P1052 - Reducing Second-Hand Smoke Exposure for Infants in the NICU/Nursery

Background: Despite efforts to reduce smoking, 40.6% of children in the U.S. are exposed to second-hand smoke (SHS). The postpartum hospital stay is an ideal time to support families at risk for smoke exposure, since 50-80% of mothers who stop smoking during pregnancy relapse after childbirth. At Zuckerberg San Francisco General Hospital (ZSFGH), there is no established process for screening infants in the neonatal intensive care unit (NICU) and Nursery for SHS exposure. Standardizing infant screening protocols and improving rates of smoking cessation interventions may reduce the number of newborns impacted by second- and third-hand smoke.

Purpose: This study aims to: 1) Determine the rates at which newborns are screened and smoking cessation interventions are offered; 2) Identify providers’ main barriers to screening and smoking cessation counseling; 3) Develop measures to improve screening and counseling rates.

Methods: To determine screening and intervention rates, a chart review was conducted for all newborns born in September 2019 (n=83). To identify barriers to screening and offering interventions, an anonymous Qualtrics survey was distributed broadly and completed by nurses (n=30), residents (n=46), and attending physicians (n=9) within the NICU, Postpartum, and Labor & Delivery units. To develop effective interventions, suggestions from the Qualtrics survey were analyzed using the PRECEDE-PROCEED model and a PICK chart analysis. Ranking of options’ feasibility/impact was based on qualitative stakeholder interviews performed over the course of this project.

RESULTS &

Discussion: Our chart review found that screening for SHS exposure was recorded in 84% of mothers’ charts but only 56% of babies’ charts by the time of the infant’s discharge (Fig 1). Furthermore, only 38% of families who screened positive for first- or second-hand smoke were offered any intervention. The survey showed that the most common barriers to smoking cessation efforts were a lack of a standardized workflow (76%), time constraints (54%), and a lack of knowledge of available resources (47%) (Fig 2). A PRECEDE-PROCEED and PICK analysis of respondents’ suggestions identified 3 enabling measures. These were to: 1) add a detailed SHS screening and intervention section to the residents’ handbook; 2) assemble a “one-stop-shop” for all SHS educational materials and intervention tools; 3) to generate and publish a straightforward process map for screening and intervention.

Conclusion:
Improving rates of smoking cessation screening and intervention in the NICU and Nursery is an opportunity to decrease SHS exposure to newborns. Our study identified key barriers to this practice. Our next steps will be to introduce measures to simplify the screening/intervention workflow and raise awareness of available resources to improve screening/intervention rates.

The results of these interventions would be completed by the time of 2020 AAP National Conference & Exhibition.