Clinical Protocols

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Protocols for Tobacco Use Cessation in the Clinics

All forms and pamphlets are in the 8th and 9th floor clinics

When you have patients who smoke or use any form of tobacco, ask them if they have an interest in quitting, and if so, would they like some help. Have those who are interested fill out a Tobacco Use Assessment Form.

The discussion with your patients can be brief but should include raising their awareness of the effects of tobacco use on cancer and periodontal disease and the benefits of a smoke-free lifestyle.

On the back of the Tobacco Use Assessment Form are the Brief Tobacco Cessation Intervention protocols. Follow the outline so that you Ask, Advise, Assess, Assist, and Arrange for follow-up to encourage and support your patients in their attempts to quit.

Write brief notes on this intervention form so that we have information about the patient to refer to.

Ask your patients if they would like some self- help pamphlets.

Ask your patients if they are willing to have a Quitline tobacco cessation coach call them to discuss quit strategies and help them with a quit plan. If they are interested, have them fill out the Minnesota Tobacco Quitlines Fax Form. We will fax the form to the Quitline and then get the results of the coaching back to you for documentation in the progress notes.

If they are interested in other quit smoking support programs give them the sheet that lists these programs.

Be sure to follow-up with your tobacco using patients who are interested in quitting. Your continued encouragement and support are important.

In the patient's chart progress notes record "tobacco cessation discussed, and include any relevant details related to the course of action".

All forms and pamphlets are in the 8th and 9th floor clinics.

Dental students and dental hygiene students are required to discuss with Dr. Bashar Bakdash at least one tobacco cessation intervention before graduation.

In order to receive credit: Please bring the Tobacco Use Assessment Form, the filled out Brief Intervention form, and any other forms to Dr. Bakdash’s office located at 7-368 MHST, so you can discuss the various aspects of the proposed intervention. Please do not leave the forms for Dr. Bakdash without meeting with him.

The best and most efficient way to meet with Dr. Bakdash is to E-mail ( him to arrange for an appointment. Please indicate in your E-mail your availability for at least several days or more ahead of the proposed date and time to meet with him, thank you.

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  • Last modified on June 28, 2012