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Registered Nurse Initiation of a Tobacco Intervention Protocol: Leading Quality Care

Zarling, Kathleen K. MS, ACNS-BC, RN-BC, FAACVPR; Burke, Michael V. EdD; Gaines, Kim A. MS, RN; Gauvin, Thomas R. MA

doi: 10.1097/01.JCN.0000317451.64778.e9

This article summarizes the development and implementation of a registered nurse-initiated protocol to intervene with hospitalized patients who are tobacco-dependent, may be experiencing tobacco withdrawal, and who are hospitalized in a smoke-free environment.

Rationale: Tobacco use is the leading cause of preventable death in the United States. Hospitalization provides a unique teachable moment to treat tobacco dependence. Nurses can be effective in talking with patients about tobacco use.

Development: The clinical nurse specialist spheres of influence model and the role of the clinical nurse specialist were important for developing a tobacco use intervention protocol. A multi-disciplinary team created key objectives. These included identifying and assessing all patients who use tobacco, providing treatment to manage both withdrawal and address tobacco dependence, providing comfort to patients while hospitalized in a tobacco-free environment, encouraging lifelong cessation. The bedside admitting nurse was chosen as the pivotal professional to trigger tobacco use interventions.

Implementation: A protocol was finalized that requires the bedside nurse to assess all patients for past and current tobacco use. The nurse is then prompted to (1) provide information about tobacco dependence and treatment, (2) ask if the patient wants nicotine patch therapy to address withdrawal and, (3) order a consult with a specialist at the patient's request. Extensive and varied educational programs were developed to support the implementation of the protocol.

Outcomes: The tobacco use intervention protocol has become important for providing assessment and intervention to patients who use tobacco. It has increased the number of specialist consults provided to patients. It has increased compliance with quality reporting data by national quality accrediting bodies.

Kathleen K. Zarling, MS, ACNS-BC, RN-BC, FAACVPR Clinical Nurse Specialist, Department of Nursing, Mayo Clinic, Rochester, Minnesota.

Michael V. Burke, EdD Treatment Program Coordinator, Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota.

Kim A. Gaines, MS, RN Nurse Administrator, Department of Nursing, Mayo Clinic, Rochester, Minnesota.

Thomas R. Gauvin, MA Counselor and Tobacco Treatment Specialist, Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota.

Corresponding author Kathleen K. Zarling, MS, ACNS-BC, RN-BC, FAACVPR, St Mary's Nursing Service, St Mary's Hospital, Mayo Clinic, Rochester, MN 55902 (

© 2008 Lippincott Williams & Wilkins, Inc.