Health educator Beverly Graham, R.N., (center), and Jenifir Bruno, M.D., assistant medical director of Hospitalist Services at FirstHealth Moore Regional Hospital, discuss FirstHealth’s tobacco-cessation program with a tobacco-using patient.
PINEHURST – The use of tobacco is “the” leading cause of preventable death in the United States.
Period. End of quote.
If that single statement isn’t enough to make you think, visit www.cdc.gov for a list of more chilling statistics about the hazards of tobacco use. A lot of related information is available as Americans prepare to observe the annual Great American Smokeout on Thursday, Nov. 18.
Still, despite all of this information and warnings from the U.S. Surgeon General dating from 1964, millions of Americans continue to smoke. And chew. And dip. Even people who are sick use tobacco products, and many tobacco-users are in hospitals – often due to conditions that are caused or aggravated by their tobacco use.
Ironically, because most health care organizations – including FirstHealth of the Carolinas – are now tobacco-free, many tobacco-users will tolerate an entire hospital stay without smoking, dipping or chewing only to return to their tobacco habit once they get home.
An inpatient tobacco-cessation program offered at FirstHealth Moore Regional Hospital in Pinehurst and at FirstHealth Richmond Memorial Hospital in Rockingham is designed to reach tobacco-users during that brief interim of tobacco-free hospitalization and to direct them to the long-term assistance of FirstHealth’s outpatient FirstQuit program.
“Tobacco-use contributes to a lot of disease processes, so it’s important to do anything we can to get tobacco-users to quit,” says Jenifir Bruno, M.D. “Tobacco-use contributes to poor health and many medical conditions.”
The assistant medical director of Hospitalist Services at Moore Regional, Dr. Bruno champions FirstHealth’s inpatient tobacco-cessation program. She says that she and her fellow hospitalist physicians feel so strongly about the benefits of the program that they have made it an automatic consult for all hospitalist patients who use tobacco products. She hopes there will be an automatic consult for all patients who use tobacco products once FirstHealth’s Computerized Physician Order Entry (CPOE) program goes live next year.
“When CPOE goes live, all providers can order consults as needed,” she says. “Nurses can enter the consults automatically.”
FirstHealth’s inpatient tobacco-cessation program is provided by Community Health Services, which has offered the outpatient FirstQuit program since it was started 10 years ago to coincide with the organization’s move toward tobacco-free status.
Health Programs Manager Linda Harte supervises the team of specially trained health educators who work with both programs. She says the inpatient program, which began as a pilot at Moore Regional during the summer of 2009, was a logical expansion of the established FirstQuit service.
FirstQuit receives daily referrals from FirstHealth Home Care Services for patients who are discharged from the tobacco-free environment of a hospital only to find themselves challenged to continue their tobacco-free status at home. A couple of years ago, that situation prompted a discussion about tobacco-cessation services that could be offered to inpatients and, Harte says, “how we could catch tobacco-using patients sooner” and “how we could support them better while in the hospital.”
Eventually, the discussion turned toward giving hospitalized patients the motivation and confidence to remain tobacco free once they got home and providing options that would help them achieve their tobacco-free goal.
Dr. Bruno and a FirstHealth committee comprised of staff representatives from such departments as Hospitalist Services, Pharmacy, Health Information Management Services and Patient Accounts worked for about six months to develop the inpatient plan. The process they came up with begins as the patient is being admitted to the hospital and indicates on an intake questionnaire that he/she is a tobacco-user. It continues when the physician in charge of the patient’s hospitalization orders a consultation with a Community Health Services health educator.
If the patient agrees to the consult (and some don’t), the health educator schedules a meeting to talk with the patient about personal tobacco-use history and triggers, readiness to quit and plans for discharge.
“Usually, if their doctor is telling them to quit, patients will accept the consultation,” says Harte. “If you’re looking for one of the best things you can do for yourself, (quitting tobacco) is it. We’re giving patients one more opportunity to meet that quit-tobacco goal.”
Each inpatient session lasts 15 to 20 minutes and includes information on the FirstQuit program as well as a referral to the NC Quitline.
“Our goal would be to direct patients to the outpatient program,” says tobacco treatment specialist Cindy Laton. “According to the Clinical Practice Guidelines for Treating Tobacco Independence, the more a patient receives a tobacco-cessation intervention, the more likely he/she is to be successful in quitting.”
Visiting relatives and friends are welcome to stay in the room during the consult and to participate in the discussion as they feel comfortable. Tobacco-using visitors are also told about the nicotine-replacement gum that is available in hospital gift shops, outpatient areas and emergency departments.
Offered at no charge to visitors, the gum is intended to help tobacco-using family members and friends manage any withdrawal symptoms they might experience during their tobacco-free hospital visit.
All of the FirstHealth health educators who provide tobacco-cessation information are specially trained. Two years ago, Laton became the first to be certified through the Tobacco Treatment Specialist Program at the Mayo Nicotine Dependence Center in Rochester, Minn. She recently earned her two-year re-certification through the program that Harte calls the “Cadillac” of tobacco-treatment training programs.
Grant funds allowed Laton to attend the week-long Mayo training program for her initial certification. Health educators Melissa Kuhn and Lynn Antil completed the same program earlier this fall, and Beverly Graham and Sallie Beth Johnson are scheduled for the training next spring – all thanks to Moore Regional Hospital Auxiliary scholarships.
Other grant funding will enable Amy Forester, of Richmond Memorial Hospital, to attend a training program, too.
On average, the health educators see about 15 patients a week.
“We’re trying to improve our referral process to see as many patients as we can,” says Harte.
Reaching tobacco-users, whether in or out of the hospital, is important work that has the potential to affect an individual’s health in many ways. For example, smokers are two to four times more likely than non-smokers to develop heart disease.
That disturbing fact has helped keep John Krahnert, M.D., very busy over the past 20 years. An early champion of the FirstQuit outpatient program, Dr. Krahnert is the heart surgeon who started the open-heart program at Moore Regional Hospital in 1990.
“My personal feelings are that smoking cessation is as important as anything we do as physicians, and it is our responsibility to do everything we can to help patients quit,” he says. “Smoking cessation clearly improves the health of the individual patient and just as importantly will improve the health of entire medical communities, which – in my opinion – is really the crux of health care reform.”
For more information on the quit-tobacco services provided by FirstHealth of the Carolinas, call FirstHealth Community Health Services at (877) 342-2255.