Aspirus Kicks Tobacco Treatment Into High Gear Using EMR

Aspirus Wausau Hospital recently used technology to rev up its tobacco dependence treatment faster than an Indy 500 race car. Ever since they added to their electronic medical records (EMR) a best-practice system for treating tobacco use, the number of patients seeking intensive counseling for quitting spiked from six in a year to 215.

The EMR system creates a mandatory pop-up screen that prompts nurses to ask every patient about tobacco use during admission. They must fill in data and click “accept” to continue.

In the Aspirus EMR system designed by EPIC, pop-up screens appear to prompt nurses to meet best practices in treating tobacco dependence.

The system then walks them through the “5 A’s” of tobacco treatment:

1. Ask about tobacco use (and document results).
2. Advise the patient to quit.
3. Assess the patient’s willingness to make a quit attempt.
4. Assist by:

a. Expressing your support.
b. Helping the patient set a quit date.
c. Prescribing appropriate medications.
d. Referring the patient to the Wisconsin Tobacco Quit Line, 1-800-QUIT-NOW. This can involve signing up for Fax to Quit so the Quit Line coach makes the first phone call.

5. Arrange follow-up. 

The system also helps Aspirus staff track performance on tobacco treatment. That’s important, given that tobacco use is the leading cause of preventable disease and death in the state and nation.

“There was little cost to set it up,” said Sheri Holmes, APRN, BC, Service Line Administrator-Women’s Health. “It just involved our time.” It all started when, in 2002, Holmes searched online for information on how best to help patients quit tobacco use and found the hospital manual created by the UW Center for Tobacco Research and Intervention (UW-CTRI). “I think all hospitals should get the UW-CTRI hospital manual,” Holmes said. “I was looking and looking online and then, wow, there it was. The manual was complete, practical and systematic.”

From Left: Susanne Morris, former UW-CTRI outreach specialist; Betty MacIntosh, RN; Susan Habrat, RN, MS, Cardiac Clinical Specialist; Sheri Holmes, APRN, BC, Director of Aspirus Women’s Health. Habrat holds a poster used to train nurses on how to use EMR to help patients quit smoking.

Back then, Aspirus provided patients with a brochure with quit tips. Now, they use a folder with Quit Line materials and other federal and local program information to help people quit. It includes Quit Tobacco Now, a step-by-step program sponsored by Aspirus and other local healthcare providers. The folders cost just a dollar a piece.

In 2006, Holmes worked with UW-CTRI staff to present evidence-based best practices to the Aspirus nursing staff. They earned support to standardize tobacco treatment into everyday care. They trained all 450 nurses and assigned champions who now follow up with patients who express an interest in quitting. They made it fun by incorporating it into a trivia game at the Nursing Practice Council. Aspirus publicized the best practices in internal publications for hospital staff.

At first, some of the nurses and respiratory therapists balked about talking to patients about quitting because they themselves smoked. But over time, most of those employees have quit; now those employees empower their patients to do the same. Patients attempting to quit say they appreciate that their provider has been through quitting nicotine and knows what it’s like.

Patients say the personal touch is welcomed and appreciated.

“In the past, patients in the hospital would be experiencing withdrawal symptoms and the staff didn’t identify the problem as nicotine induced,” Holmes said. “We used to go back to their chart and ask, ‘Could she be a smoker?’” 

Now, with EMR, they know up front.

The tobacco-treatment standards have really caught on. “It’s part of our continuum of care,” said Betty MacIntosh, one of two nurses who provide the 15-minute follow-up care to patients throughout the hospital.

“Our Wound Clinic is real strict about not using tobacco because wounds will not heal,” said Susan Habrat, RN, MS, cardiac clinical specialist and tobacco-treatment program coordinator.

Holmes, Habrat and MacIntosh said the key to setting up great quit-smoking care was to identify staff with a passion for it, and allow them to lead the program. Having go-to employees like MacIntosh who specialize in helping patients quit smoking is another key. And there’s no reason it can’t be fun.

Whenever group members bumped into a bit of hesitation among their colleagues regarding tobacco treatment, they proceeded with confidence. “Sometimes, you have to push it through using open conversation,” Habrat said.

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