ED Tapped for Secondhand Smoke Exposure Program
The Children's Hospital Emergency Department (ED) has been selected to participate in a pilot program focused on reducing secondhand smoke affects for children. For seven months starting in March, patients seen in the ED will be evaluated for possible exposure.
“The ED is the ideal setting to implement this pilot because we will be able to evaluate a large, diverse population in a short amount of time,” explained Diane Herrick, RRT-NPS, AC, program coordinator, Secondhand Smoke Initiative and Asthma Management Program. “Statistics show that 40 percent of children who appear in pediatric emergency departments are exposed to secondhand smoke. We estimate that we will reach about 400 children per week.”
When Herrick and Keith Cavanaugh, MD, a Board-certified pediatric pulmonologist, began planning the program, they surveyed 2,000 physicians, registered nurses and respiratory therapists on their level of interest in addressing issue.
“We found that there’s a discomfort; they were motivated, but not quite comfortable with providing intervention,” explained Cavanaugh. Herrick and Dr. Cavanaugh developed ways to keep evaluation, intervention and referral as simple as possible. Based in part upon a successful adult cessation model, the structure of the intervention involves the two A's and R: ask, advise and refer.
In 2005, Cavanaugh, the program’s principal investigator, received approval and a grant from the State Tobacco Education Prevention Partnership to implement the pilot, which is based on a similar cessation program for adults.
Moving forward in collaboration with Genie Roosevelt, MD, an emergency room physician at Children's, Cavanaugh and Herrick devised a brochure to help ED staff identify whether a primary caregiver is exposing the child to secondhand smoke.
Ask
The first step of the intervention is to ask. “During triage, the adults accompanying the patient will be asked if they or someone who cares for child smokes,” explained Herrick. “If the answer is 'yes,' the triage nurse gives the family a form that identifies readiness to quit smoking and provides information about secondhand smoke exposure reduction and cessation. The family takes the form with them while staff determines the most consistent and effective provider to do the intervention.”
Advise
The second step is to advise. “Intervention is then based on the feedback provided,” explained Cavanaugh. “If they check red, we know they are not ready to quit, but we advise staff to emphasize exposure reduction. The message is simple: Prevent exposure by smoking outside the house or car. Simply doing so greatly reduces a child’s exposure to secondhand smoke.”
“However, if they check green, we jump on the cessation opportunity,” added Herrick, "while still providing the information about reducing exposure until they are able to quit."
Refer
The third step is to refer. Staff offers the parent or guardian information about Quitline, a confidential smoking cessation counseling service providing free counseling and nicotine patches. Caregivers may also request that a Quitline representative contact them.
“Quitline is by far, the most evidence-based, successful program to date,” added Herrick.
Approximately four weeks after the intervention, Children's will survey the recipients to evaluate their level of acceptance of the intervention, if they recall receiving the paperwork, and most importantly, if they changed their behavior. Throughout the pilot program, Herrick and Cavanaugh will also track the volume of calls Quitline receives from Children’s visitors.
“This is an opportunity for Children's to take the lead in both implementing and evaluating a system that emphasizes secondhand smoke exposure reduction,” said Herrick.
For more about Quitline, call 800-QUIT-NOW (800-784-8669), and to learn more about the steps you can take to protect children from secondhand smoke, visit www.RaiseSmokeFreeKids.com.
