Smoking Cessation Clinical Pathway - Queensland Health
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1
2
3URN:
Family name:
Smoking Cessation
Given name(s):
Clinical Pathway
Address:
Facility:
Date of birth:
Sex:
M
F
I
.........................................................................................................
This tool is to be used for screening smoking behaviour of all patients and to provide support to those who smoke
Clinical pathways never replace clinical judgement. Care outlined in this pathway must be altered if it is not clinically appropriate for the individual patient.
Category
Date:
/
/
Ask
Have you smoked in the last 30 days?
1
(all patients on
Yes (continue with pathway)
No (congratulate, sign form, file in patient chart)
admission)
SCORE
2
How many cigarettes do you smoke on a typical day?
Assess
More than 30
21 to 30
11 to 20
10 or less
(score = 3)
(score = 2)
(score = 1)
(score = 0)
(Nicotine
dependence
3
When you wake up each day, when do you smoke your first cigarette?
score)
Within 5 mins
5-30 mins
31-60 mins
More than 60 mins
(score = 3)
(score = 2)
(score = 1)
(score = 0)
TOTAL OF
SCORES
4
Is the patient nicotine dependent? (nicotine dependent smokers will be more likely to succeed with NRT)
ABOVE
Yes (if total Score is 1-6 )
No (if total Score is 0)
OFFER NRT - see page 2 for instructions
5
Do you want to quit smoking?
Yes
No (still offer NRT to reduce withdrawals, don’t refer to Quitline)
6
Are you currently using any of the following medicines?
No
(
Nicotine replacement therapy
NRT i.e. patches/gum) continue regimen referring to algorithm on page 2
Varenicline (Champix®)
Buproprion (Zyban®)
Advise patient/treating team to continue Champix/Zyban (own medication supply) OR if not available offer NRT.
7
Advise all smokers to quit (using clear and non-confrontational language)
“As a health professional the best advice I can give you is to try to stop smoking”
Advise
“
Giving up smoking is hard however it will help with (e.g. surgery, healing, medication, finances)”
“In hospital we have NRT (patches/gum) that you can try, whether you are currently having cravings or not”
Assist
8
Consider NRT Precautions (medical approval may be required prior to initiating NRT depending on unit preference):
Children <12 years
Clozapine
Any local unit contraindications to NRT
(Discuss
treatment and
(e.g. micro-vascular surgery, finger re-implant, skin grafts etc)
other options
during
Pregnant / Lactating
Recent cardiovascular event <48 hrs
hospital stay)
Note: Patients who stop smoking with or without NRT may require a medication dose change (e.g. opioids, antipsychotics,
benzodiazepine, insulin, warfarin). Seek pharmacist advice.
9
NRT is offered to relieve nicotine withdrawal and make the patient more comfortable and/or assist with quitting.
It is always safer to use NRT than to continue smoking. NRT should be titrated to achieve effect (see flow chart page 2).
Patient offered NRT and accepted
Patient offered NRT and declined (ask again during patient’s hospital stay)
:
Patch or gum ordered (see medication chart)
Nurse initiated
Medical Officer initiated
Pharmacist initiated
NRT must be prescribed in the medication chart by a Medical Officer within 24 hours as per hospital policy.
10 Patient advised of the FREE Quitline Service (i.e. given a ‘Quit because you can’ Booklet)
Yes
No
11 Was the patient referred to the Quitline Service (i.e. phone / online referral or faxback form)
Yes (see p3)
No
Arrange
12 Complete Patient Discharge Referral
Date completed:
/
/
follow-up
Discharge script of NRT as appropriate (streamlined authority codes - see page 2) Date completed:
/
/
Comments
Signature Log This section is to be signed when page 1 of the pathway has been completed and IMMEDIATELY FILED in patient chart.
Name (print)
Designation
Signature
Date
Page 1 of 2
2118_v2.00_120903_SW321_Smoking Cessation Pathway.indd 1
3/09/2012 11:52:07 AM
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