Online Program

Public Health Nurses Lead Policy Change in Tobacco Screening for Homecare Patients in Visiting Nurse Services in Westchester (VNSW), also serving the Bronx, Dutchess, Putnam and Rockland Counties of New York State

Tuesday, November 3, 2015 : 3:00 p.m. - 3:15 p.m.

Amy Ansehl, DNP, FNP-BC, Partnership for a Healthy Population, New York Medical College School of Health Sciences and Practice, Valhalla, NY

Mary Gadomski, RN, BSN, Visiting Nurses, Visiting Nurse Services in Westchester, white plains, NY
Padmini Murthy, MD, MPH, MS, School of Health Sciences and Practice, New York Medical College, Valhalla, NY
Agustina Lopez Novillo, MPH, MS, New York Medical College, Valhalla, NY
In 2002, 2 public health nurses identified a gap in screening patients for tobacco use in the home care population at VNSW in the lower Hudson Valley of New York State. This is significant because tobacco remains the leading cause of preventable death and costs the U.S more than $193 billion dollars per year in health care expenditures and productivity costs (CDC, 2014).

As a Medicare-certified home healthcare agency, VNS Westchester utilizes OASIS (Outcome and Assessment Information Set), a   Center for Medicare and Medicaid (CMS) data collection tool used to collect and report performance data for all Medicare and Medicaid home healthcare patients. The data items measured cover a range of criteria including health and functional status, support system, environment and health service utilization characteristics of the patient. The OASIS only screened patients by eliciting information if they were a heavy smoker. Many patients were not identified or provided with help to quit smoking because of OASIS screening assessment. The policy change added a co-step so that every patient was asked whether they smoked, the frequency and whether they were interested in quitting. The 5 A’s model (American Lung Association)  was used in assessing every patient who self-reported or family member or the nurse made an assessment based on evidence of environmental tobacco smoke. The Agency for Healthcare Research and Quality framework (2008) utilization has resulted in a change in culture and sustainable policy. Since 2002, more than 84,000 patients have been screened as a result of this policy change.

Learning Areas:

Administer health education strategies, interventions and programs
Environmental health sciences
Implementation of health education strategies, interventions and programs
Other professions or practice related to public health
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Identify a minimum of 5 strategies to be utilized by public health nurses and or other healthcare providers in building organizational support to move from the adoption of an innovation to sustainable policy change. Describe the policy change developed and list 5 measurable outcomes as a result of this systems wide change of nursing care plan for all VNSW patients. Discuss a minimum of 3 key factors that contribute to and support public health nurses as leaders in policy change in their respective organizations. Review and demonstrate a minimum of 5 evidence-based literature citations that support the role of public health nurses in counseling patients in their home environment

Keyword(s): Federal Policy, Community-Based Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a public health nurse with more than 20 years of experience. I am the vice chair of the board of directors for Visiting Nurse Services in Westchester, Bronx, Putnam, Dutchess and Rockland Counties. We serve a catchment area with more than 1 million people. I am the creator of the program in collaboration with the authors. I am a doctorally prepared nurse practitioner and assistant dean and associate professor of public health practice
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.