P3.Q320: Improved Nicotine Screening and Identification with the Use of a Self-screening Tool in the Inpatient Adolescent Population

Purpose/Objectives: Electronic cigarettes are the most commonly used tobacco product by adolescents. Today’s high-nicotine devices lead to addiction and use of other substances, impact respiratory and cardiac function, and are associated with behavioral and mental health issues. While addressing substance use has traditionally been considered the purview of the outpatient office, the inpatient setting provides additional opportunities to reach youth at risk. Accurate identification of adolescent e-cigarette use (vaping) on hospital admission is challenging, as parents are often present during the verbal screening process. Additionally, vaping may not be differentiated from other tobacco use on screening tools. We aimed to improve the vaping screening rate for patients aged 11-17 in the inpatient pediatric unit to 40% by December 2023, and to improve identification of vaping to align more closely with expected New York State (NYS) prevalence by April 2024. The innovation is a paper self-screen which is collected and transcribed into the EMR by nursing in place of verbal screening. This self-screen is made to mirror the validated CRAFFT screening tool embedded into the institution’s EMR with added questions regarding vaping.

Design/Methods: A multidisciplinary committee comprised of hospitalist physicians, a resident, nurse leaders, and a quality management practitioner was formed. PDCA cycles were first initiated in February 2023 and included: 1. Distribution of pre-initiation survey to nursing to gauge compliance and barriers to prior verbal screening process; 2. Creation of a paper self-screen and nursing education on tool; 3. Nursing reeducation; 4. Tool redesign for improved completion; 5. Staff education on e-cigarette vs other tobacco product use. We report percentages of vaping screening with means and confidence limits. Primary outcome measures are percent screening completion and percent positive for vaping.

Results: Pre-initiation, vaping screening was completed in 21/120 (17.5%) abstracted charts. Post-initiation, after all of the interventions, from February-December, 355/798 eligible patients (44.5%) had vaping screening completed. Highest monthly screening rate was 56.9%, while mean vaping positivity was 21.1% with confidence limits pictured below; see charts.

Conclusion/Discussion: Vaping screening has improved by an absolute 27% on the inpatient pediatric unit, indicating that the self-screen is easily implemented and effective. Prevalence of vaping among NYS high-schoolers was 18.7% in 2022; achieving a vaping positivity rate in line with this expected prevalence lends support to the effectiveness of this intervention and provides an opportunity to offer appropriate care for this population. A limitation to this form of self-screen is the increasing workload for nursing, as they are responsible for distributing the self-screen to appropriate patients and transcribing the results. Our future endeavor is to convert to an electronic method via iPad or QR code.