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CAMH Stories Centre for Addiction
and Mental Health

CAMH enhances tobacco withdrawal support for Emergency Department clients

TORONTO, January 13, 2017 - ​CAMH’s Emergency Department (ED) is a critical first point of entry for many people seeking urgent care for mental illness and addiction.

“In some cases, it’s also the first time they may experience tobacco withdrawal – an issue that can interfere with their effective treatment,” says Dr. Paul Benassi.

The physician and resident in the University of Toronto’s Clinician Scientist Program (Dept. of Psychiatry) is leading a Quality Improvement project at CAMH that aims to address this issue -- by improving nicotine withdrawal management for clients of CAMH’s ED.

Dr. Paul Benassi
Dr. Paul Benassi

“A client is already likely to be in some distress when they arrive in the ED,” Paul says. “Tobacco withdrawal can cause more agitation and anxiety.”

“Taking a proactive stance on this issue can help to reduce agitation in some of our most vulnerable clients,” says Dr. Brittany Poynter, CAMH ED Clinical Head. Even the thought of being without tobacco can trigger agitation in some clients, she notes.

Paul notes that CAMH Emergency staff are able to offer clients effective treatments, such as nicotine replacement therapy (NRT), to help reduce the symptoms of withdrawal. “Our project is looking closely at the existing processes to see how we can improve the way we manage tobacco withdrawal. We want to ensure an effective approach, to meet the needs of our clients and enhance safety.”

After a comprehensive assessment and teamwork with ED staff, Paul and his colleagues introduced and updated some interventions this spring. These include:

  • Tracking who smokes – adding a question to the client’s formal triage assessment to find out if they smoke and, if so, how much. This can lead to a conversation about options available to the client to manage withdrawal, such as nicotine gum.
  • Enhancing access to nicotine replacement therapy – making it available immediately in the triage room.
  • Streamlining delivery – by formalizing a nurse’s ability to provide nicotine replacement through a new “order set” process in CAMH’s I-CARE clinical information system.

Dr. Brittany Poynter, Marc Greene and Tamar Frank
Dr. Brittany Poynter, at left, Clinical Head of the CAMH ED, speaks with her colleagues Marc Greene (Emergency Services Manager) and Tamar Frank (Project Manager).

With the recent process changes, “smoking history is now a mandatory part of our triage process,” says Brittany.

Preliminary findings have been positive. They include trends both in providing NRT to patients faster, and increases in NRT provision, says Paul. He is working on this project with several colleagues, the CAMH ED team, and program supervisor Dr. Paul Kurdyak of CAMH’s Institute for Mental Health Policy Research.

NRT may include nicotine gum and the patch
Nicotine replacement therapy (NRT) may include nicotine gum and the patch.

The team hopes to formalize a new care pathway for tobacco withdrawal management in the ED, based on measuring project outcomes and collaborating with front-line staff, says Paul.

“The CAMH Emergency is a fast-paced environment and helps people with complex issues and acute needs,” he says.

As CAMH continues to lead the hospital sector in providing a tobacco-free environment for its staff and clients, “it’s important to ensure that our Emergency clients who use tobacco can receive NRT in line with best practices, and as part of our client-centred care.”

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