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The impact of smokefree legislation from a hospital and ...

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  • 1. The impact of smokefree legislation from a hospital and cardiac point of view AJ McNeill, Chairman Smokefree Hospital Initiative Committee, M Campbell, Smoking Cessation Co-ordinator Altnagelvin Hospital, Londonderry
  • 2. L/DERRY 1992
  • 3. WHSSB: Western Health and Social Srvices Board
  • 4.  
  • 5. Standardised death rates NI Report of CMO NI 2005 Per 100k Popn.
  • 6. NI standardised death rates by health board area Per 100k Popn.
  • 7. The need for a change in attitude
    • Smoking is the greatest single cause of preventable illness and premature death in Northern Ireland
    • Around 2700 deaths a year
    • Contributes to health inequalities
    • Important cause of the gap in health between rich and poor
  • 8. Smoking prevalence
    • NI household survey 2006
    • Smoking prevalence 33% WHSSB, 31% NI
    • DHSSPS in NI Priorities for action
    • Reduction in smoking prevalence for NI by 7% to 24%
    • Reduction in health inequalities
  • 9. Effects of second hand smoke
    • 4000 chemicals
    • Arsenic/benzene/formaldehyde/ammonia
    • 60% carcinogenic
    • More in “sidestream” than “mainstream”
    • 85% room smoke is “sidestream”
  • 10. Health risks to passive smokers
    • Lung cancer: increased risk 20-30%
    • Heart disease: increased risk 25%
    • 30 min passive smoking reduces coronary blood flow
    • Stroke: increased risk 82% in men, 66% women
    • Asthma: acute exaccerbations
    • Pregnancy complications: low birth weight
  • 11. Legislation
    • October 2005: minister announced ban on smoking in enclosed public places with effect from April 2007
    • Public consultation: 91% support
    • Ban effective from 30 th April 2007
  • 12. Hospital policy
    • 1997: Trust policy on tobacco/smoking
    • 2004: Smokefree Hospital Initiative committee
    • Multidisciplinary. Representation from WHSSB
    • Part of World Health Organisation Smokefree Hospital Initiative and Health Promoting Hospitals group
    • Appointment of smoking cessation counsellor
    • Patient and staff training
    • Shortcomings obvious
  • 13. Revised hospital policy
    • With effect from 1 st January 2007 (before legislation)
    • Closure of patient and staff smoking rooms
    • Signed exclusion zone around entrances
    • No staff smoking on site (except cars)
    • Media coverage
    • Increased support for staff and patients
    • “ Not punitive but supportive”
  • 14. The impact of legislation and policy on staff attitude
    • 1 day snapshot staff survey March 2007
    • 46 staff, 50% never smoked, 28% current, 22% ex-smokers
    • 96% believed passive smoking detrimental to health
    • 85% believed smoke-free policy was creating a positive change in hospital
  • 15. Staff attitude continued
    • 85% agreed policy would result in positive health changes for patients
    • 83% agreed staff had a duty to discourage patients from smoking
    • 93% agreed staff had responsibility to stop those smoking in non-designated areas
  • 16. Increase in referrals for cessation
    • 1/1/07- 30/4/07: 218 referrals
    • 1/5/07-31/8/07: 302 referrals
    • Increase in staff uptake of training
    • Increase in management support for staff training
    • Raised profile for smoking cessation eg in-service training/induction/resuscitation
    • Multidisciplinary incl ancillary staff
  • 17. The impact of legislation: public health
    • Republic of Ireland: ban from 29/3/2004
    • South western Ireland (Cork)
    • March 2003/2004: 1277 admissions with acute coronary syndromes
    • March 2004/2005: 1092 admissions
    • Decline 14.5%
    • Decline greater in smokers than non-smokers
    • Cronin et al. European Society of Cardiology, Vienna, 2007
  • 18. Public health impact in Scotland
    • Ban introduced March 2006
    • Review of admissions with heart attack to 9 hospitals (63% total admissions)
    • Year to March 2006: 3235 admissions
    • Year to March 2007: 2684 admissions
    • 17% reduction
    • 20% reduction non-smokers cf 14% in smokers
  • 19. Shortfalls
    • Policy breeches by patients and visitors
    • Policy breeches by staff
    • Lack of “ownership” by some staff
    • Sense of intimidation
    • Senior management priorities
  • 20. Action plan
    • Continued opportunistic training
    • Staff support and training
    • Target specific patient groups
    • Increased signage/ auditory systems
    • Media awareness
  • 21.