ED Rounds – September 2015

Smoking Cessation

Dr. Rob Stevenson and Kerrie Luck

Report by Dr Joanna Middleton

Dr. Rob Stevenson and Kerrie Luck gave a great presentation on the new Horizon program “Smoke-Free Together”, which will be rolling out September 29th.  As of that date, smoking (or e-cigarettes) will no longer be permitted on hospital property by patients or staff members.  

Some important points specific to the ED:

  • Evidence has been shown that banning smoking does not increase “code whites”/violence.  Over time, they actually decrease.
  • Some people believe that banning smoking will deter patients (particularly those with mental health complaints) from coming to the hospital/ED for help.  This has shown NOT to be true. 
  • Smoke-free initiatives in other provinces have been highly successful and have shown substantial cost savings and health benefits.
  • Patients will continue to be offered NRT (nicotine replacement therapy) at no cost, as in inpatient, but we need to be more aggressive in ensuring they are receiving the adequate dose.  NRT options are the patch, gum or inhaler.
  • Nicotine gum will now be sold in the hospital gift shop – this is an option that can be mentioned to visitors.
  • After hours, there will be visitor care kits (a limited supply at this time) that contain supportive materials on smoking cessation, coping mechanisms and alternative options.  These can be obtained through security.
  • The smoker’s hot line offers a service that could be very useful to patients we are discharging – if the patient’s fill out a form and we fax it, the smoker’s hot line will CALL the patient and follow-up wrt smoking cessation as an outpatient.
  • Good news – NRT will hopefully be covered by medicare for seniors and for those on assistance in the near future.  Every $1 spent on NRT actually saves Medicare $3.  Pretty good deal!

Discussion points/ideas – Dr. Greer is going to bring this up with the patient care committee.

  • How do we identify patients who are smokers in the ED?  Do we ask them at triage?  
  • Should we be approaching this similar to the “got pain” program?  If we wait for patients to see the doctor before offering NRT, it could be hours, and by then the patient is already withdrawing from nicotine (agitation etc).
    • NRT is an OTC medication just like advil and tylenol…we give that out at triage…should we be giving out patches at triage?
  • Could smoker’s hot line forms be kept at registration?

It was a great talk by Dr. Stevenson – very inspiring and insightful.

Thanks to those who attended.


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