The Addition of Tick-boxes Related to Tobacco Cessation Improves Smoking-related Documentation in the Anaesthesia Chart

Abstract

The Australian and New Zealand College of Anaesthetists (ANZCA) ‘Guidelines on Smoking as Related to the Perioperative Period (PS12)’ recommends that anaesthetists should always ask about smoking, advise quitting and refer patients to their general practitioner (GP) or a telephone quit-line for quit support. In this study we evaluated the effect of adding tick-boxes for ‘quit advice given’ and ‘referral to GP/Quitline’ to anaesthesia charts of elective surgical patients to assess whether this intervention changed documentation of compliance with the ANZCA guideline. The anaesthesia charts of all smokers were reviewed for evidence of asking, advising and referring, over two three-month periods (n=999) separated by the intervention of placing a sticker to modify the preoperative charts of all elective patients which added tick-box prompts of advice and referral. No educational campaigns occurred to encourage tick-box use. No changes were made to non-elective charts. Evidence of advice to quit was 1.8% prior to, rising to 18.7% after, the intervention ( P <0.001), while evidence of referral rose from 0.9% to 5.8%. There was negligible change in non-elective patients, who did not receive the intervention. The addition of tick-boxes improved the documentation of smoking cessation support, but as documented rates of quit support remained relatively low even after the intervention, tick-boxes alone cannot be relied upon to improve alignment of care with the ANZCA guidelines.