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4CPS-183 Pharmacist led opt-out cessation treatment protocol for combustible tobacco smoking
  1. M Lefebvre,
  2. P Ly,
  3. M Gaume,
  4. C Berge-Bouchara,
  5. C Duval,
  6. C Airiau
  1. Centre Hospitalier Cholet, Pharmacy, Cholet, France


Background and Importance In hospitals where pharmacists are accountable for obtain­ing medication histories and completing medication recon­ciliation and medication ­related education for all patients, the pharmacist offers a nearly universal access point to address tobacco use and deliver a cessation intervention.

Aim and Objectives This formative study describes the development and refinement of a pharmacist­-led intervention through pilot testing to full implementation, with input from pharmacists and others.

Material and Methods A delegation protocol for hospital pharmacy inpatients who smoked cigarettes gave hospital pharmacists the authority to order nicotine replacement therapy (NRT) during hospitalisation and at discharge. The smoking cessation intervention protocol was approved by the hospital’s Pharmacy and Therapeutics Committee and Medical Board.

Patients targeted for intervention were adults (age 18 years or older) admitted to a participating inpatient unit and service who were identified via an EHR entry on admission as cur­rently smoking cigarettes (at any level of smoking), with or without other forms of tobacco use.

The programme was pilot tested in phases, with pharmacist feedback between phases, and then implemented hospital-wide. Interviews, surveys, and informal mechanisms identified ways to improve implementation and workflows.

Results Feedback from pharmacists led to changes that improved workflow, training and patient education materials, and enhanced adoption and reach. Refining implementation strategies across pilot phases increased prescribed NRT from 2% to 44%.

Conclusion and Relevance Results of this multi­-phased, pharmacist­ led smoking cessa­tion intervention roll-out suggest that improving implementa­tion strategies can meaningfully increase the rates at which hospitalised patients who smoke receive evidence ­based smoking cessation treatment.

This programme, developed by a multidisciplinary team of stakeholders, capitalises on the unique role of pharmacists who interact with nearly every inpatient at admission. Iterative input from pharmacists was used to refine implementation strate­gies and better integrate smoking cessation intervention into existing workflows to enhance the reach of NRT and tobacco quit-line referral among inpatients.

Hospitalisations provide an ideal opportunity for patients to make a tobacco quit attempt, and pharmacists can capitalise on this opportunity by integrating smoking cessation treatment into existing inpatient medication reconciliation workflows. Pharmacist-led implementation strategies developed in this study may be applicable in other inpatient settings.

Conflict of Interest No conflict of interest.

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