Canadian Smoking Cessation Clinical Practice Guideline

More documents

Recommendations

Info

CANADIAN SMOKING CESSATION GUIDELINECAN-ADAPTT SUMMARYSTATEMENTSCAN-ADAPTT’s development process reflects adynamic opportunity to ensure that its guideline ispractice informed and addresses issues ofapplicability in the Canadian context. It has built fromthe evidence and recommendations contained inexisting guidelines. It did not review the primaryliterature to inform the development of its SummaryStatements unless emerging evidence was identifiedby the Guideline Development Group. The CAN-ADAPTT Guideline Development Group hasprovided the below Summary Statements forHospital-Based Populations.SUMMARY STATEMENT #1All patients should be made aware of hospitalsmoke-free policies.GRADE*: 1CSUMMARY STATEMENT #2All elective patients who smoke should bedirected to resources to assist them to quitsmoking prior to hospital admission orsurgery, where possible.GRADE*: 1BSUMMARY STATEMENT #3All hospitals should have systems in place to:a) identify all smokers;GRADE*: 1Ab) manage nicotine withdrawal duringhospitalization;GRADE*: 1Cc) promote attempts toward long-termcessation and;GRADE*: 1Ad) provide patients with follow-up supportpost-hospitalization.GRADE*: 1ASUMMARY STATEMENT #4Pharmacotherapy should be considered:a) to assist patients to manage nicotinewithdrawal in hospital;GRADE*: 1Cb) for use in-hospital and posthospitalizationto promote long termcessation.GRADE*: 1B* GRADE: See Appendix B for Grade of Recommendation andLevel of Evidence Summary TableHOSPITAL-BASED POPULATIONS 23
CANADIAN SMOKING CESSATION GUIDELINECLINICAL CONSIDERATIONSPROCESSES IN SMOKING CESSATIONINTERVENTIONS WITH HOSPITALIZED PATIENTSManaging nicotine withdrawal duringhospitalization should be distinguished froma long term cessation attempt.Mechanisms such as standing orders, medicaldirectives or order sets, should beimplemented where possible to ensure aconsistent process or approach for smokingcessation interventions across the hospitalsetting.A systematic approach to identify, treat andfollow up with all admitted smokers has beendemonstrated to be an effective model andshould be considered where possible. Oneexample of such an approach is the OttawaModel.Patient documentation/charting shouldinclude consistent data capture (performanceindicators) to track the intervention,pharmacotherapy and follow-up.Follow-up discharge planning and referral tocommunity supports/services will benefitsustained cessation efforts, as with supportivecounselling post-discharge.As to the duration for follow-up postdischarge,existing evidence suggests at leastone month 19 , however, continuous follow-upis preferable.Efforts should be made to link patients totheir primary healthcare provider upondischarge to ensure continuation of treatmentand follow-up.HOSPITAL POLICIESOpportunity to discuss or prioritize theimplementation of smoke-free policies inhospital settings can assist in establishing orsupporting smoking cessationprocesses/programming. Examples can bedrawn from institutions such as Centre forAddiction and Mental HealthHospital management teams and staff shouldbe encouraged to support smoking cessationfor hospitalized patients.Smoking Cessation interventions should alsobe made available for hospital staff.There are challenges determining whichpractitioner(s) are in a position or havecapacity to engage in the provision ofsmoking cessation interventions. Standingorders, medical directives could beconsidered and included in the developmentof a hospital smoking cessationsystem/process.To ensure and sustain capacity of smokingcessation program/services appropriateresource allocation is an importantconsideration.Approaches may differ for smokers admittedvia emergency vs. pre-admission, according topolicies. In addition, some approaches maydiffer for patients who stop smoking forhospitalizations versus those patients whohave a desire to quit while hospitalized.Hospital policies may support cessation fromthe perspective of harm reduction.PHARMACOTHERAPYIt should be recognized that pharmacotherapycan be provided to treat withdrawal duringhospitalization as well as to promote longterm cessation attempts.HOSPITAL-BASED POPULATIONS 24
Page 1: CANADIANSMOKING CESSATIONCLINICAL P
Page 4 and 5: CANADIAN SMOKING CESSATION GUIDELIN
Page 33: CANADIAN SMOKING CESSATION GUIDELIN
Page 64: Canadian Action Network for the Adv

Canadian Smoking Cessation Clinical Practice Guideline

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?