the 30 days preceding their admission. The 30‐day window was derived from the definition of tobacco use specified in the tobacco treatment measure set of The Joint Commission (; Smith, Cobb, & Corso, ).…”