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Hospital Based Populations   Clinical Considerations


The following clinical considerations are included in CAN-ADAPTT's guideline and have been approved by the Guideline Development Group (GDG).  


Processes in smoking cessation interventions with hospitalized patients
·  Managing nicotine withdrawal during hospitalization should be distinguished from a long term cessation attempt.
·  Mechanisms such as standing orders, medical directives or order sets, should be implemented where possible to ensure a consistent process or approach for smoking cessation interventions across the hospital setting. 
·  A systematic approach to identify, treat and follow up with all admitted smokers has been demonstrated to be an effective model and should be considered where possible.  One example of such an approach is the Ottawa Model.
·  Patient documentation/charting should include consistent data capture (performance indicators) to track the intervention, pharmacotherapy and follow-up.
·  Follow-up discharge planning and referral to community supports/services will benefit sustained cessation efforts, as with supportive counselling post-discharge.
·  As to the duration for follow-up post-discharge, existing evidence suggests at least one month1, however, continuous follow-up is preferable.
·  Efforts should be made to link patients to their primary healthcare provider upon discharge to ensure continuation of treatment and follow-up.
·  It should be recognized that pharmacotherapy can be provided to treat withdrawal during hospitalization as well as to promote long term cessation attempts.
Hospital Policies
·  Opportunity to discuss or prioritize the implementation of smoke-free policies in hospital settings can assist in establishing or supporting smoking cessation processes/programming. Examples can be drawn from institutions such as Centre for Addiction and Mental Health
·  Hospital management teams and staff should be encouraged to support smoking cessation for hospitalized patients.
·  Smoking Cessation interventions should also be made available for hospital staff.
·  There are challenges determining which practitioner(s) are in a position or have capacity to engage in the provision of smoking cessation interventions. Standing orders, medical directives could be considered and included in the development of a hospital smoking cessation system/process.
·  To ensure and sustain capacity of smoking cessation program/services appropriate resource allocation is an important consideration.
·  Approaches may differ for smokers admitted via emergency vs. pre-admission, according to policies. In addition, some approaches may differ for patients who stop smoking for hospitalizations versus those patients who have a desire to quit while hospitalized.
· Hospital policies may support cessation from the perspective of harm reduction.


1. Rigotti N, Munafo’ MR, Stead LF. Interventions for smoking cessation in hospitalised patients (Review). The Cochrane Library 2008, Issue 4.

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Note that these clinical considerations were developed by the Guideline Development Group (GDG) and then edited or added to by CAN-ADAPTT network members.
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   Hospita​l Based Populations​