Implementation of a Smoking Cessation Education Program in the Emergency Department

Background: Cigarette smoking is the leading cause of preventable death in the United States and one out of five deaths in the country can be attributed to tobacco-related products. It is the leading risk factor for development of heart disease, stroke, cancers, and lung disease. As a result of these negative health effects of smoking and socioeconomic disparities among the smoking population, a disproportionate number of smokers utilize the emergency department. Registered nurses in the emergency department therefore represent an underutilized opportunity in the health care system to increase smoking cessation education and referral for at-risk patients upon discharge. However, nurses in the emergency department setting may face barriers to conducting this education among patients who screen positive for tobacco use, including a limited time and lack of knowledge of appropriate community resources.

Theoretical Framework: This project utilized the theoretical framework of Donabedian’s Healthcare Outcome Measurement Model, which proposes three closely related areas: structure, process, and outcome. Structure has an impact on process, and consequently, process affects outcome. All three areas are considered critical in quality of care evaluation.

Methods: A group of 80 registered nurses working in a local emergency department were invited to participate in the study. Of these 52 agreed to participate in the study. An educational module regarding smoking cessation counseling was provided to instruct nurses in the protocol for tobacco screening and referral. This included identification of patients reporting tobacco use; categorization of level of intervention needed for this client; and education regarding specific resources available such as pharmacological agents, quit-line referral, and outside counseling services. A pre- and post-intervention self-reported confidential survey was administered to evaluate learning outcomes.

Results: According to a comparison of survey data, the number of emergency department nurses who screened for tobacco use most of the time after the intervention remained the same. However, the number of nurses who advised, assisted, and referred services for those patients screening positive for tobacco use increased significantly in the pre-intervention survey to the post-intervention survey.

Conclusion: Through use of appropriate training, nurses can augment their ability to implement tobacco screening and smoking cessation education in at-risk patients. Providing emergency department nurses this instruction can help them to overcome barriers such as time and lack of knowledge. As nurses take an increasingly active role not only screening, but also advising, assisting and referring at-risk patients, these efforts may help to reduce morbidity and mortality secondary to tobacco-related diseases.