Continuing our series on the Irish Healthcare Awards, Valerie Ryan looks back at how, for the first time in Ireland, an entire hospital campus was declared smoke-free
A third major hospital has just gone entirely smoke free, banning patients, visitors and staff from lighting up anywhere on its campus.
The Mater Hospital joins St Vincent’s University Hospital (SVUH) and Connolly Hospital in Dublin, and also Cork University Hospital (CUH) in imposing a smoking ban on its grounds.
In January 2009, St Vincent’s became the first Irish hospital to introduce a smoke-free campus policy, followed by Connolly Hospital in Blanchardstown in May 2009.
Then in June this year, CUH followed to become the first hospital outside of Dublin to declare itself a smoke-free zone following the introduction of a smoking ban for patients, visitors and staff on the hospital campus.
The latest hospital to go smoke-free was the Mater on July 1 — and more are due to follow suit over the next five years.
The Department of Preventive Medicine at SVUH received so many calls enquiring about its initiative and the implementation of the policy, that it organised a training day on September 14 last year to share its approach. At this stage, there are more hospitals planning to come on board.
The lead shown by St Vincent’s was recognised at last year’s Irish Healthcare Awards, when the smoke-free project took home the award for Best Public Health Initiative.
The 2009 Irish Medical Times Healthcare Award — presented for the ‘Implementation of the first smoke-free hospital campus policy in Ireland at St Vincent’s University Hospital’ — “validated the good work that was done and helped in raising the profile” of the project, explained Health Promotion Co-ordinator at SVUH, Denise Comerford.
Six years ago, Ireland became the first country in the world to introduce a law banning smoking indoors in workplaces, but no health services opted for a smoking ban both indoors and outdoors.
Uncharted territory
Instead, a certain level of smoking was tolerated — facilitated by outdoor, open structures or bins at doorways. As Prof Cecily Kelleher and colleagues at SVUH and UCD explained in a published review of the implementation of the policy, it was felt to be uncharted territory, as public acceptance of the indoor ban had not been tested.
Secondly, there were compassion and civil-liberties issues to be addressed for patients, particularly whether smokers had a right to smoke outside when in hospitals. Thirdly, the implementation process had not been tested.
The smoke-free policies introduced across hospital campuses have involved long-term and step-by-step planning measures. The SVUH and UCD group say the process put in place to reach the point where an outright ban could be declared was lengthy and extensive, but necessary.
The St Vincent’s project was achieved by firstly setting up a steering group to develop a smoke-free campus policy and direct the implementation plan for January 1, 2009. The policy was communicated to all patients, staff and visitors over a six-month period from June to December 2008.
Nicotine replacement
Support was offered to staff and to patients who wanted to quit or manage their smoking — while at work or while as an inpatient — through the smoking advice service and free nicotine-replacement therapy (NRT).
Training was offered from June 2008 to February 2009 to clinical staff on how to manage patients who smoked and on dealing with difficult case scenarios. And finally, an observational audit of the grounds was carried out to assess compliance with the policy from January to March 2009.
The Department of Preventive Medicine and Health Promotion had been carrying out surveys on the prevalence of smoking among patients and staff since 1997. In the 2006 survey, it found that the majority of patients and staff agreed with the introduction of a campus-wide smoking ban. More recently, a survey was carried out at one year post-introduction of the smoke-free campus, in March 2010.
Extensive information will be available on completion of the data analysis, on smoking prevalence, attitudes of patients and staff to the policy and general compliance. It is expected this information should be available in September.
Smoke-free
On average, 2,500 people pass through the hospital every day and an estimated 725 of these are smokers. A patient information leaflet was developed to inform patients that the hospital was going smoke-free from January 1, 2009 and included information on NRT and support services available in the hospital and the community.
This was sent with appointment letters and the policy was relayed through the patient handbook, signage, digital TV system and recurring audio announcements at all main entrances. They also made sure to inform local services in the catchment area such as GPs, pharmacies, fire brigade and ambulance services.
Staff were informed of the policy through a series of measures – awareness and education sessions on each ward for nursing staff and healthcare assistants; local department meetings; and presentations at heads of department meetings.
All available existing lines of communications were used, such as newsletters, user emails, notice boards, stands, signage and hospital intranet.
A written protocol for managing patients who smoke at the time of admission was developed and circulated to all wards. A support structure for patients and staff who smoke, and for staff dealing with patients who smoke, was also put in place.
Patient referrals to the smoking advice service increased between January and February 2009.
Staff referral levels increased, reaching peak levels in December 2008 and January 2009. Units of NRT prescribed multiplied eightfold in January 2009 compared to January the previous year. However, this is returning to previous levels.
Litter free
After the introduction of the smoking ban, an audit showed high compliance by patients, staff and visitors. The visibility of litter decreased, as well as litter from cigarette butts. Smoking-related written report incidents peaked in January but in the months following the introduction, they declined.
Irish Medical Times is looking to hear from anyone who has identified a potential idea in the past year and developed a project aimed at improving the delivery of healthcare.
The entries in the Irish Healthcare Awards are judged by an independent panel of experts who look for ideas that solve problems in the health service, bridge gaps and improve patients’ lives.
“We are looking for projects and initiatives that demonstrate originality, innovation and excellence,” said IMT’s Dylan Conway.
l For further information on any aspect of the 2010 Awards contact Dylan at Tel: (01) 8176330 or email: dylan.conway@imt.ie
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