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With proper documentation, referral to a quitline meets the
VA quality assurance requirements for smoking cessation. Presently,
there is no required way to document a quitline referral.
Some of you have decided to change actual computer intake
forms to allow for a quitline check box, but for those of
you who do not have the capability; here is an alternate way
to document.
Enter a “Case Management” or “Telephone”
note (or the equivalent at your facility) into the VA Computerized
Patient Record System (CPRS) documenting the patient contact.
Follow up by writing an Rx or arranging for nicotine replacement
therapy (NRT) or other treatment through your local VA Pharmacy.
This situation is similar to that of co-managing your VA patient
with a non-VA provider. As mentioned above, document in CPRS
that the patient has an outside non-VA provider, work with
that provider (in this case the quitline counselor) by writing
an appropriate NRT and/or bupropion prescription. You can
check with your local VA Pharmacy regarding the specific forms
of NRT available at your facility.
All of the quitlines are aware of the facilities implementing
the VA 1 800 QUIT NOW campaign and some of you have made contact
with the outreach coordinators to streamline efforts and communication.
If you would like to have your local quitline contact you
directly, please let us know and we will make arrangements.
The materials you were sent are intended to last through September,
the duration of the campaign. Some facilities have already
applied for a grant to receive more materials after September.
If the opportunity arises for you to obtain additional cards,
posters, or card holders, we will let you know. In the meantime,
please visit the website to download poster images for free.
Keep in mind that many believe most NRT is under dosed. Carol
Southard, RN MSN Smoking Cessation Initiative Project Consultant
representing the American Dental Hygienists Association, Ask
Advise Refer campaign, says “ It is important to dose
the patient with an equivalent amount of nicotine via NRT
as the patient was getting via the tobacco product.The 21mg
patch is equal to about 15 cigs worth of nicotine; the 14mg
= 10 cigs and the 7 mg = 5. The 4mg gum/lozenge; one dose
of the nasal spray, and one cartridge of the inhaler all equal
only 1 cig of nicotine. One average size chew in the mouth
for 30 minutes is equivalent to 4 cigarette's worth of nicotine.It
is recommended to use any and all in any combination - especially
initially and especially in highly addictive users.”
With that said, this is the recommended dosing
for NRT: The lozenge comes in 2mg and 4mg doses with the 4mg
dose recommended for smokers whose first cigarette of the
day is within 30 minutes of getting up. The dosing is 1-2
lozenges every 1-2 hours x 6 weeks, then every 2-4 hours during
weeks 7-9, then every 4-8 hours during weeks 10-12. Some facilities
may only have the 2mg lozenge on the formulary.
For the gum (at the SFVAMC we only have the
2mg dose), use 1 piece every 1-2 hours for the first 6 weeks,
then 1 piece every 2-4 hours for the next 3 weeks, then 1
piece every 4-8 hours for the next 3 weeks with a maximum
of 30 pieces/day of the 2mg dose. The 4mg dose is used for
smokers of >=25 cigarettes/day (total of 24 pieces/day)
For the nasal spray (which is a non-formulary
item at some facilities) 1 spray delivers 0.5mg nicotine,
use 1 spray in each nostril (considered one dose) each hour
as needed. The number of doses should range between 8 and
40/day.
Recent NIH report titled “Few Smokers
Use Effective Cessation Methods”, NIH Says
Summary: A U.S. National Institutes of Health panel said in
a new report that few smokers use or have access to the stop-smoking
interventions that science has shown to be most effective.
Link
to full page.
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