An audit on smoking status identification and cessation support in a psychiatric inpatient setting
G. Montebello, G. Grech, D. Bonello, M. Galea, K. Callus, C. PurkissIntroduction
Tobacco smoking remains one of the leading causes of preventable death globally, and yet, among psychiatric inpatients, smoking is frequently overlooked or even facilitated.
Objectives
To assess the documentation of patients’ smoking history during their first clinical encounter. To evaluate whether smoking cessation advice/referrals to cessation services was provided during up until discharge. To determine if changes in smoking status were accompanied by documentation of adjustments to psychotropic medication.
Methods
Data collected from files and summary letters from adult patients discharged in December 2024.Data collectors examined if smoking status was documented, if smoking cessation advice was offered, and if referrals to cessation services were recorded. Data was tabulated to determine the proportion of patients with documented smoking status, the identified smokers who received cessation interventions, and the interventions provided—whether pharmacological, behavioral, or via referral. Descriptive statistical methods were run to highlight trends in smoking patterns in patients.
Results
The audit reviewed 219 psychiatric inpatient admissions at Mount Carmel Hospital in December 2024. Smoking status was documented in 87.7% of cases, with 113 patients (51.6%) identified as current smokers. Among these, 85% male, and smoking was significantly associated with male gender (Chi-square p = 0.00041). Smoking was also strongly linked to substance use disorders (F10), with 89% of patients in this group identified as smokers and an odds ratio of 15 (p = 4.89 × 10 -14 ). A significant association was observed between smoking and secondary education (p = 0.021), while younger age (20s–30s) was also significantly correlated with smoking (p = 0.00024). Patients with multiple psychiatric diagnoses had nearly twice the odds of smoking compared to those with a single diagnosis, though this was not statistically significant (p = 0.083). No significant associations were found with employment status or nationality.
Critically, smoking cessation support was almost entirely absent. Only one discharge letter mentioned cessation advice or referral, and no clinical documentation indicated any medication adjustments in response to smoking status.
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