Registed Nurses' Association of Ontario

Phase 2: Implementing Continuity of Smoking Cessation Intervention along the Trajectory of Cancer Care with a Focus on the Inpatient Setting

Ivy Henry
Sunnybrook Health Sciences Centre

I wish to extend a big thank you to RNAO for selecting me as one of the fellowship recipient for the smoking cessation project. I wish to thank all my Mentors at Sunnybrook for their tremendous support throughout this journey.

I deemed this RNAO Fellowship a great opportunity to work alongside Sunnybrook Pioneers for smoking cessation. This fellowship experience has been quite rewarding. I feel privileged and honoured to be selected to work in this capacity as a smoking cessation fellow but most importantly I deemed this as an opportunity to work with a team of dedicated, caring and professional individuals who embraced me and allow me to feel that I am part of their team. Their quest to train staff to promote a smoke-free environment at Sunnybrook was quite evident based on the programs that have been developed.

My journey started out when I visited the smoking cessation workshop in Oakville, Ontario. I was delighted to meet individuals from different professional affiliation. The one-day workshop gave me a fore- taste of what I was about to experience. There were many take-aways in the form of materials including pins, brochures, and booklets among others. My most memorable take away was to sit at the table with a special nurse who after many quit attempts finally “broke the chains” of smoking and is currently helping others to quit.

My official start date was May 7, 2014. Every Wednesday was assigned as a smoking cessation day by my mentors. At my first meeting with the team an executive summary was drafted by my Mentors in conjunction with the smoking cessation team as listed below:-

Executive summary from fellow’s perspective

• What are RNAO fellowship goals?
• What are the smoking cessation team goals?
• What are her(Fellow’s) personal goals?

Smoking cessation team goals

• Staff training
• OTRU training
• RNAO training
• Familiar with patient resource material
• Intranet site
• PEARL class
• Promotion such as WNTD
• Implementation in D6
• Aide with implementation in Pre-admission
• Implementation on C6 and C2
• D6 is paper based
• What will metrics look like?
• What tools will she use? Paper based i.e. Consult form
• How will she do audits?
• Connection with Katie to see how this was implemented in the Schulich & Jean Chow in babies.
• Responsibility for putting green/ red folders together
• Assist with training of clinical staff on D6, C6, C2
• Assist with policy development for e-cigarettes
• Participation in inter-professional core and steering meetings
• Participation in PBR for coding etc

Having an understanding of “coding” did not seem relevant to me at my first official meeting with the team. However, overtime I realize that coding is a useful tool to build a database for prearranged words or statements related to smoking cessation.

May – 2014 OTRU Training
My goal was to acquire knowledge be equipped and translate knowledge in staff training on D6 as well as other units. I was informed that the Ontario Tobacco Research Unit (OTRU) training was as important as the RNAO e-learning. I remember having some challenges to get connected to the RNAO e-learning so I decided in the interest of time to start with the OTRU training first. I did not think for a moment that this would be so challenging. There was really not enough time on Wednesdays only to consume such deep studying and obtain pass marks of over 70%, therefore I used as much time at home on my days off to complete the OTRU training which consists of three (3) required modules prevention, protection and cessation. (See appendix ... for attached certification)

Pearl Class: May
Every 2nd Wednesday the Pearl class was designed to help smokers quit especially those who are scheduled for surgery. To date the class is very poorly attended due to different factors. One main issue mentioned by patients is the high parking cost. In order to promote attendance to the pearl class an interview was conducted with one of the doctors in the ENT Clinic who for most times have smoking patients scheduled for surgery. The doctor promised to assist by encouraging other ENT doctors to get involved and encourage their patients to attend the Pearl class. Patients who attend the Pearl class will also have an opportunity to watch an interesting you-tube video by Dr. Mike Evans entitled, “The single most things you can do to Quit.”

ILead Best Practice Champions: May
I was quite happy to be a part of the Sunnybrook Best Practice Champion forum. There was several champions showcasing their work in different areas of the hospital such: pain, mobility, smoking cessation among others. Being new to the team with limited knowledge about smoking cessation I choose to keep a low profile as much as possible. However, I was useful in handing out flyers from our booth and also encouraging staff to select a best practice champion in smoking cessation on their unit. Most of the staff I spoke with seemed interested in having a smoking cessation champion.

Schulich Program: May- June
The Schulich Heart program appears to be the leading inpatient unit in the promotion of smoking cessation at Sunnybrook. (Smokers’helpline, 2014) Early in my fellowship I spent a few hours on the Schulich unit observing their implementation process. They are aligned with the same principles as the Odette Centre. All staff was involved in the program. The patients were divided into two categories patients who smoke and want to quit as well as those who don’t want to quit.

The green folders had several materials for those who want to quit such as a book marker on quitting, pharmacy brochure on NRTs’, booklet for “Smokers who want to quit.” CAMH, Nicotine Replacement brochure,
The red folder had a booklet “Smokers who don’t want to quit.” Both folders had a smoking cessation record and a smoking cessation referral form. Someone was selected to fax all referral forms to Smokers’helpline on a regular basis.

2014 (WNTD): June
The World No Tobacco Day (WNTD) was an exciting venture for me as I was part of the planning and implementation process. I used the opportunity during our usual Wednesday morning Gyne/Oncology rounds to introduce the smoking cessation project to the interdisciplinary, team members which include Doctors, PCM (Patient Care Manager), Educator, APN, Nurses Physiotherapist, Occupational Therapist, Chaplin, Social work and Pharmacist. Staff became aware of the smoking cessation project that will be implemented on the unit. A booth was set up in the meeting room on D6 to showcase materials such as brochures, booklet, flyers and pamphlet related to smoking cessation. Patients had the opportunity to visit both and take whatever materials they needed for themselves or family and friends. Staff on the unit showed much enthusiasm about the project. Staffs were given special pens with instructions on stop smoking and Smokers’ Helpline information as well as the pocket size card with the 5A’S model.

I later joined the team in the Atrium of the hospital where a large booth with displayed items as shown in appendix #....I was amazed by the overwhelming responses by staff, visitors, patients and families who stopped by the booth. Many filled the quiz slips with hope of winning a book written by Dr. Mike Evans entitled “The Single most Thing You Can do to Quit!” Others gave positive comments such as “It’s about time we take the lead to help patients quit smoking!” “Too many patients are dying due to tobacco use.” Overall, the event was very successful.

D6 Implementation:
After visiting the Shulich Heart Program on D3 I was quite energized to mimic most of their smoking cessation program on D6. I was given all the contact information on how to obtain supplies both from inside of Sunnybrook and outside of Sunnybrook. I contacted Canadian Cancer Society, CAMH, M1 Pharmacy for booklets, brochures, pamphlets, pens, cards etc. I also contacted the in house print shop in consultation with my mentors and ordered adequate supply of the Mosaiq documentation and referral forms as well as Grand & Toys for the green and red folders. I arranged with one of the Smoking Cessation team members to provide the first staff training exercise on the unit in consultation with my Mentors and the APN for the unit.

On June 11 a total of 10 staff members attended the first in-service training on smoking cessation. Snack and pens were provided for the staff who attended. There was much optimism by the staff although their daily workload can be very challenging; everyone echoed the need to educate patients to quit smoking. Some staff reflected on their own personal journey with a family member who smokes and expressed interest in being a best champion on the unit.

Unfortunately, the organization made some changes throughout the hospital that cause a delay in the implementation of the smoking cessation program on D6 and other surgical units. There were two new services that were introduced to the unit, Brachy Therapy and Plastics with focus on Breast Reconstruction. My mentors believed introducing another project like smoking cessation would be too overwhelming for the staff at this point.

I will continue to provide a 3- 5 minutes smoking cessation intervention to most of my patients as much as possible using the 4A’s Model. Brief documentation and referral to smokers’helpline has been incorporated in my daily plan of care.

The creation of a “D6 Stop Smoking Board” was implemented to create an awareness of smoking cessation on the unit.

I am confident that in the near future, very soon the next unit roll out by the Smoking Cessation Team will be done on D6 and the surgical units. Adequate materials are stocked on the unit and ready for implementation.

Along with attending meetings and obtaining supplies I was involved in the online OTRU course followed by the TEACH and RNAO e-learning. The OTRU had three main modules (1) Prevention (2) Protection and (3) Cessation. Each module required a passing grade of over 70%. This was not an easy task. Many of my readings and studying was done at home. However my knowledge around smoking cessation was improving day by day.

In order to be adequately prepared and equipped I was introduced to the TEACH Course. All these courses were created to provide much knowledge around smoking cessation. Teach course had 10 modules with specific instructions to submit no less than 3 submissions per week. RNAO E-learning was less challenging although an average passing grade was 80%. These courses were not easy topics/courses. All courses took a great deal of energy, studying and concentration to be successful. I am more equipped to train and teach staff with much more confidence as a result of the extensive training. All certificates and letter of completion are enclosed.

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