History of Hospital SmokeFree Policies

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SMOKING CESSATION,BUILDING THE INFRASTRUCTURE

• Linda Thomas, MS
• Manager Smoking Cessation Program
• Tobacco Consultation Service
• University of Michigan Health System
• Ann Arbor, Michigan

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Welcome

• Participant lines are listen only until the Q A
  period at the end of the presentation
• The teleconference coordinator will give
  instructions to participants to ask questions
• If you are disconnected, please call
  I-800-620-7939 and ask to be reconnected
• Power Point Slides are available on Ohio KePROs
  web site
• at www.ohiokepro.com

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Objectives of the Teleconference

• Describe the essential steps in the development
  
• and implementation of a smoke free campus.
• Identify three (3) grant sources.
• List four (4) options for reimbursement for
• smoking cessation counseling.

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Questions
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Continuing Education Credits

• To get your free nursing CE credits
• Stay online for the entire call
• Complete the evaluation document on paper or on
  line
• Online at http//www.ohiopro.com/smokeeval.asp
• OR
• Fax at 216-654-1510
• Complete evaluation within 14 days of the
  telephone conference

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Contact Us
Call us toll free on the Ohio KePRO Provider QIC
Line 1-800-385-5080 OR E-mail us at
Hospital_at_ohqio.sdps.org
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History of Hospital Smoke-Free Policies

• Late 1970s/early 1980s eliminate sale of
  tobacco products in the hospital, introduce
  smoke-free wards and a few smoke-free areas.
• 1978 survey - only 42 of hospitals had any
  anti-smoking regulations 1.2 had a total
  smoking ban inside the building.

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History (cont.)

• 1988 survey 90 of hospitals had some form of
  internal restrictions.
• 1988 Only 8 of hospitals had smoke-free
  buildings.
• 1991 JCAHO standards issued.
• 1993 inspection 95.6 were complying with the
  standards.

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We need to

• Change attitudes of our traditional health care
  system as well as the community

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Most Important First Steps

• Change attitudes
• Change roles
• Change standards of health care

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Who Needs to Be Involved?

• All physicians/PAs/NPs
• Communities
• Legislation
• Health insurance companies
• Hospitals

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Multi-Action Plan

• Total ban on smoking both indoors and outdoors.
• Identify and treat all admitted patients who are
  tobacco users.
• Provide outpatient smoking cessation for all
  patients, visitors, and employees.

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Multi-Action Cessation Plan Will

• Allow cessation efforts to reach broad base of
  population
• Improve health, production, and cost of employees
• Set example for community and the rest of health
  care system

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• The Challenge

To change the nature of clinical practice to
address universally and systematically the
leading preventable cause of morbidity and
mortality in our community.
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SELF FIRST

• All current policies and protocols were reviewed
• Smoking on hospital property was evaluated
• Team evaluation of possible changes and their
  implications
• Recommendations implement a smoke-free campus
  offer free smoking cessation counseling
  develop a timeline for implementation
• Administrative approval obtained

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Self Continued

• Policy change and timeline notifications
  circulated to staff and physicians
• Free smoking cessation offered to all staff
• Approval obtained for staff insurance provider to
  cover nicotine replacement therapy
• Signs ordered and handout informational cards
  made
• Policy was implemented, promoted and celebrated

17
Policy and Protocol Review

• Hospital smoking policy for patients, visitors
  and staff was reviewed --- Compliance with
  smoking only in the designated smoking areas was
  not being adhered.
• Smoking was occurring outside all the entrances
  of the hospital and enforcement of the policy was
  not being addressed.
• No procedures, policies or protocols existed on
  the inpatient units for interventions to be
  offered to patients who were smokers.

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Team Evaluation

• Literature search done to explore best practice
  models
• Resources procured from numerous sources (ALA,
  ACS, AHA, NCI) Cost and reimbursement issues
  evaluated
• Recommendations developed and presented to
  Administration for approval
• ( American Lung Association American Cancer
  Society American Heart Association National
  Cancer Institute)

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Recommendations

• Collaborate with other area health care providers
• Establish a smoke-free campus
• Identify smokers at the time of admission
• Offer tobacco cessation counseling to all
  inpatient smokers
• Provide cessation counseling to staff,
  outpatients and the community -- free of charge
• Develop tracking mechanisms to document
  effectiveness

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Policy Changes and Timeline Development ( 4
months)

• Smoke-free campus policy developed and shared
  with hospital staff for feedback and input
• Letters sent to area hospitals inviting a joint
  endeavor
• Approval obtained with new hospital insurance
  carrier to cover nicotine replacement therapy
• Letter and a copy of the Clinical Guidelines sent
  to all physicians (offer made to provide the NCI
  training program How to Help Your Patients Stop
  Smoking).

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Continued Policy Changes and Timeline
Development

• Free smoking cessation counseling services made
  available to staff, physicians, community and
  inpatients
• Signs, brochures and informational cards obtained
  
• In-services held at unit meetings
• Smoke-free campus implemented with goodies
  (sugarless candy straws)