Turning an entire hospital site into a smoke-free environment sounds like a daunting project but good communication and careful preparation can lead to success
Author: Wendy Preston is nurse consultant at George Eliot Hospital.
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In 2013 NICE recommended that hospital sites become smoke-free. The guidance noted that smoking cessation can have considerable health benefits, and patients in hospital who quit benefit from shorter lengths of stay and fewer complications.
Since 2013 our trust’s policy included a partial ban on smoking across the site with the provision of three external smoking shelters for patient and visitor use only. All staff, patients, carers and the general public had access to the on-site or community-based stop smoking services. Our new policy, launched at the beginning of this year, aims to achieve a smoke-free site whereby smoking is not allowed on any part of the trust’s grounds.
We started planning the policy nine months before its launch. A neighbouring trust had decided to launch its policy on the same date, while two other local trusts had already done so. We were able to learn from their implementation and facilitate standardisation across the local health economy in Coventry and Warwickshire.
We set up a group of representatives from across the trust, which was led by the public health manager. Key stakeholders are outlined in Box 1.
Box 1. Stakeholders
- Patients’ forum
- Stop smoking service
- Estates department
- Union representative
- General managers
- Human resources
- Directors (operations and community)
- Nurse and midwife
The group met monthly and developed an action plan. Communication was vital, especially with staff and patients, and our neighbours who live and work near to the trust. This included local radio and newspaper coverage, delivering letters to local residents, briefing staff via a ward managers’ pack (including an example of the disciplinary process) and changing the wording of all patient leaflets and letters. We agreed a protocol across the trust for nicotine replacement therapy, and made stock available 24 hours a day for patients who wanted to manage without cigarettes during their stay and for those who wanted to quit.
Smokers who wanted to quit could access help from NHS Warwickshire Stop Smoking Service located in the ambulatory care unit at the hospital site or at a range of locations across Warwickshire.
All health professionals received brief intervention training, which takes a few minutes. The main messages are to:
- Ask the patient about current smoking history (including type, amount and how long) and document it;
- Advise the patient on support available to quit;
- Act by referring the patient to an NHS stop smoking service and by providing nicotine replacement therapy.
Implementation went smoothly and we carried out a three-month evaluation. In the first few weeks we had a daily monitoring patrol, but this has now been reduced to weekly, in addition to security and staff reporting any breaches. So far we have had only one complaint from neighbours regarding staff congregating at the perimeters, and one member of staff received an informal warning for smoking offsite in uniform. The general feedback from smokers has been positive, with few adverse comments. Some staff are still reluctant to approach smokers on site because of the fear of violence and aggression, but by continuing to share the generally positive experiences of staff who have approached smokers we hope to dispel these anxieties.
Implementing a smoke-free policy can be daunting but collaboration, good communication and careful preparation are key to success. This includes the provision of education and training of staff and practical support for patients who smoke.
National Institute for Health and Care Excellence (2013) Smoking: acute, maternity and mental health service.