Introduction: Institutional data show that fewer than one in four patients who smoke receive nicotine replacement therapy (NRT) during hospitalization. Providers feel that this contributes to workflow disruption due to patients being off the floor to smoke and missed opportunities to discuss smoking cessation with patients upon discharge. Clinical pharmacy was recruited to assist in the development of a protocol to increase rates of NRT ordering in the hospital. Research Question or Hypothesis: Implementation of a nurse-driven protocol for NRT ordering, designed collaboratively by an interprofessional team, will increase rates of NRT ordering upon admission to the hospital. Study Design: Quasi-experimental Methods: The nurse-driven NRT protocol was implemented on two intervention floors. Two other floors served as controls. Each group (intervention and control) had one medicine and one oncology floor, all with similar NRT ordering rates at baseline. Rates of NRT ordering were compared for four months pre- and four months post-implementation of the nurse-driven NRT protocol. The primary outcome was the change in pre- and post-implementation rates of NRT ordering. Results: The study included 670 patients who smoke, with 340 admitted to intervention floors and 330 admitted to control floors. Following implementation of the protocol, intervention floors saw a 10% increase in patients who smoke with NRT orders compared to pre-implementation of the protocol. Control floors saw an 8% decrease in patients who smoke with NRT orders during this time. Furthermore, 75% of hospital providers on intervention floors reported that the nurse-driven protocol was highly acceptable, and 90% reported it as feasible to implement on a wider scale. Conclusion: Implementation of a nurse-driven protocol for NRT ordering in hospitalized patients increases the rate of NRT ordering and is well-accepted by hospital providers.
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