Smoke-Free Policy

Smoke-Free Policy

Guy’s and St Thomas’ NHS Foundation Trust is committed to providing a healthy and safe environment for patients, carers, visitors and staff. Smoking on Trust premises, including buildings and grounds, is strictly prohibited.

Document Detail
Policy group / General
Version / [ 12/03/15]
Approved by / TME 14.5.2015
Effective from / June 19.6.2015
Date last reviewed
Date of next review / May 19th 2018
Owner / Chief Nurse
Responsible Lead / Yinglen Butt
Stakeholder Group / Smoke-free steering group
Superseded documents
Related documents
Keywords / Smoking, smoke-free,
Document History
Date / Comments / Approved by
14.5.2015 / Policy presented at TME and signed off / TME

No Smoking – Smoke Free Policy Page 3 of 8

1 Scope

This policy applies to all patients and visitors, including parents and carers of any users of our services. The policy applies to all staff employed under a contract of service by Guys and St Thomas’ NHS Foundation Trust, including permanent/temporary staff, volunteers and students.

2 Rationale

2.1 This policy is the second phase of our work to have a smoke-free Trust, following the implementation of the no smoking policy for staff in January 2014.

2.2 Compliance with the Smoke Free Regulations 2006.

2.3 Compliance with the Health and Safety at Work Act ensuring employees, patients, visitors and contractors are not exposed to risks due to smoking, second hand smoke or associated risks of fire.

2.4 Compliance with the National Institute for Health and Care Excellence guidance and its recommendation to promote no smoking as the norm for people using our services and a smoke free hospital environment.

2.5 The Trust’s responsibility to protect and improve the health and well-being of all patients, visitors and staff and comply with the Health Act 2006.

2.6 The Trust’s public health responsibility to improve the health of the local population beyond those who are currently receiving health care.

2.7 To support the activities of the local Tobacco Control Alliance in reducing the prevalence of smoking.

3 Policy Objectives

3.1 To have a Trust wide systematic approach to support no smoking whilst on trust premises.

3.2 To reduce the impact of smoking on patients, visitors and staff.

3.3 To ensure the Trust promotes good health and publicises its commitment to reducing smoking and its associated risks.

3.4 To raise awareness of the dangers of smoking and passive smoking.

3.5 To maintain the Trust’s commitment to have smoke-free grounds.

4 Duties

4.1 The implementation of the smoke free policy will be monitored by the Smoke Free Steering Group reporting to the Health and Well Being Stakeholder Forum and the Trust Board of Directors.

4.2 Accountability is to the office of the Chief Nurse where the importance of no smoking is recognised and promoted and where responsibility for patient and carer experience sits.

4.3 The Deputy Chief Nurse is responsible for ensuring that:

· The smoke-free policy is recognised as a Trust wide initiative to reduce risks to patients and visitors and promote their health and wellbeing.

· The impact of patient and carer experience is considered and included in the implementation of this policy.

· Effective protocols are developed to support policy delivery.

· The 10 minute Very Brief Advice (VBA) e-learning is accessible to all staff.

· Ensuring systems are established for monitoring Trust smoke-free status.

· There is participation in internal audits as required.

· The staff No smoking Policy is reinforced across the organisation.

Directorate Management Teams are responsible for:

· Ensuring that all staff are familiar with this and the staff no smoking policy and that they know how to sign-post patients to stop smoking services.

· Ensuring compliance forms part of performance reporting.

· Being advocates for the policy.

· Releasing staff for the 10 minutes VBA e-learning.

· VBA e-learning forming part of local induction.

Clinical staff are responsible for:

· Assessing smoking status as part of all clinical assessments (Making Every Contact Count).

· Reviewing the 10 minute Very Brief Advice (VBA) e-learning by Doctors & nurses.

· Offering smoking cessation referral to all smokers.

· Doctors ensuring nicotine replacement therapy (NRT) is prescribed to all in-patient smokers.

· Advising all planned admissions of the Trust’s smoke-free policy and signposting them to stop smoking services prior to admission.

· Pharmacists ensuring there is adequate NRT available in wards and departments.

· Contributing to audits as required.

4.4 Security staff are responsible for:

· Ensuring Trust grounds and premises remain smoke-free.

· Being advocates for the policy.

4.5 Stop smoking service team are responsible for:

· Having available clinics to respond to stop smoking requests.

· Supporting patients and visitors through their abstinence or quit journey.

· Leading training and information sessions to ensure shared organisational knowledge on no smoking approaches.

· Support all clinical areas in their implementation of the policy.

4.6 The Training and Development Department will work with the stop smoking team to ensure stop smoking messages are included in all staff induction. They will organise training as required in collaboration with the stop smoking services.

4.7 All staff have a responsibility to review this policy, promote and support our smoke-free site.

5.0 POLICY DELIVERY & IMPLEMENTATION

5.1 The Trust will have arrangements in place to ensure it meets its obligation to be a smoke-free environment in line with the NICE guidance 48.

5.2 It will ensure the CO4 requirements of the London Clinical Senate underpin all its undertakings with the agreed systems for compliance and must include:

· Conversations with every patient and staff member who smokes so they have the chance to quit, referring if necessary to Stop Smoking Services.

· Make routine desktop exhaled carbon monoxide (CO) monitoring by clinicians possible.

· Code the intervention so can be evaluated for effectiveness – including death certification.

5.3 PATIENTS

5.4 Patients must be informed of the smoke-free policy prior to elective admission, appointment or procedure and advised how to access NRT prior to admission. Unplanned admissions should be informed of the smoke-free policy as early as possible.

5.5 Trust employees who are healthcare professionals must be confident in identifying patients who are tobacco users and documenting smoking status. All patients should have options to discuss NRT. Training is available to all staff to support them in implementing this for patients (www.ncsct.co.uk/kingshealthpartners).

6 APPLICATION Of THE POLICY

6.1 VISITORS/PATIENTS

6.2 Visitors and patients must not smoke on the Trust premises or in the grounds. Patients will be offered guidance and support to remain smoke-free throughout their visit or admission period at the Trust.

6.3 Trust equipment will not be allowed off the grounds.

6.4 Trust managers must ensure that all staff are appropriately trained to discuss the policy, offer support and if necessary challenge anyone who does not comply with the smoke-free policy. It is the responsibility of every member of staff to raise awareness with anyone who is not adhering to the policy, where they feel safe to do so.

6.5 Staff must not escort patients off the ward for the purpose of smoking. If a patient asks to leave the ward for the purpose of smoking a member of staff must remind the patient of the smoke-free site policy and offer the patient NRT to support them with nicotine withdrawal during their hospital admission.

6.6 Persistent failure to adhere to our smoke-free policy will be managed in line with ‘Managing challenging behaviour’ protocol at the earliest possible opportunity.

7 Supporting Patients in Evelina London Children’s Hospital and their parents/carers

7.1 Where appropriate, children and young people should be given verbal and written information about the risks of smoking and about the health benefits of stopping smoking.

7.2 Children or young people who smoke should be offered referral to specialist smoking cessation support and pharmacotherapy as appropriate.

7.3 Parents or carers who smoke, who may be resident with their child for extended periods, should be informed of the Trust smoke-free policy and directed to how they can access support to be smoke-free. This includes offering them Nicotine Replacement Therapy to manage the symptoms of smoking cessation or temporary nicotine withdrawal during their child’s hospital admission.

8 Smoking Cessation for Patients

8.1 All patients should be screened for smoking status and this information recorded.

8.2 In-patients who are current smokers should be informed of the Trust smoke-free policy and offered Nicotine Replacement Therapy to treat nicotine withdrawal during their hospital admission.

8.3 In-patients who are current smokers should be offered specialist services and onward referral to their local stop smoking service on discharge as appropriate.

8.4 Patients who agree to be referred to their local stop smoking service should be prescribed an adequate supply of NRT (at least two weeks supply) on discharge to meet their needs until their local service makes contact.

8.5 Patients attending the hospital as outpatients should be made aware of the Trust smoke free policy, and referred to their local stop smoking service or signposted to the hospital pharmacy.

8.6 Carers, family members and other visitors to the hospital should be made aware of the Trust smoke-free policy, directed to how they can access support to be smoke-free or signposted to the hospital pharmacy.

9 Supporting Patients during pregnancy and childbirth

9.1 Pregnant women accessing Trust pregnancy and childbirth services should be asked about smoking status. This should be recorded at the first maternity booking and in line with National Institute of Health and Care Excellence guidance.

9.2 Pregnant women’s exposure to tobacco smoke should be assessed with the use of carbon monoxide monitors.

9.3 Pregnant women accessing Trust pregnancy and childbirth services should be given verbal and written information about the risks of smoking and exposure to passive smoking to the unborn child, and information about the health benefits of stopping smoking.

9.4 Pregnant women accessing Trust pregnancy and childbirth services who smoke should be offered referral to specialist stop smoking support.

10 Supporting Staff

10.1 Staff including contractors who smoke can access support from the stop smoking service to quit or withdraw from smoking, whilst on duty.

10.2 Staff will have support from the stop smoking service when managing the care of patients who smoke.

10.3 Staff must access the 10 minute very brief advice e-learning to support them in Making Every Contact Count.

10.4 Staff offering domicillary visits should advise any patients who smoke of the Trust smoke-free policy and request that the patient/carer does not smoke for at least an hour before the planned visit.

11 Electronic Cigarettes

11.1 E-cigarettes are included in the Smoke-Free Policy and their use is not permitted in Trust premises or grounds. While there is some evidence that they may support smoking cessation, they are currently not regulated as a tobacco product or as a medicine in the UK.

11.2 Staff must ensure that any patient bringing an e-cigarette into the hospital is offered approved nicotine replacement therapy as per Trust NRT withdrawal protocols.

12 MONITORING & ASSURANCE

12.1 This policy will be reviewed by the GSTT Smoke-free Steering Group on a quarterly basis and findings reported at the Health & Well Being Stakeholder Forum.

12.2 The Board will receive reports on the implementation of this policy and its impact.

12.3 The Trust incident reporting system will be used to record and collate any adverse

incidents resulting from the implementation of the policy.

Policy Objectives / Monitoring methods / Assurance /
Trust wide systematic approach to support no smoking whilst on Trust premises. / · Audit of procedures and pathways.
· Training compliance reviews.
· Prescribing rates for NRT and varenicline in Trust. / TME
To reduce the impact of smoking on patients, visitors and staff. / · Regular reporting on numbers of patients with smoking status recorded, numbers of patients offered smoking cessation treatment and/or brief verbal advice, numbers of patients quitting smoking after hospital initiated quit smoking attempt. / TME
To ensure the Trust promotes good health and publicises its commitment to reducing smoking and its associated risks / · Audit /Review of smoke-free information. / TME
To raise awareness of the dangers of smoking and passive smoking / · Patient and staff feedback. / TME
To maintain Trust commitment to have smoke-free grounds / · Regular reviews and reporting of policy compliance. / TME

13 References

· The Health Act 2006, Department of Health

· NICE Guideline on Quitting Smoking in Pregnancy and following Childbirth. (PH 26), June 2010

· NICE Guideline on Smoking cessation in Secondary care: acute, maternity and mental health services. (PH 48), November 2013

· British Thoracic Society Smoking Cessation information https://www.brit-thoracic.org.uk/clinical-information/smoking-cessation/

· Smoking Kills - A White Paper on Tobacco https://www.gov.uk/government/publications/a-white-paper-on-tobacco

· Healthy Lives, Healthy People https://www.gov.uk/government/publications/healthy-lives-healthy-people-our-strategy-for-public-health-in-england

· WHO Framework on Tobacco Control Report on Electronic Nicotine Delivery Systems – July 2014. http://apps.who.int/gb/fctc/PDF/cop6/FCTC_COP6_10-en.pdf

· Schraufnagel et al (2014) Electronic cigarettes: A position statement of the Forum of International Respiratory Societies. AJRCCM. 190(6): 611-618. http://www.atsjournals.org/doi/abs/10.1164/rccm.201407-1198PP#.VCLV3fldV4

· RCP statement on e-cigarettes – June 2014. https://www.rcplondon.ac.uk/press-releases/rcp-statement-e-cigarettes

· ASH briefing on e-cigarettes – June 2014. http://www.ash.org.uk/files/documents/ASH_715.pdf

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