Smoke-free Hospital EnvironmentsSmoke-free Hospital Environments

Linda A. Thomas, MSLinda A. Thomas, MS

University of Michigan Health SystemUniversity of Michigan Health System

Tobacco Consultation ServiceTobacco Consultation Service

LEADING CAUSES OF DEATH LEADING CAUSES OF DEATH IN U.S.IN U.S.

Heart DiseaseHeart Disease Smoking, Smoking, Cholesterol, ExerciseCholesterol, Exercise

CancerCancer SmokingSmoking

EmphysemaEmphysema SmokingSmoking

StrokeStroke Hypertension, Hypertension, SmokingSmoking

Smoking-Related Causes of Smoking-Related Causes of Increased Costs in the WorkplaceIncreased Costs in the Workplace AbsenteeismAbsenteeism Medical and Dental care costsMedical and Dental care costs Health insurance and life insurance costs Health insurance and life insurance costs

and claimsand claims Disability and premature mortalityDisability and premature mortality Worker’s compensation paymentsWorker’s compensation payments Accidents and firesAccidents and fires

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

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

Recovery room stays are longerRecovery room stays are longer

for smokers than nonsmokersfor smokers than nonsmokers

The charges for a longer stay inThe charges for a longer stay in

the recovery room are at leastthe recovery room are at least

20% higher for smokers than for20% higher for smokers than for

nonsmokersnonsmokers

Patients who smoke regularly Patients who smoke regularly before surgery have twice the before surgery have twice the risk of wound infection as risk of wound infection as nonsmokersnonsmokers

Smoking is the most commonSmoking is the most common

cause of pulmonary morbiditycause of pulmonary morbidity

during surgery and anesthesiaduring surgery and anesthesia

The ProblemThe Problem

Over 440,000 deaths occur annually due to Over 440,000 deaths occur annually due to tobacco use.tobacco use.

The mission of health care facilities is at The mission of health care facilities is at odds with current practices.odds with current practices.

Movement to a smoke-free environment Movement to a smoke-free environment requires significant change and requires significant change and commitment.commitment.

Multi-Action PlanMulti-Action Plan

Total ban on smoking both indoors and Total ban on smoking both indoors and outdoors.outdoors.

Identify and treat all admitted patients Identify and treat all admitted patients who are tobacco users.who are tobacco users.

Provide outpatient smoking cessation Provide outpatient smoking cessation for all patients, visitors, and for all patients, visitors, and employeesemployees..

Pros for a Pros for a Smoke-free EnvironmentSmoke-free Environment

Sets a clear example of good health Sets a clear example of good health practices.practices.

Puts employees, patients and guests first by Puts employees, patients and guests first by providing a healthy, smoke-free atmosphere.providing a healthy, smoke-free atmosphere.

Lower clean up costs.Lower clean up costs. Encourages both employees and patients to Encourages both employees and patients to

quit tobacco use.quit tobacco use. Lower long-term health care cost.Lower long-term health care cost.

Cons to a Smoke-free CampusCons to a Smoke-free Campus

Creating a major cultural changeCreating a major cultural change

More difficult to implement due to More difficult to implement due to compliance problemscompliance problems

No place for the stressed, addicted smoker No place for the stressed, addicted smoker to goto go

ObstaclesObstacles HospitalsHospitals• traditiontradition• confrontationconfrontation• short-term interestshort-term interest

Insurance PlansInsurance Plans• turn over of customersturn over of customers• up front costup front cost

PhysiciansPhysicians• reimbursementreimbursement• lack of educationlack of education

ObstaclesObstacles

EmployeesEmployees Risk Management/SecurityRisk Management/Security Dying PatientsDying Patients Psychiatric UnitPsychiatric Unit Family member stressFamily member stress Patient rightsPatient rights JCAHOJCAHO UnionsUnions

First Steps to Implement SFEFirst Steps to Implement SFE

Change attitudesChange attitudes

Change people’s rolesChange people’s roles

Change standards of health careChange standards of health care

A Checklist for ActionA Checklist for Action Announce top management’s Announce top management’s

commitment to creating a SFEcommitment to creating a SFE

Create task force to plan Create task force to plan implementationimplementation

Develop a timetableDevelop a timetable

A Checklist for Action (con’t.)A Checklist for Action (con’t.)

Gather informationGather information• Medical, economic and social effects of Medical, economic and social effects of

smokingsmoking• 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

A Checklist for Action (con’t.)A Checklist for Action (con’t.) Draft an implementation planDraft an implementation plan Announce policy and Announce policy and

implementation plan to implementation plan to

all employees from all employees from

leadershipleadership

Educate employees, patients, and guestsEducate employees, patients, and guests

A Checklist for Action (con’t.)A Checklist for Action (con’t.)

Make changes to facilitate SFE.Make changes to facilitate SFE.

Enforce the policy.Enforce the policy.

Evaluate and refine policy.Evaluate and refine policy.• Be flexibleBe flexible

• Be patientBe patient

EnforcementEnforcement SupportiveSupportive Clear definition of smoke-free areaClear definition of smoke-free area Intervention cardsIntervention cards SignageSignage Employee complianceEmployee compliance• Patients and guests follow the example of your Patients and guests follow the example of your

employeesemployees• Consistent policy for all staffConsistent policy for all staff• Whatever your policy, enforce itWhatever your policy, enforce it

UMHS Lessons LearnedUMHS Lessons Learned Implement a policy you can enforceImplement a policy you can enforce Remember this policy is like hand washing or Remember this policy is like hand washing or

parking issues parking issues Never assume you have communicated Never assume you have communicated

enoughenough Enforcement happensEnforcement happens• Be clear, be consistent, start from the beginningBe clear, be consistent, start from the beginning

Patience is a virtuePatience is a virtue Repetition, Repetition, RepetitionRepetition, Repetition, Repetition

Want more assistance?Want more assistance?

There is free assistance to those hospitals There is free assistance to those hospitals who wish to go smoke-free. There is a CD who wish to go smoke-free. There is a CD and consultants available to assist.and consultants available to assist.

For more information call Linda Thomas For more information call Linda Thomas at 734-936-5988at 734-936-5988

Funding for this project provided by the Funding for this project provided by the Michigan Department of Community Health- Michigan Department of Community Health- Tobacco SectionTobacco Section