100% Tobacco Free Healthcare Campus

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100 Tobacco Free Healthcare Campus
Lead agency for theCrawford Co Coalition for
Tobacco PreventionFunded by the Ohio Tobacco
Prevention Foundation Suzanne Binau, BS, RE
Coordinator
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Coalition formed for Tobacco Use Cessation
Prevention
July 2003, grant awarded to the Crawford Co
Coalition by the Ohio Tobacco Prevention
Foundation, funded by the Master Settlement
Agreement major tobacco companies 46 states.

• Bucyrus Community Hospital- Lead Agency - Adult
  Youth Cessation.
• Crawford Co Alcohol, Drug Addiction Mental
  Health Board-youth tobacco use prevention
• Crawford Co Family Children First
  Council-secondhand smoke education youth
  tobacco use prevention

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12 Steps to adopting100 Tobacco Free Campus

• 1) Form a policy review committee including
• President/CEO
• Medical Chief of Staff
• Human Resource Manager
• Public Relations Manager
• RNs, RRTs staff (include two smokers)

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12 Steps to adopting100 Tobacco Free Campus

• 2) The committee reviews the current policy and
  current enforcement
• a) Where do employees smoke?
• b) Where do patients visitors smoke?
• c) Are patients escorted by staff outside to
  smoke?
• d) Do patients on oxygen wheel their tanks
  outside to smoke?

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12 Steps to adopting100 Tobacco Free Campus

• 3) Develop a new comprehensive 100 tobacco free
  campus policy
• a) Cover all forms of tobacco
• b) Refer to all people not just employees, but
  Drs, visitors, patients
• c) Specify all areas of Campus
• d) Include all owned/leased vehicles

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BUCYRUS COMMUNITY HOSPITAL Tobacco Use Policy
(as of 6/17/2004)

• Tobacco use (including, but not limited to
  cigarettes, pipes, cigars, chew, snuff or dip) is
  not permitted anywhere on hospital premises or
  groundstobacco use will not be permitted by
  anyone on hospital propertydefined as, but not
  limited tosidewalks, walkways, parking lots,
  vehicles and driveways under the hospitals
  ownership or control.

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12 Steps to adopting100 Tobacco Free Campus

• 4) Determine Advocates in Hospital
• a) Policy Committee determine a written list of
  reasons for 100 tobacco free campus
• b) Enlist advocates to disseminate reasoning

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12 Steps to adopting100 Tobacco Free Campus

• 5) Determine likely protagonists and understand
  their issues
• a) The two tobacco users on the committee may be
  totally against the policy-find out why
• b) Ask these two Who on staff are likely
  opponents to this policy and why?

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12 Steps to adopting100 Tobacco Free Campus

• 6) Determine how off campus smoking breaks will
  be calculated by payroll
• a) HR Manager will be responsible for answering
  this question
• b) One 15 minute paid break and one 30 minute
  unpaid lunch are only smoking opportunities?

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12 Steps to adopting100 Tobacco Free Campus

• 7) Announce new policy months before
  implementation
• a) Notify doctors in medical staff meeting
  months before effective date b) Notify associates
  by certified mail months before effective date of
  policy
• c) Notify patients visitors of effective date
  of policy. A form for inpatients to sign re
  Notification of policy consequences.

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12 Steps to adopting100 Tobacco Free Campus

• 8) Provide tobacco use cessation program with NRT
  to physicians, visitors and staff at no charge
• a) Offer behavior modification program months
  before effective date
• b) Provide nicotine replacement therapy with
  behavior modification

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12 Steps to adopting100 Tobacco Free Campus

• 9) Implement policy with great fanfare-invite
  media
• a) Stick laminated printed chemical names on the
  butt hut
• b) Take down the butt hut
• c) Remove harmful chemicals/poisons from outdoor
  air

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Cleaning Up the House at Bucyrus Community
Hospital

• Before new policy, BCH had been smoke free
  indoors since 1981, but
• A smoking shelter was located right outside the
  employee entrance
• There are poisons in outdoor secondhand smoke
• When smoking employees return to work the strong
  scent of tobacco on employees effects patient

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Cleaning Up the House at Bucyrus Community
Hospital Because these and many more POISONS
are in second-hand smoke, the 100 policy was
adopted.

• Carbon Monoxide
• Formaldehyde
• Benzene
• Creosote
• Hydrogen Cyanide
• Arsenic
• 4-aminobiphenyl (so toxic banned in the workplace
  for 30 years)

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12 Steps to adopting100 Tobacco Free Campus

• 10) Provide appropriate signage
• a) in the interior and exterior of all buildings
• b) in all parking lots
• c) in all driveways, by sidewalks, patios, etc

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NO SMOKING
or any tobacco use
by ANYONE, ANYWHERE on BUCYRUS COMMUNITY
HOSPITAL PROPERTY
including, but not limited to, buildings, sidewalk
s, walkways, parking lots, driveways and
hospital-owned vehicles.
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12 Steps to adopting100 Tobacco Free Campus

• 11) Enforce the policy
• a) encourage all employees to enforce the policy
• b) plant operations is primarily responsible at
  BCH
• c) teach employees to use scripting Excuse me,
  do you realize that hospital policy states
  smoking in the parking lot is not allowed?

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12 Steps to adopting100 Tobacco Free Campus

• 12) Updates on compliance monthly meetings
• a) Monthly manager meetings-review policy and
  compliance
• b) Managers report on compliance in department
  meetings with staff
• c) Review timesheets-are employees taking more
  than one 15 min smoking break?

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Barriers to Success of Policy

• Myth Im an adult and by law I have a right to
  smoke. BCH cant take that right away.
• Fact The use of tobacco is legal by persons 18
  years of age or older. However, many BCH policies
  require altered behaviors on hospital property
  and during hospital work hours.

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Barriers to Success of Policy

• Fact BCH policy concerning alcohol, a legal
  substance for adults 21 years or older, states
  that alcohol may not be consumed on the property,
  during the working shift or present in the blood
  above a certain level when reporting to work.
• Fact BCH policy states that employees should
  wear minimal or no perfume/cologne as it may
  disturb the respiration of the patients.

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Barriers to Success of Policy

• Myth Patients have a right to smoke. BCH cant
  stop them.
• Fact BCH is committed to improving the health of
  patients during their stay, so altered behaviors
  on hospital property are expected. An alcoholic
  in liver failure will not be provided a drinking
  break while a patient on hospital property.

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Barriers to Success of Policy

• Myth We are under construction. We cant expect
  the construction workers to stop using tobacco on
  the work site.
• Fact When the hospital is committed to improving
  the health of patients and visitors, altered
  behaviors on hospital property are expected of
  everyone. Within one year of the BCH 100 policy
  becoming effective, construction on a 55,000 sq
  ft addition began. Construction workers who do
  not follow the policy are removed from the job by
  the Project Manager.

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Barriers to Success of Policy

• Myth Employees and visitors are forced to go
  across the street and trespass on private
  property to smoke.
• Fact As no one can be forced to quit, no one can
  be forced to smoke. Smokers have been seen in the
  middle of the street or on sidewalks in front of
  private homes to smoke off campus. No one
  forces them to smoke anywhere. They choose to do
  so.

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Barriers to Success of Policy

• Myth Cigarette butts are not trash, so people
  who smoke may throw their butts on the ground.
• Fact Cigarette butts are trash and if smokers
  throw their butts on the ground, they may be
  cited for littering by the police.

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ROLES OF THE BCH TOBACCO TERMINATOR TEAM

• Susan Wise, RRT, RCP, TTS, Project
  Coordinator
• 1) Consults with inpatients, ER, outpatients
  that use tobacco
• 2) Facilitates the Freedom From Smoking Sessions
• 3) Prepares faxes program surveys, class/batch
  forms, attendance records, etc
• 4) Contacts media, coalition members state
  legislators
• 5) Completes Progress Activity forms

• Suzanne Binau, BS,
• RE Coordinator
• 1) Grant proposal writer
• 2) Budgeting Revisions
• 3) Reporting and Evaluation
• Tammi Wolfe, RN, BSN, HealthLink, Vascular,
  Cardiac/Pulmonary Mgr.
• Supervises the team
• Cooperates with other hospital departments

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American Lung AssociationsFreedom From Smoking
(FFS)

• Referral of inpatients from hospital staff
  physicians. Inpatient Pathways info form has
  question Do you use tobacco?
• Referral of ER outpatients from hospital staff
  physicians. Specific question on ER form.

• Referral of patients from physician offices.
  Office staff ask the question Do you use
  tobacco?
• Self-referral through word of mouth (free NRT)-
  Current participants will often bring a family
  member or friend to class.

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American Lung AssociationsFreedom From Smoking
(FFS)

• 1150 Crawford County residents participated in
  FFS classes from 10/2003 to 12/2006.
• 40 are currently enrolled.
• By contract with Galion Community Hospital (GCH),
  Freedom From Smoking is provided in Galion.
  Bucyrus Community Hospital provides GCH with all
  supplies and nicotine replacement therapy as well
  as a fee per participant in FFS.

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American Lung AssociationsFreedom From Smoking

• Classes are offered at different times of the day
  to access all three shifts. At BCH classes are
  provided at 430-530pm, 730-830pm and 9-11am.
  A Saturday 10am-12pm is offered quarterly. BCH
  staff go off-site to businesses to provide FFS to
  employees. GCH offers FFS quarterly at 7-9pm.
• Classes have been offered at 14 different
  locations- ten business sites, two hospitals, one
  Union Hall, and one Public Library.
• Classes, FFS books, supplies, nicotine patches,
  lozenges and gum are completely free of charge
  through OTPF grant.

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American Lung AssociationsFreedom From Smoking

• Objectives
• To increase quit attempts reduce adult tobacco
  use.
• Barrier to success
• Physicians hesitant to refer patients to FFS
  program.
• Participants believe they will be chastised in
  program.
• Participants dont believe program and NRT are
  free.

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American Lung AssociationsAlternative to
Suspension Not On Tobacco (for youth)

• 122 youth were referred by the Crawford Co.
  Juvenile Court or the schools to the Alternative
  to Suspension program from 10/2003 to 12/2006.
• Most classes were provided at Bucyrus Community
  Hospital. Some were provided at the schools and a
  few at Galion Community Hospital.
• Completely free of charge