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Counseling Tobacco Smoke Exposure Reduction Measures in Pediatrics: A Quality Improvement Project
Kevin Ferguson1, Sankaran Krishnan2,3, Emily Sullivan4
1Maria Fareri Children's Hospital at WMC Health, Valhalla, N.Y.
Insights
Pediatric clinics can improve tobacco smoke exposure (TSE) screening and counseling for children by integrating assessments into routine visits and using educational materials. This approach significantly increased identification and support for reducing children's exposure to secondhand smoke.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Clinical Practice Improvement
Background:
- Over 40% of US children experience tobacco smoke exposure (TSE).
- The American Academy of Pediatrics (AAP) recommends routine TSE assessment in clinical settings.
- Effective strategies are needed to increase screening and counseling for TSE reduction.
Purpose of the Study:
- To enhance the rates of tobacco smoke exposure (TSE) screening among children.
- To increase provider counseling for reducing TSE.
- To implement an evidence-based approach in a pediatric pulmonology practice.
Main Methods:
- Conducted a quality improvement project using Plan-Do-Study-Act (PDSA) cycles.
- Integrated TSE screening into nursing vital signs documentation.
- Developed and utilized an electronic health record educational handout for counseling.
Main Results:
- TSE screening increased from 46% to 85% through patient passport refinement.
- TSE reduction counseling rose from 44% to 80% with the educational handout.
- Caregiver desire to reduce TSE was high (median 9.4/10).
Conclusions:
- Integrating TSE screening into vital signs documentation ensures sustained screening.
- Electronic health record enhancements and process changes effectively increased counseling for TSE reduction.
- These strategies can be adapted to improve counseling for other child health guidelines.
Abstract:
With over 40% of children in the USA exposed to tobacco smoke, the AAP recommends tobacco smoke exposure (TSE) assessment during clinic visits. We aimed to increase the rates of TSE screening and provider counseling regarding TSE reduction using an evidence-based approach.
Methods:
We conducted the project at a large pediatric pulmonology practice. Baseline caregiver surveys and medical record review of TSE documentation took place in July/August, 2019. From September 2019 to July 2021, PDSA cycles were conducted to increase TSE screening and reduce counseling.
Results:
Before starting the project, 18% of smoking caregivers acknowledged smoking in the home and 41% in the car. While caregivers strongly desired to decrease TSE (median 9.4/10 on Likert scale), physician counseling of TSE reduction was offered only to 44%. PDSA cycles led to refining our patient passport, a document used during patient intake, which increased screening of TSE from 46% to 85%. Creating an educational handout in our electronic record addressing TSE increased TSE reduction counseling from 44% to 80% of children with smokers in the home.
Conclusions:
Incorporating TSE screening into established nursing documentation of vital signs led to the sustained screening of TSE among children in a pediatric pulmonology practice. Embedding educational material in our electronic record and changes in clinic processes increased TSE reduction counseling. Similar changes could improve rates of counseling caregivers of other guidelines aimed to improve the children's health.
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