Do You Have 30 Do You Have 30 Seconds to Save a Life?Seconds to Save a Life?

Tobacco Tobacco CessatioCessationn

PHIPHI

► This is a self-study module developed by This is a self-study module developed by members of the Research and Quality members of the Research and Quality Councils to provide staff the best evidence on Councils to provide staff the best evidence on tobacco cessation.tobacco cessation.

► At the end of this module, the participant will At the end of this module, the participant will be able to:be able to: Describe the importance of tobacco cessation Describe the importance of tobacco cessation

interventionsinterventions Discuss the 5 A intervention process for quittingDiscuss the 5 A intervention process for quitting Describe the role of the PinnacleHealth tobacco Describe the role of the PinnacleHealth tobacco

cessation counselorcessation counselor Identify three resources available within Identify three resources available within

PinnacleHealth System or the community to assist PinnacleHealth System or the community to assist patients with tobacco cessation. patients with tobacco cessation.

The CrimeThe Crime

Crime Scene EvidenceCrime Scene Evidence► Annually 430,000 people die from tobacco-Annually 430,000 people die from tobacco-

related diseasesrelated diseases

►Healthy People 2010’s goal is for 85% of Healthy People 2010’s goal is for 85% of healthcare providers to routinely advise healthcare providers to routinely advise about cessationabout cessation

►Nurses can focus efforts in 2 directions: the Nurses can focus efforts in 2 directions: the 26% of the population that use tobacco & 26% of the population that use tobacco & also in primary preventionalso in primary prevention

How can this crime be How can this crime be prevented?prevented?

►Motivate high-risk groups Motivate high-risk groups

►Minimal efforts improve long-term quit Minimal efforts improve long-term quit rates by 5-10%rates by 5-10%

► Consistent, persistent approach Consistent, persistent approach

►Multiple, personalized interventionsMultiple, personalized interventions

How can nurses prevent the How can nurses prevent the crime?crime?

►Nurse-led tobacco cessation Nurse-led tobacco cessation interventions increase success by 50%interventions increase success by 50%

►““If the 2.2 million nurses in the US If the 2.2 million nurses in the US each helped 1 person/yr quit, nurses each helped 1 person/yr quit, nurses would triple the US quit rate (Tobacco would triple the US quit rate (Tobacco free nurses, 2002)free nurses, 2002)

A crime-free society takes A crime-free society takes timetime

►Cessation requires many attemptsCessation requires many attempts

►The process is different for each The process is different for each personperson

►Quitting occurs in stages and nurses Quitting occurs in stages and nurses need to intervene at each stageneed to intervene at each stage

Tampered Evidence (myths)Tampered Evidence (myths)

► Smokers don’t Smokers don’t wantwant to quit. to quit.Fact: Fact: Seventy to eighty percent of smokers do Seventy to eighty percent of smokers do

want to quit but are unable to do so without want to quit but are unable to do so without assistance.assistance.

►Nurses don’t have enough time to provide smoking cessation advice.Fact: A brief smoking intervention (< 3 minutes)

can increase quit rates.►Nurses who smoke can’t be helpful to

patients using tobacco.Fact: No one understands the difficulty of quitting

more than a person who has recently attempted quitting.

Short-Term Risks of Tobacco Short-Term Risks of Tobacco UseUse

► SmokersSmokers shortness of breathshortness of breath exacerbation of asthmaexacerbation of asthma harm to pregnancyharm to pregnancy impotence, infertilityimpotence, infertility

► Smokeless tobacco usersSmokeless tobacco users mouth and gum diseasemouth and gum disease

Long-term Risks of Tobacco UseLong-term Risks of Tobacco Use

► SmokersSmokers Heart attackHeart attack COPDCOPD StrokeStroke Cervical cancerCervical cancer Pancreatic cancerPancreatic cancer Bladder CancerBladder Cancer Lung cancerLung cancer Oral, pharyngeal, esophageal cancerOral, pharyngeal, esophageal cancer

► Smokeless Tobacco UsersSmokeless Tobacco Users Oral, pharyngeal, esophageal cancerOral, pharyngeal, esophageal cancer

Environmental Risks of Tobacco Environmental Risks of Tobacco UseUse

► Lung cancer and Lung cancer and heart disease from heart disease from second hand smokesecond hand smoke

► Low birth weightLow birth weight► SIDSSIDS► AsthmaAsthma► Middle ear infections Middle ear infections ► Respiratory Respiratory

infections infections

Rewards/Benefits of QuittingRewards/Benefits of Quitting►After 20 minutes . . . After 20 minutes . . .

Blood pressure and heart rate drop to normalBlood pressure and heart rate drop to normal Body temperature of extremities increases to Body temperature of extremities increases to

normalnormal

►After 8-12 hours . .After 8-12 hours . . . . Blood oxygen level increases to normalBlood oxygen level increases to normal Carbon monoxode levels drop to normalCarbon monoxode levels drop to normal

►After 24-48 hours . . .After 24-48 hours . . . Chance of heart attack is decreasedChance of heart attack is decreased Nerve endings start regrowingNerve endings start regrowing Smell and taste is enhancedSmell and taste is enhanced

Rewards/Benefits of QuittingRewards/Benefits of Quitting►After 2-3 weeks . . .After 2-3 weeks . . .

Circulation improvesCirculation improves Walking becomes easierWalking becomes easier Lung function increases up to 30%Lung function increases up to 30%

►After 1-12 months . .After 1-12 months . . . . Coughing, sinus congestion, fatigue, SOB decreaseCoughing, sinus congestion, fatigue, SOB decrease Cilia regrow in lungs, reducing risk of infectionCilia regrow in lungs, reducing risk of infection Body’s overall energy increasesBody’s overall energy increases Risk of coronary heart disease is decreased Risk of coronary heart disease is decreased

by half by half

Rewards/Benefits of QuittingRewards/Benefits of Quitting►After 5 years . . .After 5 years . . .

Lung cancer death rate decreases by halfLung cancer death rate decreases by half Stroke risk similar to non-smokerStroke risk similar to non-smoker Risk of mouth, throat and esophageal cancers is Risk of mouth, throat and esophageal cancers is

decreased by halfdecreased by half

►After 10-15 years . . .After 10-15 years . . . Lung cancer death rate similar to non-smokerLung cancer death rate similar to non-smoker Pre-cancerous cells are replacedPre-cancerous cells are replaced Risk of cancer to other organs decreasesRisk of cancer to other organs decreases Risk of coronary disease is equivalent to Risk of coronary disease is equivalent to

a non-smoker a non-smoker

Barriers to QuittingBarriers to Quitting

►Previous unsuccessful quit attemptsPrevious unsuccessful quit attempts►Enjoys smoking and has smoked for a long Enjoys smoking and has smoked for a long

timetime►Living with other smokers or smoking Living with other smokers or smoking

friendsfriends►Stress relieverStress reliever►Fear of weight gainFear of weight gain►Fear of failureFear of failure►Withdrawal symptomsWithdrawal symptoms

5 A’s – Intervention for 5 A’s – Intervention for QuittingQuitting

►AAsksk►AAdvisedvise►AAssessssess►AAssistssist►AArrangerrange

►Ask Ask patients about their patients about their tobacco status.tobacco status.

““Are you currently using Are you currently using tobacco products?”tobacco products?”

““How much tobacco are you How much tobacco are you using?”using?”

►Advise Advise your patient to quit using your patient to quit using tobacco products.tobacco products.

““It is important for you to quit smoking It is important for you to quit smoking now and we can help you”now and we can help you”

►Personalizing the message can Personalizing the message can increase its impact. increase its impact.

►Reinforce that it can take up to Reinforce that it can take up to seven attempts to successfully stay seven attempts to successfully stay quit.quit.

►Assess Assess readiness to quit.readiness to quit.““Are you interested in Are you interested in quitting with our help?”quitting with our help?”

““Are you ready to quit in Are you ready to quit in the next few weeks?”the next few weeks?”

►Assist Assist patient to quit.patient to quit.

Contact Tobacco Cessation Contact Tobacco Cessation Counselor if patient is ready to Counselor if patient is ready to quit at 221-6263.quit at 221-6263.

Provide “Preparing to Quit Using Provide “Preparing to Quit Using Tobacco” on patient education Tobacco” on patient education intranet site:intranet site:

http://home.pinnaclehealth.org/PatientEd/http://home.pinnaclehealth.org/PatientEd/TobaccoPreparingToQuit.pdf TobaccoPreparingToQuit.pdf

Tobacco Cessation Counselor Tobacco Cessation Counselor RoleRole

► Assists patients in developing an Assists patients in developing an individualized plan to quit.individualized plan to quit.

► Consult generated when smoking checked on Consult generated when smoking checked on Admission Assessment Admission Assessment BUTBUT: counselor is part : counselor is part time and time and not not able to see all pts.able to see all pts.

► Counselor will follow up with phone Counselor will follow up with phone consults first. Call if pt ready to quit consults first. Call if pt ready to quit and in need of a “plan”. and in need of a “plan”.

►ArrangeArrange follow-up to monitor follow-up to monitor progress.progress.

►QUIT line is available 24 hours, QUIT line is available 24 hours, seven days/week for ongoing seven days/week for ongoing support. support.

►QUIT line - 1-877-724-1090.QUIT line - 1-877-724-1090.

Methods to Help QuittingMethods to Help Quitting►PharmacotherapyPharmacotherapy►Self-help materialsSelf-help materials►Individual counseling and group Individual counseling and group

therapytherapy►Alternative therapies Alternative therapies

Use of multiple methods can increase the Use of multiple methods can increase the chance of successfully quitting.chance of successfully quitting.

PharmacotherapyPharmacotherapy

►Nicotine Replacement Therapy can be Nicotine Replacement Therapy can be used for short-term therapy reduce used for short-term therapy reduce withdrawal symptoms in patients.withdrawal symptoms in patients.

►This should only be used with patients This should only be used with patients that still have nicotine in their that still have nicotine in their systems.systems.

► It takes an average of 3 days for It takes an average of 3 days for nicotine to clear from the smoker’s nicotine to clear from the smoker’s body.body.

Nicotine Replacement Nicotine Replacement TherapyTherapy

► Available in various forms Available in various forms – gum, transdermal – gum, transdermal patches, intranasal spray patches, intranasal spray and lozengeand lozenge

► Advise patient to consult Advise patient to consult with physician before use with physician before use of these productsof these products

► Advise patients to read Advise patients to read product instructions prior product instructions prior to useto use

PharmacotherapyPharmacotherapy

►Bupropion SR (Zyban or Bupropion SR (Zyban or Wellbutrin) has been found to Wellbutrin) has been found to decrease the urge for smoking.decrease the urge for smoking.

Individual Counseling and Group Individual Counseling and Group TherapyTherapy

► Both forms of counseling have been shown to be Both forms of counseling have been shown to be effectiveeffective

► PinnacleHealth offers Tobacco Cessation Classes for a PinnacleHealth offers Tobacco Cessation Classes for a fee. Information is found on the Learning Institute fee. Information is found on the Learning Institute intranet site. Click on “intranet site. Click on “Community EducationCommunity Education””

► Areas of potential information include Health Areas of potential information include Health Screening, Support Groups, Wellness Services, Screening, Support Groups, Wellness Services, Women’s Programs.Women’s Programs.

► http://www.pinnaclehealth.org/body.cfm?http://www.pinnaclehealth.org/body.cfm?id=94&action=list id=94&action=list

Alternative TherapiesAlternative Therapies

►Hypnosis, acupuncture, acupressure Hypnosis, acupuncture, acupressure and electroacupressure have been and electroacupressure have been utilized but not shown to have utilized but not shown to have conclusive benefitconclusive benefit

►These can be adjunctive therapy These can be adjunctive therapy with the other therapies with the other therapies

Self-Help MaterialsSelf-Help Materials

►Written materialsWritten materials► Audio/video tapesAudio/video tapes► Computer programs/chat roomsComputer programs/chat rooms► Internet-based cessation programsInternet-based cessation programs► Telephone hotlinesTelephone hotlines

These materials are more effective than no These materials are more effective than no intervention and should be tailored to the intervention and should be tailored to the individual tobacco user.individual tobacco user.

Pinnacle ResourcesPinnacle Resources►IntranetIntranet: Click on “Departments” then : Click on “Departments” then

“Learning Institute” “Learning Institute”

►For patient education handouts, click on For patient education handouts, click on “Patient Education” “Patient Education”

►Click on “Click on “TT” for Tobacco Cessation Module. ” for Tobacco Cessation Module. Includes list of Tobacco Cessation resources Includes list of Tobacco Cessation resources and FREE QUITLINE: 1-877-724-1090 and FREE QUITLINE: 1-877-724-1090

http://home.pinnaclehealth.org/PatientEd/http://home.pinnaclehealth.org/PatientEd/TobaccoPreparingToQuit.pdfTobaccoPreparingToQuit.pdf

Pinnacle ResourcesPinnacle Resources► Intranet home page, click on Intranet home page, click on

“Departments”, click on ““Departments”, click on “Women Care Women Care Resource CentersResource Centers””

►Site has many helpful resources for Site has many helpful resources for women women

►May be helpful to pts/families or staff May be helpful to pts/families or staff

looking for supportlooking for support

► http://home.pinnaclehealth.org/womancare/ http://home.pinnaclehealth.org/womancare/ inwcare.htminwcare.htm

Internet ResourcesInternet Resources

► httphttp://://www.tobaccofreekids.org/www.tobaccofreekids.org/http://www.tobaccofreekids.org/research/http://www.tobaccofreekids.org/research/  

Tobacco Free Nurses - second one is their Tobacco Free Nurses - second one is their fact sheet on nurses fact sheet on nurses

► http://www.tobaccofreenurses.orghttp://www.tobaccofreenurses.org..http://tobaccofreenurses.org/media/documents/facthttp://tobaccofreenurses.org/media/documents/factsscreen.pdfsscreen.pdf  

This site is the guide for nurses using the 5As, gives This site is the guide for nurses using the 5As, gives some resources for pts, and lists some resources for pts, and lists pharmacotherapies and their durations pharmacotherapies and their durations

Internet ResourcesInternet Resources, cont., cont.

► http://www.ahrq.gov/about/nursing/hlpsmksqthttp://www.ahrq.gov/about/nursing/hlpsmksqt.htm.htm  

Has a 5-Day Countdown to Your Quit Date Has a 5-Day Countdown to Your Quit Date sheet telling patients what to dosheet telling patients what to do

► http://www.surgeongeneral.gov/tobacco/5dhttp://www.surgeongeneral.gov/tobacco/5daybook.htmaybook.htm  

"Treating Tobacco Use and Dependence" - "Treating Tobacco Use and Dependence" - quick reference guide from Surgeon quick reference guide from Surgeon GeneralGeneral

Internet ResourcesInternet Resources, cont., cont.

► http://www.surgeongeneral.gov/tobacco/tobahttp://www.surgeongeneral.gov/tobacco/tobaqrg.htmqrg.htm  

Interactive TIPS sheet from the CDC showing Interactive TIPS sheet from the CDC showing how various organs look after you've smokedhow various organs look after you've smoked

► http://www.cdc.gov/tobacco/sgr/sgr_2004/http://www.cdc.gov/tobacco/sgr/sgr_2004/sgranimation/flash/index.htmlsgranimation/flash/index.html

PA 24 hr Quitline: 1-877-724-PA 24 hr Quitline: 1-877-724-10901090

One Final Word . . . . . One Final Word . . . . . Don’t Forget to Document!!Don’t Forget to Document!!

SelectEducation

Documentation

SelectTobacco

Cessation

► Anderson, J.E., Jorenby, D.E., Scott, W. J. & Fiore, M.C. (2002). Anderson, J.E., Jorenby, D.E., Scott, W. J. & Fiore, M.C. (2002). Treating tobacco use and dependence: An evidence-based Treating tobacco use and dependence: An evidence-based clinical practice guideline for tobacco cessation. Chest, 3, p. clinical practice guideline for tobacco cessation. Chest, 3, p. 932-941. 932-941. http://www.chestjournal.org/cgi/reprint/121/3/932http://www.chestjournal.org/cgi/reprint/121/3/932

► Joanna Briggs Institute – Smoking Cessation Interventions and Joanna Briggs Institute – Smoking Cessation Interventions and Strategies Information Sheet, 2001. Strategies Information Sheet, 2001. http://www.joannabriggs.edu.au/best_practice/BPISsmok.php http://www.joannabriggs.edu.au/best_practice/BPISsmok.php

► National Clearing House for Practice GuidelinesNational Clearing House for Practice Guidelines http://www.guidelines.gov/search/searchresults.aspx?http://www.guidelines.gov/search/searchresults.aspx?Type=3&txtSearch=Treating+Tobacco&num=20 Type=3&txtSearch=Treating+Tobacco&num=20

► Nursing Best Practice Guideline: Integrating Smoking Nursing Best Practice Guideline: Integrating Smoking Cessation into Daily Nursing Practice Cessation into Daily Nursing Practice http://www.rnao.org/bestpractices/PDF/BPG_smoking_cessatiohttp://www.rnao.org/bestpractices/PDF/BPG_smoking_cessation.pdfn.pdf

ReferencesReferences

Thank youThank you

► Kim Fowler, MSN, RNKim Fowler, MSN, RN► Sarah Harne-Britner, MSN, RN, CCRNSarah Harne-Britner, MSN, RN, CCRN► Patricia Baxter, BSN, RNBCPatricia Baxter, BSN, RNBC► Trish Bennett, MSN, RN, CCRNTrish Bennett, MSN, RN, CCRN► Barbara Nace, RNBarbara Nace, RN► Linda Blough, RNLinda Blough, RN► Betsy Ross, MSBetsy Ross, MS► Arletta Molnar, RNCArletta Molnar, RNC► Brad PetersonBrad Peterson