Steven Brantley, MPH, Practice Enhancement Research Coordinator, Northwest Cooperative
One practice participating in the Northwest Cooperative of EvidenceNOW was able to get 177 active tobacco users to stop smoking by engaging all of their staff in the implementation of a quality improvement process.
Two third-year residents and one nurse held a series of staff education sessions about why smoking cessation is so vital and how each staff member could contribute to supporting their patients in quitting. They followed-up these sessions with surveys to find out if staff retained the information, and felt engaged. They made sure the entire team understood the HOW of smoking cessation. They found that staff were doing well on screening patients who smoked, but were not offering counseling. To increase counseling, clearer role guidelines were established with the help of all the staff’s input. For example, they clarified that nurses’ and medical assistants’ job was to document the intent a patient had to stop smoking and then pass along that information to the clinician; clinicians were then responsible for addressing smoking cessation by offering counseling. Other elements of this project included patient education materials displayed in the waiting and exam rooms, and changes made to how the practice was tracking the smoking cessation counseling being offered. The practice started at around 12% of tobacco users being offered counseling, and have now been around 85% for about 5 months.
It’s sometimes hard to appreciate all the upfront work that goes into engaging all clinic staff in targeting behavior change like smoking cessation. Knowing that even a single patient has quit smoking is a very tangible way to see progress. Hearing the news of 177 “quitters” was a huge motivator for the whole practice, as well as myself. I am motivated to share this approach with other practices, and to think about using this for other EvidenceNOW quality improvement areas.