1. Michigan’s Smoke-free Hospital Campuses: Steps to Implementation Michigan’s Smoke-free Hospital Campuses: Steps to Implementation Linda A. Thomas, MS Tobacco Consultation Service University of Michigan Health System

2. The charges for a longer stay in the recovery room are at least 20% higher for smokers than for nonsmokers The charges for a longer stay in the recovery room are at least 20% higher for smokers than for nonsmokers SIlverstein, P: Smoking and wound healing. Paper presented at the Medical Leadership Conference, Effects of smoking: A global perspective, Washington, DC, July, 1991.

3. Smoking will retard wound healing, whether the wound is surgical or the result of trauma or burns. SIlverstein, P: Smoking and wound healing. Paper presented at the Medical Leadership Conference, Effects of smoking: A global perspective, Washington, DC, July, 1991.

4. Patients who smoked regularly before surgery had twice the risk of wound infection as nonsmokers Jones, R. M. (1985). Smoking before surgery: The case for stopping. British Medical Journal, 290, 1873-1764.

5. Smoking is the most common cause of pulmonary morbidity during surgery and anesthesia SIlverstein, P: Smoking and wound healing. Paper presented at the Medical Leadership Conference, Effects of smoking: A global perspective, Washington, DC, July, 1991.

6. The Problem The mission of healthcare facilities is at odds with current practices The mission of healthcare facilities is at odds with current practices Movement to a smoke-free environment requires significant change and commitment Movement to a smoke-free environment requires significant change and commitment

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

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

9. Obstacles Hospitals Hospitals tradition tradition confrontation confrontation short-term interest short-term interest Insurance Plans Insurance Plans turn over of customers turn over of customers up front cost up front cost Physicians Physicians reimbursement reimbursement lack of tobacco related education lack of tobacco related education

10. Obstacles Employees Employees Risk Management/Security Risk Management/Security Dying Patients Dying Patients Psychiatric Unit/Long Term Care Psychiatric Unit/Long Term Care Family member stress Family member stress Patient rights Patient rights JCAHO JCAHO Unions Unions

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

12. Multi-Action Plan Will: Allow cessation efforts to reach broad base of population Allow cessation efforts to reach broad base of population Improve health, productivity, and cost of employees Improve health, productivity, and cost of employees Set example for community and the rest of health care system Set example for community and the rest of health care system

13. Most Important First Steps to Implement SFE Change attitudes Change attitudes Change people’s roles Change people’s roles Change standards of health care Change standards of health care

14. Project Summary Sponsored by the Michigan Department of Community Health Sponsored by the Michigan Department of Community Health Project began April, 2000 Project began April, 2000 Six MI hospitals had implemented smoke- free environment (SFE) at time project began Six MI hospitals had implemented smoke- free environment (SFE) at time project began First step was to survey 166 MI hospitals First step was to survey 166 MI hospitals 95% return rate 95% return rate

15. Project Personnel Jodie Faber, BS – United Memorial Hospital, Greenville Therese Green, MHS – Northern Michigan Hospital, Petoskey Mishelle Bakewell, MA – Holland Hospital Lisa Roberts – University of Michigan Health System, Ann Arbor Thomas Peterson, MD – Michigan Medical PC, Grand Rapids Linda Thomas, MS – University of Michigan Health System, Ann Arbor Jake Weirich – University of Michigan Health System, Ann Arbor

16. Results to Date 26 hospitals with SFE as of 12/1/03 26 hospitals with SFE as of 12/1/03 5 hospitals in stages of implementation 5 hospitals in stages of implementation Materials sent to 73 non-MI hospitals Materials sent to 73 non-MI hospitals Information sent to 4 international hospitals: Britain, India, Australia, and Japan Information sent to 4 international hospitals: Britain, India, Australia, and Japan User friendly CD provides framework for implementing a SFE User friendly CD provides framework for implementing a SFE

17. SFE Implementation CD-Rom

18. Introduction Page of CD

19. CD Topics Include Contact Information and project personnel credentials Contact Information and project personnel credentials SFE Implementation Checklist SFE Implementation Checklist Typical Concerns and Suggested Solutions Typical Concerns and Suggested Solutions Adaptable Powerpoint presentation Adaptable Powerpoint presentation Suggestion/material examples for staff education Suggestion/material examples for staff education

20. Topics Included in CD continued Ideas for implementing an Outpatient Tobacco Cessation program Ideas for implementing an Outpatient Tobacco Cessation program Ideas for implementing an Inpatient (bedside) Tobacco Cessation program Ideas for implementing an Inpatient (bedside) Tobacco Cessation program Policy, signage, media examples Policy, signage, media examples Section on legal issues Section on legal issues SFE Implementation examples SFE Implementation examples JCAHO Core measures JCAHO Core measures AHRQ Guidelines AHRQ Guidelines ACCESS program for cessation program and follow-up data ACCESS program for cessation program and follow-up data

21. Implementing an Inpatient Program

22. For Information or CD Contact: Linda Thomas, MS UMHS Tobacco Consultation Service 300 N. Ingalls 2D19/0430 Ann Arbor, MI 48109/0430 ph.734-936-5988 ph.734-936-5988 fax 734-647-1516 quitsmoking@med.umich.edu www.med.umich.edu/mfit/tobacco