Addressing Tobacco on Hospital Campuses by Meeting the Gold Star

Standards of ExcellenceOctober 1, 2014

Webinar Logistics

► All participants will be muted throughout the presentation, questions will be answered at the end of the webinar.

► Participants can ask a question at anytime throughout the webinar by typing it into the “question” box of the webinar toolbar.

► The webinar will be recorded and archived on www.MaineTobaccoFreeHospitals.org and www.SlideShare.com/BreatheEasy.

Who We Are

The Maine Tobacco-Free Hospital Network is an initiative of the Breathe Easy Coalition of Maine, which has a mission to reduce exposure to

secondhand smoke by supporting tobacco-free policy adoption in multi-unit housing, behavioral health organizations, hospitals and colleges.

Resources and technical assistance provided by BEC are provided through funding support from the Partnership for a Tobacco-Free Maine, Maine CDC/DHHS.

The Case for Tobacco-Free Hospitals

The Case for Tobacco-Free Hospitals

■ Tobacco use continues to be the leading cause of preventable disease and death – about 480,000 deaths in the US per year.

The Case for Tobacco-Free Hospitals

■ There is no risk free level of exposure to secondhand smoke, even brief exposure can be harmful.

■ Exposure to secondhand smoke increases a nonsmoker’s risk of developing heart disease by 25-30% and for developing lung cancer by 20-30%.

■ Secondhand smoke poses a health risk in outdoor settings – smoking within 20-feet of a nonsmoker outside can cause harmful levels of exposure equivalent to those found in indoor settings.

The Case for Tobacco-Free Hospitals

■ Children exposed to secondhand smoke are at higher risk for health issues, including SIDS, respiratory infections, asthma, learning disabilities, behavioral problems and ear infections.

■ Thirdhand smoke is the lingering tobacco smoke residue or smoke contamination that remains after a cigarette, cigar or other smoked tobacco product has been extinguished.

■ Thirdhand smoke toxins, similar to those in secondhand smoke, linger on carpets, sofas, clothes, hair, skin and other surfaces long after smoking has ceased.

The Case for Tobacco-Free Hospitals

■ The creation of smoke and tobacco-free policies is an effective, evidence-based strategy to:

Reduce exposure to secondhand smoke.

Reduce the prevalence of tobacco use.

Increase the number of tobacco users who quit.

Reduce initiation of tobacco use by young people.

Reduce tobacco-related morbidity and mortality, including acute cardiovascular events.

The Case for Tobacco-Free Hospitals

Growing Support for Tobacco-Free Policies:

http://www.jointcommission.org/assets/1/18/Smoke_Free_Brochure2.pdf

http://www.themha.org/policy-advocacy/Issues/Maine-Hospital-Association-Position-Statement-on-T.aspx

The Case for Tobacco-Free Hospitals

Maine hospital participation in the Gold Star Standards by year.

■ Nationally, more than 3,700 hospitals have adopted 100% tobacco-free policies.

■ In Maine, 30 hospitals have adopted 100% tobacco-free policies.

20122010 2011 2013

What are the Gold Star Standards of Excellence?

■ Voluntary, free recognition program for

health care organizations in Maine aimed

at creating tobacco-free environments

and supporting tobacco-free lifestyles.

■ Ten evidence-based environment specific

tobacco control standards for

organizations to meet through written

policies and procedures.

■ A potential low cost, high return policy

change initiative.

■ Annually implemented imitative with

recognition and press event opportunity.

1

76

14

2

6

12

20

2

10

16

28

3

10

18

31

0

5

10

15

20

25

30

35

Bronze Silver Gold Total

MTFHN Award Level Participation 2010-2013

2010 2011 2012 2013

Gold Star Standards of Excellence Implementation

■ Applications Due to MTFHN by October 23rd (available at

http://mainetobaccofreehospitals.org/gold_stars/ )

■ Recognition event on November 19th at the Maine Hospital

Association for hospitals meeting at least six of ten standards.

■ To support application completion, MTFHN has developed a Gold

Star Standards of Excellence Guidance Document with best practice

answers from Maine hospitals.

■ Support resources for change, such as template policies, FAQs,

model signage, informational documents and others available

through our Tobacco-Free Hospital Toolkit – available at

http://mainetobaccofreehospitals.org/resources/.

2014 Gold Star Standard #1

The hospital has a 100% tobacco-free campus policy that prohibits the use of

all tobacco products including cigarettes, electronic cigarettes, smokeless tobacco, snuff, chew, cigars, pipes and non-FDA approved nicotine delivery

systems. Each campus is well-marked with clear signage communicating the

policy at all building entrances and other high traffic areas. Tobacco use by staff, patients, visitors and contractors is prohibited at all times on the

hospital’s property including in cars, parking lots at satellite facilities or other

properties that the hospital owns and/or rents. The policy extends to all off-site meetings and conferences, and in hospital vehicle when off-site.

Components of a 100% Tobacco-Free Policy

► Background/Purpose section about why you are creating a tobacco-free environment.

Explaining the harmful effects of secondhand smoke, dangers of tobacco use and how going tobacco-

free meets the organization’s mission.

► Definition of what tobacco products are covered in the policy.

Best Practice: Tobacco use is defined as the smoking or use of all cigarettes, cigars, snuff, smokeless

tobacco, snus, electronic cigarettes, and other non-FDA approved nicotine delivery devices.

► Explanation of where tobacco use is prohibited.

Best Practice: Tobacco use is prohibited in all indoor and outdoor areas of a property at all times.

Including parking lots and vehicles being used in the course of work.

► Outline of compliance expectations and enforcement parameters for staff, vendors, visitors and patients.

2014 Gold Star Standard #2

The hospital has a policy and clearly defined procedures to reduce patient and employee exposure to thirdhand smoke.

■ Example answer:

“There are two policies at MaineGeneral with provisions geared towards protecting individuals from thirdhand smoke. Please see

MaineGeneral’s General Conditions of Employement Policy that states under the fragrance sensitivity portion of the policy…Additionally,

employees/volunteers who smoke must keep patient and coworkers sensitivity in mind and ensure not to expose others to the smell of

smoke. Thirdhand smoke is also specifically mentioned in our Hospital Tobacco Policy.” – MaineGeneral Medical Center

2014 Gold Star Standard #3

Written policies and procedurs exist that detail the hospital’s policy (whether 100%

tobacco-free or not) and include a plan for enforcement and employee expectations.

Potential Strategies:

■ All staff are required annually to acknowledge in writing that they have read/understand the tobacco policy.

■ New staff orientations include education about the policy.

■ Progressive discipline for employee violations is written into policy and made clear to all employees.

■ Information about the policy is readily available on the hospital website and/or through the HR department.

■ The tobacco policy or procedures defines which staff members or departments are responsible for enforcing the policy and handling infractions.

■ Employee training on how to handle policy violations with employees, patients and visitors is provided to all staff.

■ Patients receive information on the hospital’s tobacco policy on admission and again during their hospitalization, if necessary.

2014 Gold Star Standard #4

Advertisement or promotion of tobacco products is prohibits on the hospital’s campus and satellite facilities. This includes hospital

publications and magazines subscribed to by the hospital for placement for placement in the waiting room.

Example answer:

“We made signage that we laminated and placed on all magazine racks that state ‘Tobacco product advertising in magazines is not supported by Redington-Fairview General Hospital.’ We have the hospital’s logo and the logo for Somerset Public Health on the signage. This has been implemented system-wide in all departments and practices associated with RFGH.” – Redington-Fairview General Hospital

2014 Gold Star Standard #5

Information about tobacco dependence and treatment, secondhand smoke,

thirdhand smoke and local/statewide treatment resources are readily available to patients and visitors.

■ Example answer:

“At Waldo County General Hospital all bulletin boars are posted with the Maine Tobacco HelpLine and QuitLink information. Brochures are displayed in the Emergency Room, cafeteria, lobbies, and practice waiting rooms. Yearly, we

have a Great American Smokeout display. In the Maternity Unit, each patient receives a brochure from the Center for Tobacco Independence. Promotion of group cessation Fresh Start classes are also displayed in the above listed

locations.” – Waldo County General Hospital

2014 Gold Star Standard #6

The hospital supports employee participation and attendance in evidence-based

education/training on tobacco dependence and treatment so that staff can provide counseling

and education to patients who use tobacco.

■ Example answer:

“Six Sebasticook Valley Health staff have completed the Basic and Intensive Tobacco Intervention Training offered through the Center for Tobacco Independence. SVH trained staff deliver the Maine Helper’s Training, The Better Breather’s Club and the Take the Next Step Program, which utilize the Training Tobacco Use and Dependence booklet and PTM education and resource materials.

SVH provider, trained by the Center for Tobacco Independence, offers one-on-one counseling services for local employers and SVH employees.” – Sebasticook Valley Health

Treatment & Training Resources

2014 Gold Star Standards #7

All patients admitted to the hospital are screened for tobacco use, tobacco status is documented and patients are offered

comprehensive treatment services during their stay. This includes dependency counseling/coaching at the bedside,

clinical assessment and management for patients experiencing nicotine withdrawal, offering FDA-approved tobacco treatment

medications, and referral to counseling post-discharge.

2014 Gold Star Standards #7

Example Answer:“As of May 2012, Pen Bay Medical Center now has a Tobacco Treatment Specialist, who, through an

electronic admission assessment process completed by nursing, is automatically notified of all inpatients who answer “yes” to the question “have you used tobacco products in the last 12 months” along with 4 other usage questions. This, in turn, generates a referral to the Tobacco Treatment Specialist who then does a face-to-face intervention for tobacco cessation. If the patient is not available to meet, a “Sorry I

missed you” card is left with her contact information and quit resources. She makes additional attempts to visit the patient at a later time. If the patient has been discharged before being counseled by the Tobacco

Treatment Specialist, she will do a post-discharge phone intervention.

In addition to our tobacco treatment services, members of Nursing and/or Respiratory Care Departments will also conduct brief tobacco interventions for inpatients. This acts as a safety net to ensure coverage for

tobacco cessation counseling during those times when the tobacco treatment specialist is not available.

During the Tobacco Treatment Specialist inpatient visit, a quit plan is developed for and with the patient which includes instructions for use of tobacco treatment medications. A copy of this written plan is given

to the patient as well as one sent to their primary care provider. Information regarding the next Free Freshstart Group Tobacco Cessation Program is given and encouraged to attend. These groups are also

facilitated by our Tobacco Treatment Specialist.” – Pen Bay Medical Center

2014 Gold Star Standard #8

Tobacco treatment services are a covered benefit in the hospital health insurance package for employees and dependents. Benefits include coverage for counseling and medications for quitting tobacco, with minimal, or no barriers to utilization (ie copays, out of pocket costs,

limits).

■ Example answer:

“Smoking cessation is covered as prevention care and will be covered at 100% when billed as part of a prevention care provider visit. Prescription medications are also covered under the benefits prescription plan. In addition, wellness coaching is offered at no cost to employees on the medical plan.” – The Aroostook Medical Center

2014 Gold Star Standard #9

The hospital provides a list of local 100% smoke-free lodging for visiting patients and families to allow them to make healthy choices regarding

their lodging.

■ Example answer:

“At Mount Desert Island Hospital, a list of smoke-free lodging establishments in Hancock County was provided by Healthy Acadia. The list is made available to Care Managers and other departments that would aid accommodations.” – Mount Desert Island Hospital

2014 Gold Star Standard #10

The hospital has a written policy stating it refuses all donations from the tobacco industry, and divests itself of all tobacco company stock.

■ Example answer:

“The hospital does not have any current investments and will not accept any. Our tobacco policy states: ‘Administration and governing board will ensure divestments, donations, grant funds, and trust dollars are free from tobacco industry ties.’ The investment companies that Goodall Hospital works with for employee pension and endowment funds ensured us no investments are through the tobacco industry and no donations are accepted.” – Goodall Hospital

Save the Date!

■ Gold Star Standards of Excellence Applications Due – October 23rd.

■ Recognition Event – November 19th, 10am at the Maine Hospital Association.

Questions and Connect with Us

www.MaineTobaccoFreeHospitals.org

www.SlideShare.net/BreatheEasy

207-874-8774

Breathe.easy.maine@gmail.com

Connect with us Socially:

www.facebook.com/BreatheEasyMaine

www.twitter.com/BreatheEasyME

Applications Due:

10/23/14