Development of a Pharmacist-Led Opt-Out Cessation Treatment Protocol for Combustible Tobacco Smoking
Monday, March 22, 2021
Posted by: Natalia Gromov
Trapskin
PJ, Sheehy A, Creswell PD, et al.
Development of a
Pharmacist-Led Opt-Out Cessation Treatment Protocol for Combustible Tobacco
Smoking Within Inpatient Settings.
Hospital Pharmacy. March 2021. doi:10.1177/0018578721999809
Background. Although
people who smoke cigarettes are overrepresented among hospital inpatients, few
are connected with smoking cessation treatment during their hospitalization.
Training, accountability for medication use, and monitoring of all patients
position pharmacists well to deliver cessation interventions to all
hospitalized patients who smoke.
Methods. A
large Midwestern University hospital implemented a pharmacist-led smoking
cessation intervention. A delegation protocol for hospital pharmacy inpatients
who smoked cigarettes gave hospital pharmacists the authority to order nicotine
replacement therapy (NRT) during hospitalization and upon discharge, and for
referral to the Wisconsin Tobacco Quit Line (WTQL) at discharge. Eligible
patients received the smoking cessation intervention unless they actively
refused (ie, “opt-out”). The program was pilot tested in phases, with
pharmacist feedback between phases, and then implemented hospital-wide.
Interviews, surveys, and informal mechanisms identified ways to improve
implementation and workflows.
Results.
Feedback from pharmacists led to changes that improved workflow, training and
patient education materials, and enhanced adoption and reach. Refining
implementation strategies across pilot phases increased the percentage of
eligible smokers offered pharmacist-delivered cessation support from 37% to
76%, prescribed NRT from 2% to 44%, and referred to the WTQL from 3% to 32%.
Conclusion.
Hospitalizations provide an ideal opportunity for patients to make a tobacco
quit attempt, and pharmacists can capitalize on this opportunity by integrating
smoking cessation treatment into existing inpatient medication reconciliation
workflows. Pharmacist-led implementation strategies developed in this study may
be applicable in other inpatient settings.
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