Smoking Cessation Clinical Pathway - Queensland Health Page 2

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Smoking Cessation
Given name(s):
Clinical Pathway
Address:
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THIS PATIENT IS ON THE SMOKING CESSATION CLINICAL PATHWAY. Page 1 of this pathway can be found in the patient chart.
Combination NRT Algorithm
Commence 1 x 21mg nicotine transdermal patch every 24 hours
CEASED SMOKING
CONTINUES TO SMOKE
Eliminates both smoking and cravings
Reduces smoking but needs extra NRT
to smoke / symptoms of nicotine
Add 4mg nicotine gum for continued smoking/cravings
withdrawal
If smoking persists and using >10 pieces NRT gum,
add a second patch
Continue for 2 weeks and then try reducing added NRT
Continue 1 x 21mg nicotine patch for 8 -12 weeks from last cigarette.
FOR PRECAUTIONS - See page 1 / product information
(adapted from Bittoun, Combination Therapy in the Hard to Treat, JSC, 1:1, 2006)
DIRECTIONS ON USE OF NICOTINE REPLACEMENT THERAPY (NRT)
• The evidence shows that NRT helps people to quit smoking, doubling long-term success rates. Combination therapy (patch plus gum) is
effective for those experiencing significant withdrawal and increases the chances of long term abstinence (Cochrane review 2012).
• NRT provides lower nicotine levels than smoking, relief from physiological withdrawal symptoms and does not produce strong dependence.
• Most NRT products are available for sale over the counter (non-prescription) and are classified as low risk medications.
• Seek medical advice for information on buproprian Hcl (Zyban®), or varenicline (Champix®).
NICOTINE TRANSDERMAL PATCHES 21mg/24hr
Instructions
Considerations
1. Apply to clear, dry, non-hairy area of chest, back, upper
• Mild patch irritation can be treated by using a steroid cream e.g. 0.02%
arm or hip and secure with medicinal tape if required.
betamethasone or 1% hydrocortisone. If patient experiences an allergic
2. DO NOT apply to freshly shaven, broken or inflamed skin
reaction to the adhesive, cease patches and use 4mg gum.
(can cause irritation).
• Apply patch last thing before sleep to allow slow release of nicotine overnight
3. Rotate site daily.
- likelihood of first cigarette of the day “craving” is strongly diminished.
• Sleep disturbances including imsomnia and vivid dreams may occur. Patch
4. Wait at least one hour after adhesion before bathing
or showering with the patch.
can be removed at night.
NICOTINE ORAL GUM (4mg max 12 pieces per day)
Instructions
Considerations
• Some people may not like the ‘peppery’ taste.
1. Chew one piece slowly until the taste becomes strong.
2. Rest between your gum and cheek to allow absorption of
• Amount of time needed in mouth (30 mins out of every hour).
• May not be suitable if wearing dentures.
nicotine into the bloodstream.
3. When taste has faded, chew and park again - repeat for 30 mins.
• Recommended for use if: pregnant, allergic to patches or as combination
therapy.
4. Do not swallow excessively (stomach doesn’t absorb nicotine).
5. Use a fresh piece of gum after about an hour.
Discharge authority scripting
NRT patches (Nicorette®, Nicabate® and Nicotinell®) are available at a cheaper price on prescription through the Pharmaceutical
Benefits Scheme (12 weeks per year). 28 x 2 repeats.
Streamlined authority codes: 4344 Aboriginal and Torres Strait Islander, 4348 in a counselling program, 4307 entering in a program.
See .au for more details.
PROFESSIONAL DEVELOPMENT AND FURTHER INFORMATION
The Statewide Respiratory Clinical Network has information to assist clinicians around nicotine addiction and smoking cessation on the Clinical
Access and Redesign Unit QHEPS intranet page:
Dispelling the Myths about NRT Video (11 minutes)
Online Brief Intervention Training (general or maternity and child health version)
The Quitline is available to support and provide information to clinicians on assessing nicotine dependence, pharmacotherapy, behaviour
change techniques and on how to approach a conversation with someone about their smoking. You can call 13QUIT (7848) between 7am and
10pm, 7 days to ask questions and get support.
.
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