Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Lam WSV, Fung WL
Affiliation :
Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
Smoking increases perioperative morbidities and mortality. It is also associated with chronic, multi-systemic illnesses that have significant anaesthetic implications. The perioperative period provides a potential 'teachable moment' towards smoking cessation. Anaesthetists are encouraged to utilise these opportunities to promote smoking cessation. Sustained effort in quitting is more likely with further, continued support through pharmacological and non-pharmacological means provided by smoking cessation services.
Objectives :
To assess the compliance in advising smoking cessation and referral of patients to the smoking counselling and cessation clinic (SCCC).
Methodology :
This is a six-months, retrospective, pilot audit on patients who attended the perioperative medicine clinic (POMC). We evaluated the prevalence of smokers, their demographics and the details of their planned surgery. Documentation on smoking cessation advice, referral to SCCC and the subsequent treatments offered were assessed. Based on an Australian study, we set our initial targets of giving smoking cessation advice in POMC and SCCC referral at 80% and 30% respectively.
Result & Outcome :
288 patients attended POMC for preoperative assessment and optimisation from January to June 2023. All patients (100%) were screened on their smoking history. Twenty-seven active smokers were identified (9.375%). More than half of them were scheduled for vascular or colorectal surgeries. All smoking patients received smoking cessation advice from our staffs, either by the Advanced Practising Nurses or Anaesthetists. Six referrals to the SCCC were made (22.2%) which was below our target. Three of them had documented record of SCCC attendance and received the corresponding advice, education and prescription. The other three patients had uncertain SCCC attendance. The reasons for non-referral of patients were otherwise not clearly documented. The overall success rate of smoking cessation was also unknown. We postulated the added costs, time and effort for a separate clinic attendance might reduce patient incentives to attend the SCCC. Time interval between POMC and scheduled surgery could be optimised. Staff and patient education should be enhanced. Patient information leaflet should be tailored specifically towards the perioperative period.
In conclusion, we were able to achieve our predetermined targets and utilise POMC as an opportunity to educate patients. However, there is room for improvements in the rate of SCCC referral where patients can be better equipped and supported towards sustained smoking cessation.
