Change Concepts for a Brief Tobacco Cessation Intervention

Change Concept / Recommended Interventions / Change Ideas to Test
Assessment
Manage Variation and Design Systems to Avoid Mistakes / Screen all patients tobacco use and document it in the clinical record /
  • Ensure screening question is part of part of patient health assessment i.e. include in nursing history
  • Include a question as part of all intake assessments i.e. triage, ambulatory registration

Manage Variation and Design Systems to Avoid Mistakes / Assess readiness for change /
  • Use standard screening questions based on the Stages of Change Model

Advise
Manage Variation and Design Systems to Avoid Mistakes / Advise quitting smoking is the single most effective thing you can do to improve the quality and length of your life. /
  • Develop a written cue/script for providers i.e. patient pamphlet

Assist
Manage Variation and Design Systems to Avoid Mistakes / Provide Stage-Matched information for changing smoking behaviour
Provide NRT or other pharmacological interventions as appropriate /
  • Develop a patient pamphlet based on the stages of change
  • Develop standing orders
  • Ensure appropriate pharmacotherapy is available in the formulary
  • Provide information on cost and coverage for NRT and other drugs

Arrange
Manage Variation and Design Systems to Avoid Mistakes / Agree and act on a plan of care /
  • Initiate pharmacotherapy
  • Refer/provide information on to local resources i.e. Addiction Services, Help Line, Family Doctor

Change Concept / Recommended Intervention / Example to Test
Communication
Improve Work Flow / Communicate the results assessment and interventions to the healthcare team /
  • Document in a prominent place on the patient.
  • Develop hand-over form/report which includes information on patient’s smoking cessation plan of care
  • Develop a tracking sheet to collect data on patients screened and interventions

Education
Change Work Environment / Educate all staff on the Smoking Cessation /
  • Education on: Ask, Advise, Assist and Arrange Intervention; Stages of Change; and treatment modalities
  • Identify and coach Clinical Champions
  • Develop a Standardized Education Package
  • Include education in orientation and regular staff updates
  • Track staff participation in Education Sessions
  • Make training mandatory for all clinical staff and available to all others with an interest in the topic
  • Provide visual cues i.e. Posters

Change Concept / Recommended Intervention / Example to Test
Organizational Strategies
Change Work Environment / Establish organizational support for tobacco cessation interventions /
  • Align with organizational strategic and operational plans.
  • Establish an Improvement Team
  • Develop a charter, with a committed Executive Sponsor
  • Identify clinical and administrative champions
  • Include influential Committee chairs in your communication plan
  • Develop a policy addressing staff education on smoking cessation interventions, NRT, and smoke free work environments
  • Include information in newsletters and internal communications

Social Support
Change Work Environment / Establish local and Provincial Support /
  • Use Champions to lobby for legislation and by laws that create smoke free environments
  • Partner with professional organizations and community groups to address tobacco use
  • Access and refer to agencies involved with tobacco reduction, prevention and treatment
  • Engage and work withy media around key events i.e. Weedless Wednesday

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