As the lung health experts in their hospitals and in their communities, respiratory therapists are the right practitioners to help people quit smoking. More and more of them are doing just that, and in a wide variety of ways. We asked members to share how they’re working with patients to help them quit smoking. These resources and ideas can help you prepare for the Great American Smokeout, as well as year-round smoking cessation program efforts.
In the pulmonary clinic
As a pulmonary function technologist at Novant Health Presbyterian Medical Center in Charlotte, NC, Colleen Parker, RRT, RPFT, CTTS, stood by and watched pulmonary function decline in the same patients year after year because they still smoked.
“I didn’t know how to help them and felt I was doing a disservice to my patients by not doing more,” Parker said.
She decided to change that situation for the better by writing up a proposal for a tobacco cessation program and submitting it to her hospital’s Fish For My Wish program. Fish For My Wish allows any hospital employee to request funding for an area in which he or she sees a need.
Parker didn’t receive funding there, but it got things moving and funding soon came through via the hospital’s cancer center. She and a colleague were sent to the Medical University of Mississippi for tobacco treatment training and she earned her Certified Tobacco Treatment Specialist (CTTS) credential.
Now Parker provides individualized tobacco treatment to patients in a pulmonary clinic using evidence-based guidelines and a tool to measure exhaled carbon monoxide, a step she believes is critical to helping smokers visualize the benefits of becoming smoke-free.
“This is a true passion of mine and I feel like I’m making a real difference in peoples’ lives by helping them to beat their nicotine addiction,” she said. It appears to be working. Her program currently has a 23 percent quit rate and patient satisfaction has improved.
Free weekly sessions
Renato Galindo, BSRC, RRT, CPFT, a care transition coordinator at Medical Center Hospital in Odessa, TX, spent three years as his facility’s pulmonary educator and tobacco cessation counselor before taking on his current position, and free weekly meetings for smokers was part of the mix.
“We started our program when Texas DSHS started their Potentially Preventable Hospitalization program,” Galindo said. The goal was to reduce unnecessary hospitalizations for people with various disease states, including COPD.
“They provided funds to be used at the contractor’s discretion,” Galindo said. “I was able to train at Rutgers Tobacco Program.”
The program launched shortly after the first of the new year, with 20 people taking part. They were offered the first set of recommended nicotine replacement therapy (NRT) along with education aimed at helping them quit.
Tackling a challenging population
People struggling with drug addiction and/or mental health issues make up a large section of the smoking population today, and helping them quit poses special challenges.
Ken Capek, MPA, RRT, director of cardiopulmonary services at Bergen Regional Medical Center in Paramus, NJ, a 1000-bed safety net hospital with 300 behavioral health and 85 drug detox beds, is taking on those challenges.
“I provide four, one hour group sessions a month in the in-house chemical dependency and mentally impaired units and once every other month in the outpatient follow-up program,” Parker said. An ex-smoker himself — he quit 21 years ago — he knows how hard it can be and he uses that personal experience to fuel the sessions.
“You must be completely open and honest and have empathy for your patients,” Capek said.
Given the issues faced by his patients, he also believes it is important to address addiction in general and how smoking can be covered at the same time as drugs and alcohol.
“Bottom line is that they must get encouragement from you because they need faith that they can do this, and then a plan of action to follow. It’s all about reprogramming,” Capek said.
These days, Mary Martinasek, PhD, MPH, RRT, CPH, MCHES, is an associate professor of public health at the University of Tampa in Tampa, FL, but she taps into her more than 25 years working as an RT in hospitals to help people quit tobacco use on her campus.
“Our program is funded by the tobacco settlement funds from the Florida settlement in 1998,” she said. “I provide classes at the university and it serves faculty, staff, students, and community members who want to become smoke free.”
Both counseling and NRT are provided at no cost.
“A combo therapy of patches and gum or lozenge works best in combination with altering their environment to make it different when they kick the habit,” Dr. Martinasek said. “For chew tobacco, the gum for a longer time works best.”
Taking the message to inpatients
Chrissy Acker, RRT, CTTS, can trace her interest in tobacco treatment to her job as a certified asthma educator at her hospital. She saw the need for more one-on-one education of people who smoked, and her facility — NWTHS in Amarillo, TX — paid her way to attend a week-long seminar on smoking cessation at the Mayo Clinic.
A year later she earned her CTTS credential.
“I am the only smoking cessation educator at NWTHS coming in Monday through Friday,” says Acker. “I visit all the inpatient smokers admitted into the hospital, working off a task list that is generated when patients are admitted and asked if they smoke.”
She offers them a free program run by Texas Tech Medical School that provides NRT on discharge and then at least two additional months of NRT if they agree to attend two 90-minute classes taught by pharmacists. In the hospital, she is free to spend as much time as a patient wants discussing reasons to quit and providing encouragement to do so.
On average, she visits about 250 patients each month, many of them on Medicare or Medicaid and some who are even homeless. She believes RTs can be the champions for similar programs in their facilities.
“The need is great for anyone with a passion to help fight this fight,” Acker said. “The more patients that I see, the more my passion grows to continue this journey of hope for many who have lost it.”
Talking tobacco in a COPD management program
Tobacco cessation is a major component of the integrated COPD management program at Western Michigan University in Kalamazoo, according to Michael Hess, BS, RRT, RPFT, chronic lung disease coordinator at the university hospital.
“We talk tobacco at every encounter with active smokers, and we provide ongoing support for those who have successfully quit, in order to celebrate their accomplishment and hopefully provide positive reinforcement to keep them quit,” Hess said.
He uses a range of strategies to get the job done, from pharmacotherapy to emotional/psychological support to an in-house ‘quit kit’ that offers people a list of activities they can do to replace the tactile components of tobacco use.
It even comes with a can of Play-Doh they can reach for instead of a pack of smokes.
Hess is a big proponent of the gradual wean process, a tactic he learned during his own battle with weight loss.
“I was addicted to food for a very long time, and used it as a stress reliever/crutch, just as many smokers use tobacco products,” he said. Hess realized losing weight wasn’t going to happen overnight and he knows the same is true for his patients trying to give up smoking.
“That expectation often sets people up for failure in their own mind, which is why I favor the more gradual approach,” Hess said.
Going out into the community
A couple of years ago, Rita Newman, RRT, started seeing more and more patients at her hospital who were expressing an interest in quitting smoking and decided to capitalize on that interest by becoming a facilitator for the ALA’s Freedom from Smoking program and completing tobacco treatment training offered by the University of Massachusetts.
Now the patient care educator at Baptist Health-Little Rock in Little Rock, AR, facilitates Freedom from Smoking sessions that meet once a week for seven weeks, attends wellness fairs in her community to spread the stop smoking message, and offers carbon monoxide monitoring and simple spirometry during education and screening days at physicians’ offices.
She has also helped to form a new group called The Next Step, which meets once a month and features a talk by an ex-smoker, the goal being to provide extra support for those who still need it after the formal sessions end.
“So far our quit rate for those that complete the program is about 70 percent,” Newman said. “I am so glad I started providing this service for the community and wish it had not taken me 30+ years as a respiratory therapist to do so . . . I love what I do!”