Implementation Toolkit

• Clinical Practice Guideline for Treating Tobacco Use and Dependence (2008)
• Centers for Disease Control and Prevention (CDC) clinical tools
• Summary map of states where pharmacists can prescribe tobacco cessation medications
• Helpful handouts:
  • 5 A’s Tobacco Cessation Counseling Guidesheet
  • Implementing Ask-Advise-Refer
  • Drug Interactions with Smoking Table
  • Pharmacologic Product Guide
  • Relapsed Smokers Protocol

Handouts for behavioral aspects of quitting:

• Benefits of Quitting
• Withdrawal Symptoms Handout
• Coping with Quitting
• Tobacco Use Log
• Planning for Quitting

Patient-friendly medication handouts:

• Nicotine patch
• Nicotine gum
• Nicotine lozenge
• Nicotine inhaler
• Nicotine nasal spray
• Varenicline
• Bupropion SR

Consider having patients calculate their cost savings associated with quitting smoking.

Recommended referral resources:

• Tobacco quitline, 1-800-QUIT NOW: contact your State Health Department for free quitline cards and brochures.
• Web-based programs and apps: consider referring your patients to additional resources, such as Becomeanex.org and Smokefree.gov, which have tailored versions available for veterans, women, teens, 60+, and in Spanish.

• List your pharmacy on the Quit Smoking Pharmacies website: QuitSmokingPharmacies.com
• Protocol implementation forms – these 4 sample forms can be downloaded and modified, as needed, to meet your state’s documentation requirements.
  1. Patient Intake: key information to gather from your patient.
  2. Treatment Plan Summary: for your files and for faxing to the Primary Care Physician (if applicable in your state).
  3. Initial Follow-up: documenting a check-in with patient within 14 days after the quit date.
  4. Final Contact: finalize the cessation service, documenting outcomes.
• Workflow integration suggestions for community pharmacies (who does what?).
• Modifiable marketing tools:
  • Instagram template
  • Facebook template
  • Poster
  • Flyer