P1043 - Clearing the Clouds in Kids’ Clinics: Improving Vaping Screening.

Aim:
To increase the screening rate for vaping during well child visits (age 11-18 years) at University of Florida (UF) Pediatrics clinics by 20% in 6 months.

Background:
E-cigarettes (vaping) are the most popular tobacco product used by teenagers. In 2019, 27% of high school and 10% of middle school students reported vaping. Vaping has been linked to severe illness and over 50 deaths. The AAP recommends screening and prevention counseling for vaping.

Methods:
We surveyed primary care pediatricians (PCPs) and learners (residents and fellows) about their vaping screening and intervention practices and assessed confidence and barriers in these practices. Based on survey results, we developed several interventions that targeted all general and subspecialty UF pediatric clinics. We held an educational session with providers about vaping prevalence, devices, ingredients and dangers, and sent a recording to all PCPs. Two weeks later we sent CDC vaping recommendations to all PCPs. The third intervention integrated vaping screening into the adolescent well child template. We created a smart phrase with a hard stop for closing the note that incorporated a questionnaire with drop downs for vaping use, frequency, duration, devices and nicotine/THC/flavors content.
Two months afterwards, our electronic medical record (EMR) updates disabled the smart phrase. We encouraged providers to insert the smart phrase in their notes on demand. Eventually, we were able to rebuild the hard stop smart phrase. We collected data from the primary teaching clinic, which includes 7 faculty, 12 pediatric residents and 1 physician assistant. We reviewed 10 randomly selected adolescent well child visit charts monthly for documentation of vaping screening over a 16-month period (10-month baseline).

Results:
Documented screening for vaping during adolescent well child visits was 0% in the 10-month baseline period. Documented screening increased to 20% after the first 2 interventions and to 100% in the 2 months after smart phrase implementation. The screening rate dropped when the hard stop smart phrase was disabled. It continued dropping although smart phrase was made available to providers on demand. The rate improved to 90% when we recreated the hard stop smart phrase.
Though we did not formally measure provider satisfaction with the process, anecdotally we received no complaints about the hard stop.

Conclusions:
We achieved promising results in the first 3 months of our intervention, especially after introducing a smart phrase with a hard stop. While education and information (our first 2 cycles) are usually necessary, they are not reliable improvement strategies. Forcing functions such as hard stops are much more successful. Screening decreased once the hard stop was removed, demonstrating the importance of continued monitoring after successful implementation. Next steps include data collection at other clinics and increasing vaping cessation interventions for patients with positive screens.