The current clinical practice guideline for smoking cessation recommends that all patients be asked about their smoking status at every patient visit and that patient smoking status be documented every visit (Fiore et al., 2008). Data obtained in creating this guideline suggests that most patients are interested in cessation and that many providers are in frequent contact with smoking patients, providing them with an opportunity to address smoking cessation. However, research has also shown that many health care providers do not assess smoking status regularly with patients. The Centers for Medicaid and Medicare Services ( CMS; 2014) state that ongoing interest in cessation is a crucial first step in helping patients achieve cessation.
The capstone site EMR has a place for documentation of smoking status. However, the EMR does not prompt the provider to complete a smoking status assessment during each patient visit. The most current guidelines recommend incorporating a smoking status assessment with the vital signs assessments with each patient. Therefore, the smoking status of each patient could be assessed, recorded, and documented at the time of vital signs assessment. The smoking status of each patient could be recorded in the chief complaint and saved. Allowing the provider to see this assessment when starting the patient visit. Since the previous visit chief complaint is reviewed at the start of each patient visit, the previous month’s assessment could be reviewed as well as serve as a reminder to re-assess at each visit. The additional benefit to completing these assessments during each visit is that it assists in maintaining Meaningful Use Stage 1 Criteria which states that all patients over the age of 13 have their smoking status recorded (CMS, 2014). These assessments could help to to prompt staff to ensure that smoking status is recorded where the EMR tracks smoking status, which has the potential to increase compliance with current Meaningful Use requirements.
Assessments are also a typical place to begin a Motivational Interviewing (MI) conversation. Therefore smoking status assessments during patient visits can assist with opening the conversation about cessation. An excellent way to follow up with a patient that states he or she is a smoker would be to use the readiness ruler technique. Read more about the readiness ruler here.
A copy of the 2008 guidelines for smoking cessation can be found here
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Motivational Interviewing for Smoking Cessation 