Program Training and Consultation Centre

Transcription

1 Development of Minimal Contact Intervention (MCI) for Tobacco Cessation Policies Laurie Nagge, Region of Waterloo Public Health Laura McCammon-Tripp, PTCC July 7,

2 Welcome! WebEx application under Training > Training Resources for a copy of the slide presentation & audio recording This webinar is being recorded 2

3 How to pose a question on WebEx: 1. click on the chat function located in the upper right hand column of your screen. 2. direct your questions to the Host. OR raise your hand using the raise-hand function in your toolbox.

4 Agenda Welcome and Introduction Documentation of Practice The Development of the ROWPH s MCI Policy Overview of the LEARN Documentation Resources Question & Answer 4

5 Speaker Bio: Laurie Nagge, RN, BScN, MHS Public Health Nurse, Tobacco and Cancer Prevention, Region of Waterloo Public Health Project lead on the implementation of the Region of Waterloo s MCI for Tobacco Cessation Policy 5

6 Speaker Bio: Laura McCammon-Tripp, BA, MSc Research Associate, Program Training and Consultation Centre Conducts documentations of local tobacco control public health practices 6

7 Webinar Objectives Discuss the process of developing, implementing and evaluating the MCI policy at Region of Waterloo Public Health (ROWPH) Highlight key success factors and lessons learned from practice from ROWPH s experience 7

8 The Learning through Evidence, Action and Reflection Networks (LEARN) Project A knowledge development and exchange strategy of PTCC Main goals: Facilitating knowledge exchange and innovation Supporting the development and enhancement of relationships among public health practitioners, their community partners and researchers Documenting practice-based knowledge and experiences to support the implementation of more effective practices Strengthening the link between research and practice by supporting the use of research-based evidence in practice, and championing practicebased research 8

9 Documentation of Practice The LEARN team documents practice-based knowledge on priority areas of interest within the tobacco-control system in Ontario Topics are identified through LEARN Communities of Practice (CoPs) and by identifying other emerging priorities at the local level Documentation helps practitioners build on past experiences when planning and implementing future activities, replicate effective interventions 9

10 Documentation of the ROWPH s MCI Policy Minimal Contact Intervention for Tobacco Cessation policies were identified as a priority area ROWPH s policy was identified as a case for documentation 10

11 Methods Case study approach Document reviews, archival records, physical artifacts Analysis to identify information related to: Policy development and implementation processes Key success factors and lessons learned from practice 11

12 Development of an MCI for Tobacco Cessation Policy at the Region of Waterloo Public Health 12

13 Registered Nurses Association of Ontario Best Practice Guideline (BPG) Integrating Smoking Cessation into Daily Nursing Practice Recommendation: Nurses implement minimal tobacco use intervention using Ask, Advise, Assist, Arrange protocol with all clients 13

14 Getting Started Tobacco Cessation Community of Practice (CoP) 50+ health care professionals Public Health Nurse (PHN) supported local hospitals to implement the Ottawa Model Lead by example 14

15 Getting Support Presentation to Divisional Leadership Team: Evidence supporting RNAO BPG and 4-5 A's approach Facts - tobacco - leading cause of preventable disease and death Established linkages to organizational mandates, strategic directions and initiatives Identified gaps in existing tobacco programming and resources 15

16 Determine the Scope Who will be required to participate? All staff involved in client assessment in person or by phone Who will not be required to participate? Immunization team 16

17 Project Deliverables Policy "Minimal Contact Intervention for Tobacco Cessation" Champions Advisory Committee Development of tools and resources to support policy implementation Integration of the "4 As" (Ask, Advise, Assist, Arrange) into documentation and practice Staff training Chart audit compliance data 17

18 Team Champions Representative selected from each team PHN lead provided a three-hour training on tobacco cessation and the BPG Meet with Tobacco PHN lead to coordinate BPG implementation Coordinate policy activities with team Link between PHN and teams Staff orientation Meet twice/year and ad-hoc 18

19 Policy Integration = Sustainability All public health staff involved in client assessment, either in person or by telephone, from the designated teams listed below are required to query and document tobacco use using the minimal contact intervention (MCI) for tobacco cessation four A s: ASK, ADVISE, ASSIST, ARRANGE protocol. 19

20 Adapting the BPG in a Public Health Unit Time to complete protocol varies by team, generally limited Focused practice/silos Tobacco Use/Smoking status Paper and electronic documentation Different client populations Different practice settings 20

21 Time Limitations Focus on minimal contact intervention ONLY ASK, ADVISE, ASSIST, ARRANGE referral to community resources: Smokers' Helpline (SHL) Region of Waterloo Public Health's Tobacco Information Line Currently in process of adopting SHL Fax referral 21

22 Ask about tobacco use with all clients Have you used tobacco products in the last 6 months? If client says no select has not used protocol complete If client says yes select has used proceed to complete Advise, Assist and Arrange Advise Assist Arrange all tobacco users to consider quitting As a nurse, the most important advice I can give you, about tobacco use, is to quit using (e.g. cigarettes). If you did advise the client to quit select advised to quit proceed to Assist If you did not advise the client to quit select did not advise to quit proceed to Assist determine the clients readiness to quit Have you thought about quitting in the next 6 months? If you ask the client about quitting select asked about quitting proceed to Arrange If you did not ask the client about quitting select did not ask about quitting proceed to Arrange for referral for smoking cessation support Can I provide you with information that can help you with quitting when you are ready? Smokers Helpline (SHL) Region of Waterloo Tobacco Information Line (TIL) If you offered the pamphlet to the client, select offered pamphlet If you did not offer the pamphlet to the client, select did not offer pamphlet 22

23 ASK Tobacco Use Status RNAO Non-smoker Smoker Ex-smoker Quit date Keep it simple Yes No Additional information would not impact on MCI in a public health setting relevant to acute care setting 23

24 Documentation Addition of 4 A's Relevant legislation - PHIPA, MFIPPA Paper and electronic Ability to audit for staff compliance - PHN actions versus client response Tailored by team to fit with practice and documentation format Support resource - instructions for documentation 24

25 Electronic Documentation Did not implement Tobacco 4 A s Protocol Ask Have you used tobacco products in the last 6 months? Has not used Has used Advise As a nurse, the best advice I can give you, about tobacco use, is to quit using. Advised to quit Did not advise to quit Assist Have you thought about quitting in the next 6 months? Asked about quitting Did not ask about quitting Arrange Can I provide you with information that can help you with quitting when you are ready? Offered pamphlet Did not offer pamphlet 25

26 TB Paper Documentation Have you used tobacco products in the last 6 months? Has not used Has used As a nurse, the best advice I can give you, about tobacco use, is to quit using. Advised to quit Did not advise to quit Have you thought about quitting in the next 6 months? Asked about quitting Did not ask about quitting Can I provide you with information that can help you with quitting when you are ready? Offered pamphlet Did not offer pamphlet 26

27 Staff Training and Support Staff training 1 to 1.5 hours/team Staff support documents Instructions for documentation Protocol map Policy Copy of Best Practice Guidelines RNAO bookmarks, pocket guides and posters Team Champion New Staff Orientation Team champion meets with individual to share above supports, new staff complete RNAO online training module 27

28 Timelines Family Health Teams June 2007 Sexual Health and Reproductive Health February 2008 Dental Health July 2008 AIDS/STD September 2008 Travel/TB January

29 Evaluating the Policy Team Planner and Tobacco Programs Planner randomly select records Audits completed 3 months post policy implementation Small sample of charts At least 5 charts/nurse Various settings Paper and electronic 29

30 Compliance Matrix 100% Compliance Yes No NAS Not Assessed ASK used tobacco products in the past 6 months? ADVISE provided advice to quit (tobacco user) ASSIST asked about quitting ARRANGE offered SHL & TIL resources 30

31 Audit Results Staff compliance with protocol implementation 72.85% (7 teams) Potential to revise protocol implementation/documentation for each team Champion liaison 31

32 Communications to Staff/Community Partners Internal web portal MOH corner January 2008 Physician's Update May 2008 Waterloo Region Annual Report June 2008 CDDSR television Promoted Smokers' Help Line and Tobacco Information Line Internal portal article "We Did It" May 2009 Presentation at the National Tobacco Control Conference - November

33 Key Success Factors Keys to success: DLT/Management support Dedicated Project lead Team Champion Advisory Group/link Evaluation support for audit Documentation expert consultation, PHIPA Policy - Integration into documentation, practice change Literature reviews how risks of tobacco use fit with each team's focus Momentum & support in the tobacco field 33

34 Lessons Learned from Practice Adoption of change, buy-in Public health setting vs. acute care Unique client populations served by each team (e.g., children, teens, families) Various forms of documentation Staff time/competing demands often not enough time or not within practice scope to provide more intensive (<3 min.) tobacco cessation follow-up 34

35 Future Directions Smokers Helpline Fax Referral Program addition to our protocol in 2011/2012 Creation of an online training module for new staff orientation 35

36 LEARN Resources on ROWPH s MCI Policy Documentation Report includes information on: The development and adoption of the MCI for Tobacco Cessation Policy The pilot implementation of the policy Broad implementation across all relevant public health teams Evaluation Highlights key success factors and lessons learned from practice Program Training and Consultation Centre 36

37 LEARN Resources on ROWPH s MCI Policy Appendices Program Training and Consultation Centre Collection of documents that were used in the planning, implementation and evaluation of the MCI policy at ROWPH Includes: Policy documents Promotional materials Evaluation tools and reports 37

38 LEARN Resources on ROWPH s MCI Policy Reading and Resource List Recommendations and Best Practice Guidelines Peer-reviewed literature Skill-building opportunities Program Training and Consultation Centre All materials are available on the PTCC website 38

39 Questions 39

40 About PTCC Resource Centre of the Smoke-Free Ontario Strategy since 1993 Funded by the Ontario Agency for Health Protection and Promotion Partners include:

41 PTCC Services Technical assistance, training & resource development Knowledge development, exchange & programming to increase the use of research & practice-based evidence LEARN Communities of Practice, Documentations of Practices, Backgrounders, Community-Based Health Research Media relation training & consultation services through the Media Network in the areas of: Tobacco Control Healthy Eating, Active Living

42 Consider joining a LEARN CoP! Topics of our 3 communities of practice: 1) Tobacco Use Reduction for Young Adults 2) Tobacco-free Sport and Recreation 3) Media Advocacy for Healthy Public Policy For practitioners, researchers and policy-makers actively working in these areas Opportunity to deepen understanding of a topic area through sharing experiences across Ontario, documenting what is known, jointly determining what evidence is needed to advance the practice, and initiating collaborations Monthly webinar meetings & in-person meetings 2x/year, e-communication between meetings

43 To learn more, join a CoP or nominate a practice for documentation: Contact: Sume Ndumbe-Eyoh PTCC Health Promotion Specialist, Knowledge sume.ndumbe-eyoh@cancercare.on.ca ext or talk to a current CoP member

44 Contact Information Laurie Nagge, RN, MHS Public Health Nurse Region of Waterloo Public Health ext Laura McCammon-Tripp, MSc Research Associate Program Training and Consultation Centre ext

45 thank you For more information, contact: Program Training & Consultation Centre