Operational Excellence

Document Type


Publication Date



Psychiatry, Nursing, Maine Medical Center

MeSH Headings

smoking, patients, nicotine withdrawal, United States, patient centered care, nicotine, goal, root cause analysis, tobacco, hospital units, pilot


Smoking is one the leading causes of preventable death in the United States. Patient centered care revolves around encouraging patients to reduce their chances of preventable disease and death. To that end, nicotine replacement therapy (NRT) prescribed within 24 hours of hospital admission increases the chance of quitting and decreases the chance of nicotine withdrawal.

A pilot performance improvement project was initiated on two cardiac units at an academic tertiary medical center. The goal the project was to have NRT ordered within 24 hours of admission 100% of the time. Baseline metrics demonstrated admission NRT orders were below acceptable levels and subsequent root cause analyses showed barriers to reaching the established goal.

Several countermeasures were initiated to include several KPIs. Post rollout, a significant increase in NRT orders was demonstrated. Next steps include educating staff on all hospital units as well as adding tobacco assessment to the yearly competency policy.



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