Over the last 4 years we have been working towards becoming smoke free by a number of means:

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1 Appendix Borders NHS Board TOBACCO POLICY Aim To gain approval of the Tobacco Policy. Background NHS Borders has had a Tobacco Policy since 2002 that committed the organisation to moving towards being a smoke free environment. The current Policy has been in situ since 2006 and reflects the national smoking ban and the Guidance on smoking policies for the NHS, local authorities and care services providers This guidance directs NHS to move towards a complete smoke free environment. Our current policy has been in place for 4 years. Two years after its implementation a review was considered by the Occupational Health & Safety (OH&S) Forum and the decision taken to extend the extant policy for another 2 years. This current policy does allow inpatients to smoke within a designated external area, mental health inpatients may also smoke within an internal designated smoking area. Outpatients and day patients, relatives, staff and visitors may not smoke whilst on our premises including buildings, car parks and grounds. Staff may not smoke whilst at work. Over the last 4 years we have been working towards becoming smoke free by a number of means: The Mental Health Network are changing their internal smoking areas to be external smoking shelters. Phasing out the internal areas over a period of time. The BGH Clinical Board have been trying for 4 years to identify an acceptable external smoking area but have been unsuccessful; this has caused the inpatients to smoke mainly at the front entrance which in turn has encouraged others to smoke at the front of the Hospital. The Community Hospitals opted 3 years ago not to have smoking shelters within their grounds but to encourage patients to quit. They make provision on an individual basis should it be absolutely necessary. Community staff have been distributing patient leaflets for home visits asking patients not to smoke in the room where treatment would take place for at least 1 hour. This is in line with SBC policy also. More recently, further work has been underway to move closer to a complete smoke free environment. This review process was started by firstly setting up a working group (all members of the OH&S Forum and representatives from: Clinical Boards, Support Services, Health Improvement and Staff side were invited) the current Tobacco Policy was reviewed in light of the established policy commitment to move to smoke free environments, Scottish Government initiatives and Executive Team discussions. 1

2 Appendix Extensive consultation has taken place as described on the policy sign off sheet. This included a presentation to the Public Partnership Forum. The revised policy commits to no smoking as our norm for everyone. The Policy allows some flexibility to the norm as being the mental health inpatients units may facilitate smoking within external areas and when matters of safety arise i.e. patient safety or staff safety for example the de-escalation of aggressive behaviours. It also recognises that the BGH site is unique and requires specific definitions as to what will constitute grounds; these definitions are within the supporting guidance. The policy also gives more defined sanctions when staff are found to be smoking against policy. The OH&S Forum debated the Tobacco Policy at the 27 th Sept 2010 meeting and the Forum members supported the revised policy but wished more guidance on implementation. The BET & the Risk Management Board have similarly debated the issues and comments have been incorporated into the revised policy which is attached for consideration. The Tobacco Policy Guidelines are also attached for information (these are pending approval by OH&S Forum Feb 2011). Summary Current policy principles April 2006 NHS Borders has a responsibility to: -set a good example in promoting healthy lifestyles; and -work towards national targets which have been set to reduce the prevalence of smoking; and the incidence of diseases caused by tobacco smoke. NHS Borders is also committed to promoting healthy living and non-smoking as its normal culture No smoking as the norm whilst within our premises including grounds and car parks applies to: Day patients, outpatients, staff, visitors, contractors, healthcare partners Smoking is allowed for inpatients: mental health inpatients may smoke in internal designated room and in grounds, acute/community inpatients may smoke within designated external areas. Revised Policy changes Remain as the underlying principles of the policy No smoking as the norm whilst within our premises including grounds (BGH has unique definition) and car parks is extended to apply to everyone including inpatients. Exemptions: - In exceptional circumstances mental health in-patient units will have a designated external smoking area Rationale for change Demonstrated in the revised policy by taking more steps towards no smoking as our norm. The policy message is one of promoting healthy lifestyles by leadership. Complies with national directives and health promotion initiatives. Supports Corporate Objective: Health Improvement and Health Inequalities: We will promote and protect health and well-being This was the next phase in working towards a smoke free environment. The disparity between inpatients and others allowed smoking particularly at the front of the BGH which has made it difficult to implement the no smoking as our norm for others. To uphold our health promotion principles it was decided to move forward to a more equitable position of no smoking as our norm for everyone. Together with a 2

3 Exemptions: This means that out-patients and day-patients as the norm are asked not to smoke whilst on healthcare premises. There may be some situations that this would adversely affect day/out-patient care, where the organisation would support clinical staff in making judgements to, in exceptional circumstances, allow these patients to utilise external smoking areas. Current policy principles April 2006 Smoking whilst at work by NHS Borders staff members will be regarded as misconduct, consistent with breaches of other aspects of health and safety policy. Repeated breaches of this policy will lead to disciplinary action, as specified in the organisation s disciplinary policy and will be enforced on an equitable basis. - All patients are asked not to smoke whilst on healthcare premises. There may be some situations that this would adversely affect patient care or raise a safety issue, the organisation would support clinical staff in making judgements to, in exceptional circumstances, allow these patients to utilise the grounds to smoke on a temporary basis. Revised Policy changes Smoking whilst at work by NHS Borders staff members will be regarded as misconduct, consistent with breaches of other aspects of health and safety policy. Staff breaching policy will be subject to procedures within our Management of Employee Conduct Policy. Two recorded breaches of this policy within one year may lead to disciplinary action, as specified in the organisation s managing disciplinary policy and will be enforced on an equitable basis. Managers are reminded that support for employees to comply with policy is available and should form part of any agreed action plan. Appendix unique definition of the BGH grounds, this will make implementing no smoking at the front of the BGH easier. Mental Health in patients units have already decreased the use of internal smoking areas and have invested in external smoking shelters. The exemption rule that already applies to out-patients and day patients has been extended to all patients in circumstances of patient safety or staff safety. Comments Improvements in wording and a better description of sanctions for staff that have been in breach of the policy has been included. This was to help clarify to staff what the sanctions would be and to ensure fairness for all. This would support managers in ensuring compliance with policy. Recommendation The Board is asked to approve the Tobacco Policy. Policy/Strategy Implications Consultation Consultation with Professional Committees Supports the Health Improvement Strategies. As per the policy sign off sheet As per the policy sign off sheet 3

4 Appendix Risk Assessment Compliance with Board Policy requirements on Equality and Diversity Resource/Staffing Implications Attached As per the policy sign off sheet As per the policy sign off sheet Approved by Name Designation Name Designation June Smyth Interim Director of Workforce & Planning Author(s) Name Designation Name Designation Sheila MacDougall Risk & Safety Manager 4

5 For Approval Nov 2010 BORDERS Tobacco Policy Version number: 4.0 Prepared by (group or post title): Occupational Health and Safety Services Tobacco Group Distribution date: April 2004/06/08/10 Review date: November 2013 Distribution arrangements: OH&S Manual holders Intranet This policy has been approved for NHS Borders.. Chief Executive Approval date:.. Employee Director 1

6 1 Introduction 1.1 Health risks Tobacco smoking is an addictive habit, which causes disability, disease and death, and represents the single largest preventable cause of ill health and mortality in Scotland. Tobacco smoke in the environment is also a health hazard to both smokers and non-smokers. 1.2 Health & Safety benefits and requirements NHS Borders is responsible under British and European 1 employment law to: maintain a safe and healthy working environment; protect the health of patients and staff, and not subject them to hazardous environments and materials; and make sure that staff understand their responsibilities to look after the health and safety of others. 1.3 Health promotion and improvement NHS Borders has a responsibility to: Encourage health improvement and disease prevention work towards national targets which have been set to reduce the prevalence of smoking; and the incidence of diseases caused by tobacco smoke. NHS Borders is also committed to promoting healthy living and non-smoking as its normal culture. It will do this by establishing a smoke-free environment for all who wish it, while being sensitive to the needs of those who smoke and offering support to those who wish to give up. The long-term aim has been to work towards a complete smoke free environment. This document outlines how we will achieve Phase Three of our Action Plan. 1 European workplace regulations require employers to carry out written risk assessment. The risk posed to staff from tobacco smoke (from all sources, including staff, patients or visitors) and associated fire risks should be assessed and minimised. 2

7 1.4 Public Health Legislation NHS Borders must comply with the Public Health (the Prohibition of Smoking in certain premises) Regulation 2006 which makes it illegal to smoke in public places and in vehicles other than private cars. Included in these public places are:- Offices, factories and other premises that are non-domestic in which one or more persons work. Hospitals, hospices, psychiatric hospitals, psychiatric units and health care premises. Vehicles which one or more persons use for work. Premises providing care homes services, sheltered housing or secure accommodation services. Educational institution premises. Public Transportation. Conference centres, public halls and exhibition halls Exemptions Within the Public Health Regulations there are some premises that have been made exempt and can allow smoking in a designated room/s, those pertinent to the NHS are: Designated rooms in adult care homes. Adult hospices. Designated rooms in psychiatric hospitals and psychiatric units. In order to maximise health improvement for NHS Borders staff and clients, our policy extends beyond these legal requirements. Within NHS Borders smoking is now prohibited in all buildings and on all sites which includes grounds and carparks, except in designated external smoking areas for mental health in-patients. These designated areas will be clearly marked and are for the use of the mental health network inpatients only Signs There will be at least one NO SMOKING sign in every building and in each NHS owned/pool car used by NHS Borders. The signs will display the international no smoking symbol and the title of the official to whom complaint must be made by anyone observing someone smoking in a no smoking place. There will be signs at every entrance to NHS Borders sites confirming the smoke-free policy. 1.5 Tobacco Industry NHS Borders shall not profit from direct investment in the tobacco industry or from the receipt of sponsorship, research grants or donations from tobacco interests. 3

8 1.6 Consultation This policy has been developed in partnership with staff and staff-side representatives. The Involving People Network and healthcare partners will be included in the consultation process. 2 Scope and principles 2.1 Scope This policy covers all health service premises in Borders, and will be applied across NHS Borders. It applies to: all staff, regardless of staff group or designation; patients, including out-patients, day cases, in-patients and long-stay patients; visitors; and the wider NHS family (i.e. contractors, students, voluntary staff, Scottish Borders Council, other healthcare partners and anyone whose work, study or personal circumstances brings them into contact with NHS Borders). 2.2 Principles This policy is designed to improve the health of the workforce of NHS Borders by providing a smoke-free environment for all, while offering support to those who smoke and would like to stop. No patient, visitor or member of staff should be exposed to tobacco smoke against their will. To achieve this, smoking is prohibited within health service premises in the Borders as described in this policy. Smoking is not permitted by any persons including staff, patients, visitors and healthcare partners: within the buildings of the NHS in Borders; and within the grounds and car parks (as defined in the guidance) including: vehicles parked within NHS Borders grounds in any NHS Borders owned/pool vehicle A minimal exception is made for external designated smoking areas for mental health in-patients (see 4.1) Patients who cannot or choose not to stop smoking should be offered advice and pharmacological aid at the appropriate time. Every effort will be made to assist patients in smoking cessation including referral to smoking cessation services and replacement therapies. However, where patients refuse to refrain from smoking, then NHS Borders, following advice from a senior clinician responsible for the patients care, may instigate early discharge or review as per section 4.2 We recognise that it is tobacco smoke, and its effect on those who use it and are exposed to it, that is the problem, rather than the smokers themselves. The Occupational Health and Safety Service co-ordinates a range of support and advice to NHS staff who wish to stop smoking, and this will be advertised throughout 4

9 NHS Borders. This will continue to be offered either on a one to one basis or through smoking cessation groups where appropriate. 3 Commitment to a smoke-free environment 3.1 Health promoting message Smoking is linked to many ill health issues amongst the population; NHS Borders recognises this and is working towards a complete smoke free environment as a long-term aim. 3.2 Visitors Visitors and relatives are not permitted to smoke. 3.3 Patients In compliance with the Health Bill NHS Borders cannot allow patients to smoke within premises (in-patient, out-patient or day patient). This policy extends this prohibition to include entrances, grounds and car parks of all NHS premises except Borders General Hospital (smoking is permitted within car parks 1-6 only). Patients are not permitted to smoke. (For definition of grounds/car parks please refer to guidance.) Minimal exceptions apply and can be referenced in section Staff and Healthcare Partners Staff and healthcare partners are not permitted to smoke whilst at work. Staff who work more than 6 hours in a shift are entitled, under the working time directive, to a minimum of a 20-minute break (meal break); during this time staff are not considered to be at work. If staff wish to follow the activity of smoking at this time they must leave the premises and grounds to do so and observe the uniform policy. During tea breaks staff are still considered at work and therefore cannot smoke at these times. Smokers will not be allowed longer or more frequent breaks than non-smoking colleagues. Healthcare partners must follow this policy whilst on our premises and should refer to their own contractual policies regarding smoking off Health Board premises. 3.5 Staff residencies Although the staff residencies are not owned by NHS Borders but are rented, staff members are asked not to smoke within communal areas and in the interests of fire safety, staff residents are requested not to smoke in their bedrooms. 5

10 4. Exceptional circumstances 4.1 Mental Health in-patient units Where health care accommodation is defined as a psychiatric unit, local managers have the discretion to implement the policy sensitively and to protect the health and welfare of both smoking and non-smoking patients. In exceptional circumstances mental health in-patient units will have a designated external smoking area. However, patients will be made aware that designated external smoking areas are not continually supervised by healthcare staff and do not have emergency call systems. Where appropriate psychiatric in-patients must tell ward staff if at any time they leave their ward/premises to go to a smoking area. The in-patients using designated smoking areas will be asked to keep to a code of conduct governing the use of the facility, which should be kept tidy with any rubbish disposed of appropriately, the disposal of cigarette materials and matches should be within bins and ashtrays provided so as to avoid unsightly littering and to ensure fire risks are minimised. The condition of the designated smoking areas will be monitored during hazard spotting and the risk assessment process undertaken by the ward/department overseeing them. Any risks identified arising from smoking within designated areas will be managed in accordance with the Risk Management Strategy and Occupational Health and Safety Policy. All smoking areas will be provided with means of tobacco disposal. If it is not possible to provide an external designated mental health in-patient area, the right of non-smokers to a smoke-free environment will take precedence. Ultimately it is hoped that such areas may not be needed. Staff, relatives, visitors and other patients may not use these designated smoking shelters. 4.2 Patients All patients are asked not to smoke whilst on healthcare premises. There may be some situations that this would adversely affect patient care or raise a safety issue, the organisation would support clinical staff in making judgements to, in exceptional circumstances, allow these patients to utilise the grounds to smoke on a temporary basis. (Refer to guidance notes) 5 Support for Smokers 5.1 Options available Quit 4 Good NHS Borders Smoking Cessation service provides support to smokers who wish to stop smoking. A Quit 4 Good Advisor covers the BGH and is available to discuss support options for in-patients wishing to stop smoking and to arrange follow-up in the community following discharge. Community based support free and is available as: 6

11 one to one advice support groups The NHS Borders Smoking Cessation Service telephone number is Support can be accessed via health centres, pharmacies, community settings and hospitals. Occupational Health provides NHS Borders Smoking Cessation Service for staff. This support is for staff that wish to stop smoking or gain support with other smoking issues. The support offered by the Occupational Health and Safety Service is widely advertised throughout all health service premises, tel: The National Smokeline number it Training NHS Borders provides training for managers and staff in implementing the risk assessment process through which smoking will be controlled as identified within the risk controls. Staff requiring skills to assist patients through cessation or helping them with coping mechanisms can receive advice and training from Quit 4 Good. 6 Policy implementation This policy will be supplemented by the Departmental/Local Occupational Health and Safety Policy, these local policies will reflect that staff may not smoke whilst on duty, indicate that public areas are non-smoking and will clearly identify that grounds and car parks are designated non smoking areas. Where staff have to work within smoke laden areas the local policy must be clear what systems are in place to minimise the time staff may be exposed to second hand smoke. 6.1 Communication Prior to introduction of this policy we will communicate to the public and staff, visitors, relatives via the following channels: Local printed and radio media Through information points in NHS Borders premises Through walk round information discussions in hospital grounds. Staff newsletter and notice boards We will communicate this policy to staff, patients and visitors through admission booklets, discussion, at interview, contracts and the Occupational Health & Safety Services Manual. The Occupational Health and Safety Policy commits the organisation to ensuring, as far as reasonable practicable, a safe environment for all, this Tobacco Policy forms part of the arrangements to ensure staff, patients and the public are provided an environment that limits passive smoking and any ill health risks associated with this. As such, this policy is part of each individual s employment contract and we will tell all interview candidates about this policy. The policy will also be confirmed to successful candidates in their Conditional Offer of Appointment, at induction and in their Principal Statement of Terms and Conditions of Employment. 7

12 6.2 Roles and responsibilities NHS Border as an employer must ensure there: Is a designated named person/s from the organisation that complaints may be directed to if required. This to be displayed on appropriate legal signs. This designated person will be the Chief Executive Managers are responsible for ensuring that: Incorporating the requirements of this policy into the arrangements within the required local occupational health and safety policy. No-smoking signs are prominently displayed. Where healthcare staff are exposed to passive smoking whilst delivering care, (community/home visits/mental Health in-patient unit), Managers must apply the generic Passive Smoking Risk Assessment and put in local arrangements to minimise time spent by staff in smoke laden atmospheres, give staff a procedure by which to withdraw from the smoke laden atmosphere without significantly compromising clinical care levels and consult the Occupational Health and Safety Services when a vulnerable member of staff i.e. Asthmatic, will have significant exposure to smoke on a regular basis. Ensure their area is monitored for evidence of smoking by using the hazard recognition process, taking appropriate action when evidence is found. Implement this policy and ensure staff are aware and follow the policy. Clinical Boards will develop implementation plans as part of the OH&S Intervention Plans. Investigate any incidences of policy breaches, taking remedial actions as appropriate. Receive and investigate incidents of staff breaches, if verified, record this within personnel files. Agree supportive actions with staff member with timescales. If a further breach occurs within one year the line manager must refer to Managing of Employee Conduct Policy as appropriate. When applicable appropriate mental health designated external smoking areas are clearly signed as such Managers, staff and staff side representatives are jointly responsible for ensuring that: individual staff know, understand and comply with this policy; contractors or non-nhs staff know, understand and comply with this policy; contraventions are identified and are managed in accordance with NHS Borders Policies and; the policy is monitored in their own area Staff are personally responsible for complying with this policy. They are also responsible for making sure that patients and visitors comply with this policy by acting on any breaches of policy. 8

13 6.3 Sanctions Smoking whilst at work by NHS Borders staff members will be regarded as misconduct, consistent with breaches of other aspects of health and safety policy. Staff breaching policy will be subject to procedures within our Management of Employee Conduct Policy. Two recorded breaches of this policy within one year may lead to disciplinary action, as specified in the organisation s managing disciplinary policy and will be enforced on an equitable basis. Managers are reminded that support for employees to comply with policy is available and should form part of any agreed action plan. Patients who smoke out with designated areas will be reminded of the policy and asked not to smoke. Visitors who smoke on the premises will be asked not to smoke and will be reminded of the policy Fines for smoking within no smoking premises Under the Public Health (The Prohibition of Smoking in Certain Premises) Scotland Regulations 2006, failure to comply with the law is a criminal offence. Individuals may be fined a fixed penalty of 50 for smoking in any no-smoking premises. The manager or person in control of any no-smoking premises could be fined a fixed penalty of 200 for either: allowing others to smoke in a no-smoking premises failing to display warning notices in no-smoking premises refusal to pay or failure to pay may result in prosecution and a fine of up to 2,500 The Environmental Health Department, Scottish Borders Council, are the enforcing authority for the regulations and will impose any fines and initiate any prosecutions What to do if someone ignores the policy We hope that the majority of people will respect the policy requirement not to smoke. However, it is important that we know what to do if someone does continue to smoke: If smoking within a building - Draw the person s attention to the No Smoking signs and remind them that they re committing an offence. Politely ask them to stop smoking. Advise the person that it s also an offence for NHS Borders to let anyone smoke. Explain to them that NHS Borders has a no smoking policy in buildings and grounds to ensure a safe working environment for all staff, patients and visitors. If the person smoking is an employee: If your warning has been ignored and the individual is going to carry on smoking, if appropriate ask them to immediately leave the premises and grounds or inform line manager. If the person refuses, inform your line manager and the normal disciplinary procedures may be used for breach of policy/contract Record on the incident reporting system: general incident form failure to follow system 9

14 If the person is a visitor/relative: Explain that NHS Borders staff are legally obliged to refuse access to the premises if they continue to smoke. Remind them that it is the policy of NHS Borders that there should be no smoking within premises and grounds; let them know where they can smoke. If the person carries on smoking, ask them to leave the premises/grounds. If he/she refuses, implement the normal procedure for anti-social behaviour in the premises. Record such incidents as appropriate on general incident form i.e. verbal aggression, personal safety, failure to follow system. If a member of staff feels unable to approach the smoker they must report the matter to their line manager. If the person is a patient: At the appropriate time explain the NHS Borders no smoking policy and ask them to stop smoking. Consider any alternatives that may be offered; how to access appropriate advice and support from the Quit 4 Good. In extreme and dangerous circumstances e.g. patient on oxygen or in shared ward, smoking materials may have to be removed for safe keeping and returned at discharge. At the appropriate time explain the legal implications and that this could affect the ability of NHS Borders to continue providing them care on healthcare premises if they continue or repeatedly break the legal requirements. In some cases this may require an exploration of how the needs of the patient may be met in light of the legal requirements and this policy, and will require written confirmation to the patient. If the patient is, at the time of inappropriately smoking, unable to recognise their actions as being unlawful or in breach of NHS policy then other means of compliance must be explored at the first opportunity. These situations should be referred to ward managers and clinical service managers. In all cases where physical violence or intimidation is threatened or encountered, seek the assistance of the police. Ensure these are reported on the general incident recording system. 7 Monitoring and evaluation 7.1 Outcomes and indicators The following indicators will be used to monitor how the policy is being implemented: Is the policy effectively and widely communicated? Is appropriate information available for staff, patients and visitors? Are staff aware of the policy and its implications? Is the policy covered at Induction? 10

15 What information can be gained from anonymised OHS information elating to this? Has there been any evidence within the hazard spotting process and risk assessment process that indicates non-compliance? Increase in referrals to Smoking Cessation Service and the Occupational Health Service Levels of enforcement activity Review of complaints related to smoking activity are reviewed Incident reports The Chair of the Occupational Health and Safety Forum will co-ordinate the evidence gathered from the monitoring processes and ensure a report is submitted to the Health Board. The Risk Management Strategy and Occupational Health and Safety Policy lays out the monitoring process and the annual self-assessment tool will incorporate performance review at Departmental/Ward level regarding compliance with this policy. 7.2 Review This policy will be on a 3 year cycle and the Tobacco Policy Review Group will make recommendations to the Board Executive Team/Clinical Executive on further developments to the Tobacco Policy, following the review. 11

16 TOBACCO POLICY GUIDANCE 2010 draft v3 Introduction These guidance notes are to supplement the NHS Borders Tobacco Policy and to help staff understand and implement both our policy and the Smoking in Public Places Legislation (March 2006). Staff Our tobacco policy clearly states that staff may not smoke whilst at work or on NHS Borders property (including grounds and vehicles used for work.) Under the working time directive staff who work more than 6 hours in a shift are entitled to a minimum 20 minutes break (meal break). During this time staff are not considered to be at work. If staff wish to smoke in this period they must leave healthcare grounds and observe the uniform policy. During tea breaks staff are still considered to be at work and cannot smoke at these times. Smokers will not be allowed longer or more frequent breaks than nonsmoking colleagues. Healthcare Partners All healthcare partners staff members i.e. social work SBC, working within NHS Borders premises must comply with NHS Borders Tobacco Policy. Any NHS Borders staff working within healthcare partner s premises must comply with NHS Borders policy of not smoking whilst at work but during meal breaks those who wish to smoke must adhere to the host employers smoking rules. Legislation Under the Smoking in Public Places Legislation it is an offence for anyone to smoke in enclosed public places. Only Mental Health in-patient wards are exempt in NHS Borders; Huntlyburn Wilton View Poynder View Cauldshiels Hume Galavale East & West Brig Melburn Lodge It is therefore an offence for any person (except those exempted) to smoke in buildings including patients. Policy NHS Borders has further extended the smoking ban to include banning all patients from smoking within buildings including the mental health patients. It is now against policy to allow mental health patients to smoke within buildings but they may smoke in designated external smoking areas. All persons including all patients: NHS Borders policy commits to no smoking as our norm on all NHS property. 1 Smacd/p:Tob Policy consultation12/01/11

17 This means entrances, grounds and car parks of all NHS property. Patients/staff/visitors/relatives/healthcare partners/contractors/public are not permitted to smoke. Refer to definition of grounds and premises below. Exceptional circumstances for mental health in-patients All mental health inpatient units have committed to having external smoking areas only. In-patients may be offered smoking cessation advice and support but may wish to still smoke; staff must direct them to the external smoking area. Exceptional circumstances by reason of safety for in-patients/outpatients/day patients All persons are asked not to smoke whilst on healthcare premises. There may be some situations that this would adversely affect patient care or raise a safety issue, the organisation will support clinical staff in making judgements to, in exceptional circumstances, allow these patients to utilise the grounds to smoke on a temporary basis. Certain exceptional circumstances (e.g. patient refuses life saving treatment because they wish to smoke, alleviate aggressive behaviours or any other type of staff/patient safety issue) may mean that patients should temporarily be allowed to smoke within the grounds. Supervision of this smoking activity is a decision taken at the time of the incident and may or may not be appropriate depending on clinical needs and staff safety issues. What to do if someone ignores the smoking ban We hope that the majority of people will respect our no smoking as the norm. However, it is important that we know what to do if someone does continue to smoke: Generally: If they are smoking within a building: advise the person that it s an offence for NHS Borders to let anyone smoke within buildings. They could face a fine as we could too. Explain to them that NHS Borders has a no smoking policy to ensure a safe working environment for all staff, patients and visitors. As our grounds, car parks and entrances are the first impression of NHS Borders that people/patients see when they visit us we are asking for their help to promote a positive health image. Part of our healthcare message is healthy lifestyles and we need help from the public to spread the good word. If the person smoking is an employee: Please ask the employee to stop smoking. If your warning has been ignored and the individual is going to carry on smoking, if appropriate ask them to immediately leave the building and grounds and inform your line manager that a fellow employee has been seen or is continuing to smoke inappropriately, give them the location. If possible identify the person breaking policy. Line managers must inform the smokers own line manager, who must then apply the Tobacco Policy and HR policies as appropriate. Record on the incident reporting system: general incident form failure to follow system 2 Smacd/p:Tob Policy consultation12/01/11

18 If the person is a visitor/relative: Explain that NHS Borders staff are legally obliged to refuse access to the buildings if they continue to smoke. Remind them that it is the policy of NHS Borders that there should be no smoking within buildings and NHS Borders has adopted no smoking as our norm and smoking is also banned in the grounds to all persons; let them know where they can smoke. As our grounds, car parks and entrances are the first impression of NHS Borders that people/patients see when they visit us we are asking for their help to promote a positive health image. Part of our healthcare message is healthy lifestyles and we need help from the public to spread the good word. If the person carries on smoking, ask them to leave. If he/she refuses, implement the normal procedure for antisocial behaviour. Record such incidents as appropriate on general incident form i.e. verbal aggression, personal safety, failure to follow system. If a member of staff feels unable to approach the smoker they must report the matter to their line manager. If the person is a patient: At the appropriate time explain the NHS Borders restricted smoking policy and ask them to stop smoking. Consider any alternatives that may be offered; how to access appropriate advice and support from the Smoking Cessation Service. In extreme and dangerous circumstances e.g. patient on oxygen or in shared ward, smoking materials may have to be removed for safe keeping and returned at discharge. At the appropriate time explain the legal implications and that this could affect the ability of NHS Borders to continue providing them care in healthcare buildings. If they continue or repeatedly break the legal requirements. In some cases this may require an exploration of how the needs of the patient may be met in light of the legal requirements and this policy, and will require written confirmation to the patient. If the patient is, at the time of inappropriately smoking, unable to recognise their actions as being unlawful then other means of legal compliance must be explored at the first opportunity. These situations should be referred to ward managers and clinical service managers. In all cases where physical violence or intimidation is threatened or encountered, seek the assistance of the police. Ensure these are reported on the general incident recording system. What constitutes NHS grounds/premises Most of NHS Borders premises/grounds are quite straight forward and it is relatively easy to know where NHS property boundaries are. The Borders 3 Smacd/p:Tob Policy consultation12/01/11

19 General Hospital site is rather more problematic due to its rural setting and extensive grounds and farm lands surrounding the buildings. Definitions: NHS Borders properties other than those on the Borders General Hospital site, the definition of grounds/premises is : The grounds covers all car parks, surrounding garden areas up to boundary markers (fences or walls) Most grounds have boundary walls, hedges or fences, there is to be no smoking beginning at the grounds entrances (both vehicle and pedestrian entrances) to NHS property, there may be a sign stating welcome to NHS Borders, NHS Health Centre, Westgrove at that entrance. Every car park and garden area within the boundaries is NHS property. Where possible external boundary signs will be adjusted over a period of time to state NHS Borders is smoke free. For buildings on the Borders General Hospital site: main hospital, Education Centre, Cauldshiels, Melburn Lodge, primary service block and adjacent buildings and grounds, no smoking is permitted. The grounds where visitors may smoke are: Within car parks vehicle areas: car parks 1, 2, 3, 4, 5, & 6, smoking will cease as soon as people step onto the pavements leading to the main building. It is planned that all pedestrian routes leading to the Hospital and buildings entrances will be clearly marked and sign posted to inform people they have entered a no smoking area. These smoking areas are for the use of visitors only and not for staff members. Reporting incidents The introduction of no smoking as our norm may have an impact on our staff and patient community and staff may experience outcomes such as: Staff/patient safety concerns prevent asking a person smoking illegally to stop. Experiencing aggressive behaviour when informing patients/relatives about policy. Evidence of smoking indoors (e.g. within toilets) is found Tobacco smoking activity related fire. Use of the exceptional circumstance for inpatients (other than mental health inpatients) In any of these cases an incident should be recorded stating the relation to the Tobacco Policy. Making home visits where smoking takes place NHS Borders has a leaflet (available on the Risk, Health and Safety Intranet site) that asks patients who are receiving a home visit and who allow smoking within their homes to help protect staff from second-hand smoke by: 4 Smacd/p:Tob Policy consultation12/01/11

20 refraining from smoking inside the house for at least 1 hour before NHS staff arrive open windows and doors to fully ventilate the area try to keep one room smoke free at all times. During the visit: do not smoke or let anyone else in the house smoke in the area wherever possible, when NHS Borders staff are in the house, ask other smokers to go outside to smoke. Staff should assess whether the home environment they are entering is safe. If a smoke free environment cannot be provided, a risk assessment will be required in order to reduce risk to a level as far as is reasonably practicable. We will support staff to leave an environment they deem to be unsafe however alternative treatment options must be developed to deliver the healthcare necessary for the patient whilst keeping staff safe. Smoking cessation: help for all Quit 4 Good NHS Borders Smoking Cessation service provides support to smokers who wish to stop smoking. A Quit 4 Good Advisor covers the BGH and is available to discuss support options for in-patients wishing to stop smoking and to arrange follow-up in the community following discharge. Community based support free and is available as: one to one advice support groups The NHS Borders Smoking Cessation Service telephone number is Support can be accessed via health centres, pharmacies, community settings and hospitals. Advice and support is also available from local pharmacies. Occupational Health provides NHS Borders Smoking Cessation Service for staff. This support is for staff who wish to stop smoking or gain support with other smoking issues. The support offered by the Occupational Health and Safety Service is widely advertised throughout all health service premises, tel: The National Smokeline number it Any queries regarding the implementation of the Tobacco Policy, please contact Risk, Health and Safety Team. 5 Smacd/p:Tob Policy consultation12/01/11

21 Occupational Health & Safety Related Policy Sign-off Checklist This checklist to be completed and attached to all OH&S Policies for agreement Policy Title: Lead: This Policy Has Been: (tick one) Has the Policy been produced in accordance with legislation? Please give details of applicable legislation Has the OH&S Policy been produced in accordance with PIN guidelines? Tobacco Policy Sheila MacDougall Yes Reviewed Developed Health and Safety at Work Act Management of Health and Safety At Work Regulations Smoking, Health and Social Care (Scotland) Act Prohibition of smoking in certain premises (Scotland) Regulations Managing Health at Work 2003 used as template in 2004 Currently out of date Please give details of applicable PIN Who was involved in the review/development? Name Position Sheila MacDougall Risk and Safety Manager Jenny Webb Unite H&S Rep Eileen Frame RCN H&S Rep Sue Keean PMAV Co-Ordinator Fiona Doig Health Promotion OH&S Forum members including representatives from clinical boards Health Board members Has a Rapid Impact Assessment been done? (tick one) If yes, was a full EQIA required? (tick one) Are there any cost implications? (tick one) If yes, please detail costs and note source of funding Are there any service implications? (tick one) If yes, please detail Yes No Yes No Yes No Publicity campaign in local media Revision of external signage Revision of internal signage New patient information leaflets/posters Funding source: Risk & Safety/Estates Yes No Services will have to be proactive in promoting, implementing and monitoring policy. More support required for patients to cope with not smoking for an unknown period of time

22 Details of consultation Who must comply with the policy? How will they be informed of their responsibilities? Consultation period: 12/05/10 11/06/10 extended to 01/07/10 for public forum consultation Issued to: OH&S Forum Clinical Boards Clinical Exec/BET APF Public Partnership Forum Joint Partnership Forum/SBC Nursing Leads Clinical Risk Management Group Intranet for all staff All staff, healthcare partners, contractors, patients and the public Policy, leaflets and posters Is any training required? If yes, what form will this take? When will the policy take effect? (tick one) Yes No Nursing staff can access training from Health Promotion re smoking cessation & patient support Hazard spotting and safety walk rounds training available on request from Risk & Safety Team Risk Assessment Training as per training directory On approval date: TBC Who is responsible for auditing the implementation of the policy? Who will receive the audit reports? Risk, Health and Safety Team OH&S Forum When will the policy be reviewed and by whom? April 2013 Tobacco Policy review group as sub set of OH&S Forum Signed: Sheila MacDougall Date: 04/11/10

23 RISK ASSESSMENT DETAILS The details contained on this form records the risk analysis as part of the risk assessment process. All details will be required to be filled in to enable the risks identified to be recorded on the Risk Register. Directorate: NHS BORDERS Dept/Ward: ALL SITES Corporate Objective: (Risks will all be linked in some way to NHS Borders objectives.) Risk Management Standards and Staff Governance Opportunity: (Is there any benefit to be experienced) To improve health, safety and welfare and ensure compliance with Health and Safety at Work etc Act and subordiante legislation Context: (The risk assessment subject will need to be placed in context with parameters of assessment being made clear) Impact of Tobacco Policy Type: Tick one box patient experience Injury Patient (Physical/ psychological) Injury Staff/public/visitor (Physical/ psychological) Staffing & Competence Adverse Publicity/ Reputation Financial including damage/loss/ fraud Service business interruption OH&S Environment/ Equipment OH&S Activity OH&S Specific AV/M&H/COSHH OH&S Policy:- generic Category: (operational, strategic, both) Governance System: Corporate/Clinical/Staff/Public one or combination of these Both Staff Risk Owner; (Name of Director/Manager who has overall responsibility) Status: Managed: Resources to be allocated Tick Tolerate: No resources or minimal resources one Transfer: Move risk to another organisation box Terminate: Remove the risk altogether Review Entry: How often does the Risk owner wish to revisit the risk register entry i.e (6 months/12 months) Current Level of Risk This is the risk level determined using matrix. Take current risk controls and their effectiveness into consideration when determining risk level. If there are multiple risk scores then this entry will be the highest level determined. LIKELIHOOD: Rare IMPACT: Negligibile RISK LEVEL: Low Target Risk Level This should be the level of risk that is desired after the action plans have been implemented and risk controls optimised. LIKELIHOOD: Rare IMPACT: Negligibile RISK LEVEL: Low Risk Assessment Process details: Stakeholder details (who was consulted/involved) Lead Assessor: name/designation/department Manager s Signature Print name. Date Assessment completed:

24 RISK ASSESSMENT Source of Problem, concern, hazard. Threat to achievement of objective 1. Passive smoking inpatients smoking in Mental Health NHS Premises Designated smoking rooms for inpatients within mental health residential units, in exceptional circumstances. Patient bedrooms temporary smoking arrangements One to one nursing within mental health residential units, time spent in smoke laden atmosphere. Escort outside to designated external smoking areas for inpatients. Persons affected by the problem/hazard or risk All nurse grades CPNs General Services Staff Estates Staff Asthmatics Respiratory Sensitised Staff Pregnant Workers Students Contractors Patients Risk arising/risk identified Passive smoking causing acute ill health for asthmatic/respiratory sensitised Increase in likelihood and complication of pregnancy including health affects on baby Passive smoking causing chronic ill health Potential scope/consequences of risk. Risk impact Sickness/absence increase. Redeployment required. Civil Case Breach of health and safety legislation and/or policy leading to prosecution Adverse affect on recruitment/retention Increase in financial burden Adverse affect on quality of healthcare given over shift period. Current control measures Occupational Health and Safety Policy Tobacco Policy Incident Reporting System Natural ventilation in a patients own room under exceptional circumstances. Local good practice i.e. procedures to limit exposure to passive smoking. Limit staff time spent in smoke laden atmosphere Local Tobacco Policy risk assessment Are controls effective - effective - partial - ineffective Assessment Score Likelihood Consequence Risk Level Possible Minor Medium Rare Moderate Low Rare Major Medium Visitors Members of the public Smoking cessation advice and support Occupational Health Services Pregnancy Risk assessment

25 Source of Problem, concern, hazard. Threat to achievement of objective 2. Passive Smoking patients/relatives smoking during home visit Staff exposed to smoke laden atmosphere Persons affected by the problem/hazard or risk Staff making home visits Students Asthmatics Respiratory Sensitised Staff Pregnant Workers Risk arising/risk identified Passive smoking causing acute ill health for asthmatic/respiratory sensitised Increase in likelihood and complication of pregnancy including health affects on baby Passive smoking causing chronic ill health Potential scope/consequences of risk. Risk impact Sickness/absence increase. Redeployment required. Civil Case Breach of health and safety legislation and/or policy leading to prosecution Adverse affect on recruitment/retention Increase in financial burden Current control measures Occupational Health and Safety Policy Tobacco Policy Incident Reporting System Natural ventilation in a patients home Short periods of exposure Good practice guidelines for patients to follow Are controls effective - effective - partial - ineffective Assessment Score Likelihood Consequence Risk Level Possible Minor Medium Rare Moderate Low Rare Major Low Local good practice i.e. procedures to limit exposure to passive smoking. Local arrangements for minimising exposure to passive smoke Smoking cessation advice and support Occupational Health Services Pregnancy Risk Assessment

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