1. Smoke-free Hospital Environments Linda A. Thomas, MS University of Michigan Health System Tobacco Consultation Service

2. LEADING CAUSES OF DEATH IN U.S. Heart DiseaseSmoking, Cholesterol, Exercise CancerSmoking EmphysemaSmoking StrokeHypertension, Smoking

3. Smoking-Related Causes of Increased Costs in the Workplace n Absenteeism n Medical and Dental care costs n Health insurance and life insurance costs and claims n Disability and premature mortality n Worker’s compensation payments n Accidents and fires

4. As much as 35 minutes per smoker per day (or 18.2 days per smoker per year) is lost on smoking and smoking rituals.

5. Excess absenteeism costs an employer an estimated $330 extra a year for each smoker on the payroll.

6. Recovery room stays are longer for smokers than nonsmokers

7. The charges for a longer stay in the recovery room are at least 20% higher for smokers than for nonsmokers

8. Patients who smoke regularly before surgery have twice the risk of wound infection as nonsmokers

9. Smoking is the most common cause of pulmonary morbidity during surgery and anesthesia

10. The Problem n Over 440,000 deaths occur annually due to tobacco use. n The mission of health care facilities is at odds with current practices. n Movement to a smoke-free environment requires significant change and commitment.

11. Multi-Action Plan n Total ban on smoking both indoors and outdoors. n Identify and treat all admitted patients who are tobacco users. n Provide outpatient smoking cessation for all patients, visitors, and employees.

12. Pros for a Smoke-free Environment n Sets a clear example of good health practices. n Puts employees, patients and guests first by providing a healthy, smoke-free atmosphere. n Lower clean up costs. n Encourages both employees and patients to quit tobacco use. n Lower long-term health care cost.

13. Cons to a Smoke-free Campus n Creating a major cultural change n More difficult to implement due to compliance problems n No place for the stressed, addicted smoker to go

14. Obstacles n Hospitals traditiontradition confrontationconfrontation short-term interestshort-term interest n Insurance Plans turn over of customersturn over of customers up front costup front cost n Physicians reimbursementreimbursement lack of educationlack of education

15. Obstacles n Employees n Risk Management/Security n Dying Patients n Psychiatric Unit n Family member stress n Patient rights n JCAHO n Unions

16. First Steps to Implement SFE n Change attitudes n Change people’s roles n Change standards of health care

17. A Checklist for Action n Announce top management’s commitment to creating a SFE n Create task force to plan implementation n Develop a timetable

18. A Checklist for Action (con’t.) n Gather information Medical, economic and social effects of smokingMedical, economic and social effects of smoking Smoke-free policies of other organizationsSmoke-free policies of other organizations Facility questionsFacility questions Employee positionsEmployee positions Your institution’s existing policyYour institution’s existing policy Legal issuesLegal issues

19. A Checklist for Action (con’t.) n Draft an implementation plan n Announce policy and implementation plan to all employees from leadership Educate employees, patients, and guests

20. A Checklist for Action (con’t.) n Make changes to facilitate SFE. n Enforce the policy. n Evaluate and refine policy. Be flexibleBe flexible Be patientBe patient

21. Enforcement n Supportive n Clear definition of smoke-free area n Intervention cards n Signage n Employee compliance Patients and guests follow the example of your employeesPatients and guests follow the example of your employees Consistent policy for all staffConsistent policy for all staff Whatever your policy, enforce itWhatever your policy, enforce it

22. UMHS Lessons Learned n Implement a policy you can enforce n Remember this policy is like hand washing or parking issues n Never assume you have communicated enough n Enforcement happens Be clear, be consistent, start from the beginningBe clear, be consistent, start from the beginning n Patience is a virtue n Repetition, Repetition, Repetition

23. Want more assistance? There is free assistance to those hospitals who wish to go smoke-free. There is a CD and consultants available to assist. For more information call Linda Thomas at 734-936-5988 Funding for this project provided by the Michigan Department of Community Health- Tobacco Section