1ENSH WCTOH 2002

European smoke free hospital Netwok

Stefano Nardini

Anne Marie Schoelcher

Ann 0’riordan

Ariadni Ouranou

François Chieze

Bertrand Dautzenberg

Audit of smoke free hospital

ENSH WCTOH 20022

European code1. Engage decision-makers. Inform all personnel and patients. 2. Appoint an action group. Propose a strategy and an implementation plan. 3. Set up a training plan to instruct all staff on how best to approach smokers. 4. Organise cessation support facilities for patients and staff in the hospital

and provide continuity outside the hospital. 5. Indicate smoking zones clearly, for as long as they are considered

necessary, and keep them away from clinical and reception areas. 6. Adopt appropriate signs, including posters, signposts, etc. 7. Remove all incentives to smoke -such as ashtrays, tobacco sales, etc.. 8. Renew and broaden information to maintain commitment to the policy. 9. Ensure follow-up and quality assurance. 10.First convince, constrain considering legislation if needed. Have patience!

ENSH WCTOH 20023

Smoke-free Hospital membership

Initial Phase:Membership of a Smoke-free Hospital Network is acquired by : A letter of commitment from hospital management The designation of a tobacco prevention correspondent for the hospital

ENSH WCTOH 20024

Smoke-free Hospital : Bronze levelThis first phase outlines what a hospital must achieve in order to

awarded the bronze level. It is the first step towards becoming a smoke-free hospital label.

This stage can be reached in less than 1 year, or in a trimester if a clear engagement of hospital management exists, especially when re-organizing, moving or building are planned, or if a new organization is to be implemented or if any other positive changes are planned within the hospital.

On the other hand, when the hospital has problems, it may take longer for it to reach bronze level.

For a hospital to reach the bronze level, points 1 and 2 of the European code must be achieved.

gold

silver

bronze

ENSH WCTOH 20025

Smoke-free Hospital : Silver level

Reaching this level will take longer - from 1 to 10 years.Implementation will proceed in a step-by-step progression.Successful implementation of the minimum standard Smoke-free

Hospital policy means that the hospital is fully committed to the minimum smoke-free requirements.

The progressive implementation of this stage requires positive and continuous pressure, along with a search for consensus. Constraint needs to be used only as an ultimate action, but may be considered necessary as stated in point 10 of European code.

gold

Silver

bronze

First convince, constrain considering legislation if needed. Have patience!

ENSH WCTOH 20026

Smoke-free hospital : Gold level

gold

Silver

bronze

This stage is the ultimate goal to be reached, with no smoking either inside the hospital buildings or in open areas around the hospital.

This ultimate goal will take a long time, often more than 10 years.

When this goal is reached, there will still be a need for:

• Periodic reviews, audits and preventive measures to remain at this level of quality.

• Provide help to other non-hospital based communities in order to implement further smoke-free places.

ENSH WCTOH 20027

Auto audit process

A volontary process of hospitals to assess tobacco policies

A one page self audit questionnaireThe questionnaire could be repeat each yearThe questionnaire follow the European codeAfter a first validation of questionnaire, 3

countries of ENSH are volontaire to test the questionnaire

ENSH WCTOH 20028

Methods

Ireland, Italy and France corerspondant of ENSH selected 25-50 hospitals to participate

.Each country analyse his data and propose

change in the audit questionnaire.All the data are pulled as excell file then

analysed

ENSH WCTOH 20029

Questionnaire

For each item the answer is

0 non implemented

1

2

3

4 totally implemented

NA non applicable

ENSH WCTOH 200210

Self audit questionnaire in Ireland• Irish Smoke-free Health Service Initiative developed in line

with the European Code for Smoke-free Hospitals and national legislation was established 2000.

• ENSH Self audit questionnaire was incorporated into the Irish Smoke-free Health Service Initiative in 2001.

• The Irish Initiative has four distinct stages, hospitals that reach stage four can categorise themselves as being bronze, silver or gold by using the self audit questionnaire.

• Results presented here are from 25 (68%) of the initial 37 hospitals invited to use the self audit questionnaire

ENSH WCTOH 200211

ENSH Code : 1 - Engage decision makers

Two questions in the self audit :

1 - 1 Hospital documents (general contracts, public documents etc) specify the hospital smoke free policy

1 - 2 Staff and patients are clearly informed of smoke-free policies

4 3 2 1 0 NA

4 3 2 1 0 NA

ENSH WCTOH 200212

1. Policy : response from Italy

0

2

4

6

8

10

12

num

ber o

f res

pons

es

1 2

0 (no)

1

2

3

4 (yes)

Policy on official documents Information to patients and staff

ENSH WCTOH 200213

Policy : response from Ireland

0

5

10

15

20

Policy on official documents Information to patients & staff

0 1 2 3 4 NA

ENSH WCTOH 200214

Policy : response from France

0 02

46

4

18

24

44

36

0

5

10

15

20

25

30

35

40

45

50

Policy on official documents Information to patients & staff

0

1

2

3

4

ENSH WCTOH 200215

0

5

10

15

20

num

ber o

f re

spon

ses

1 2 3 4 5

0 (no)

1

2

3

4 (yes)

non applicable

no response

2. Working Group : response from Ireland

Working group

appointed

Audit results

Previous plans auditedin 2002

New strategylaunched in 2002

Chair fromtop

manag.

ENSH WCTOH 200216

3. Staff Education and Training : response from Ireland

0

5

10

15

num

ber o

f re

spon

ses

1 2

0 (no)

1

2

3

4 (yes)

non-applicable

Education planned

Time allowed

ENSH WCTOH 200217

Results from Italy

ENSH WCTOH 200218

Results from Italy

ENSH WCTOH 200219

Results from Italy

ENSH WCTOH 200220

Results from Italy

ENSH WCTOH 200221

Results from Italy

ENSH WCTOH 200222

Results from Italy

ENSH WCTOH 200223

Results from Italy

ENSH WCTOH 200224

Results from Italy

ENSH WCTOH 200225

Results from Italy

ENSH WCTOH 200226

Results from Italy

ENSH WCTOH 200227

Comparison of individual score for 28 hospitals in 3 countries

Audit score for each test hospital

0

20

40

60

80

100

120

140

1 4 7 10

13

16

19

22

25

N° of hospital

Ireland

France

Italie

ENSH WCTOH 200228

Comparison of individual score for 28 hospitals in 3 countries

Audit score for each test hospital

0

20

40

60

80

100

120

140

1 4 7 10 13 16 19 22 25

N° of hospital

Ireland

France

Italie

Very important variation are observed in the same country The score decrease from north to southIrland>France>Italy

ENSH WCTOH 200229

Joint us