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Documentation of smoking care in a major Australian psychiatric hospital
Paula Wye, PhD Candidate, University of Newcastle, New South Wales, Australia
Abstract
Background:
Although the prevalence of smoking has dropped in the general population, smoking rates among psychiatric patients remain high. An inpatient stay is an opportunity to provide smoking cessation care, however the level of smoking care currently provided in psychiatric services is unknown.
Aims:
To investigate the level of documentation of smoking care for patients in a major Australian psychiatric hospital.
Method:
A retrospective medical record audit of all discharges between 1 September 2005 and 28 February 2006 (n=1012).
Results:
Although 42% of discharge records included documentation of tobacco use, only 29% of records indicated smoking assessment on admission. There were no records documented with a diagnosis of nicotine dependence. Five records documented the patient wished to quit, however only one documented that NRT was provided, and only at discharge. Only four records documented the use of NRT.
Conclusions:
Although 42% of smokers were identified, much higher rates have been reported in inpatient populations. Documentation of tobacco use appears more likely to occur for statistical record keeping rather than as a guide for clinical care. No documentation occurs for the provision of smoking care. Staff training and regular auditing are required to improve documentation of smoking care.
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