Role of Smoking Counselling & Cessation Counsellor and sharing of experience on anti smoking services

Transcription

1 Role of Smoking Counselling & Cessation Counsellor and sharing of experience on anti smoking services Wu Man Ying Winnie Learning Objectives 1. Understand the background and services of Smoking Counselling & Cessation Clinic 2. Recognize the role of Smoking Counselling & Cessation Counsellor 3. Identify patients for referral to SCCC APN (FM & GOPC) /NDH 2007 Background Since May 2002, HAHO had initiated the Smoking Counselling and Cessation Program (SCCP) in 10 Smoking Counselling and Cessation Centres (SCCCs 無煙新天地 ) including five hospitals and five General Out-patient Clinics Locations of SCCC (May 2002) Hong Kong Island Pamela Youde Nethersole Eastern Hospital Sai Ying Pun Jockey Club GOPC Kowloon Region Princess Margaret Hospital SOPC Queen Elizabeth Hospital Our Lady of Maryknoll Hospital Cheung Sha Wan Jockey Club GOPC Tseung Kwan O Jockey Club GOPC New Territories North District Hospital Tuen Mun Hospital, Ambulatory Care Centre Tuen Mun Yan Oi Polyclinic Background( Cont d) Till now the number of SCCCs has increased to 30 including 16 full-time & 14 part-time hospitals/ GOPCs In the past few years, a total of about 200 smoking cessation counsellors have been trained by IANS 1

2 The statistics of Smoking Counselling & Cessation Centres (May 2002-April 2007) Number of new cases: 17,000 Average success quit rate at 1 month 62.5% (2002) 68.3% (2003) 76.2% (2004) 75.3% (2005) 75.0% (2006) HAHO Quitline Role of Smoking Cessation Counsellor Role model Individual Counselling Motivate and encourage smokers to have Smoking Cessation Help smokers to overcome barriers Provide pharmacological and behavioral change therapy Telephone follow up counselling Prevent relapse of smoking Monitor client s progress as follows 1 st visit : Face to face counselling 2 week : Telephone counselling 1 month : Face to face counselling 3 month, 6 month, 1 year : Face to face counselling or telephone couselling At First Visit (Face to face counselling) Monitor vital signs, body weight, body height, BMI Assess smoker s smoking history: e.g. daily smoke consumption of cigarettes, smoking habit & quit history and etc Identify and assess the smoker of readiness to quit Assess the smoker s nicotine dependence level by using Fagerstrom Test Total score may vary from 0 to 10 Score 0-3 : low nicotine dependence Score 4-5 : moderate nicotine dependence Score 6-10 : high nicotine dependence Assess the smoker s stages for change (Pre-contemplation, contemplation, preparation, action & maintenance) Review the smoker s medical history, surgical history, psycho- social history and etc Measure CO level by using CO monitor 2

3 Motivate the smoker to quit Educate the smoker about the effects/ hazards of smoking Educate the smoker about the benefits of smoking cessation Set a quit date Identify and develop plans to avoid triggers Skills training: help smokers to overcome barriers associated with cessation, such as nicotine withdrawal symptoms, depression and weight gain. and coping skills, behavior therapy, weight control and using 5D to deal with cravings 5D : Declare Delay Deep breathing Drink more water Distract yourself Recommend nicotine replacement therapy (NRT). Educate the client how to use NRT, dosage, duration of therapy and adverse reaction Encourage smokers express their fears and difficulties Gain support for smoker from spouse, family members and friends Arrange follow up 1 week telephone counselling Ask about : The smoker s smoking status The difficulties while quitting The use of NRT Any signs of nicotine withdrawal symptoms Repeat the coping skills Provide support, concern and encouragement 1 month follow up ( prefer face to face counselling ) Check vital signs: BP, pulse, BW Measure CO level by using CO monitor Ask about the smoking status, side effect of NRT Encourage the quitter to report perceived benefits form stopped smoking Provide skills in maintenance and prevention of relapse 1 month follow up For smoker - reinforce smoker s decision to quit - review the benefits for quitting - assist the smoker to anticipate the problems during quitting Encourage diet control & exercise to prevent gaining body weight Give support, concern and encouragement Including : successful award certificate and souvenir Arrange follow up 3

4 3 month, 6 month, 1year follow up (telephone or face- to- face counselling) 3 month, 6 month, 1year follow up ( telephone or face- to- face counselling) Ask about the smoking status Encourage the quitter to report the benefits of quitting Avoid triggers Provide skills in maintenance and prevention of relapse For smoker - Reinforce smoker s decision to quit - Review the benefits of quitting - Assist the smoker in solving problems during quitting Provide support, concern and encouragement & including souvenir Arrange follow up Suggest and encourage the quitters to share the quitting process to smokers 20 mins BP/P normal, circulation improves 8 hrs. CO level in blood drops to normal rate. O2 level in blood increases to normal 24 hrs Chance of heart attack decreases 48 hrs Nicotine not detectable, taste and smell improved 72 hrs Breathing easier, energy increases 2-12 wks Circulation improves, walking easier 1-9 months.coughing, sinus congestions, fatigue and SOB all decrease.body s overall energy level increases 1 year Heart disease death rate is halfway back to that of a nonsmoker 10 year.ca lung death rate drops almost to the rate of nonsmokers.incidence of other cancers decreases ( College of Nursing at Ohio State, 2002) Nicotine Replacement Therapy (NRT) Nicotine Patch Nicotine Gum Nicotine Inhaler 4

5 Consult Medical Advisor for the following conditions Severe cardiovascular disease Unstable angina Hyperthyroidism Diabetes Mellitus Uncontrolled hypertension Client aged < 18 years old Sources of Referrals Professionals from own affiliated hospital e.g. In-patient, SOPD, paramedical staff such as dietian, physiotherapist and etc Self-enrolment through NDH Quitline ( ) or HAHO Quitline ( ) Walk-in SCCC / NDH Sources of Referral April March 2007) 60% 56.6% Waiting time of the referrals 50% Percentage of referral 40% 30% 20% 10% 27.1% 2% 0% 6.1% 8.2% Stat or as soon as possible if medical condition needed 1 day later Usually within 1 month 0% In-patient SOPD Other dept. NTEC Cluster Quitline Walk-in Difficulties / Problems encountered Withdrawal symptoms Misunderstanding about the complications after quitting smoking Weight gain No concept of the harmful effect of smoking to the health Not supported by relatives (e.g. old aged) Poor social or psychological support Denial Help our patients stop smoking Today!!! 5