Identifying Nicotine Abuse: A Quality Improvement Project
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Authors
Sellon, Daniel
Issue Date
2026-03-17
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Abstract
Background: Tobacco use causes approximately 480,000 deaths annually, contributes to 16 million chronic diseases, and accounts for 20% of cancers. Nicotine use is disproportionally higher in vulnerable populations, and electronic cigarette use has increased among younger individuals. Smoking cessation rapidly improves symptoms and significantly reduces cardiovascular risk within one to two years.
Purpose: This quality improvement project aimed to improve identification of patients using nicotine products in a primary care clinic by implementing a standardized screening process in a midwestern suburban internal medicine clinic over a 12-week period.
Methods: Participants included front desk staff, rooming staff, and one nurse practitioner, Direct patient involvement included patients 19 years or older presenting to the clinic for any type of visit. Staff documented screening results in the electronic health record, provided brief cessation advice, and the provider conducted cessation counseling and billing.
Results: Screening forms were collected in 10.0% of total encounters, a nicotine use rate of 20.2%. Among returned forms, rooming staff advised 72.2% of nicotine users to quit and 83.3% received cessation counseling from the provider. Documentation of nicotine status decreased from 53.5% to 42.2% during the intervention. Billing codes for tobacco cessation counseling increased from 0.1% of encounter pre-intervention to 3.6% post-intervention, a 36-fold increase of cessation counseling. All staff reported the intervention was sustainable long term.
Conclusion: The implementation of a standardized screening and workflow process improved cessation counseling and demonstrated potential for sustainable integration into routine primary care practice.
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Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University