Smokefree Site Policy

Transcription

1 Smokefree Site Policy ID Reference Number OPS/POL/001 Category Classification: Search Criteria: Purpose Superseded Trust-wide Controlled Documents Policy Risk, Health and Safety Smokefree, smoking, stop smoking, electronic cigarettes To protect anyone on Trust sites from the harmful effects of secondhand smoke, support a reduction in prevalence and smoking s harmful effects on health and wellbeing and promote local NHS Stop Smoking Services. N/A Version Number: 3.0 Date Approved by appropriate Group : Date Approved by Controlled Document Review Group Smokefree Site Group 25/8/15 12 th October 2015 Date approved by Trust Board if applicable 2 nd December 2015 Review Date: October 2018 Issue Date: 3 rd December 2015 Title of Originator/Author Title of Responsible Director: Impact / Equality Impact Assessed Target Audience Public Health Manager Director of Community Services Jane Wright, Public Health Manager, 7/9/15 Anyone on Trust sites If printed, copied or otherwise transferred from SharePoint, policies and procedural documents will be considered uncontrolled copies. Staff must always consult the most up to date versions registered on SharePoint. Smoke Free Site Policy V3 Page 1 of 19

2 Version Title of Trust Committee/Forum/Body/Group consulted during the development stages of this Date controlled document Trust Board 27/5/15 Smokefree Site Policy Group Various JNC 9/9/15 Document Amendment Form Number Date Page N o. Amendment Authorised by Smoke Free Site Policy V3 Page 2 of 19

3 Table of Contents Section Description 1 Introduction 2 Purpose Page Definitions 6 4 Duties 6 5 Policy Details 5.1Main Policy Statement 5.2 Electronic Nicotine Delivery Systems 5.3 Staff 5.4 Patients 5.5 Vehicles 5.6 Care in Private Homes 5.7 Support for Staff Who Smoke 5.8 Sales of Tobacco Products 5.9 Exemptions Dissemination 11 7 Implementation 11 8 Document Control including Archiving Arrangements 12 9 Monitoring Reference and Bibliography GEH Associated Records Staff Compliance Statement Appendix 1Smokefree Site/Stop Smoking Protocol 15 Smoke Free Site Policy V3 Page 3 of 19

4 Summary 0.1 Smoking is not permitted in any part of the premises or grounds/sites managed, leased or owned by the Trust at any time. 0.2 Electronic Nicotine Delivery Systems (ENDS) such as electronic cigarettes/vaporisers can only be used by in-patients who are already using them on admission and they can only be used outside. ENDS cannot be used on site otherwise. 0.3 The main focus of this policy is not whether anyone smokes but with where they smoke and the effect this has on patients, visitors, colleagues and other members of the wider health community. 0.4 Smoking remains the leading cause of preventable death and disability in England (NHS Information Centre, 2010). 0.5 As a major provider of healthcare, the Trust has a responsibility to lead the way and set an example in providing a totally smoke free environment to help aid patients recovery and reduce complications, promote health and support a reduction in smoking prevalence and smoking s harmful effects on health and wellbeing. 0.6 This policy is in line with NICE Public Health Guidance 48 Smoking Cessation in Secondary Care: Acute, Maternity and Mental Health Services (2013) 0.7 All staff have a role in supporting the effective implementation of the policy both in terms of their own behaviour and to communicate the policy to patients and visitors. 0.8 Staff can only smoke/vape out of working hours and off-site, where they are non-identifiable as a member of the GEH staff. Staff should not smell of smoke during work hours. 0.9 Coming into Trust premises presents many patients with an ideal opportunity to stop smoking. The Trust is committed to providing practical help, support and advice to patients who wish to take advantage of this opportunity. Stop smoking support is available to all staff and others who want to stop smoking from: 1. Hospital Stop Smoking Service contact x Warwickshire NHS Stop Smoking Service contact www.smokefreewarwickshire.org 0.10 Smokers who do not wish to stop smoking will be provided with stop smoking medication so they can manage without cigarettes during their hospital stay. Smoke Free Site Policy V3 Page 4 of 19

5 1. Introduction Smoking remains the leading cause of preventable death and disability in England (NHS Information Centre, 2010). Exposure to second-hand smoke (breathing other people s tobacco smoke) is hazardous to health, causing a range of diseases, many of which can be fatal (Healthy Lives, Healthy People: A Tobacco Control Plan for England, DH, 2011). As a major provider of healthcare, the Trust has a responsibility to lead the way and set an example in providing a totally smoke free environment to help aid patients recovery and reduce complications, promote health and support a reduction in smoking prevalence and smoking s harmful effects on health and wellbeing. Reducing smoking prevalence is a key local and national public health priority (Dept of Health 2014, Improving outcomes and supporting transparency Part 1A: a public health outcomes framework for England ) This policy is in line with NICE Public Health Guidance 48 Smoking Cessation in Secondary Care: Acute, Maternity and Mental Health Services (2013). Section 2(2) of the Health and Safety at Work Act 1974 places a duty on employers to provide and maintain a safe working environment which is, so far as is reasonably practical, safe, without risks to health and adequate as regards facilities and arrangements for their welfare at work. Several EU directives relating to health and safety in the workplace cover the issue of secondhand smoke include the Management of Health and Safety at Work Regulations 1999 which, under General Principles of Prevention, include: Avoiding risks Combating risks at source Replacing the dangerous by the non-dangerous or the less dangerous Giving collective protective measures priority over individual protective measures. 2. Purpose The Trust acknowledges that breathing other people s smoke is both a public health hazard and a welfare issue. Therefore, this Policy covers control measures for smoking at George Eliot Hospital NHS Trust premises (buildings and grounds). This policy is agreed between the Trust and those staff side organisations recognised by the Trust. This policy intends the following outcomes: a. Asmoke free, healthy environment for anyone on Trust premises/grounds b. Anyone on Trust premises/grounds is protected from the harmful effects of second-hand smoke c. Compliance with Health & Safety Legislation, Employment Law and NICE Guidance Smoke Free Site Policy V3 Page 5 of 19

6 d. Encouragement and support for smokers to stop e. Support to smokers who don t want to stop smoking to manage without cigarettes whilst on Trust premises/grounds. 3. Definitions Smoking - The action or habit of inhaling and exhaling the smoke of tobacco, emitting smoke or a visible vapour. Second-hand (passive) Smoking - the inhalation of smoke by persons other than the intended active smoker which can cause disease, disability and lead to death. Electronic Nicotine Delivery Systems (ENDS) - also known as electronic cigarettes, e-cigs or vaporising units, are battery-powered devices delivering nicotine by heating and vaporising a solution that typically contains nicotine, propylene glycol and/or glycerol, and flavourings. 4. Duties As a major provider of healthcare, the Trust has a responsibility to lead the way and set an example in providing a totally smoke free environment to help aid patients recovery and reduce complications, promote health and support a reduction in smoking prevalence and smoking s harmful effects on health and wellbeing. Therefore, the policy applies to all Trust premises/grounds and to anyone coming onto Trust premises/grounds. Responsibility for implementing this policy rests with the Chief Executive. Day-today responsibility for implementation lies with Directors and Managers. The Smoke free Site Policy Group will co-ordinate activity around this policy. The hospital in-house stop smoking service and Warwickshire Stop Smoking Service will provide advice and support to any smokers interested in stopping smoking, including Trust staff. All initial assessments with patients will include the Smoke free Site/Stop Smoking Protocol. To ensure that everyone entering the Trust sites understands the smoking policy clear signs will be displayed. Appointment letters and patient related information will include reference to the smoke free policy. PALS will also give support in signposting visitors and patients to stop smoking services. All staff have a role to play in enforcing this policy. The Smoke free Site Policy Group will co-ordinate regular checks of the site for smoking/evidence of smoking will be undertaken. Any smokers seen at these times will be asked to put out their cigarette or move off-site. Staff will be asked for their name and their Manager and HR will be informed. Each member of staff is responsible for maintaining up-to-date awareness of this policy, and for adhering to it in the course of their daily work Smoke Free Site Policy V3 Page 6 of 19

7 5. Policy Details 5.1 Smoking is not permitted in any part of the premises or grounds/sites managed, leased or owned by the Trust at any time. This includes: Smoking in cars on Trust car parks or in Trust cars Doctors Residences on the George Eliot Hospital NHS Trust site Other premises where Trust staff work Patient s/client s homes 5.2 Electronic Nicotine Delivery Systems (ENDS), also known as electronic cigarettes, e- cigs or vaporising units, are battery-powered devices delivering nicotine by heating and vaporising a solution that typically contains nicotine, propylene glycol and/or glycerol, and flavourings. There are 2 mains forms of ENDS products: Disposable - single use products which are self-contained, nonrechargeable/non- refillable and last for approximately tobacco cigarettes. Rechargeable - multiple use products with rechargeable batteries which are re-fillable. Due to risks of poor quality chargers, the exposed heating element being run without a guard and the toxicity of the nicotine solution "capsules", rechargeable units are banned from Trust premises. The charging of these devices (or any similar device) is not permitted on Trust premises in accordance with the Fire Safety (SWH 00295) and Health and Safety (SWH 0021) Policies. ENDS use at GEH sites: Patients - in-patients who are already using an ENDS product on admission cannot use it inside Trust buildings but may be able to use it outside buildings away from entrances and exits if it is deemed to be clinically appropriate (where nicotine replacement therapy is found not to be appropriate to manage the patient's nicotine addiction). Patients cannot charge ENDS products on Trust premises. Outpatients/community patients cannot use ENDS products on Trust sites. Patients seen in their own home will be asked to refrain from using their ENDS product shortly before and during the visit. Visitors - cannot use ENDS products on Trust sites. Staff - cannot use or charge ENDS products on Trust sites. The rationale for visitors and staff not being able to use ENDS is due to the potential for them creating a negative image of smoking and the difficulties allowing their use could create in achieving compliance generally with the overall policy. Signs at public entrances/exits will inform patients and visitors of the smoke free site policy. Regular monitoring of the policy will take place. Smoke Free Site Policy V3 Page 7 of 19

8 5.3 Staff a. Staff can only smoke/vape out of working hours and off-site (at least 15 m from site boundaries), where they are non-identifiable as a member of the GEH staff. b. Staff should not smell of smoke during work hours. c. Staff should not congregate in groups to smoke outside Trust premises. d. Staff are not permitted to smoke/vape at any time in public when representing the Trust and when attending meetings on behalf of the Trust, wherever these are held. e. New staff will be informed of the Trust smoke free policy within the recruitment process and corporate induction process and at local induction. f. All staff have a role in supporting the effective implementation of the policy with anyone who is on Trust premises/grounds: i. Other staff if staff are observed to be smoking/vaping on site they should remind them about the policy. Breaches of policy can be reported to the staff member s line manager or where the line manager is not known via HR to find out the line manager. Alternatively, where appropriate, security staff can be informed who will look to escalate this to the line manager. ii. Patients/visitors, etc. if patients/visitors are observed to be smoking/vaping on site they should be asked to put their cigarette out/stop vaping appropriately or take it off site. If this is done appropriately most smokers will adhere to the request. If staff don t raise the issue then the smoker/vaper get the message that it s OK to carry on smoking/vaping wherever they want to and this can encourage others to do the same. Credit cards are available to give to people to remind them of the policy. Suggested words to use with a smoker/vaper on site, Good morning/afternoon. Can I just remind you that this is a smoke/vape free site? Please could you put your cigarette out/ stop vaping or take it off the site. Thank you for your co-operation. In the unlikely event of a member of the public becoming aggressive or confrontational when the smoking/vaping issue is raised then normal procedures for dealing with violence and aggression should be followed (See Violence and Aggression Policy). g. In other premises outside of the Hospital site where Trust staff work there may be a role in staff asking smokers to move away from smoking directly outside entrances/exits (the NHS guideline is for smokers to be at least 15 metres away from entrances/exits). h. All staff are encouraged to set an example by promoting stop smoking and are expected to help and support patients and colleagues who wish to give up smoking. This links with the national Making Every Contact Smoke Free Site Policy V3 Page 8 of 19

9 5.4 Patients Count (MECC) agenda which is about healthcare staff taking every opportunity to raise and reinforce public health messages to support healthy lifestyle behaviours and thereby contribute to improvements in individuals and population health. i. Staff who want to stop smoking can contact 1. Hospital Stop Smoking Service contact x Warwickshire NHS Stop Smoking Service contact www.smokefreewarwickshire.org j. Staff who don t want to stop smoking can find information on how to manage without cigarettes at work on the intranet on the Health and Wellbeing page. k. Adherence to this Policy is part of staffs contract of employment and any breach could result in disciplinary action. a. Coming into Trust premises presents many patients with an ideal opportunity to stop smoking. The Trust is committed to providing practical help, support and advice to patients who wish to take advantage of this opportunity. b. Smokers who do not wish to stop smoking will be provided with stop smoking medication so they can manage without cigarettes during their hospital stay. c. The Smoke free Site/Stop Smoking Protocol should be used with all patients who come into contact with the Trust (Appendix 1). d. GP practices will be informed of the policy and where an in-patient stay is planned it is anticipated that the GP will advise the patient of the benefits of stopping smoking in relation to their condition and also advise them of the Trust s Smoke free Site policy. The GP will then advise on the options for stopping smoking/managing a hospital stay without cigarettes. 3. ENDS in-patients who are already using an ENDS product on admission cannot use it inside Trust buildings but may be able to use it outside buildings away from entrances and exits if it is deemed to be clinically appropriate (where nicotine replacement therapy is found not to be appropriate to manage the patient's nicotine addiction). Patients cannot charge ENDS products on Trust premises. Out-patients/community patients cannot use ENDS products on Trust sites. Patients seen in their own home will be asked to refrain from using their ENDS product shortly before and during the visit. 5.5 Vehicles Smoking/vaping is not permitted in Trust vehicles. Smoking/vaping is not permitted in leased or staff private vehicles whilst used on Trust business or on Trust sites. Smoke Free Site Policy V3 Page 9 of 19

10 5.6 Care In Private Homes a. When care is offered to patients of the Trustin their own home, it is essential that a request be made to provide a smoke free environment whilst the visit is taking place. This request should be made in the text of the appointment letter or on the phone when an appointment is made. b. A verbal request can also be made at the time of the visit and the client should be respectfully asked not to smoke whilst the employee is working within that environment. If the patient/carer/relative/friend chooses to continue to smoke, despite being advised that further home visits could cease, then the appropriate consultant/ GP will be informed. 5.7 Support For Staff Who Smoke a. The Trust recognises its duty towards employees who smoke. Advice and support to stopsmoking is available via the following routes: 1. Hospital Stop Smoking Service contact speed dial Warwickshire NHS Stop Smoking Service services in a wide range of premises across the county, contact , text free LIFE to 80800, b. All Stop Smoking Services provide the following: Advice on the options available before making a commitment An individual programme over 12 weeks, including regular appointments and stop smoking medication at prescription rates (free if you don t pay for prescriptions) c. Wherever possible staff should be allowed to attend a Stop Smoking Service in work time. 5.8 Sales of Tobacco Products a. No sales of tobacco products will be allowed on any Trust premises. It is a criminal offence for anyone to sell, transport or possess illegal tobacco products. Penalties for such offences may include imprisonment and/or fines including fines of up to 5000 for any manager allowing their premises to be used for such activities. The selling/storing and dealing in any way of illegal cigarettes and tobacco on Trust premises will not be tolerated. b. The George Eliot Hospital NHS Trustwill fully co-operate with Law Enforcement agencies, such as HM Revenue and Customs, in their investigations. Any such illegal activity will be considered as Gross Misconduct and will result in appropriate disciplinary action. The Counter Fraud staff will be informed of any suspected activity of this nature. Smoke Free Site Policy V3 Page 10 of 19

11 5.9 Exemptions a. The Trust Board recognises that some patients have circumstances that will require staff to make an assessment as to whether special arrangements need to be made so that the patient may be permitted to smoke on the Trust site on a case-by-case basis. This will always be as last resort when other options such as provision of nicotine replacement products are not suitable/appropriate. b. Permission to grant an exemption will rest with the nurse in charge of the ward or unit and will be formally recorded in the patient s notes. c. In all cases where an exemption has been made there should be demonstrable evidence that smoking cessation/temporary abstinence with nicotine replacement products has been fully considered as part of the patient care pathway, in conjunction with the patient and/or their relatives. Where an exemption is made, every effort must be made to minimise staff exposure to smoke. 6. Dissemination a. Tenders and contracts with the Trustwill stipulate adherence to this policy as a contractual condition. Elective patients will be advised of the new policy prior to admission and others on admission to Trust premises. GP practices will also be informed of the policy. Existing patients will also be addressed through a series of information sessions via electronic media and promotion by staff in patient and ward areas, with the support of stop smoking specialists (hospital in-house stop smoking service or Warwickshire Stop Smoking Service) as appropriate. b. Appropriate support will be provided to allow front-line clinical staff to deliver the Smokefree Site /Stop Smoking Protocol. Job advertisements will include reference to the smoke free policy and indicate that adherence to it will form part of the contract of employment. c. Appointment letters and patient related information will include reference to the smoke free policy. PALS will also give support in signposting visitors and patients to stop smoking. 7. Implementation a. Responsibility for implementing this policy rests with the Chief Executive. Day-to-day responsibility for implementation lies with Directors and Managers. The hospital in-house stop smoking service and Warwickshire Stop Smoking Service will provide advice and support to any smokers interested in stopping smoking, including Trust staff. All initial assessments with patients will include the Smokefree Site/Stop Smoking Protocol. To ensure that everyone entering the Trust sites understands the smoking policy clear signs will be displayed. b. All staff have a role to play in enforcing this policy (see section 4.1). If Managers or staff feel apprehensive about their own safety in regard to Smoke Free Site Policy V3 Page 11 of 19

12 addressing any breach, they should call the Security staff. It is important to note that primary emphasis should be placed on prevention of such situations arising. In the event of a breach of the policy by a patient or visitor they will be directed off-site. c. Any member of staff found smoking on Trust premises will be liable to disciplinary action in accordance with the Trust's Disciplinary Policy. In the event that staff from other organisations persistently breach the policy the appropriate organisation will be contacted by the HR Department. Any complaint relating to this policy from or on behalf of patients should be dealt with under the Trust s complaint procedure. d. Regular checks of the site for smoking/evidence of smoking will be undertaken. Any smokers seen at these times will be asked to put out their cigarette/stop vaping or move off-site. Staff will be asked for their name and their Manager and HR will be informed. e. Executive Directors are responsible for ensuring that review takes place of policies within their sphere of control. Clinical Directors and General Managers are responsible for overseeing reviews of local policies. f. Awareness of the policy will be included within: i. Induction ii. Annual statutory and mandatory updates iii. Making Every Contact Count iv. Medics training v. Ad-hoc training will be provided where appropriate 8. Document Control/Archiving a. The policy will sent by to all staff and their duties highlighted. It will be included on the intranet. Regular reminders will be sent out via various communications channels, working through the Communications Dept. b. Older versions will be taken out of circulation by replacing with the new version through the routes as above. c. The Smokefree Site Policy Group will be convened for any reviews. Smoke Free Site Policy V3 Page 12 of 19

13 9. Monitoring Table Aspect of compliance or effectiveness being monitored Adherence to policy - Monitoring method Spot check at GEH site to ascertain evidence adherence/ nonadherence to policy CBU7 (Comm.) feedback by Mgrs Individual or Dept responsible for monitoring GEH site Smokefree Site Policy Group CBU7 (Community) via Service Mgrs Frequency of the monitoring activity Monthly Group/Cttee/ forum which will receive the findings/ monitoring report Smokefree Site Policy Group Cttee/ individual responsible for ensuring that the actions are completed Smokefree Site Policy Group 10. References And Bibliography Department of Health (2011) Healthy Lives, Healthy People: A Tobacco Control Plan for England. London: Department of Health [Online]. Available at: 757/dh_ pdf (accessed 8/1015) Department of Health (2014) Improving outcomes and supporting transparency Part 1A: a public health outcomes framework for England ) London: Department of Health [Online]. Available at: 658/ _PHOF_Improving_Outcomes_PT1A_v1_1.pdf National Institute for Clinical Excellence (2013) Smoking cessation in secondary care: acute, maternity and mental health services ph48. London: National Institute for Clinical Excellence [Online]. Available at: NHS Information Centre (2010) Statistics on Smoking: England, NHS Information Centre, Leeds United Kingdom. The Health and Safety at Work Act, [Online] Available at: (accessed 30/7/15) 11. GEH Associated Records Uniform policy Violence and Aggression Policy 12. Staff Compliance Statement All staff must comply with the Trust-wide controlled document and failure to do so maybe considered a disciplinary matter leading to action being taken under Smoke Free Site Policy V3 Page 13 of 19

14 the Trust s Disciplinary Procedure. Actions which constitute breach of confidence, fraud, misuse of NHS resources or illegal activity will be treated as serious misconduct and may result in dismissal from employment and may in addition lead to other legal action against individual concerned. 13. Equality And Diversity Statement The Trust aims to design and implement services, policies and measures that meet the diverse needs of the needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. Smoke Free Site Policy V3 Page 14 of 19

15 Appendix 1 Smokefree Site/Stop Smoking Protocol Aim: To use contact with GEH as an opportunity to encourage and support patients to quit or to abstain from smoking during their time at the Trust in accordance with smokefree legislation and the Trust smokefree site policy. Make patient/client aware of smokefree site policy prior to attendance at site At first contact with Trust, conduct very brief smokefree site/stop smoking intervention ASK and record smoking status (All patients attending pre-operative assessment and a maternity booking appointment will have their smoking status ascertained via a carbon monoxide test and all identified smokers are automatically referred to NHS Warwickshire Stop Smoking Service) ADVISE on quitting/abstaining from smoking whilst on GEH grounds The best way of stopping smoking is with a combination of medication and specialist support / products can be supplied to help you manage without cigarettes during your stay. ACT on patient s response build confidence, give information, refer, prescribe. You are up to four times more likely to quit successfully with support or I can arrange for you to have some free products so you can manage without cigarettes during their stay. In-Patient Wants to stop Doesn t want to smoking for good stop smoking Refer to a Stop Smoking Service: GEH x5617 or use e-referral on intranet/computer screen NHS Warwickshire Stop Smoking Service Where appropriate ensure they are issued with nicotine replacement therapy (NRT) from ward stock. On discharge issue 2 weeks of NRT and refer to a Stop Smoking Service. Note: the stop Advise the patient that they cannot smoke on site. Where appropriate ensure they are issued with nicotine replacement therapy (NRT) from ward stock to manage without nicotine during their stay. See NRT protocol overleaf. On discharge reinforce brief and refer to stop smoking service if appropriate. Electronic Nicotine Out-Patient/Community Wants to stop Doesn t want to smoking for good stop smoking Refer to a Stop Where appropriate Smoking Service: advise the patient GEH x5617 or use that they cannot e-referral on smoke on site. intranet/computer screen NHS Warwickshire Stop Smoking Service (WSSS) Note: it may be possible for WSSS to see housebound patients If they are being seen in their own home advise of the smokefree site policy, ie. They should not smoke shortly before, or during, the visit. Electronic Nicotine Delivery Systems (ENDS) such as e-cigs, vaping devices cannot be used in Trust premises or grounds. Patients seen in their own Smoke Free Site Policy V3 Page 15 of 19

16 smoking service can be initiated in hospital and the patient transferred to a community stop smoking service via the shared service protocol Delivery Systems (ENDS) such as e- cigs, vaping devices cannot be used in Trust premises but may be used outside where NRT is found not be clinically appropriate to manage the patient s nicotine addiction. home will be asked to refrain from using their ENDS product shortly before and during the visit. Smoke Free Site Policy V3 Page 16 of 19

17 Smokefree Site/Stop Smoking Protocol How to Select a Nicotine Replacement Therapy (NRT) for In-Patients NOTE: This is not the full range of products available but provides a limited range which is easier to manage and will cover most needs. Medium, High and Very Dependent Smoker (smokes more than 10 a day) Patch - 21 mg 24 hour patch (Nicotinell or NiQuitin) Plus an intermittent product*: Inhalator 15 mg 4-6 cartridges per day keeps hands and mouth busy (Nicorette) Mini lozenge 4 mg 8-12 per day (NiQuitin) Low Dependent Smoker (smokes less than 10 a day) Usually one product: Patch - 14 mg 24 hour patch (Nicotinell or NiQuitin) Inhalator 15 mg 4-6 cartridges per day keeps hands and mouth busy (Nicorette) Mini lozenge 1.5 mg 8-12 per day (NiQuitin) If patients on just a patch experience breakthrough cravings consider adding an intermittent product. *A combination of patch and a faster acting intermittent product has been shown to increase the chances of success compared to using one product. Refer all smokers to the in-house stop smoking service x5617. Notes: 1. This guidance applies from 12 years of age. 2. Ideally, patients should be assessed for nicotine requirements within 30 minutes of admission to ensure that they do not have nicotine withdrawal symptoms. 3. A&E/day cases should be offered an intermittent product. 4. All in-patients should have a PRN even if they don t want a product at the point of asking as this will make it easier to manage should they change their mind later on. 5. Patients on medication for mental health conditions such as clozapine may need their dose reducing when they quit so will require close monitoring. 6. For more information see SPCs at Authors: Jane Wright, Public Health Manager Wendy Preston, Nurse Consultant Date: 7 September 2015 Smoke Free Site Policy V3 Page 17 of 19

18 Equality Impact Assessment Tool To be completed and attached to any procedural document when submitted to the appropriate Committee for consideration and approval. Yes/No Comments 1. Does the document/guidance affect one group less or more favourably than another on the basis of: Race No Ethnic origins (including gypsies and travellers) No Smoke Free Site Policy V3 Page 18 of 19

19 Nationality No Gender No Culture No Religion or belief No Sexual orientation including lesbian, gay and bisexual people No Age No Disability - learning disabilities, physical disability, sensory impairment and mental health problems No 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are there any exceptions valid, legal and/or justifiable? 4. Is the impact of the document/guidance likely to be negative? No NA NA 5. If so, can the impact be avoided? NA 6. What alternative is there to achieving the document/guidance without the impact? 7. Can we reduce the impact by taking different action? NA NA Smoke Free Site Policy V3 Page 19 of 19