Improving 5A's Tobacco Cessation Counseling Usage in Adult Clients of the Health Department

Summary

Impact Statement:

Even the implementation of evidence-based public health interventions poses challenges for most health departments. Using rapid-cycle tools and regular status monitoring, Cleveland County Health Department dramatically improved completion of the 5A’s smoking cessation service.

Summary:

The Cleveland County Health Department (CCHD) conducted a quality improvement (QI) project to increase the use of the 5A's Tobacco Cessation Counseling program among health department clients. The project aim statement was to increase the percentage of completed 5A’s Tobacco Cessation Counseling forms from baseline to 90% in all adult Children First clients and all adult clinic clients with a chart. Through the project, many process improvement suggestions were obtained from the nursing and clerical staff involved in the 5A's process, which were then tested and implemented through rapid Plan-Do-Check-Ask (PDCA) cycles. By the end of the project, completion rates increased to 92%. In addition, morale improved, buy-in from the clerical and nursing staff implementing the 5A's program within the health department was gained, and QI knowledge among staff throughout the health department improved.

Organization that conducted the QI initiative:

Cleveland County Health Department

Citation:

James, A. Public Health Quality Improvement Exchange. Improving 5A's Tobacco Cessation Counseling Usage in Adult Clients of the Health Department. Thu, 11/07/2013 - 15:13. Available at https://www.phqix.org/content/improving-5as-tobacco-cessation-counseling-usage-adult-clients-health-department. Accessed October 10, 2024.

Background and Aim

Planning and Execution Details

QI Implementation:

CCHD began implementing the evidence-based 5A's Tobacco Cessation Counseling program in all programs in 2011. However chart audits indicated the forms, and therefore the 5A's, were only being completed by the nurse about 60% of the time. To begin the process of improvement in the usage rates, the QI team focused on completing flow charts of each clinic and program. Next, an hour-long focused conversation, brainstorming session, and the 5-Whys were completed, with participation from nursing and clerical staff, to learn more about the current state and the root causes or barriers to completion. After this work, a 1-hour consensus workshop was held with nursing and clerical staff to determine and prioritize solutions and to generate specific improvement ideas. One of these new suggestions was implemented each week, and a 15-minute "hotwash" meeting was held each Friday afternoon with nursing and clerical staff to discuss how that improvement was working. If things were going well, the improvement became a permanent part of the process. If improvement did not take place, the improvement idea was discontinued. Monthly monitoring of form completion was carried out throughout the project via chart audits. The health department increased 5A's completion to 92%.

Focus activities

Population-based Primary Prevention :

Tobacco

QI Methods:

PDCA/PDSA Cycle (Plan, Do, Check/Study, Act)

QI Tools:

QI Tool Documentation:

Flow Charts.pdf

Monthly Team Meeting Discussion Questions.docx

Moore Consensus Workshop 7-27 prioritization.docx

Norman Consensus Workshop 7 20 12-prioritization.docx

Initiative Dates:

4/1/12 to 11/30/12

Initiative Duration:

Between 6-12 months

Methods of evaluation:

During the check phase, the 15-minute weekly "hotwash" meeting held with nursing and clerical staff who helped to measure which interventions would have the greatest improvement impact. During the monitoring phase, the form completion audits further indicated which added interventions should be institutionalized and which should be discontinued.

Other Information:

1. This QI project is the first phase in an ongoing project to address the high smoking rates in Cleveland County. Now that the health department has increased the usage of the 5A's Tobacco Cessation Counseling with the clients, it is beginning to locate and use data related to cessation services use rates and health department client quit rates. The health department has experienced barriers in obtaining data related to quit rates, but is currently monitoring the number of referrals made to the statewide quit line. Since the implementation of the 5A's Tobacco Cessation Counseling into nursing services, referrals made by the health department to the quit line have increased from 3.7 callers per month to 4.1 callers per month. 2. After the beginning of this QI project, the health department experienced some staff shortages in nursing and clerical teams. Because of this shortage, nursing and clerical staff in the Norman and Moore clinics were not as involved in the entire process as was originally hoped because of lack of time and manpower. Once the necessary staffing levels were again obtained, nursing and clerical staff could be more greatly involved in future QI projects.

Results

Training and Preparation

Information about the Community

Population Size:

250,000 to 499,999

Population Characteristics:

Cleveland County is the third largest county in Oklahoma, behind Oklahoma and Tulsa Counties. More than half (68.0%) of its residents live in one of Cleveland County’s three largest cities: Norman (population: 109,063), Moore (population: 53,762), and Noble (population: 11,169). It is a suburb of the Oklahoma City metro area and is just 20 miles from the state capital. This close proximity to the downtown area has, in part, contributed to the current rapid growth. Cleveland County’s population has increased 22.9% in the past 10 years. Among the rapidly growing population are the Hispanic and Asian communities, which have increased to 75% and 36%, respectively. The majority (79.3%) of county residents are white. Nearly one-quarter (23.1%) of residents are under 18 years of age and 10.2% are 64 years or older. More than 5.0% of residents are foreign-born and 9.0% of households report a language other than English is spoken in their home; both percentages are higher than the state average. The typical Cleveland County resident is educated and middle-income. Around 90% of adults are high school graduates and 31.2% currently have a bachelor's degree or higher. This exceeds both the state and national rates. The median household income is $52,688, and the percentage of those whose income is below the poverty level is 12.9%, both of which are better than the state averages. Cleveland County ranks highest of all Oklahoma counties in terms of overall health; however, Oklahoma ranks 48th in the nation for overall population health. The state is 48th in the nation for rates of smoking (23.7%), 40th for obesity (31.3%), 43rd for diabetes (10.4%), 46th for childhood immunization coverage, and 41st for infant mortality (7.9/1,000 live births). Cleveland County’s population has several assets. The community has transportation and educational services to ensure economic and cultural growth, such as the University of Oklahoma, the state’s largest institution for higher education. There are also several quality health care facilities, including two new hospitals in Norman and Moore, which are attracting more doctors and health care providers to the area, making health care more accessible.

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Submission Status:

Completed

Comments

Great process map for this

Great process map for this project! Really liked the red boxes at the bottom of each page with process value-added steps and insights. What software was used to create these maps?

Public Health Services Manager
Clark County Health Department, KY
bethv.willett@ky.gov
www.clarkhealthdept.org
@CCHealthDept

These were created in Excel,

These were created in Excel, but PowerPoint has also been very useful in creating similar process maps.

Sarah Ashmore
Accreditation Coordinator
Cleveland & McClain County Health Departments
Norman, OK

Improving 5A's Tobacco Cessation Counseling Usage in Adult Clients of the Health Department

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

Great process map for this

These were created in Excel,

QI Spotlight

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Improving 5A's Tobacco Cessation Counseling Usage in Adult Clients of the Health Department

Summary

Background and Aim

Planning and Execution Details

Results

Training and Preparation

Information about the Community

Information about the Health Department

QI Staff Information

Accreditation Details

Contact Information of the Submitter

Comments

QI Spotlight