2. Why? Tobacco use is a primary cause of delayed healing following hospital treatment and approximately doubles the risk of complications and emergency readmissions Smoking is the number one cause of premature death and illness in the UK Research shows patients and visitors to a hospital site do not think smoking should be allowed on site Second hand smoke and tobacco related litter lowers the quality of the environment of the hospital Why this Hospital Has Gone Smokefree

3. What does this mean? Smoking is not allowed anywhere on the hospital site Staff may not smoke during the working day except during unpaid breaks. Staff must leave the site and not be identifiable as staff members when smoking There are no exceptions to this rule Staff who smoke should remove the smell of tobacco before having contact with patients and members of the public N.B. These points can be adapted to include individual regulations in the hospital smokefree policy (Name)Hospital Has Gone Smokefree

4. How? All members of staff will have a responsibility to approach smokers and inform them the hospital site is 100% Smokefree Patients will be offered nicotine replacement therapy (NRT) to treat cravings for tobacco while an inpatient The local stop smoking service will provide clinics at the hospital for staff and patients Senior management will undertake regular walks to identify smoking on site Smokefree Hospital cards and leaflets will be available for staff, patients and members of the public. (Name) Hospital Has Gone Smokefree

5. Please visit link to policy Speak to your line manager Contact local stop smoking service Further training Support to stop smoking More information

6. Very brief advise on stopping smoking is the single most cost effective preventative intervention Opinions of Healthcare Practitioners (HCP) are crucial to the success of stop smoking interventions Brief advice from a HCP should be delivered opportunistically during a routine consultation (Whether or not they are seeking help with stopping smoking) 40% of smokers make a quit attempt following brief advice from a GP

7. Smoking related deaths in the UK Equivalent to a full jumbo jet crashing every day of every year with no survivors

8. The Weapon of Mass Destruction Common UseCommon Use Nail polish removerNail polish remover Floor and toilet cleanerFloor and toilet cleaner Rat poisonRat poison Industrial solventIndustrial solvent Diesel exhaustDiesel exhaust Cigarette lighter fluidCigarette lighter fluid Rechargeable batteriesRechargeable batteries Car exhaustCar exhaust InsecticideInsecticide Preservative for dead bodiesPreservative for dead bodies Barbeque lighterBarbeque lighter Gas chamber poisonGas chamber poison FlaresFlares Swamp gasSwamp gas Rocket and car fuelRocket and car fuel Moth ballsMoth balls Insecticide and the addictive drug in tobaccoInsecticide and the addictive drug in tobacco Petrol additivePetrol additive DisinfectantDisinfectant Radioactive compoundRadioactive compound Candle waxCandle wax Aeroplane and missilesAeroplane and missiles ExampleAcetoneAmmoniaArsenicBenzeneBenzo(a)pyreneButaneCadmium Carbon Monoxide DDTDieldrinFormaldehydeHexamine Hydrogen Cyanide MagnesiumMethaneMethanolNaphthaleneNicotineNitrobenzene Nitrous Oxide Phenols Polonium 210 Stearic Acid Titanium

9. Numbers Needed To Treat to prevent one death OutcomeInterventionNNT StatinsPrevent 1 death over 5 years 107 Antihypertensive therapyPrevent one stroke, one MI death over 1 year700 Cervical cancer ScreeningPrevent 1 death over 10 years1140 GP brief advice to stop smoking <5 minutes Prevent one premature death*80 … + pharmacological supportPrevent one premature death*38-56 …+ behavioural supportPrevent one premature death*16-40 *Over half of all smokers will die prematurely from a smoking-related disease. For every 2 long term quitters one premature death is avoided (Doll & Peto)

10. 20 minutes Blood pressure and pulse return to normal Circulation improves in hands and feet, making them warmer 8 hours Nicotine and carbon monoxide levels in the blood reduced by half 24 hours CO levels eliminated from the body Lungs start to clear out mucus 48 hours Nicotine eliminated from the body. Taste/smell improved 72 hours Breathing becomes easier as the bronchial tubes relax. Energy levels increase The minute smoking stops, the benefits begin!

11. 2-12 weeks Blood circulation improves 3 to 9 months Cough’s and breathing problems improve: Overall lung function may improve by 5-10% 5 years Risk of heart attack falls to about half of that of a smoker 10 years Risk of lung cancer falls to half of that of a smoker 15 years Relative risk of lung cancer only slightly greater then that of a non- smoker. Risk of heart attack is almost same as someone who’s never smoked. ……benefits continued

12. Good News!! 70% of smokers want to stop Patients expect smoking to be raised as a subject during a healthcare intervention

13. The 3 A’s ASK Identify smoking status ADVISE The best way to stop ASSIST Refer to Stop Smoking Support for advice

14. ASK Be alert to opportunities for brief advice Ask smoking status and record it Raise the issue sensitively Examples of asking the question. Do you smoke Are you a smoker Have you smoked or used tobacco in the last 2 weeks?

15. Advise The offer of support is better than advising to stop ‘We know that the best way to stop is with free support and medication’ Or ‘Have you ever thought of stopping or tried to stop before? I can tell you where to get the best help.’ Or ‘With the right support you are more likely to stop and stay stopped and this will help reduce the amount of time you are in hospital’

16. ASSIST ‘ Local Stop Smoking Support can offer you advice on quitting. ‘You are up to 4 times more likely to stop with support ‘Shall I refer you? It really is the best thing you can do right now. And ….it’s a free advice service’

17. Add in here the details of your Stop Smoking Service and how to refer