Implementing Tobacco Free Campuses: learning from experience in the South - Miriam Gunning
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Implementing Tobacco Free Campuses: learning from experience in the South - Miriam Gunning Presented on Friday 6th June 2014.
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Implementing Tobacco Free Campuses: learning from experience in the South - Miriam Gunning
- 1. Implementing tobacco free campuses – learning from experience in the South Ms Miriam Gunning Senior HPO for Tobacco HSE DNE National Lead – ‘Tobacco Free Campus’ Miriam.gunning@hse.ie
- 2. National Context • 1995 -2004 - Smoking Target Action Group (STAG) • 1996 - National Cancer Strategy • 1996 - Membership of HPH Network • 1999 - Building Healthier Hearts • 2000 - National Health Promotion Strategy • 2000 - ‘Minimum Standards for Smoke Free Hospitals’ • 2000 - Membership of ENSH Network • 2004 - ‘Irish Workplace Smoking Ban’
- 3. The ENSH Concept http://www.ensh.org • Mission • The ENSH-Global mission is to promote and support smoke-free health care centres all over the world. • Objectives • To promote the exchange of information and the sharing and pooling of experience between members • To collect comparable data for evaluation and benchmarking purposes • To continuously develop concepts that promote the establishment of smoke free health care centres through networking • To stimulate collaboration with other organizations involved in the same area of activities • To develop common concepts, strategies, implementation and monitoring tools based on existing models available • To share supportive tools and processes for an effective implementation of smoke free health care centres
- 4. ENSH Tools - Standards The 10 quality Standards recommended by the ENSH Global Network for Tobacco Free Health Care Services to implement a comprehensive tobacco free campus policy • ENSH Standard 1. Commitment • ENSH Standard 2. Communication • ENSH Standard 3. Education & Training • ENSH Standard 4. Identification & Cessation Support • ENSH Standard 5. Tobacco Control • ENSH Standard 6. Environment • ENSH Standard 7. Healthy Workplace • ENSH Standard 8. Health Promotion • ENSH Standard 9. Compliance Monitoring • ENSH Standard 10. Policy Implementation
- 5. • 42 items / total score 168 points • 10 sections • Self administrated • Helps identify strengths and areas needing attention • Helps to monitor progress • Ensures continuous quality improvement
- 7. SILVER Standard 1 to 10 Training Smoking Cessation No cigarettes sales Health Promotion Regional activities Evaluation 126 points 1-10 (75%) BRONZE Standard 1 and 2 Working Group Strategy Communication 30 points 1-2 (75%) MEMBERSHIP Commitment from the Management Completed Self audit Contact person National Certification levels
- 8. SILVER Standard 1 to 10 Training Smoking Cessation No cigarettes sales Health Promotion Regional activities Evaluation 126 points 1-10 (75%) BRONZE Standard 1 and 2 Working Group Strategy Communication 30 points 1-2 (75%) MEMBERSHIP Commitment from the Management Completed Self audit Contact person National Certification levels Standard 1 und 2 Arbeitsgruppe Strategie Kommunikation >30 Punkte 1-2 Erklärung der Klinikleitung Selbsteinschätzung Ansprechpartner Self audit Strategy Structured report Evidence and action plan Support, sharing good practice, workshops training Audit on peer review basis and On-site-visit Sharing and learning process
- 10. ENSH Silver Certificate 2004
- 12. Standard 1. Commitment • HSE commitment - development of the Tobacco Control Framework - TCF • Commitment to implement ENSH standards - (TCF action 2.4) • Commitment to develop and implement TFC policy (TCF action 2.1) • TFC implementation group set up to implement the framework • Project manager appointed • Tobacco actions imbedded in NSP annually • National Tobacco Free Campus Policy drafted 2012
- 13. Supporting national studies • HIPE (Hospital Inpatient enquiry) study - all inpatient discharges (over 18’s, excluding maternity) from acute hospitals with any diagnosis of tobacco use (2005-2011) • Z72.0 current tobacco use, • Z86.43 past history of tobacco use, • F17.1 harmful tobacco use, • F17.2 tobacco dependence or • F17.3 withdrawal state (In 2011, almost a quarter of inpatient discharges had a recording of any tobacco use on their HIPE record) Smoking attributable diseases (in 2008) accounted for • 36,255 (3.7%) discharges @ €7,700 each • 300,756 (8.7%) bed days
- 14. Development of National TFC Policy • Huge engagement with stakeholders in the drafting of the national policy (2010/11) – • Internal consultation with each directorate • External consultation with the joint council of unions • Labour court decision affirmed and commended the HSE on this policy initiative The purpose of the policy • Treating tobacco addiction as a care issue thus providing a better outcome for patients • De-normalise tobacco use in ALL healthcare settings • Dr. Steevens HSE Headquarters Tobacco Free since 2011
- 15. Standard 2. Communication • National media plan developed along with national press release • Toolkit of TFC resources developed http://www.hse.ie/eng/about/Who/TobaccoControl/campus/ • National TFC signage designed • National patient/staff information leaflet drafted and designed • Guidance for managers on implementation • Presentation for staff & ‘Yes but No Butt’ DVD • Draft letters for staff, GP’s, external services, contractors • Sample survey for staff to assess tobacco prevalence • Q&A sheet -general/staff/managers • Voice over text for entrances/exits • Regional communications personnel to support regional sites in terms of all media and communication requirements
- 16. Social Marketing Campaign 1 in 2 stories; reality of loss = why to quit Support services; peer to peer = how to quit
- 17. HSE Press Release - 8th March, 2013 Our Lady of Lourdes Hospital to receive Highest International Award for their Tobacco Free Campus
- 18. Standard 3. Education & Training • Presentation for staff on TFC policy • ‘Yes but No butt’ DVD including instruction on how to increase confidence in approaching tobacco users to inform them of the policy • TCF commits to training front line staff in BISC • National Brief Intervention Training Programme developed and accredited by An Bord Altranais (6 CEUs) and the ICGP (5.5 CPD credits) • National on-line registration & pre-training assessment for staff • Q1- Q4 training plan and targets drafted (1350 staff in total for 2013/14)
- 19. Standard 4. Identification & cessation support • Tobacco included in new referral forms and any other appropriate care pathway documentation • ALL smoking cessation services - www.quit.ie QUITline 1800 201 203 QUITplan sign up option Facebook page ‘You can QUIT’ www.facebook.com/HSEquit Live email and Live chat (to be made available before year end) Trained tobacco cessation specialists – clinics/groups/one to one GPs/Pharmacists support and advice on nicotine replacement therapy (NRT) and other cessation pharmacotherapies • Systematic client centred referral to intensive services currently being scoped to ensure efficiency and accessibility at all service delivery levels
- 20. • National standard developed for intensive SC support services • National monitoring of ALL intensive SC services • Combination NRT therapy licensed • 2-day training update provided for ALL SC providers
- 21. Prevention of Chronic Disease Programme Aim • To make every healthcare contact and every policy count in order to prevent morbidity and mortality from chronic disease.
- 24. National Performance Indicator Activity Suite
- 25. Standard 5. Tobacco Control • The 2013 NSP committed to 100% of acute sites implementing the policy by year end (90% achieved) • All newly opened primary care sites and 35% of existing sites (92% achieved) • 1350 staff to be trained in BISC (above target 1395 trained) • Assessment of all sites nationally/regionally and breakdown of staff disciplines to make it easier for services to deliver on the target • Individual letters from TCFIG chair to each local manager • Annual ENSH on-line audit & development of QIP • Key members of TCFIG become national ENSH jury for Gold Forum candidates • Exemption process – risk assessment
- 26. Standard 6. Environment • Pride and corporate image become a focus • Tobacco-free becomes the new health service norm • Staff are profiled as good role models • Public begin to recognise the familiar tobacco free signage, absence of smoking on hospital campus, absence of cigarette disposal bins • Blue line branding of campus boundaries • Familiar voice over messages
- 27. Standard 7: Healthy Workplace • SC support service provided to staff – TCFIG priority • Staff audit of tobacco use took place in 2012 Staff smoking 15% (11% daily, 4 % non-daily) Medical : 4%, General Support Staff: 25% • Develop partnership with Occupational Health • Promote TFU campaign/ ‘WHO Code of Conduct for HP’ • Reduced cost NRT via Smoking Cessation Support Service • Management of non-compliance with policy by staff – existing disciplinary procedures
- 28. Standard 8. Health Promotion • Department of Health Promotion & Improvement under the ‘Health & Wellbeing Division’ • Members of the TCFIG were key members of the DOH Tobacco Policy Review Group - Tobacco Free Ireland 2025 • Key partnership - national stakeholders group • Health Promotion/HPH/HS/ASH/TFRI have supported county councils to develop tobacco free playgrounds etc • Working with the GAA to progress smoke free stadia • Supporting Universities to develop tobacco free campus • Include TFC in HP conferences – national & international
- 29. ENSH Standard 9: Compliance Monitoring • Continued membership of ENSH and annual on-line audit • Maintain / improve cessation follow up • Document non-compliance, corporate walkabouts, complaints • HIQA Hygiene audit • Clinical care audits • QPSA national audit of tobacco free campus policy in 2014 national service plan • Carry out internal audit on TFC policy - Methodology • Staff Survey • Patient survey • Visitor survey • Head of Department survey • Observation survey
- 30. • 10. Policy Implementation Full commitment at a national level to TFC policy implementation NSP scorecard for 2013 and 2014 Tobacco Control % hospital campuses with tobacco-free policy 100% No. and % of smokers on cessation programme who were quit at one month New PI No. of smokers who received intensive cessation support from a cessation counsellor 9,000 No. of frontline healthcare staff trained in brief intervention smoking cessation 1,350 No. of sales to minors test purchases carried out 320 20142013
Editor's Notes
- Identifying strengths and areas of improvement Systematically implementation instead of single action I Internal controlling instrument
- 50 acres
- There is longstanding commitment at a senior level in the HSE to tobacco control generally though the development of the tobacco control framework which stemmed from the transformation programme and was launched in early 2010.
- Dr Steevens introduced the policy in October 2011
- Yes but No Butt DVD – DVD produced by HPHS which features HSE staff acting out various scenes relating to implementation of the TFC policy – e.g. an elderly patient with COPD who lights up in the ward, a staff member who smokes in her car on site and is asked not to by security. It presents real life scenarios aimed at prompting discussion / debate and to explore different views on possible interventions Commitment secured from national communications (Fidelma) for regional communications personnel to support regional sites in terms of all their communication requirements
- Educating and informing staff about the policy is key to its success. Sites are encouraged to organise staff information sessions in the lead up to launch day – we have presentations to support this input. The yes but not butt dvd and the Q and A sheets will also support this input to staff. The roll out of brief interventions training for front line staff is a really important part of successful implementation. A national training programme has been developed and accredited and a national on line application system set up. We have training targets agreed with associated performance indicators in the NSP Deliver accredited training in brief intervention for smoking cessation to 1,350 frontline healthcare workers: DML 300 DNE 400 South 250 West 400
- The ultimate goal is to have a systematic procedure in place to identify and document tobacco addiction in each service – we are not there yet but the TCFIG is seeking the commitment of care groups to include tobacco in their referral forms or any other appropriate care pathway forms for example Primary care are piloting an electronic referral form in a number of sites and tobacco is included in this. All campaign materials refer to each of the cessation support options – website details quitline information, facebook details website and quitplan link as well as QUITline and individual cessation counseling services. Identification of smokers has been implemented in the many of the acute sites that have already gone tobacco free through the nursing care plan – Mid western regional hospital group recently amended nursing care plans to include tobacco identification and treatment The ideal system would be a centralised referral system for intensive cessation services and work is underway to develop this so that Gp’s or health professionals could send a referral to a central system and then these people would be directed to the most appropriate support service. HIPE hospital Inpatient patient …. Fenton looking at what we can pick up PCTs are issuing and receiving electronic referrals Healthlinks – system which allows electronic referrals HIQUA referral from adapted for primary care concluding the end of march between primary care team members primary care and acute sector for OPD
- The specific actions have already been covered in fentons presentation An exercise was undertaken to assess the number of sites in each region examine the staffing levels by discipline and draft a plan for training by region which makes it more manageable for services to meet the PI. The chair of the TCFIG recently wrote to each hospital manager, ISA manager and general manager to ask for their support in meeting these targets. Every effort was made to personalise this communication and tailor these letters individually to each site.
- The policy is also about pride and corporate image. Picture of buts on the ground Changing the culture so that the public will not expect to be allowed to smoke within the grounds of health services Role modelling for the next generation It helps create a supportive environment for patients/service users and staff to stop smoking
- Ash Ireland will detail some of this work later today - Fingal, Clare County Council, Donegal