Reduced Agitation in Psychiatric Inpatients Associated with Increased Exposure to Nicotine Replacement

Objective: Nicotine addiction remains one of the most prevalent substance use disorders worldwide, particularly within psychiatric inpatient populations. The inability of many psychiatric patients to leave the ward has caused patients to experience acute nicotine withdrawal that can exacerbate underlying mental health conditions. The aim of this project was to reduce the time to nicotine replacement therapy (NRT) initiation and ensure adequate dosing to decrease nicotine withdrawal-related agitation and aggression. Methods: The project was implemented in three stages: a baseline data collection period of three months; on-the-job NRT education for all staff; and a post-education data collection period of three months. Results: Between the pre- and post-education groups, there was: an increase (63.6% pre-, 86.7% post-) in patients prescribed NRT within 24 hours (p = .024) and; an increase (14.6% pre-, 70% post-) in the supply of adequate NRT for nicotine dependence (p < .001). For post-education patients, there was a trend toward decreased surrogate markers of agitation and arousal. Conclusion: NRT education for staff was successful in reducing time to prescription and increasing number of patients receiving adequate NRT. Patients that received adequate NRT in a timely manner were less likely to demonstrate severe agitation.