Competency: Resistance Training in Outpatient Cardiac ...



Competency: Tobacco Cessation Counseling

Name _______________________ Date _________ Dept. ( Cardiac Rehab

( Pulmonary Rehab

Objective: Rehab staff members will be able to provide effective counseling to help those patients who wish to quit using tobacco products do so during the course of rehab.

| |Essential Elements of Performance: |Proficient |Needs Review/ |Inadequate |

| | | |Improvement |** |

|1 |Explain the impact of continued tobacco use on | | | |

| |cardiac/pulmonary disease & the benefits of quitting now. | | | |

|2 |Recognize smoking/ tobacco use as a routine outcome measure & | | | |

| |point-out questions in both admission & discharge interviews | | | |

| |that collect that information | | | |

|3 |Discuss recent alternatives to cigarette smoking, e.g. | | | |

| |e-cigarettes, hookah, vaping | | | |

|4 |At the beginning of rehab, assess the current tobacco status of| | | |

| |each patient & document their answer as: never user, former | | | |

| |user, recent user, or current user. | | | |

|5 |Differentiate recent & former users as: | | | |

| |Recent user = quit in last 6 months | | | |

| |Former user = quit more than 6 months ago | | | |

|6 |For current & recent users, determine & document their usual | | | |

| |number of tobacco uses per day | | | |

|7 |Ask every patient about exposure to second-hand smoke; identify| | | |

| |where ( home, work, car, etc.) & how often | | | |

|8 |For current & recent users, ask if they are now ready to try to| | | |

| |quit or to stay quit; from their response identify their stage | | | |

| |of readiness to change as: Pre-contemplation, contemplation, | | | |

| |preparation, action, or maintenance | | | |

|9 |Name appropriate counseling strategies including: | | | |

| |The 5 As for cessation counseling | | | |

| |The 5 Rs for relapse prevention | | | |

|10 |Explain the STAR strategy for those now willing to quit | | | |

|11 |List common medications used to assist smoking cessation, | | | |

| |including nicotine replacement & psychotherapeutics, & have | | | |

| |related information about each available | | | |

|12 |Identify outside resources | | | |

| |Hospital Tobacco Counselor | | | |

| |Community cessation programs | | | |

| |Help line by phone or internet | | | |

| |that can be tapped for additional help during rehab or | | | |

| |follow-up after rehab | | | |

|13 |Define a tobacco counseling session as: | | | |

| |Brief session = 3-10 minutes of routine advice | | | |

| |Intense session = more than 10 minutes of more personalized | | | |

| |coaching | | | |

|14 |Describe if/when to use the Fagerstrom survey on nicotine | | | |

| |dependence as an additional assessment tool | | | |

|15 |State the importance of reassessing the stage of change every | | | |

| |30 days on all those who were current/recent users at start of | | | |

| |rehab; verify if recent users have stayed quit | | | |

|16 |Be prepared to introduce appropriate cessation strategies | | | |

| |whenever a change in readiness is identified | | | |

|17 |At rehab exit, evaluate the current tobacco status of each | | | |

| |patient & document their answer as: never user, former user, | | | |

| |recent user, or current user; | | | |

| |for current users, record their number of uses per day. | | | |

| |for recent quits, confirm & record their quit date | | | |

|18 |Summarize that discharge plans for tobacco users need to | | | |

| |include; | | | |

| |Take-away advice & reminders of how to get/stay quit | | | |

| |Follow-up recommendations, e.g. PCP assistance, | | | |

| |hospital/community classes, etc. | | | |

Resources:

|For knowledge |For skills |

|AACVPR PR Guidelines (new 4th edition) section on Smoking Cessation, |Workshop with hospital Tobacco Counselor to emphasize: |

|pgs. 60-64 |assessing readiness to change |

|AACVPR CR Guidelines, 5th ed., chapter 8 Modifiable Risk Factors, pgs.|teaching prescribed medication use |

|90-94 |Trial call to PA Free Quit line: 1-800-QUIT-NOW (784-8669) |

|US Dept. of Health, Treating Tobacco Use & Dependence, 2008. |to inquire what services are available |

|Krames patient workbooks | |

Cross-reference to AACVPR Core Competencies:

|Cardiac Rehab |Pulmonary Rehab |

|AACVPR. Core Competencies for Cardiac Rehabilitation/Secondary |AACVPR. Clinical Competency Guidelines for Pulmonary |

|Prevention Professionals: 2010 Update. JCRP 2011: p. 7, Tobacco |Rehabilitation Professionals. JCRP 2014; p. 299, Tobacco |

|Cessation = all 7 Knowledge bullets & 3 Skill bullets. |Cessation = all 7 Knowledge bullets & 2 Skill bullets. |

Evaluation: Signature _______________________________ Date ________________

** any/all ratings of Inadequate require a corrective action plan tailored to the staff member involved

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