Creating a TOBACCO FREE CAMPUS at your medical facility

1
Creating aTOBACCO FREE CAMPUS at your medical
facility

• Clare Lemke, R.N.
• MHA Champions for Quality Conference
• July 19, 2008

2
TOPICS THAT WILL BE COVERED

• Why should we address tobacco use?
• What is happening at many hospitals?
• Why create a tobacco free campus?
• Are other hospitals doing this?
• Is your hospital ready to get started?
• How can this be accomplished?
• What help is available?

3
Why should we address tobacco use?

• TOBACCO IS THE NUMBER ONE CAUSE OF
  PREVENTABLE DEATH

4
TOLL OF TOBACCO - DEATH

• Every year, 438,000 Americans die from tobacco
  use, including 1,400 Montanans.
• One in six deaths is tobacco-related. Tobacco
  use is the 1 cause of preventable death in the
  United States.
• About a third of deaths from cardiovascular
  disease are attributed to cigarette smoking.
• Adults who smoke die an average of 14 years
  earlier than nonsmokers.

5
TOLL OF TOBACCO - DISEASE

• The toxins in tobacco products reach nearly every
  organ of the body.
• Tobacco use is the 1 cause of cancer.
• Exposure to secondhand smoke increases a persons
  risk of heart disease lung cancer.
• Smoking during pregnancy harms the mother and the
  developing baby.
• Spit tobacco use increases risk of oral cancer
  and heart disease.

6
TOLL OF TOBACCO -

• 277 million Annual medical costs in Montana
  attributed to smoking
• 67 million Annual medical costs in Montana
  attributed to smoking that are covered by the
  state Medicaid program
• 559 per household Montana residents state
  and federal tax burden from smoking-caused
  government expenditures

7
TOLL OF TOBACCO - ADDICTION

• Nicotine inhaled from a cigarette reaches the
  brain within 7 seconds. Because of this rapid
  response and the frequency of dosing, it is
  considered more addictive than heroin and
  cocaine.
• Kids can easily become addicted to nicotine and
  then spend their adult life trying to quit.
• Nicotine addiction costs money - a pack-per-day
  smoker spends over 1,600 and 600 hours per year
  on their addiction.

8
TOLL OF TOBACCO - KIDS

• Every year, the tobacco industry spends about
  41.8 million in Montana to market its deadly and
  addictive products.
• Nearly 90 of smokers start by age 18.
• About 20 of high school students in Montana use
  tobacco.
• Nicotine exposure and addiction in youth has been
  linked with increased likelihood they will
  experiment with and become dependent on alcohol
  or other drugs.

9
What is happening at many hospitals?

• TOBACCO USE POSES HEALTH AND SAFETY ISSUES
  FOR PATIENTS, EMPLOYEES, AND VISITORS

10
PATIENT HEALTH AND SAFETY
11
EMPLOYEE HEALTH AND PRODUCTIVITY
12
PUBLIC IMAGE AND SAFETY
13
Why create a tobacco free campus?

• GOALS BENEFITS OF A TOBACCO FREE
  MEDICAL CAMPUS POLICY

14
GOALS OF A TOBACCO FREE MEDICAL CAMPUS
POLICY

• To provide a safe and healthy environment for
  employees, patients, and visitors.
• To promote cessation and support tobacco free
  lifestyles for all community members.
• To align the policies of an organization with its
  mission.

15
THIS POLICY IS GOOD FOR PATIENTS

• Encourages patients to work on quitting tobacco.
  Patients who dont use tobacco recover quicker
  and have fewer complications.
• Decreases patients risk of falling or having
  treatment complications because they are not
  going outside to smoke.
• Provides an opportunity to promote tobacco
  cessation and discuss resources.
• Patients wont be exposed to the lingering smell
  of smoke or tobacco from others.

16
THIS POLICY IS GOOD FOR EMPLOYEES

• A tobacco free environment provides a safe and
  healthy workplace.
• Employees will have more an incentive to quit
  smoking or chewing tobacco, and those who try
  will be more successful.
• With fewer employees using tobacco, the workforce
  will be healthier, resulting in less absenteeism
  and sick leave.
• Improvement in employee morale with the
  elimination of multiple smoke breaks.

17
THIS POLICY IS GOOD FOR THE COMMUNITY

• Supports community members who are working on
  quitting tobacco.
• Eliminates all exposure to secondhand smoke on
  the property.
• Role models healthy behavior and makes a clear
  statement that the use of tobacco does not
  support health. Reinforces youth prevention
  messages.
• Helps change attitudes regarding tobacco and
  support for other health initiatives.

18
THIS POLICY IS GOOD FOR PUBLIC RELATIONS

• Your organization is taking a leadership role on
  a major public health issue.
• It aligns the policies of your organization with
  your mission and vision.
• It is a model for other businesses to implement
  health enhancing practices.
• More attractive grounds with less tobacco litter.
• By helping employees and community members quit
  tobacco, it shows that your hospital cares.

19
THIS POLICY IS GOOD FOR THE BOTTOM LINE

• Improves productivity when employees arent
  taking multiple smoke breaks. Healthier
  employees have less medical care costs.
• Risk of fires is lower. Insurance, maintenance
  and janitorial costs can go down.
• Decreased liability risk when patients arent
  going outside to smoke.
• Reduces the economic burden of treating
  tobacco-related illnesses.

20
BENEFITS OF A POLICY THAT INCLUDES CHEW
TOBACCO

• Acknowledges the harm caused by the use of all
  forms of tobacco, not only cigarettes. Does not
  promote switching to smokeless tobacco.
• Addresses the growing problem of chew tobacco
  usage in Montana.
• Counters the tobacco industrys increased
  marketing of smokeless tobacco products.
• Provides equitable policy provisions for all
  tobacco users, not just smokers.
• Eliminates tobacco-laden sputum on grounds.

21
Are other hospitals doing this?

• TRENDS ATTITUDES REGARDING
  TOBACCO FREE CAMPUS POLICIES

22
ITS A TREND NATIONWIDE

• Many states have successfully instituted a
  tobacco free hospital initiative including
• Kansas Wisconsin Wyoming
  Nebraska Maine Rhode Island
  Missouri Oregon South Carolina
  Ohio Iowa West Virginia
  Tennessee Kentucky North Carolina

• And it is happening other health settings
• State and local health departments
• Medical dental clinics
• Health organizations

23
ITS A TREND IN MONTANA TOO!

• In 2007, several hospitals requested assistance
  in creating a tobacco free policy.
• In July 2007, the Montana Tobacco Free Medical
  Campus Project was initiated by the Montana
  Tobacco Use Prevention Program to assist
  hospitals and medical facilities in creating a
  tobacco free campus policy and achieving a
  successful implementation.
• August 2007, Project Coordinator begins to
  receive requests from hospitals.

24
STATUS OF MONTANA HOSPITALS ONE YEAR AGO

• Information gathered from a survey of Montana
  hospitals regarding campus-wide tobacco policies
• 3 had a tobacco free campus policy
• 7 had a smoke free campus policy
• The remaining prohibited smoking inside their
  facility, or had a campus-wide policy with
  exceptions.
• Over 40 of the hospitals were interested in
  exploring the possibility of creating a tobacco
  free campus.

25
STATUS OF MONTANA HOSPITALS TODAY

• 6 hospitals and one health department have a
  tobacco free policy in place (in addition to the
  seven who have a smoke free campus policy).
• 4 hospitals have approved a tobacco free policy,
  which will take effect by the end of 2008.
• 8 hospitals and one health department are
  actively engaged in the planning process.
• 11 more hospitals, one health department, and one
  nursing home have taken steps to move in
  this direction.

26
Is your hospital ready to get started?

• DETERMINE YOUR HOSPITALS READINESS FOR
  CHANGE

27
STAGES OF CHANGE

• Precontemplation
• Everything is fine the way it is.
• I dont want to change. Maybe next year.
• It will never work!
• Contemplation
• Ive heard other hospitals are doing it and its
  working.
• One of the doctors has asked us to look into
  it.
• Maybe we should consider it.
• Lets give Clare a call and find out more.

28
STAGES OF CHANGE

• Preparation
• We have already started to work on it.
• Lets set up a site visit by Clare to help get
  us started.
• We have created a task force.
• We are working on writing our new policy.
• Action
• Our policy has been approved.
• We are getting the word out to the community.
• Cessation assistance for employees is underway.
• We are preparing for our implementation date.

29
How can this be accomplished?

• KEY STEPS, PRINCIPLES FOR
  SUCCESS, OVERCOMING RESISTANCE

30
KEY ACTION STEPS Phase 1

• The commitment of senior management has been
  secured.
• Create a planning committee.
• Assess your current situation.
• Develop a timeline.
• Get input and support from medical staff.
• Decide on policy components.
• Plan cessation assistance for employees.
• Create a communication plan.
• Plan provisions for inpatients.

31
KEY ACTION STEPS Phase 2

• Policy is officially approved.
• Create talking points and train managers.
• Announce policy to employees and begin cessation
  assistance.
• Implement communication plan. Develop media
  materials. Determine signage needs.
• Plan kick-off day activities.
• Post signs right before launch date.

32
KEY ACTION STEPS Phase 3

• Policy takes effect.
• Enforce policy equitably from day one.
• Continue to educate patients, employees, and the
  community to foster compliance.
• Assess signage placement. Post more if needed.
• Provide ongoing monitoring to identify any
  problems and ways to enhance success.
• Planning committee continues to meet as needed.
  Assess long-term outcomes.

33
QUESTIONS AND CONCERNS

• It will be hard to manage.
• Employees wont comply or will quit their jobs.
• It will be expensive.
• You cant force people quit tobacco.
• The community will not support this.
• Who will enforce this?
• What will smokers and chewers do to relieve
  their stress?

34
PRINCIPLES FOR ACHIEVING A SUCCESSFUL
TRANSITION

• The support of top management is essential.
• Focus on the health and safety benefits.
• Provide avenues for input from stakeholders.
• Engage health care providers in the process.
• Create a realistic timeline. Dont be in a hurry.
• Address employee break time in the policy.

35
PRINCIPLES FOR ACHIEVING A SUCCESSFUL
TRANSITION

• Provide timely and accurate communication to
  patients, employees, and the community.
• Keep your messages positive.
• Provide training for managers.
• Offer tobacco dependency treatment.
• Dont stigmatize people who use tobacco.
• Treat this policy like any other personnel policy
  and enforce it fairly and consistently.

36
What help is available?

• ASSISTANCE PROVIDED THROUGH THE MONTANA
  TOBACCO FREE MEDICAL CAMPUS PROJECT

37
WAYS THAT WE CAN HELP

• Information and support through telephone and
  email communication.
• Site visit to meet with administrator, managers,
  and/or hospital policy committee to outline the
  process, conduct presentations, and answer
  questions.
• Cessation training for key staff can also be
  arranged.

38
WAYS THAT WE CAN HELP

• Materials provided without cost
• Implementation Guide
• Cessation Resource binder
• Signage for your facility and parking lots
• Banners to borrow for launch date
• An individually tailored media package

39
CONTACT INFORMATION

• Clare Lemke, RN, Project Coordinator
• Tobacco Free Medical Campus Project
• Livingston HealthCare
• 315 North 8th Street, Livingston, MT 59047
• 406-222-8282
• clare.lemke_at_livingstonhealthcare.org
• Stacy Campbell, MA, Project Supervisor
• Montana Tobacco Use Prevention Program
• PO Box 202951, Helena, MT 59620-2951
• 406-444-3138
• stcampbell_at_mt.gov

40
QUESTIONS AND COMMENTS