PROJECT MANAGEMENT PLAN – Smoking Cessation Project
Vision StatementLung cancer, coronary artery disease, and chronic obstructive pulmonary disease are the 3 leading causes of death in Hamilton County, Cincinnati, OH. The Smoking Cessation Project is a sustainable program in the Internal Medicine Resident Clinic at The Christ Hospital that will improve documentation of smoking status and involve the design of a smoking cessation program that includes educating nursing staff and medical residents in smoking cessation clinical skills. The implementation will have a meaningful positive impact on the established underserved population from the Internal Medicine Residency Clinic community by improving early detection of lung cancer.
Team ObjectivesOur objective was to design a smoking cessation program and to standardize documentation of smoking status. Our project requirements were to educate residents and nursing staff on how to review and record smoking status in a patient’s chart during each visit, to create an algorithm that residents and nursing staff can follow when educating a patient on smoking cessation, and to implement follow-up phone calls by a nurse after the patient has agreed to stop smoking. Our goal was to achieve 100% documentation of smoking status in our clinic patient population. A long-term goal was to provide low-dose CT scans at no charge to high-risk patients once their smoking history was documented correctly.
Success FactorsThe most successful parts of our work were as follows:
  • Improving smoking status documentation

  • Creating a follow-up program called the “Don’t Do It” protocol to help support our patients in their efforts to quit smoking (this included close nurse follow-ups with phone calls to see how they were doing and to check on any medication side effects)

  • Inadvertently assuring that smoking status documentation was correct so that patients who should qualify for the low-dose CT scans for cancer screening did qualify. This came about when we realized that updating a smoking status when a patient had cut back could skew the numbers and make the patient’s smoking history appear to be less than it actually is in the EMR. Once we noticed this, correct documentation helped them qualify through insurance to get the screening they needed.

We were inspired by the progress we made in improving smoking status documentation and counseling. This, along with implementing an entirely new follow-up program for smoking cessation, showed that we could leave a lasting impact on our Internal Medicine Resident Clinic.
BarriersThe largest barriers encountered were patient demographics and willingness/insight to quit smoking. Another barrier was the number of residents and nurses who needed to be educated about documentation and our new follow-up program. All were extremely busy with their other duties, so to reach everyone and have them remember was difficult. To overcome the barrier with our patient population, we tried to incentivize them and follow-up closely to help them quit smoking. We hung signs in patient rooms showing how much money they would save if they quit smoking, and we created the “Don’t Do It” protocol for nurse phone calls after their visit. To overcome the barrier of reaching and educating everyone, we had multiple venues with education about how to correctly document smoking status at each visit and about the “Don’t Do It” protocol.
Lessons LearnedThe single most important piece of advice to provide another team embarking on a similar initiative is to know as early as possible what to focus on in the project.