Arran Woodhouse Tobacco Liaison Specialist, Kings College Hospital, London
Dr Irem Patel Consultant Respiratory Physician, Kings College Hospital, London
Abstract
Background: King’s College Hospital has approximately 6,500 smoking related acute admissions/year. Under the Making Every Contact Count CQUIN clinical staff assess/record patients’ smoking status and offer Very Brief Advice. Carbon monoxide (CO) monitoring is recommended in guidelines but not routinely performed in most acute settings.
Aim: A pilot of routine CO testing was implemented on two acute medical admission wards to assess the range of CO readings seen and the feasibility and acceptability of CO monitoring to patients and clinicians in this setting.
Results: The table below shows CO readings and self- reported smoking status for patients over a 30 day period. 15% of patients acutely admitted to a medical ward who self-reported as non-smokers had an elevated CO reading.
Patients’ self-reported smoking status
CO reading
5-9ppm 10-20ppm 20+ppm
Non- smoker 40 16 5
(n=137)
Smoker (n=30) 16 12 2
Conclusion: Causes for a raised CO other than active/passive smoking need to be considered. However these findings suggest that in a significant proportion of acutely unwell patients asking about smoking status is not adequate for a full assessment of tobacco dependence. CO monitoring is important to ensure patients at risk of acute nicotine withdrawal are identified early.
