• E Melinda Mahabee-Gittens, Judith W Dexheimer, Meredith Tabangin, Jane C Khoury, Ashley L Merianos, Lara Stone, Gabe T Meyers, and Judith S Gordon.
• Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: melinda.mahabee-gittens@cchmc.org.
• Am J Prev Med. 2018 Jan 1; 54 (1): 64-71.

IntroductionA high proportion of children presenting to pediatric urgent cares are exposed to tobacco smoke. An electronic health record-based clinical decision support system for nurses to facilitate guideline-based tobacco smoke exposure screening and counseling for caregivers who smoke was designed and evaluated.DesignA mixed-methods, 3-month, prospective study that began in November 2015, data were analyzed in June 2016.Setting/ParticipantsFive urgent cares that were part of a large children's hospital in Cincinnati, OH. Participants were urgent care nurses.InterventionThe clinical decision support system prompted nurses to Ask, Advise, Assess, and Assist caregivers to quit smoking. Monthly feedback reports were also provided.Main Outcome MeasureClinical decision support system use rates, nurses' attitudes towards tobacco smoke exposure intervention, and percentage of children screened and caregivers counseled.ResultsAll nurses used the clinical decision support system. Compared with Month 1, nurses were twice as likely to advise and assess during Months 2 and 3. There was significant improvement in nurses feeling prepared to assist caregivers in quitting. Nurses reported that feedback reports motivated them to use the clinical decision support system, and that it was easy to use. Almost 65% of children were screened for tobacco smoke exposure; 19.5% screened positive. Of caregivers identified as smokers, 26% were advised to quit and 29% were assessed for readiness to quit. Of those assessed, 67% were interested in quitting, and of those, 100% were assisted.ConclusionsA clinical decision support system increased rates of tobacco smoke exposure screening and intervention in pediatric urgent cares. Rates might further improve by incorporating all components of the clinical decision support system into the electronic health record.Trial RegistrationThis study is registered at www.clinicaltrials.gov NCT02489708.Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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