Naval hospital twentynine palms by lJt41jZz

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									                   NAVAL HOSPITAL TWENTYNINE PALMS
                    STANDARD OPERATING PROCEDURE

Subj: TOBACCO CESSATION PROGRAM

Encl: (1) List of Facilitators, Guideline for Facilitators and Calendar of Classes
      (2) Surgeon General’s Report on Tobacco, 2000 & Fact Sheet Set
      (3) NHTP Instruction 5100.13D & DOD/Navy Information
      (4) History of Tobacco Use & General Information Articles
      (5) Prescription Protocols, Medical Assessment Forms & Zyban Condition Form
      (6) Week One Slides & Handouts – General Information & Methods of Quitting
          and Side Effects
      (7) Week Two Slides & Handouts – Preparing to Quit, Addiction Information,
          Benefits of Quitting
      (8) Week Three Slides, Lecture Script, & Handouts – Stress & Nutrition
          Information
      (9) Week Four Slides, Lecture Script, & Handouts – Relapse Prevention
      (10) Guide to Clinical Preventive Services – Report of the U.S. Preventive Services
           Task Force
      (11) PPIP Guidelines
      (12) MMWR Youth Tobacco Surveillance
      (13) World Health Report - Curbing The Epidemic: Governments and the
           Economics of Tobacco Control
      (14) NEHC Tobacco Cessation Class Metrics Reports
      (15) Copies of all Facilitator Training Certificates (Current & Past)

1. Purpose. To provide step by step guidance for the administration and execution of the
   Naval Hospital Twentynine Palms Tobacco Cessation Program.

2. Background. The tobacco cessation program at NHTP has been designed to meet the
   unique needs of the TRICARE eligible and civilian population of NHTP and
   MCAGCC. The program focuses on helping the patient to enable themselves to
   develop the skills needed to become tobacco free. The program focuses not only on
   the adverse health effects of tobacco use but also the economics of tobacco use,
   second hand tobacco effects, stress reduction, nutrition awareness and relapse
   prevention.

3. Eligible Participants. The population eligible for this program consists of anyone
   who is TRICARE eligible, TRICARE For Life eligible or who is a civilian employee
   of the Naval Hospital or MCAGCC. However, as TRICARE does not pay for the
   cost of either the Nicotine Replacement Patch (NRP) or the Zyban, only those
   individuals who are TRICARE or TRICARE For Life eligible may receive the
   pharmacotherapy’s for free. Civilian employees may take the class for free but must
   access their own health insurance for the pharmacotherapy’s. The cost of the tobacco
   cessation program pharmacotherapy is borne by the NHTP operating budget.




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4. Knowledge, Skills, and Abilities required of the Facilitator.
      a. Knowledge of effective tobacco cessation methods.
      b. Familiarity of program content.
      c. Proper Professional attitude and adherence to professional provider/ patient
         boundaries.
      d. Maintain up to date knowledge base through appropriate use of tobacco
         information news services, research and popular journals and listservs.
      e. Maintain a working knowledge of the proper use, side effects and
         contraindications of both the NRP and the Zyban pharmacotherapy.

5. Responsibility of the Facilitator.
      a. The facilitator MUST be a non-tobacco user. They may be a former user, but
          must be tobacco free at the time of the class and must remain tobacco free in
          order to continue teaching the class.
      b. Maintain up to date knowledge of the topic of tobacco use and its effects on
          the health, economics, etc of the tobacco user.
      c. Never give medical advice. If the class participant has a medical question
          specific to their health status, direct them to their primary care provider.
      d. Encourage active participation of class participants.
      e. Clear all new material for the class through the program manager, the health
          promotions coordinator. This works in reverse as well, the health promotions
          coordinator will ensure that all facilitators are kept up to date in regards to
          updates in the class materials.
      f. If there is any question regarding the medical status of a participant and the use
         of the pharmacotherapy, the facilitator will clear the issue with the participant’s
         primary care provider via email and will keep that email as part of the written
         record of the class.
      g. Follow up at three and six months of the participants as to their tobacco use
          status. The resulting data from these follow ups is recorded and formatted for
          the class metrics which are maintained in the Health Promotions program as
          well as forwarded to NEHC every six month.
      h. Ensure that the POA is made aware of the class schedule so that it can be
          posted in the Examiner and MCAGCC speed call.

6. Class Format
       a. The tobacco cessation program consist of a four week long program offered
          through the Health Promotions Program. The class always meets on Tuesday’s
          and lasts for one hour each. The class is offered at two convenient times of
          1200 and 1730 so that the participant may work the class into their schedule.
       b. Class week one consists of enrolling the participant and informing them of the
          therapy options available to them as well as side effects and contraindications.
          The resulting intake sheet is used to generate a class list of participants which
          is then forwarded to the pharmacy for disbursement of the NRP and Zyban.
          The class discussion for week one also includes the health risks of tobacco use,
          the effects of second hand smoke and the economics of tobacco use in general
          as well as to their personal budget. The participant is also given the course



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           booklet, information on social support and services available to them in
           addition to the tobacco cessation course. If the participant elects to access the
           Zyban, they will pick it up from the NHTP pharmacy on Thursday of week
          one.
       c. Class week two consists of disbursement of the NRP and a discussion of the
           genetics and brain chemistry that links their bodies to nicotine addiction.
       d. Class week three involves a discussion of stress reduction and the nutrition
           impact that tobacco has on their body.
       e. Week four of the class involves a discussion of relapse prevention and handing
           out refill slips for the remainder of their pharmacotherapy.
       f. Follow up calls are performed at three and six months post class to determine
          tobacco status. Those individuals lost to follow up are considered missing data
          and are NOT used to calculate the success rate of the class.

7. Objectives
       a. Week One: Getting Started –
              1. Assess readiness to change
              2. Inform of treatment modalities available as well as risks and benefits of
                 each.
              3. Inform of health risks from both active and passive smoking and of
                 smokeless tobacco use.
       b. Week Two: Genetics and Brain Chemistry of tobacco use –
              1. Hand out NRP and discuss proper use of the patch as well as storage
                 and disposal of the NRP in a secure manner.
              2. Discussion of the genetics which hard wire the body to nicotine
                 addiction and the brain chemistry that re-enforced the addiction.
       c. Week Three: Stress Reduction and Nutrition
              1. Inform of the adverse outcomes seen on the human body as a result of
                distress.
              2. Review stress reduction techniques such as cognitive restructuring, deep
                 breathing and progressive muscle relaxation..
              3. Inform regarding the nutrition deficits caused by tobacco use as well as
                 the digestive system damage caused by tobacco. Also, offer a common
                 sense approach to minimizing weight gain due to metabolism changes
                 as nicotine levels drop and hand out the NIH DASH diet booklet.
       d. Week Four: Relapse Prevention
              1. Distribute the refill slips for any remaining pharmacotherapy.
              2. Review methods to prevent relapse back to tobacco use.

8. Supplemental tools for the tobacco cessation program
       a. Week Two – “Poisoning Our Children” by American Academy of
          Otolaryngology – Head and Neck Surgery Foundation. Distributed by The
          Health Connection at 1 (800) 548-8700
       b. Week Three – “Smoking & Nutrition” by National Health Video, Inc. at 1
          (800) 543-6803
       c. Week Three – “The Cognitive Restructuring Workbook for Managing Stress”



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         from AudioVision at www.Stressstop.com.

9. Follow-Up. All individuals, regardless of whether or not they finish the entire four
   week course, will be called three and six months post course to asses their current
   tobacco status. This data will then be used in assembling tobacco cessation course
   metrics. These metrics are forwarded to NEHC twice a year.

10. Evaluation. Class evaluations consist of either “today’s visit” or “compliment” cards.
    These evaluations are placed in the appropriate suggestion boxes located throughout
    the hospital.

11. Policy on Attendance and Pharmacotherapy. Since TRICARE does not pay for the
    pharmacotherapy for the tobacco cessation class and since the CDC clearly states that
    those individuals who do not attend a structured tobacco cessation program have little
    chance of being successful, the Naval Hospital has linked access to the
    pharmacotherapy to attendance of the tobacco cessation program classes. If an
    individual needs to miss a class due to valid reasons, the missed class must be made
    up in the health promotion coordinator’s office. Failure to do so will result in the
    participant being dismissed from the program and no further access to the
    pharmacotherapy without enrolling in another cycle of tobacco cessation classes. The
    entire class is structured to give the participant the best chance of success possible
    and this entails locking access of the pharmacotherapy to attendance in the class.

12. Action. All Active Duty or civilians who wish to participate in the facilitation of the
    tobacco cessation program will do so under the guidance of the health promotions
    coordinator and will familiarize themselves with all materials offered to the
    participants. They will also agree to abide by this Standard Operating Procedure and
    all other manuals present in the health promotions office.

13. Applicability. This Standard Operating Procedure shall apply to all tobacco
    cessation programs offered through Naval Hospital Twentynine Palms.

February 2, 2005




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