Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Dr. Beverly Woods

Committee Member

Dr. Julianne Ossege


BACKGROUND: In the United States, lung cancer has the highest mortality rate of all other cancers among men and women. Kentucky is ranked 50th among all states, leading the nation in new lung cancer cases each year. Lung cancer screening using Low dose Computed Tomography (LDCT) can reduce lung cancer-related morbidity and mortality. Lack of smoking history documentation to identify eligible patients is a major contributing factor to low national screening rates. Obtaining complete smoking history remains the most important technique in identifying candidates for lung cancer screening.

PURPOSE: The purpose of this quality improvement project was to evaluate the rates of complete smoking history documentation and LDCT orders in one primary care setting after implementing evidence-based interventions to improve documentation and screening rates.

METHODS: This quality improvement project followed a quasi-experimental design. Using the FOCUS-PDSA as the improvement model, baseline data for complete smoking history documentation and LDCT orders were analyzed, and a target goal was set. A total of three rapid cycles of change using evidence-based improvement strategies (patient information poster in exam room, staff education, and clinical reminder cards) were implemented and evaluated to assess changes in the amount of smoking history documentation recorded and lung cancer screening orders after each cycle.

RESULTS: Smoking history documentation throughout the study improved significantly (p = .039). Documentation was significantly higher after the final cycle (PDSA cycle 3) compared to both cycle 1 (p=.022) and cycle 2 (p=.010) There was no significant difference in LDCT orders over the three cycles (p=0.248). There was minimal improvement overall when evaluating accurate documentation with ordering LDCT (p=0.30).

CONCLUSION: Through the combination of interventions used, there was a significant increase in smoking history documentation throughout the study. No specific intervention used was found to have a significant improvement independently. LDCT orders were not affected substantially by the interventions used in combination with each other or individually. The results suggest that the use of clinical reminders had the greatest improvement in LDCT orders overall and had a significant increase in former smokers’ lung cancer screening orders within the chosen clinic.