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

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

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

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