1) Enhanced academic detailing with staff nurses.
Academic detailing is a form of educational outreach
that employs two-way interactions with clinical staff to
encourage adoption of a desired practice pattern.14,15 In
this trial, we used enhanced academic detailing (faceto-
face training, performance feedback, and periodic
check-ins with both nurse managers and peer leaders)
to promote use of the 5A’s framework; this approach
has been used successfully in primary care to support
practice change in the delivery of cessation counseling.
16 Specifically, we provided personalized, on-site
instruction for one or two nurses at a time during their
assigned shift. Because of multiple competing demands
on their time, nurses were instructed to perform the
5A’s within 5 min at the time of hospital admission (or
as soon as the patient’s acute medical condition had
stabilized), and were shown how to use charting and
referral tools for cessation counseling in the VA
Computerized Patient Record System (CPRS). Each
face-to-face training session lasted approximately 25–
30 min, and was supplemented by a 30 min online
tutorial and post-test. To increase awareness of the 5A’s
intervention, posters were displayed in each nursing
break room. In addition, members of the research team
periodically circulated on the medicine units to answer
questions, to provide support, and to distribute pens
and note pads with the study logo to nursing staff.
Group feedback on use of the 5A’s was presented