Ask every patient at every visit "Do you smoke?" Document tobacco use status along with vital signs. Expanding the vital signs to include tobacco use status, or the use of other reminder systems such as chart stickers or computer prompts, significantly increases clinical intervention. Below are two samples.
PATIENT CHART OPTIONS
Vital Signs |
Date: ___________________ |
Temp: ___________________ |
BP: ___________________ |
Pulse:___________________ |
Height: ___________________ |
Weight:______ |
BMI: _______ |
|
|
|
|
Yes |
No |
Tobacco Use: |
_____ |
_____ |
Advice Given: |
_____ |
_____ |
Ready to Quit: |
_____ |
_____ |
Referral Made: |
_____ |
_____ |
Rx Given: |
_____ |
_____ |
|
|
|
Vital Signs |
Date: ___________________ |
Temp: ___________________ |
BP: ___________________ |
Pulse: ___________________ |
Height: ___________________ |
Weight:______ |
BMI:______ |
|
|
|
|
Yes |
No |
Tobacco Use: |
_____ |
_____ |
Advice Given: |
_____ |
_____ |
Ready to Quit: |
_____ |
_____ |
Referral Made: |
_____ |
_____ |
Rx Given: |
_____ |
_____ |
|
|
|
0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
No Pain |
|
Mild |
|
Moderate |
|
Severe |
|
Very Severe |
|
Worst Pain |
|