P0136 - Improving Secondhand Smoking Screening and Documentation of Smoking Cessation Interventions for Families of Children Hospitalized with Asthma in an Urban Children’s Hospital

Background: Philadelphia has the second highest rate of smoking of any US city (26%). A child’s hospitalization for an asthma exacerbation represents a timely opportunity to screen for secondhand smoke exposure and offer interventions such as nicotine replacement therapy and Cap4kids resources (Figure 1A) to aid in smoking cessation for family members. This study aims to improve rates of screening and documenting smoking cessation interventions (Figure 2).
Design/

Methods: Observational time series with multiple planned sequential interventions was carried out by a resident-led quality improvement team utilizing a key driver diagram (Figure 1B) as contextual framework. Patients age 2-18 years admitted to the medical-surgical unit with asthma as primary diagnosis were included. During a 12-month baseline period twenty charts were sampled each month. During the study period, all eligible patient charts were reviewed. Statistical process control P charts were used to display monthly rates of screening and documenting smoking cessation interventions (Figure 2). Established rules for detecting special cause variation were applied.

Results: A total of 1491 patient charts were reviewed. Screening rate improved from 84.7% to 88.8% (Figure 2A) with an improvement in the running mean (without special cause). The rate of documenting smoking cessation intervention(s) improved from baseline of 13.3% to 25.9% shortly after initiation of monthly Plan-Do-Study-Act (PDSA) cycle meetings and then to 54.4% temporally related to distributing documentation templates and integrating interventions into resident workflow. Both of these demonstrated special cause improvement (8 consecutive points above the mean and 2 of 3 points approaching the upper control limit, respectively (Figure 2B)).
Conclusion(s): Over the course of the 2-year study period, both screening for secondhand smoke exposure and documentation of smoking cessation interventions improved. Keys to success include: creating a standardized template, PSDA meetings early in the month, and stocking the pharmacy with smoking replacements. There is still room for further improvement. Next steps include targeting patients admitted into pediatric intensive care units. Future studies may determine if this intervention impacts emergency department utilization and hospitalization.