An audit of the prevalence of recorded nicotine dependence treatment in an Australian psychiatric hospital.
OBJECTIVE
To investigate the prevalence of recorded smoking status, nicotine dependence assessment, and nicotine dependence treatment provision; and to examine the patient characteristics associated with the recording of smoking status.


METHODS
A retrospective systematic medical record audit was conducted of all psychiatric inpatient discharges over a six-month period (1 September 2005 to 28 February 2006), at a large Australian psychiatric hospital, with approximately 2,000 patient discharges per year. A one-page audit tool identifying patient characteristics and prevalence of recorded nicotine dependence treatment, and requiring ICD-10-AM diagnoses coding was used.


RESULTS
From 1,012 identified discharges, 1,000 medical records were available for audit (99%). Documentation of smoking status most frequently occurred on the admission form (28.8%) and diagnoses summary (41.6%). Documentation of nicotine dependence was not found in any record, and recording of any nicotine dependence treatment was negligible (0-0.5%). The rate of recorded smoking status on discharge summaries was 6%. Patients with a diagnosis of alcohol, cannabis, sedative use disorders or asthma were twice as likely to have their smoking status recorded compared to those who did not have these diagnoses.


CONCLUSIONS
Mental health services, by failing to diagnose and document treatment for nicotine dependence, do not conform to current clinical practice guidelines, despite nicotine dependence being the most commonly diagnosed psychiatric disorder.


CONCLUSIONS
Considerable system change and staff support is required to provide an environment where a primary prevention approach such as smoking care can be sustained.
Wye
Paula
P
School of Psychology, University of Newcastle, Callaghan New South Wales. Paula.Wye@newcastle.edu.au
Bowman
Jenny
J
Wiggers
John
J
Baker
Amanda
A
Carr
Vaughan
V
Terry
Margarett
M
Knight
Jenny
J
Clancy
Richard
R
D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008485:Medical Audit / Q000379:methods / Q000706:statistics & numerical data; D008499:Medical Records; D008605:Mental Health Services; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult