Ferguson Kevin, Krishnan Sankaran, Sullivan Emily, Bhela Shyall, Dozor Allen J, Welter John J
Maria Fareri Children's Hospital at WMC Health, Valhalla, N.Y.
Boston Children's Health Physicians, Hawthorne, N.Y.
Pediatr Qual Saf. 2022 Sep 15;7(5):e588. doi: 10.1097/pq9.0000000000000588. eCollection 2022 Sep-Oct.
With over 40% of children in the USA exposed to tobacco smoke, the AAP recommends tobacco smoke exposure (TSE) assessment during clinic visits. We aimed to increase the rates of TSE screening and provider counseling regarding TSE reduction using an evidence-based approach.
We conducted the project at a large pediatric pulmonology practice. Baseline caregiver surveys and medical record review of TSE documentation took place in July/August, 2019. From September 2019 to July 2021, PDSA cycles were conducted to increase TSE screening and reduce counseling.
Before starting the project, 18% of smoking caregivers acknowledged smoking in the home and 41% in the car. While caregivers strongly desired to decrease TSE (median 9.4/10 on Likert scale), physician counseling of TSE reduction was offered only to 44%. PDSA cycles led to refining our patient passport, a document used during patient intake, which increased screening of TSE from 46% to 85%. Creating an educational handout in our electronic record addressing TSE increased TSE reduction counseling from 44% to 80% of children with smokers in the home.
Incorporating TSE screening into established nursing documentation of vital signs led to the sustained screening of TSE among children in a pediatric pulmonology practice. Embedding educational material in our electronic record and changes in clinic processes increased TSE reduction counseling. Similar changes could improve rates of counseling caregivers of other guidelines aimed to improve the children's health.
在美国，超过40%的儿童暴露于烟草烟雾中，美国儿科学会建议在门诊就诊时进行烟草烟雾暴露（TSE）评估。我们旨在采用循证方法提高TSE筛查率以及针对降低TSE的医护人员咨询率。
我们在一家大型儿科肺病诊所开展了该项目。2019年7月/8月进行了基线护理人员调查以及对TSE记录的病历审查。从2019年9月至2021年7月，开展了计划-执行-检查-处理（PDSA）循环以提高TSE筛查率并减少咨询。
在项目开始前，18%的吸烟护理人员承认在家中吸烟，41%承认在车内吸烟。虽然护理人员强烈希望降低TSE（李克特量表中位数为9.4/10），但只有44%的儿童接受了医生关于降低TSE的咨询。PDSA循环促使我们完善了患者护照，这是患者入院时使用的一份文件，TSE筛查率从46%提高到了85%。在我们的电子病历中创建一份关于TSE的教育手册，使得在家中有吸烟者的儿童中，接受降低TSE咨询的比例从44%提高到了80%。
将TSE筛查纳入既定的生命体征护理记录中，使得儿科肺病诊所的儿童中TSE筛查得以持续进行。在电子病历中嵌入教育材料以及诊所流程的改变增加了降低TSE的咨询。类似的改变可能会提高针对其他旨在改善儿童健康的指南对护理人员的咨询率。
