Behavioral Health

1

• Behavioral Health
• and the
• Tobacco Free Initiative

2
Objectives

• This presentation has three objectives
• To present the history of SSM Healthcares
  Tobacco Free initiative
• To detail the implementation plan for Behavioral
  Health Services
• To describe the outcomes of our initiative,
  including current status

3
history

• SSM Health Care became tobacco free on November
  18, 2004
• Throughout 21 hospitals in four states
• Including Medical Office Buildings and other
  properties
• Indoors and Outdoors
• Largest private healthcare system at that time to
  undertake this effort
• Over one year of planning the roll-out

4
history

• Patient / Visitor Issues
• Voluntary program, but all staff to prompt
  compliance
• No more designated smoking areas
• Reminder card for visitors

5
history

• Employee Issues
• 18 of SSM Health Care employees used tobacco
  products
• Of those, about half wanted to quit.
• SSM pharmacy programs that previously excluded
  smoking cessation medications began coverage
• Covered employees who do not use tobacco products
  receive a tobacco-free taxable incentive of 60
  annually
• Smoking cessation resources were made available,
  but seldom utilized

6
history

• Tobacco-Free Steering Teams
• Environment Services/Plant/Security Subteam
• Patient/Family/Visitor Subteam
• Physician Subteam
• Education/Support Subteam
• Smokers Subteam
• Communications Subteam
• Human Resources Subteam
• and
• Behavioral Health Subteam

7
history

• Behavioral Health Subteam
• The only team devoted to a specific patient group
• Recognized the unique challenges and
  perceptions regarding Mental Health and Smoking
• Monthly teleconferences with administrators,
  psychiatrist and treatment team representatives
• Exemption was not an option!

8
implementation plan

• Behavioral Health Subteam Tasks
• Completed literature review
• Described the issues
• Very limited treatment recommendations
• Tailored nicotine replacement therapy (NRT)
  protocols for Behavioral Health
• Integrated NRT protocols into Emergency Dept.,
  Inpatient and Outpatient settings
• Prepared client education materials

9
implementation plan

• NRT Options
• Provide Transdermal Nicotine Patch or Nicotine
  Gum to Inpatients
• Offer in Emergency Dept (patch takes 6 hours)
• Provide Nicotine gum or Lozenge to Outpatients
• Provide 12-week supply of Transdermal Nicotine
  Patch to Intensive Outpatients who commit to
  Smoking Cessation Program
• Coordinate with caregiver
• 150 expense

10
implementation plan

• Client Education
• Routine groups on Nicotine Dependence
• Health risks
• Mental Health / smoking statistics
• Financial impact of tobacco use
• Discussion of pros cons
• Information about smoking cessation and program
  availability
• Detailed instruction on use of Nicotine
  Replacement medications

11
implementation plan

• Client Assessment
• Fagerstrom Index of Nicotine Dependence
  administered
• During planning phase
• Immediately prior to implementation
• Added questions to predict
• Added questions to predict client response
  (Outpatient example)
• Wants to quit to quit, selects nicotine patch
• Will abstain from smoking, selects nicotine gum
  or lozenge
• Will abstain from smoking without Nicotine
  Replacement
• Client will quit the program

12
implementation plan
13
Outcomes
BEHAVIORAL HEALTH OUTPATIENTS Predicted number
quit program (2) Small percentage quit smoking
(2) Fewer use nicotine replacement than
predicted (14 vs. 31) Total daily cost of
nicotine replacement products 19.48 Number of
patients identified as non-smokers increased by
20
14
Outcomes
BEHAVIORAL HEALTH INPATIENTS 62.86 of Inpatient
smokers use Nicotine Replacement Therapy Total
daily cost of Nicotine Replacement products
42.44 Number of patients identified as
Non-Smokers increased by 7
15
outcomes

• Additional Benefits
• Inpatient Units converted smoking lounges to
  alternate use
• Removed daily chore of managing patient smoking
• Less smoking-related disturbance on inpatient
  units without tobacco available

16
outcomes

• Ongoing Concerns
• Continuing challenge to manage smoking on breaks
• Particularly with Chemical Dependency clients
• Organize healthy options during program breaks
• Healthy snacks
• Group walks
• Competitive Issues
• 2006 Missouri Hospital Assoc. initiative
  converted all inpatient facilities to smoke-free
• Many Outpatient providers continue to allow
  outdoor smoking
• No impact on our outpatient census
• When do you inform clients?