5 A's - Helping Smoker's Quit - A Guide for Nurses

Why should I treat tobacco dependence?

If the 2.2 million working nurses in the U.S. each helped one person per year quit smoking, nurses would triple the U.S. quit rate.

-Tobacco Free Nurses

  • 70% of smokers see a physician each year
  • 70% of smokers want to quit
  • 46% try to quit each year

Annual Deaths:

Sum of Deaths from:

  • AIDS +
  • SUICIDE +
  • ALCOHOL +
  • CRACK +
  • HEROIN +
  • CAR ACCIDENTS +
  • FIRE

= Tobacco Deaths

 

Tobacco dependence is a CHRONIC CONDITION that often requires REPEATED intervention.

  1. Tobacco dependence is a chronic condition that often requires repeated intervention. However, effective treatments exist that can produce long-term or even permanent abstinence.
  2. Because effective tobacco dependence treatments are available, every patient who uses tobacco should be offered at least one of these treatments:
    • Patients willing to try to quit tobacco use should be provided with treatments that are identified as effective in the guideline.
    • Patients unwilling to try to quit tobacco use should be provided with a brief intervention that is designed to increase their motivation to quit.
    • It is essential that clinicians and health care delivery systems (including administrators, insurers, and purchasers) institutionalize the consistent identification, documentation, and treatment of every tobacco user who is seen in a health care setting.
  3. Brief tobacco dependence treatment is effective, and every patient who uses tobacco should be offered at least brief treatment.

Tobacco use results in true drug dependence

Nicotine:

  • Causes physical dependence characterized by withdraw symptoms upon cessation.
  • Is Psychoactive
  • Tolerance producing

How do I treat tobacco users who are willing to quit?

The 5 A’s For Patients Willing To Quit:

  • ASK about tobacco use.
  • ADVISE to quit.
  • ASSESS willingness to make a quit attempt.
  • ASSIST in quit attempt.
  • ARRANGE for follow-up.

  1. ASK

    ASK EVERY patient at EVERY visit:

    VITAL SIGNS

     Blood Pressure: _______________________________

    Pulse: ________________ Weight: _______________

    Temperature: ________________________________

    Respiratory Rate: _____________________________

    Tobacco Use: Current Former Never (circle one)

  2. ADVISE

    • Advise all tobacco users to quit
    • Even brief advice to quit results in greater quit rates
    • Advice should be: Clear Strong Personalized*

    “As your health care provider, I must tell you that the most important thing you can do to improve your health is to stop smoking.”

    YOUR three minute conversation can TRIPLE the patients success rate.

  3. ASSESS

    • Determine whether the patient is willing to quit at this time
    • Assess stage of readiness:
      • Pre- Contemplative
      • Contemplative
      • Preparation
      • Action
      • Maintenance
      • Relapse
    • Questions you can ask:
      • “Would you like to talk about your smoking?”
      • “Are you willing to try to quit at this time? I can help you.”
      • “Have you considered quitting?”

  4. ASSIST

    • Help develop a quit plan
    • Provide practical counseling
    • Encourage social support
    • Recommend pharmacotherapy - except in special circumstances
    • Provide supplementary materials

  5. ARRANGE

    • Schedule a follow-up contact within one week after the quit date
    • Telephone contact Quit lines
    • The majority of relapse occurs in the first two weeks after quitting

MAUREEN RHODES
Project ACTION Tobacco Free Coalition
518. 841.7123