The Medical College of Virginia (MCV) developed and implemented a smoking cessation initiative for inpatients in their cardiac care unit. They utilized the resources and training provided by APTNA which can be found on this website. Here is a description of that project submitted to APTNA by Joe Walsh, RN, Clinical Nurse III, M10E, Virginia Commonwealth University Medical Center:
QUIT FOR LIFE: MCV's Smoking Cessation Initiative
Here are some details about the "Quit for Life" (QFL) program at M10E, MCV:
- Unit-based program on a 28-bed tele cardiology medicine step down unit caring primarily for CAD, MI, CHF, Pacemaker population.
- The "QFL" team consists of eight novice RNs (less than one year post graduation for nursing school). These nurses have received extra training on the specifics of smoking cessation counseling. In addition, we plan on offering continuing education opportunities for the team such as the web/teleconference the Virginia Health Quality Center will be offering at the end of this month.
- When a patient is admitted to M10E, the admitting nurse (this is any nurse not a QFL team member per se) conducts a smoking survey. Basically, "do you smoke and if so are you interested in talking with one of our specially trained nurses about quitting strategies?" The admitting nurse fills out a simple form and places it in the patient's medical record. Thus, we document smoking screening on 100% of our patient population.
- If the patient does not smoke or has not smoked in over 12 months, we simply document in the medical record that a screening has taken place. If the patient smokes and absolutely has no interest in stopping, the admitting nurse briefly suggests that quitting would be a great option and offers them "You Can Quit Smoking" pamphlet. Again, we place the screening tool in the medical record stating that the patient does smoke but that he/she is not interested in quitting.
- If the patient is interested in quitting, the admitting nurse places the screening tool in the medical record and then places a magnetic yellow smiley face (a la 1970s) next to the patient's name on our census board. This smiley face will notify our QFL team that we have a patient on the floor who needs cessation counseling.
- Any of the QFL counselors--whoever has twenty minutes to spare that day - will conduct the counseling on that patient. Along with verbal counseling, the patient receives a full color brochure that we generated which contains standard data and strategies concerning smoking cessation.
- The patient is given a smiley button to wear on their gown so that other staff members can identify them and offer support during the hospital stay.
- The QFL counselor then writes a focus note about the cessation counseling and places it in the medical record. In addition, the patient's name and home number are logged and we place a follow-up call (if permitted by the patient) one week after discharge and then one month after discharge.
- We recently obtained standing orders for nicotine patches - either 21mg or 14mg based on smoking consumption-- which the nurses are allowed to order.
- In addition we have an excellent smoking cessation bulletin board in our hallway with pamphlets available next to the bulletin board.
We've been doing this program for one month and things look very positive thus far. In my opinion, the strengths of our QFL program are as follows:
- The smiley face logo is catchy and easily identifiable.
- The booklet we give our patients is slick and easy to read.
- We have a follow-up program in place.
- We use the nicotine patches and the nurses have the autonomy to place those orders.
- We screen all patients.
- Most importantly, the new nurses are hungry to excel at an additional duty. Often in nursing the "new kids" are "left alone" so that they can get their feet wet. On M10E we took a different approach and gave them an additional task that they could call their own. This is an integral part of our program because our counselors are very invested and motivated.
If the opportunity ever arises, we would love to have visitors come to M10E to see the program and meet the people involved. If it seems that our program could serve as an example for others. If you have a success story to share, please let us know!