A Quality Improvement Project to Increase Smoking Cessation in a Hospital Acute Cardio-Respiratory Admissions Unit

We aimed to increase smoking cessation referrals by 30% within three months, to improve identification of patients’ smoking status, offer patients very brief advice (VBA) and increase the prescription of nicotine replacement therapy (NRT). Our multidisciplinary team (MDT) used ‘plan-do-see-act’ methodology to conduct a quality improvement project to increase referrals to smoking cessation services in a busy acute cardio-respiratory admission unit (CDU). We collected baseline and fortnightly data for 17 weeks documenting smoking status (%), VBA (%), NRT prescription (%) and referrals to smoking cessation services (%). The interventions were ‘smoking cessation’ champions, MDT education, increased availability of NRT on CDU with an ‘opt-out’ approach and a documentation ‘sticker’ for the medical records. We compared NRT prescription with the continuous Royal College of Physicians national COPD audit data. 278 medical notes were reviewed between 2/11/2018 to 16/03/2019. Referrals to smoking cessation services from CDU increased from 20% to 50% after the interventions were implemented. Documentation of smoking status ranged from 80% to 100%. VBA and NRT prescription increased from an average of 15% to a peak of 100% but subsequently decreased to 25 and 23%, respectively. Our COPD national audit results show that for patients with COPD, NRT prescription increased during the intervention period and was higher than the national average. We exceeded our goal by at least doubling the number of smoking cessation referrals with minimal resources by forming a multi-disciplinary team of existing healthcare professionals to prioritise ‘smoking cessation’ on a busy acute unit.