Smoke Free Policy Practice Guidance Note Guidance on the use of E-Cigarettes by Service Users, Staff and Visitors - V02

Transcription

1 Smoke Free Policy Practice Guidance Note Guidance on the use of E-Cigarettes by Service Users, Staff and Visitors - V02 Date Issued Planned Review PGN No: Issue 1 Mar 16 Issue 2 11 Mar 16 March 2019 HWB-PGN-05 Part of NTW(O)13 Smoke Free Policy Author/Designation Responsible Officer / Designation Sally Faulkner - Health Improvement Specialist Rajesh Nadkarni Medical Director Contents Section Description Page No 1 Introduction 1 2 Types of e-cigarette 2 3 Summary of the Use of E-Cigarettes in relation to the Trust Smoke Free Policy 4 Use of E-cigarettes within Forensic Services 3 5 E-Cigarettes - Health & Safety considerations 3 6 The use of E-Cigarettes for harm reduction 4 7 The use of e-cigarettes and anti-psychotic medications 4 Document No Description Appendix Issue Issue Date 2 Review Date 1 Examples of types of e-cigarettes 2 11 Mar 16 Mar Introduction 1.1. E-cigarettes are used by an increasing number of people to assist with either reducing the number of cigarettes they use, or stopping smoking altogether An independent evidence review commissioned by Public Health England was published in August 2015 and concluded that although e-cigarettes are not proven to be 100% safe, it is reasonable to say that they are 95% less harmful than smoking tobacco. There are plans for e-cigarettes to be regulated and licensed from The Trust acknowledges that e-cigarettes can be useful as part of a harm reduction plan for current smokers. However, they are not currently licensed products and this lack of regulation has several important consequences. Northumberland, Tyne and Wear NHS Foundation Trust 1

2 1.4. Due to the lack of regulation, e-cigarettes cannot currently be prescribed or recommended as an alternative to nicotine replacement therapy (NRT) In addition that there may be some health and safety considerations that need to be addressed when considering their use across our Trust, this is due to issues surrounding counterfeit products, faulty chargers and the potential fire hazards this presents (see section 5) There are a large number of products available which are different both in appearance and function. Some of them look very similar to tobacco cigarettes and emit a vapour which can look like smoke. Others look very different form ordinary cigarettes. 2. Types of e-cigarettes 2.1. First generation e-cigarettes (Appendix 1, Fig. 1) typically look like ordinary cigarettes ( cigalikes ) and generally use cartomisers (a cartridge plus an atomiser). They are disposable after use, being neither rechargeable nor refillable. When the user takes a puff (or presses a button on some models) the device heats a coil which vapourises the e-liquid and creates the vapour that can be inhaled Second generation e-cigarettes (Appendix 1, Fig. 2) look less like normal cigarettes and generally contain a tank that can be refilled with e-liquid of varying flavours and strengths. Some newer models of e-cigarette are now being referred to as personal vapourisers these bear little resemblance to cigarettes and can be used with various atomisers, cartomisers and tank systems. These typically use larger batteries and have adjustable power settings Third generation e-cigarettes (Appendix 1, Fig. 3) allow the user to vary the voltage applied to the atomiser. These often have rechargeable batteries and can come with software to allow users to programme voltage and or monitor their usage patterns. 3. Summary of the Use of E-Cigarettes in relation to the Trust Smoke Free Policy 3.1. Northumberland, Tyne and Wear NHS Foundation Trust (the Trust/NTW) has a Smokefree policy (NTW(O)13), which is designed to both protect people from exposure to second hand smoke and also promote the image of the organisation as a health promoting public body Therefore, for the purposes of the Trust smokefree policy, due to the evidence outlined above, first generation e-cigarettes / cigalikes are generally permitted for use by service users only on Trust sites, in outdoor spaces only (exceptions apply to Forensic Services see section 4). These e-cigarettes must be the non-rechargeable and non-refillable models Any variety of e-cigarette that is rechargeable and/or refillable will not be permitted anywhere on sites owned or managed by the Trust. No variety of e-cigarette is permitted to be used within Trust buildings or vehicles. Northumberland, Tyne and Wear NHS Foundation Trust 2

3 3.4. Staff are not permitted to use e-cigarettes on any site owned or managed by the Trust or during working hours Where the Trust operates services on sites owned and managed by other organisations, the policy of that organisation will apply (this applies to both staff and service users) E-cigarettes of any variety should NOT be used in an oxygen rich environment. 4. Use of e-cigarettes within Forensic Services 4.1 Due to security issues e-cigarettes of any variety are not permitted within Forensic Services. 5. E-Cigarettes - Health and Safety considerations 5.1. An NHS alert previously identified a number of incidents which have been reported across the UK involving e-cigarettes that have exploded or ignited to cause a fire while recharging. A number of different brands of e-cigarette have been implicated within these incidents and it is difficult to readily identify or distinguish these products from those with less protection or possibly no over-charge protection The recharging of rechargeable e-cigarettes has, therefore, been identified as a potential fire hazard. The Trust considers that it is not feasible to implement adequate supervision over the recharging of rechargeable e-cigarettes because of the diversity of e-cigarettes available, the lack of instructions specific to each model, a lack of assurance that any recharger is the original to the model of e-cigarette and absence of regulation of any safety systems employed in each model Therefore, the recharging of rechargeable e-cigarettes is prohibited on all premises which are owned or managed by the Trust, or from which the Trust operates services, either clinical or non-clinical. Recharging is also prohibited in any vehicle owned or operated by the Trust Service users can continue to use first generation e-cigarettes which cannot be recharged or refilled, and are disposable, subject to compliance with the Trust smoke free policy A further case of explosion occurred when an e-cigarette was being used in an oxygen rich environment. In view of the identified risk of explosion when used in oxygen rich environments, e-cigarettes must not be used in the vicinity of any person using oxygen, or within the vicinity of any oxygen containing equipment (such as cylinders) The Trust protects its service users and staff from the danger of fires by identifying and limiting potential fire hazards. It must also comply with health and safety guidance There are an increasing number of reports of either accidental or deliberate poisoning using the nicotine refills available for refillable e-cigarettes. The exact dose of nicotine which they deliver can be unreliable, despite labelling. Northumberland, Tyne and Wear NHS Foundation Trust 3

4 5.8. There have also been reports of incidents where refillable e-cigarettes have been used for the self-administration of drugs and chemicals other than nicotine (including legal highs and illegal drugs) Other issues which have been identified include exposure of bystanders to nicotine containing vapour, irritation from the vapour. However, the recent evidence report commissioned by Public Health England suggests that e-cigarettes release negligible levels of nicotine into ambient air with no identified health risks to bystanders. 6. The use of E-Cigarettes for harm reduction 6.1. The Trust does recognise the role of e-cigarettes in harm reduction for current smokers of tobacco products. However, lack of regulation and licensing means that e-cigarettes cannot currently form part of a recommended smoking cessation plan While the Trust will not prescribe or advise the use of e-cigarettes as nicotine replacement therapy, it will make first generation (non-rechargeable, non-refillable) e-cigarettes available for sale within Trust managed shops where a service user may purchase them should they so wish. They will not be available from pharmacy departments As first generation e-cigarettes generally contain less nicotine than rechargeable e- cigarettes, the Trust will make other forms of nicotine replacement therapy (such as NRT patches) available to be used in addition to a first generation e-cigarette if necessary. Service users may use an e-cigarette in addition to use of prescribed NRT if they wish The Trust will continue to promote smoking cessation through support and access to other forms of nicotine replacement therapy and appropriate medication. 7. The use of E-Cigarettes and anti-psychotic medications 7.1. Changing from smoking tobacco based products to using e-cigarettes (or NRT) can alter the way in which some drugs are metabolised in the body, and cause changes in blood levels. This is particularly important for some anti-psychotic medications (such as clozapine and olanzapine) but can also affect some other drugs commonly prescribed for mental and physical health conditions (such as theophylline) (see practice guidance notes sitting with NTW(O)13 Smoke Free Policy, HWB- PGN Smoking cessation and psychotropic drug interactions and PPT- PGN-05 Safe Prescribing of Clozapine) Therefore, service users who use e-cigarettes must be asked by Level 2 advisors if they have changed their tobacco smoking habits and this information documented and discussed with the prescriber and/or pharmacist. (Please note that it is the cessation of smoking tobacco, and not the use of nicotine, that causes the issues with anti-psychotic medications). Northumberland, Tyne and Wear NHS Foundation Trust 4

5 Examples of types of e-cigarettes Appendix 1 NB. The images below are not exhaustive, therefore please be aware that other variations of e-cigarette may be found. Figure 1: Example of a first generation electronic cigarette: Permitted for use on Trust sites under the following conditions: By service users only In outdoor spaces only Must be disposable, non-rechargeable, non-refillable models only Figure 2: Example of a second generation electronic cigarette (not permitted): Northumberland, Tyne and Wear NHS Foundation Trust 5

6 Figure 3: Example of a third generation electronic cigarette (not permitted): Northumberland, Tyne and Wear NHS Foundation Trust 6