Controlled document This document is uncontrolled when downloaded or printed. Patient & Staff Experience Committee

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1 Smoke Free Policy Controlled document This document is uncontrolled when downloaded or printed. Reference number Version 8 Author & Job Title Executive Lead WHHT: HR068 Caroline Lankshear, Head of Employee Relations and Rupi Virdee, Employee Relations Adviser Director of Human Resources Approved by/date HR Policy Approval Group / June 2017 Ratified by Quality & Safety Group Date ratified September 2017 Committee/individual responsible Issue date September 2017 Review date September 2020 Target audience Key Words Patient & Staff Experience Committee All WHHT employees, patients, visitors and contractors Smoking, electronic cigarettes, vaporisers, tobacco Author: Rupi Virdee Review Date: September 2020 Page 1 of 17

2 Contribution List Key individuals involved in developing this version of the document Name Christine Taylor Caroline Lankshear Rupi Virdee Abigail Jackson Farzana Khan Designation Employee Relations Team Manager Head of Employee Relations ER Adviser Consultant Herts Stop Smoking Specialist Approved by Committee June 2017 Change History Version Date Author Reason Liz Quick & Carlene Crane Out of date policy Tanishka rris Out of date policy Christine Taylor Out of date policy Introduction of electronic cigarettes Annette Behagg Out of date policy Rupi Virdee Update Policy Author: Rupi Virdee Review Date: September 2020 Page 2 of 17

3 Values are essential to West Hertfordshire NHS Trust as they describe the way we work and our vision to deliver the very best care for every patient, every day. Our values are at the heart of what we do and ensure we provide consistency across the Trust and within all our services. All staff must adhere to the Trust values, whatever their role or duty and incorporate the values in all the work they do for WHHT. Our values are Commitment, Care and Quality. Commitment Doing things that are going to make a positive difference Being dedicated, motivated and optimistic and looking to the future t being afraid to do things differently or to challenge Doing the right thing at the right time in the right place Being flexible when needed, going the extra mile and delivering on our promises Taking responsibility for personal development and performance Care Making sure that we consider the impact of our decisions on the care of all patients Treating everyone with kindness, compassion, courtesy and respect Listening and communicating in a way that is clear, straightforward, effective and inclusive Recognising vulnerability and showing empathy Supporting and working with others to provide joined-up, compassionate care Caring for each other, looking after our own wellbeing and that of our colleagues Quality Working together to provide the best possible service we can for our patients and their families Striving to deliver best practice and best possible outcomes for all Seeking to improve what we do as an organisation and completing all activities to agreed standards Expecting ourselves and each other to produce high quality work based on evidence of what works Acting in a professional manner at all times Being part of a team that takes pride in their work and their environment It is every employees responsibility to work in a way that is consistent with these values in delivering every element of their role, taking us forward in delivering our mission. Trust policies need to adhere and embed our values. Also see Trust Behaviour Standards on the Intranet for further information. Author: Rupi Virdee Review Date: September 2020 Page 3 of 17

4 Contents 1 Introduction 5 2 Objectives 5 3 Scope 5 4 Roles and Responsibilities 6 5 Definitions 7 6 Stop smoking support of staff 7 7 Stop smoking support patients 8 8 Stop smoking support for visitors 10 9 Procedure Use of electronic cigarettes & vaporisers Education and Training for Hospital Staff Contravening the Trust s Smoke Free Policy Impact on health inequalities and diversity Evaluation Measures Monitoring and Audit References Related Policies Review of this Policy Equality Impact Assessment 14 Appendix 1 Appendix 2 Appendix 3 Referral Form for Hertfordshire Health Improvement Service Risk assessment for patients leaving ward/department ASK flow chart Author: Rupi Virdee Review Date: September 2020 Page 4 of 17

5 1 INTRODUCTION Smoking remains the leading cause of preventable morbidity and premature mortality in England, causing around 96,000 deaths every year, and more deaths than the next six most common causes of premature mortality and 1,500 deaths per year in Hertfordshire alone. Cigarette smoking causes a wide range of diseases and accounted for 1090 smoking related hospital admissions per 100,000 population aged over 35 years in Hertfordshire. In addition to the human cost, smoking is estimated to cost the NHS in England 5.2 billion a year and the NHS in Hertfordshire 55 million in This does not include other costs to Hertfordshire such as payment of sickness or invalidity benefits, litter and smoking related house fires. The cost to wider society in Hertfordshire was estimated to be 278 million in West Hertfordshire Hospitals NHS Trust is committed to providing the best possible working conditions and environment for all employees and in doing so is keen to promote a smokefree environment. It is therefore the belief of the Trust that all employees have the right to breathe air free of tobacco during the course of their duties and be protected from the harmful effects of second-hand smoke. The Trust also has a legal obligation in accordance with the Health and Safety at Work Act 1974 and Smoke-free (Premises and Enforcement) Regulations 2006 to ensure the safety of all employees during the course of their duties and in recognition that smoking not only affects smokers, but also non-smokers exposed to passive smoking, then it is considered appropriate for the Trust to enforce a smoke-free working environment. 2 OBJECTIVES The key objectives to the policy are Protect and improve the health and safety of staff, patients and visitors. Implement NICE guidance PH48 smoking cessation in secondary care: acute, maternity and mental health services. Ensure that in-patients and staff have easy access to Nicotine Replacement Therapy or prescription only medication to aid quitting, treat withdrawal symptoms and assist with compliance of the smoke free policy. Motivate and support all smokers, to quit by providing smoking cessation advice and support. POLICY STATEMENT Smoking and using any form of tobacco, or the use of electronic cigarettes are not permitted anywhere on any West Herts Hospital NHS Trust sites; this includes all internal and external areas, including car parks, Trust vehicles and covers the Trust boundaries. 3 SCOPE This policy applies to all employees, visitors, patients, contractors, and employees of other Trusts and organisations that occupy or use West Hertfordshire Hospitals NHS Trust s premises, and promotes a smoke free environment, for the benefit of patients, staff and visitors. Author: Rupi Virdee Review Date: September 2020 Page 5 of 17

6 West Hertfordshire remains committed to helping people to stop smoking and to encourage and support staff to quit smoking or to manage their addiction whilst on Trust premises in order to adhere to the policy and reduce harm from tobacco. 4 ROLES AND RESPONSIBILITIES 4.1 Trust Responsibilities Overall responsibility for implementing this policy and ensuring it is fully supported by staff, rests with the Trust s Chief Executive and Executive Board The Trust has a legal and moral obligation to provide a safe and comfortable working environment that is compliant with the Health and Safety at Work Act 1974 and Smoke-free (Premises and Enforcement) Regulations 2006 The Trust will seek to take any appropriate action against employees who choose to negatively impact upon the working experience and health of colleagues and patients by smoking in unauthorised places 4.2 Line Manager Responsibilities To make employees aware of this policy and the restrictions on smoking during working hours, in work uniforms, and on work premises including Trust Vehicles To support staff by allowing time off work to attend stop smoking support To ensure that contractors or non-nhs staff comply with this policy To raise concerns with their employees immediately after having been made aware of a potential breach in the smoking regulations To make employees aware of the possible implications from smoking in unauthorised places on Trust premises and/or whilst being in uniform and take appropriate disciplinary action as required To ensure that the application of the policy is monitored in individual areas To advise prospective employees and new employees of the policy either through Job Application Information Packs, the Trust s Induction Programme or directly by their Ward/Departmental Manager 4.3 Employee Responsibilities All employees have a responsibility for implementing the Smoke Free Policy Employees should respect the rights of their colleagues to work in a smoke-free environment and not engage in any smoking-related activity whilst on Trust premises Employees should act as role models for promoting a healthy lifestyle and not therefore engage in any smoking-related activity whilst in Trust uniform or in Trust vehicles Employees should adhere to the restrictions placed on smoking-related activities as specified in this policy Employees should, where safe to do so, advise those contravening the terms of this policy not to smoke whilst on site and/or in uniform Employees are not expected to enter into any confrontation with patients or visitors that may put their personal safety at risk Author: Rupi Virdee Review Date: September 2020 Page 6 of 17

7 5 DEFINITIONS Smoking Cigarette E-cigarette / electronic cigarette Smoking-related activity Smoke free site Nicotine Replacement Therapy (NRT) Varenicline (Champix) Smoking or being in possession of a lit substance such as tobacco or any other substance that may be smoked Tobacco-filled cylinder that is ignited therefore allowing the user to inhale the smoke Battery-powered vaporiser that gives the user a similar experience to smoking tobacco and produces a mist or vapour Engaging in smoking or tobacco or the use of batteryoperated vaporisers Where smoking, including use of shisha, water pipe or other inhaled tobacco products and oral tobacco are not permitted anywhere within the defines boundaries of the organisation Pharmacological products such as transdermal (skin) patches, gum, lozenge, inhalers and mouth spray are licensed products to help people stop or reduce smoking and available on prescription, and on general sale Prescription-only medication licensed for use in the treatment of nicotine addiction 6 STOP SMOKING SUPPORT FOR STAFF NHS Trust staff should be encouraged and supported to quit smoking. Occupational Health should assess the smoking status of all staff and provide stop smoking support for staff wanting to quit, including access to NRT and Champix through community pharmacies through the letter of recommendation system. Staff who wish to quit smoking should be allowed protected time during working hours to attend stop smoking appointments. Staff are discouraged from smoking at any time during the working day, however, staff who continue to smoke when at work, must smoke only during official break times and they must leave the site completely. Staff choosing to go off site particularly when on a late shift or night duty, should undertake a risk assessment to ensure their personal safety is not compromised. Staff must ensure that any form of identification is completely covered up. Staff should be required to change out of uniform prior to smoking, this is to ensure that they are not identified as Trust staff and to reduce the impact of smoke on their clothes when administering patient care. Staff are not permitted to smoke, or have smoking material, or electronic cigarettes visible at any time in public when representing the Trust and when attending meetings on behalf of the Trust. Author: Rupi Virdee Review Date: September 2020 Page 7 of 17

8 Applicants for positions at West Herts Hospital NHS Trust will be advised of the Smokefree policy. Smoking cessation, advice and support will be offered. The Smokefree Policy will be referred to in relation to health and safety information at staff induction. This policy recognises that passive smoking adversely affects the health of all employees. It is concerned not only with where people smoke but the effect that this has on non-smoking colleagues. However, it is recognised that the policy may impact on smokers working lives. In an effort to help individuals adjust to this change Occupational Health will provide cessation advice and support to members of staff. The Hertfordshire Health Improvement Service is also available to offer support to staff and can be contacted on or alternatively further information can be found on their website: The National NHS smoking help line ( ) is also available to staff to access and gives help and advice to smokers to quit, and can offer information on where to access local NHS cessation services. Further information is available at: Trust employees can also seek advice and support from the Employee Assistance Programme. This is a confidential support service, providing practical information, legal advice, telephone and face-to-face counseling. The service is free and available to all Trust employees, 7-days a week, by telephoning , or via at assist@ciceap.co.uk or via text relay (for people with speech or hearing impairment) on STOP SMOKING SUPPORT FOR PATIENTS Patients should be advised of the existence of the Trust s Smokefree Policy prior to the attendance of any appointment and should be provided with written communication on how to stop smoking. Planned admissions should be referred to Hertfordshire Health Improvement Service at the earliest opportunity and offered support to either stop smoking or abstain from smoking during the course of their stay in hospital. All staff should be trained in how to give brief intervention advice, which promotes quitting and reduces resistance to behaviour change. All patients over 16 years (inpatients, outpatients and pregnant women and their partners) should have smoking status recorded and clearly documented on the inside front cover of the patients notes. Actions taken by the member of staff to promote stopping smoking should also be clearly documented on the inside cover of the patients notes including any follow-up actions. All smokers should be referred to Hertfordshire Health Improvement Service using the appropriate referral form (Appendix 1) or by contacting the Hertfordshire Health Improvement Service on or by health.improvementservice@hertscc.gcsx.gov.uk (secure address). NICE Guidance PH26 recommends that all pregnant women should have a Carbon Monoxide (CO) reading taken at the time of booking in order to assess exposure to CO through smoking or second hand smoke and should be reviewed at every appointment. Pregnant women who are still smoking at the time of delivery should be given advice on the continued risks of smoking and dangers of second hand smoke to their baby. Post-natal Author: Rupi Virdee Review Date: September 2020 Page 8 of 17

9 women who smoke and their partners who smoke should also be encouraged to quit and referred to Hertfordshire Health Improvement Service. Following assessment of smoking status and nicotine dependence, the medical staff or other qualified staff should consider prescribing nicotine replacement therapy (NRT) for patients in order to manage withdrawal symptoms and/or to support the smoker in quitting smoking. Varenicline may be prescribed for smokers planning to quit, but smokers may require NRT in the short term to manage cravings before the therapeutic dose of varenicline is reached. Medical staff or other qualified staff will, if appropriate, prescribe NRT on a prescription chart or outpatient prescription. All outpatient prescriptions must be in line with Hertfordshire Guidance: Stop Smoking Medication (usual prescription charges apply). People with mental health conditions who require intensive behavioural support and potentially higher doses of nicotine should be referred to Hertfordshire Health Improvement Service. The Trust is responsible for ensuring that all patients receiving NRT or Champix are referred to Hertfordshire Stop Smoking Service before discharge as there is a high risk of relapse once the patient returns home without ongoing support. This will prevent a gap in service to the client and ensure that access to NRT or Champix and stop smoking support is provided seamlessly. High-risk patients (e.g. pregnant women, cardiovascular disease, lung disease, diabetes or pre-operative patients) should be prioritised for referral. Please advise patients against leaving the site to smoke or use electronic cigarettes and ensure that they are using sufficient NRT to manage withdrawal symptoms. Should they still choose to leave the ward or department, staff must highlight the risks of accident, deterioration of condition and reduced access to care and treatment. These risks are set out in. If you advise a patient against leaving the ward to smoke, but they still choose to do so, this will be document in their clinical record and complete the risk assessment to be signed by the patient (Appendix 2). The Smokefree policy also applies to all WHHT patients with mental health conditions who are being cared for by the general hospital. Consideration may be needed to provide much higher doses of NRT, as smokers with mental health conditions are usually very addicted smokers and at greater risk of smoking-related disease. Advice and support in managing very addicted smokers can be obtained from Hertfordshire Health Improvement Service. Staff that visit patients/clients in their homes to deliver treatment and/or care will not be expected to be exposed to second-hand smoke. It is recommended that if it is known that a visit is being made to a patient who smokes (or a relative or carer) they are asked (usually by letter), to refrain from smoking in the room to be used for at least one hour prior your arrival and for the duration of your visit. If a patient/client/ other person refuses to do this, the patient may be asked to attend a suitable Smokefree venue instead for their treatment/care to be delivered. It is unlikely that the use of electronic cigarettes by patients or carers in their own homes will pose any significant risk to staff. Author: Rupi Virdee Review Date: September 2020 Page 9 of 17

10 8 STOP SMOKING SUPPORT FOR VISITORS Visitors are not permitted to smoke or use electronic cigarettes anywhere on the Trust premises. Information for visitors, including information on the hospital website, should inform visitors of the Trust s Smokefree policy. Distressed relatives or carers who wish to smoke should be dealt with sympathetically but no provision can be made for them to smoke on site. The staff member dealing with them may wish to direct them to the boundary of the Trust site or, if staff availability allows, escort them there. Staff should not remain in a position where they are exposed to second-hand smoke or seen to be endorsing smoking. Visitors should have access to information about local Stop Smoking Services and are able to self-refer or may be referred by a member of staff. Posters and leaflets are in place throughout the organisation advertising these services. Licensed nicotine containing products (NRT) should be available to be purchased within Trust retail premises. 9 PROCEDURES Partner organisations will be informed of the Trust s Smokefree Policy. Trust staff are expected to ensure that visitors, staff and patients are compliant with the Smokefree policy and to inform visitors, patients and staff of the policy if they are found to be in breach of it. Smokers should be dealt with non-judgementally and smokers should be offered help to quit or to manage withdrawal symptoms (including cravings). Staff will not be expected to enter into any personal confrontation that is likely to put their personal safety at risk, though it is hoped staff will contribute to increasing awareness of the Smokefree policy and that through appropriate training contribute to its implementation. Should any employee have a complaint made against them for politely informing someone of the Trust s Smokefree Policy, they will have the Trust s full support in taking action which is in compliance with this policy. The Smoke Free Policy will be made available on the Trust intranet and website. Information leaflets are also available throughout the Trust for patients, staff and visitors. All correspondence to patients will inform them of the Trust s Smokefree Policy. Adequate signage will be prominently displayed at the entrances to buildings, and other necessary locations throughout the Trust re-enforcing and identifying that the Trust operates a Smokefree Environment. sale of tobacco products will be allowed on the premises. 10 USE OF ELECTRONIC CIGARETTES AND VAPORISERS The Trust recognises that the use of electronic cigarettes and vaporisers are not covered by current smoke free legislation however staff are not permitted to use electronic cigarettes anywhere within Trust grounds. Author: Rupi Virdee Review Date: September 2020 Page 10 of 17

11 Guidance from Public Health England has confirmed that E-cigarettes have the potential to help reduce tobacco use and the serious harm this causes to smokers and those around them. An independent review of evidence published by PHE in 2015 found that vaping is around 95% safer fir users than smoking. The Trust therefore permits patients and visitors to use these devices as an alternative to smoking in the hospital grounds but not near entrances / exits / windows / inside buildings or where patients/staff congregate. Everyone is also reminded that they must not use Trust facilities to charge electronic cigarettes and vaporisers anywhere on site due to potential fire hazards. 11 EDUCATION AND TRAINING FOR HOSPITAL STAFF The Department of Health (DH) recommends that all front line health care professionals provide at least Very Brief Intervention (VBI) advice to smokers 30 seconds to save a life This is line with the NHS commitment to Make Every Contact Count i (MECC) ASK: Ask about smoking status (current smoker/ex-smoker/date of last cigarette/nonsmoker) ADVISE: Advise about the benefits of quitting smoking and that they are 4 times more likely to be successful with a stop smoking service ACT: Refer the smoker and their partner (if appropriate) to the local stop smoking service unless they choose to opt out of this invitation Summary shown in Appendix 3 If time allows a more comprehensive assessment of the smoker s intention to quit in the short term can be made and more motivational support can be provided. Frontline staff can receive this can be arranged with Hertfordshire Health Improvement Service on Ideally all wards/departments should have a dedicated stop smoking champion who is responsible for ensuring staff attend Brief Intervention training and that the identification of smokers, the assessment of their addiction, the provision of medication and referral pathways are in place. The champion should also ensure that posters and displays materials are clearly visible and for patient information and referral forms are accessible to patients and staff. The Trust should have a named consultant responsible for stop smoking (usually a chest physician). 12 CONTRAVENING THE TRUST S SMOKE FREE POLICY 12.1 West Hertfordshire Employee The Trust takes seriously any breach to the smoke free policy and considers that secondhand smoke could significantly and adversely affect the health of employees. It is therefore the commitment that upon the first instance of an employee being observed and/or reported to have contravened the Trust s smoke-free policy that there will be a meeting convened by their line manager to explain the implications of their behaviour. Author: Rupi Virdee Review Date: September 2020 Page 11 of 17

12 At this meeting the employee should be made aware of the following: That they have been observed and/or reported to have contravened the Trust s smoke-free policy Reminded that their behaviour could constitute misconduct in accordance with the Trust s disciplinary policy and procedure, and that further instances of such behaviour could lead to a formal investigation and disciplinary sanction being applied Explanation of the risks of their behaviour with regards to financial penalties being imposed on the Trust for breaching the Smoke-free (Premises and Enforcement) Regulations 2006 and associated reputational damage to the Trust Expectations set with regards to future behaviour A summary of this discussion should be provided by the line manager to the employee within seven calendar days of the meeting. For any further instances of the employees breaching the smoke-free policy reference should be made to the disciplinary policy and an investigation commissioned if appropriate Patient or visitor breaches the policy Patients or visitors found smoking should be advised of this policy by security staff and by members of staff. The person should be politely asked to stop smoking or to move off the Trust grounds. An information card with details of Hertfordshire Health Improvement service should be given to the person smoking. If the person smoking is an inpatient, medical staff or other qualified staff will, if appropriate, prescribe NRT on a prescription chart and provide support to the patient to abstain or quit smoking whilst on trust premises. If the person smoking is an outpatient or a visitor and he or she persists in smoking, security should be called and asked to request that the person leaves the site. A referral to Hertfordshire Health Improvement Service should be offered. (appendix 1) When considering whether to ask a patient or visitor not to smoke in the Trust grounds, staff should be sensitive to that person s personal situation, particularly if the patient or visitor is visibly distressed Volunteer breaches the policy Volunteers found smoking should be advised of this policy by security staff or by other members of staff. The volunteer will be politely asked to stop smoking or to move off the Trust s ground. Referral to the Hertfordshire Health Improvement Service should be offered. An information card with details of Hertfordshire Health Improvement Service should be given to the Volunteer. Volunteers found: Smoking on Trust grounds on more than one occasion, or Smoking outside Trust grounds while wearing a recognisable Trust uniform or Trust identification badge on more than one occasion will be reported to a member of security. Security will then inform the Volunteer Manager, and the matter could be dealt with as misconduct under the Voluntary Services Policies Contractor or supplier breaches the policy Author: Rupi Virdee Review Date: September 2020 Page 12 of 17

13 Contractors or suppliers found smoking should be advised of this Policy. The person should be politely asked to stop smoking or to move off the Trust s grounds. If the person persists in smoking, security should be informed and they will inform a Senior Manager in the Estates and Facilities team. The Manager will contact the employer of the person concerned. The employer will be expected to take action to guarantee that the person will not smoke on the Trust s grounds again. 13 IMPACT ON HEALTH INEQUALITIES AND DIVERSITY Smoking is a profound source of inequalities in health. Smoking has worst health and economic cost to women, those in deprived communities, black and minority ethnic communities and lesbian, gay, bisexual and transgendered communities, mental health service users, prisoners and the homeless and is a major cause of long term disability. It is believed that the implementation of this policy will have no negative impacts on anyone with in relation to a protected characteristic. Reduction in second-hand smoking and reduction in smoking has overwhelmingly positive impacts on all communities and all ages and this is evidenced in extensive research. 14 EVALUATION MEASURES MONITORING AND AUDIT The Employee Relations Department will log any cases that have been commissioned including outcomes/ appeals as a result of this policy not being adhered to. 15 REFERENCES Health Act, [Accessed on 20 th January 2017]. Available from: Public Health England. Use of E-cigarettes in pubic places and workplaces. 6 July RELATED POLICIES Disciplinary Policy Grievance Policy Uniform Policy 17 REVIEW OF THIS POLICY This policy is expected to be reviewed within 3 years or if there are significant changes to Government Tobacco Control Policy or if electronic cigarettes become licensed by the MHRA and able to be prescribed as medication but if this is deemed unnecessary the policy will remain in force until such time as it is reviewed. Author: Rupi Virdee Review Date: September 2020 Page 13 of 17

14 18 EQUALITY IMPACT ASSESSMENT 1. Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems Marriage & Civil partnership Pregnancy & maternity 2. Is there any evidence that some groups are affected differently? 3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4. Is the impact of the policy/guidance likely to be negative? Yes/ n/a n/a 5. If so can the impact be avoided? n/a 6. What alternatives are there to achieving n/a the policy/guidance without the impact? 7. Can we reduce the impact by taking different action? n/a Comments Author: Rupi Virdee Review Date: September 2020 Page 14 of 17

15 Appendix 1 Author: Rupi Virdee Review Date: September 2020 Page 15 of 17

16 Risk assessment for patients leaving ward/department Appendix 2 Patients name: Ward: Patient Address: Contact details Tel: For completion by patient I am aware of the Trust s Smokefree Policy and I understand that I am not to smoke anywhere on the hospital property or ground. Staff have made an assessment of my smoking status and level of nicotine dependency and they have offered me information about stopping smoking and offered to provide me with Nicotine Replacement Therapy so that I do not experience cravings or withdrawal symptoms whilst I am in hospital. I am aware that the risks of leaving the ward/department include: Increased risk of accident Potential deterioration of my condition Reduced access to care and treatment I am fully aware of the risks of leaving the ward/department to go off site to smoke and I do not hold West Hertfordshire Hospital Trust accountable for my actions if I choose to leave the ward/hospital. Signature: Print name: Date: For completion by employee: I have fully explained the risks of smoking and leaving the ward/department to smoke. I have offered this patient information and advice on stopping smoking and offered them NRT or Champix and a referral to Hertfordshire Health Improvement Service (HHIS) which they have: ACCEPTED/DECLINED (please delete as appropriate). Signature: Print name: Ward / Department: Date: Author: Rupi Virdee Review Date: September 2020 Page 16 of 17

17 Appendix 3 ASK Ask Smoking Status Smoker n-smoker Reinforce concern about adverse effects do a brief intervention linking risks of smoking to presenting condition & explain hospital Smokefree Policy If QUIT, give positive feedback, if recently quit, give details for HHIS Take CO + Record in clinical notes (if you have a CO monitor) Ask if they would like help to stop smoking If yes, refer to specialist service within 24 hours. If refused, leave the offer of help open and explain you will ask in further appointments. Offer harm reduction advice use NRT (or e-cigs) to reduce smoking or stop smoking on a temporary basis. Give contact details for HSSS Phone Text SMOKEFREE to health.improvementservice@hertscc.gcsx. gov.uk NO UNSURE YES If unsure about quitting, ask permission to refer anyway and a stop smoking specialist will call to discuss options. Offer harm reduction advice use of NRT (or e-cig) to reduce smoking or stop smoking on a Phone: Text: SMOKEFREE to health.improvementservice@hertscc.gcsx. gov.uk Offer information leaflets on NRT Organise NRT treatment in the interim Author: Rupi Virdee Review Date: September 2020 Page 17 of 17