2. Overview Why tobacco control at TBRHSC? Smoke-Free Grounds Policy
Implementation plan
Supports for staff
Supports for patients
Question & Answer

3. Why tobacco control at TBRHSC?
Demonstrates commitment to improving health of people in NWO
Puts health of patients first
Part of an academic and research-based, acute care environment
Favours those committed to healthy lifestyles
Smoke-Free Grounds are supported by the majority of community and partners
We held engagement sessions with the community, staff, patients late in 2011 and early 2012 where it was made clear that we should keep our grounds smoke-free – this also meant without building designated smoking sections.

4. Tobacco Control Strategy
TBRHSC Board of Directors
TBRHSC Senior Management Council
Chronic Disease Prevention & Management
Prevention & Screening Council
Steering Committee
(PFA)
Plan has received approval from the Board, Senior Management Council, endorsement from the Medical Advisory Committee, and has also received support at the Director and Management levels when we presented at a manager engagement session in March.
There are about 50 people working on this project between the Steering Committee and 3-sub Working Groups.
Smoke-Free Grounds Working Group
(PFA)
In-patient
Working Group
Out-patient
Working Group

5. Smoke-Free Grounds Policy
Policy defines tobacco products not allowed on grounds
Map of TBRHSC Grounds
Includes our parking lots and vehicles on our grounds
Expectations & Responsibilities of TBRHSC Staff
Smoke-Free Ontario Act
Compliance Guidelines
Policy revised and approved by the Policy and Procedures Committee in March.
Tobacco products included: tobacco in any processed or unprocessed form that may be smoked, inhaled, or chewed, including but not limited to snuff, chewing tobacco, snus, cigarettes, contraband cigarettes, cigarillos, cigars, pipe tobacco, hookah pipe, herbal cigarettes, or any products which can be smoked legally or otherwise (e.g., Marijuana); E-cigarettes are also prohibited.
We expect that all staff uphold and demonstrate the values of our organization, including our smoke-free grounds.
Compliance guidelines in the back of the policy used to help guide us as we move forward.

6. Map includes our parking lots, and the vehicles in them, as well as the new Health Services Building on Oliver Road.

7. Implementation Plan Launch Date – May 31 Education and Awareness
Go Live – Sept. 30
Compliance
April
May
June
July
Aug.
Sept.
Manager training
Staff information, awareness, education

8. Supports for Staff Greenshield Benefits for Full-and Part-time staff
$500 each per Lifetime for benefit holder and spouse
Community pharmacists and Occupational Health & Safety
Community partners
Thunder Bay District Health Unit: Take Control, Smokers’ Helpline, The Quit Coach
Pharmacists are now able to provide cessation support through counseling and prescribing NRT to patients as part of their scope of practice.
Best practice evidence shows NRT + counseling has the best quit results.
We’re not asking you to quit smoking, we’re asking staff not to smoke while they’re at work.

9. Supports for Patients Inpatients Outpatients Brief intervention (5A’s)
Nicotine replacement therapy medical directive
Bedside smoking cessation counseling and follow-up
Smokers’ Helpline referral
Outpatients
Working to provide counseling in outpatient clinics
RNAO best practice spotlight project at TBRHSC

10. Supports for Visitors Care kits at Information Desk
Information pamphlets with support
Internet page

11. Smoking Cessation and Cancer Patients
Improves post-surgical would healing and lowers risk of pneumonia and respiratory failure
Radiation therapy and chemotherapy – improves response of treatment and survival
Lowers risk of complications, recurrence, and a second primary cancer
Cancer diagnosis is a teachable moment for the patient and family members
While some perceive smoking cessation following a cancer diagnosis as a little too late, smoking cessation activities in the regional cancer program have great potential to decrease the burden of illness resulting from tobacco use – especially in NWO where our rates of smoking are so high.
References:
McBride & Ostroff, 2003
USDH, 2004
Parsons, Daley, Begh, & Aveyard, 2010
Travis et al, 2006
McBride et al, 2003
Patterson et al, 2010

12. Smoking Cessation – Regional Cancer Programs
Screen all new ambulatory cancer patients
Standardize screening questions, referral questions, and data collection
Monitor effectiveness of the Smoking Cessation Framework
Develop and maintain an inventory of smoking cessation services available within each LHIN
Establish partnerships
Take steps to minimize risks to implementation and increase sustainability
Cancer Care Ontario initiative
- Cancer risk reduction is a priority in Ontario Cancer Plan III
Regional Cancer Programs are to be role models for risk reduction by 2015
- Smoking Cessation Framework recommendations from the Smoking Cessation Steering Committee (formed in 2012)
Purpose was to recommend an approach to smoking cessation for ambulatory care patients in RCPs, outlining minimum standards of service and expected outcomes.

13. RCP’s are required to:
Identify all current and recent tobacco users among new ambulatory patients, offer brief advice on benefits of quitting and referral to internal or external cessation service
Adhere to standardized questions
Identify and establish referral relationships with partners
Provide data to Cancer Care Ontario for analysis and evaluation

14. Standardized Data
Proportion of new patients asked the tobacco use screening question
Proportion of screened patients who are current or recent tobacco users
Proportion of current or recent tobacco users given a referral offer
Proportion of current or recent tobacco users who accept the offered referral for cessation advice
Data will be collected quarterly by CCO.

15. RCC-NW Process
Train staff in brief intervention and revised patient assessment in Mosaiq
Designate trained staff to identify and complete the patient assessment
Crystal report to be built for data to be sent to CCO
Reports to be shared with RCCNW staff for ongoing process improvement and sharing quit success stories
- Share care kits, CCS booklets, and ask for feedback about needs for resources and further education

16. Question & Answer