Building Smoking Cessation into Daily Practice in a Public Health Setting, by Susan Hall & Lorraine Vandenberg

The Nursing Practice Council (NPC) at the Middlesex-London Health Unit (MLHU) initiated the process of implementing the Nursing Best Practice Guideline (BPG) "Integrating Smoking Cessation into Daily Nursing Practice" agency wide.

The NPC supported five staff members to participate in Best Practice Champion workshops. These Best Practice Champions partnered with a content expert in smoking cessation and two members of the NPC to form the Smoking Cessation Implementation Team (SCIT).

The team identified the need for a plan to guide the process, and the RNAO Toolkit: Implementation of Clinical Practice Guidelines was used. The stakeholder analysis provided information on facilitators and barriers for various implementation strategies and identified staff that could influence the implementation of the guideline. As a result of the stakeholder analysis, other staff members became involved in the implementation process.

After the initial assessment, implementation began. Implementation included developing a communication plan, securing cessation resources, and providing professional development opportunities.

These opportunities included two workshops with the Program Training and Consultation Centre (PTCC), and the Senior Nurse Leader encouraged all nurses to complete the RNAO e-learning module for smoking cessation. Over 76% of all nurses in the agency completed the e-learning education. To celebrate our work, a launch party was held on May 31, 2005, World No Tobacco Day. The launch served to remind the nurses about the Best Practice Guideline, to network, and celebrate the completion of the e-learning.

One of the key outcomes of the project was increased awareness and interest in RNAO BPGs. This past October 2005, ten more nurses attended the RNAO Best Practice Champions workshop, which has resulted in an internal network of 15 Best Practice Champions. A major goal of the Middlesex-London Health Unit Champions Network is the sustainability of this and future guidelines. For this Smoking Cessation BPG the sustainability plan includes:

 

• incorporating smoking cessation intervention training for all new nurses hired,
• revising current nursing documentation records to incorporate the new smoking cessation protocol,
• establishing a procedure to ensure smoking cessation resources are available, and
• ongoing staff reminders and updates.

As with any new project many lessons were learned. These included the need to:

 

• have a dedicated staff member to coordinate the project who is in direct communication with the Professional Nurse Leader,
• clarify the roles, authority, and decision making process for SCIT,
• develop a communication plan,
• augment “buy-in” from staff agency wide, include other disciplines on the implementation committee,
• build in dedicated time for evaluation process early,
• build timelines into the process, and
• track time spent at meetings and time following up on action items in order to secure dedicated time for future BPG projects

The implementation of the BPG has been a wonderful learning experience. If you are interested in hearing more details about the project please contact Susan Hall, Public Health Nurse at susan.hall@mlhu.on.ca or (519) 663-9581 ext. 2286.