Managing nicotine dependence in NSW hospitals under the Smoke-free Health Care Policy.

Under the new NSW Health Smoke-free Health Care Policy, the smoke-free status of public hospital campuses has been reaffirmed and all clinical staff are required to provide routine brief interventions for all smoking patients. The policy creates a unique opportunity to assist smokers to quit permanently in a supportive environment when motivation to quit is high. Smoking remains the leading cause of preventable death and disability in New South Wales (NSW). Counselling beginning in hospital and continuing for at least 1 month after discharge significantly increases quit rates. Smoking can be addressed using the 5As model, which includes asking about smoking, assessing readiness to change and nicotine dependence, advising all smokers to quit, assisting smokers to quit and arranging follow-up. Postdischarge support is a vital ingredient for long-term success and should be arranged during the hospital stay. Nicotine replacement therapy (NRT) should be offered to all nicotine-dependent smokers soon after admission. NRT helps manage cravings and nicotine withdrawal symptoms and significantly increases quit rates. Most smokers commence NRT on a nicotine patch, with an oral form of NRT added as required. It is important to give patients detailed instructions on the correct use of NRT and to ensure an adequate dose is taken to relieve symptoms. NRT is well tolerated and can be used perioperatively, during pregnancy and in patients with cardiovascular disease. Blood levels of certain drugs rise within several days after smoking cessation, so dose reductions may be required. Drugs with a narrow therapeutic index such as clozapine, olanzapine, warfarin and theophylline are of special importance.