Tobacco Treatment Measures KATHY WONDERLY RN, MSED, CPHQ CONSULTANT DEVELOPED: JANUARY 2018

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1 Tobacco Treatment Measures KATHY WONDERLY RN, MSED, CPHQ CONSULTANT DEVELOPED: JANUARY 2018

2 Background This measure set is required for The Joint Commission participating hospitals only. Tobacco use is the single greatest cause of disease in the USA today. This use accounts for more than 480,000 deaths each year (CDC MMWR 2014.) Tobacco use impacts society as well as individuals. Smoking related health care expenditures are estimated to be at least $130 billion/year. Tobacco related health issues are estimated to cause an additional $150 billion in lost productivity (DHHS 2014.) There is strong evidence that tobacco dependence interventions provided in a timely and effective manner significantly reduce the user s risk of suffering tobacco related disease (Rigotti 2012.). Inpatient hospitalization provides an opportunity to address tobacco use and treatment options.

3 TOB-1 Tobacco Use Screening Measure Each hospital must use a screening tool to identify and document tobacco use status. This screening must be done within the first day of admission (by the end of Day 1). Some patients may refuse screening and this must be clearly documented in the medical record. With few exclusions, all patients 18 years of age and older are included in this measure set. Those excluded are patients who are cognitively impaired, patients whose length of stay is less than or equal to one day, length of stay greater than 120 days and patients with comfort measures only documented.

4 TOB-2 Tobacco Use Treatment Provided or Offered Measure Patients who screen positive for tobacco use within the past 30 days must be offered a brief intervention and FDA approved cessation medication during their hospital stay. Documentation of the intervention must be included in the medical record. If the patient refuses such an intervention or medication, this must be documented in the medical record.

5 TOB- 2a Tobacco Use Treatment This measure includes the number of patients who receive counseling AND medication during their hospital stay And The patients who receive counseling and had a reason for not receiving the medication during the hospital stay. Documentation of the intervention must be included in the medical record.

6 Excluded Patients For the Receiving Medication Measures TOB-2 and 2a Smokeless tobacco users Pregnant smokers Light smokers Patients with reasons for not administering FDA-approved cessation medications

7 TOB- 3 Discharge Plan Patients who screen positive for tobacco product use within the past 30 days should be referred to outpatient counselling AND receive a prescription for a FDA approved medication for cessation upon discharge. If the patient refuses to participate in one of these treatments the refusal must be documented in the medical record. If the patient has a reason for not receiving a prescription for medication, this reason must be documented in the medical record.

8 TOB- 3 Exclusions Patients that: are transferred to another facility, leave AMA, are discharged to hospice or live outside the USA are excluded from this measure set.

9 TOB- 3 Exclusions continued Patients excluded from the medication prescription component of the measure include: Smokeless tobacco users Pregnant smokers Light smokers Patients with reasons for not administering FDA-approved cessation medications

10 Test Your Knowledge 1. Only patients that smell like smoke need to be screened for alcohol or drug use. A. True B. False

11 Test Your Knowledge 2. Patients who screen positive tobacco product use should be offered during their hospital stay. A. a private room B. an counseling and FDA approved cessation medications C. an extra snack

12 Test Your Knowledge 3. Discharge information should include a referral to outpatient counseling treatment program and a prescription for a FDA approved cessation medication. A. True B. False

13 References Centers for Disease Control and Prevention. (2014). Current cigarette smoking among adults United States, Morbidity and Mortality Weekly Report (MMWR), 63(47), Retrieved from Rigotti, N. A., Clair, C., Munafo, M. R., & Stead, L. F. (2012). Interventions for smoking cessation in hospitalized patients. Cochrane Database of Systematic Reviews. Retrieved from U.S. Department of Health and Human Services. (2014). The health consequences of smoking 50 years of progress: A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved from years-of-progress/full-report.pdf.

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