Tobacco Free Hospitals

Transcription

1 Tobacco Free Hospitals Improving the Health of the Community Tom Peterson, M.D.

2 Disclosure Tom Peterson, MD, is on the speaker s bureau of Pfizer, Inc.

3 Learning Objectives Define a smoke-free hospital campus what it means, how it functions, and how it exists with other hospital values and missions Demonstrate how implement smoke-free campus policies, how to respond to them, and how to sustain them Demonstrate how to include other smoke-free campus policy including other smoke-free policies, inpatient and outpatient cessation efforts and community collaborations.

4 A New Call for Hospitals In 2007: Smoke-free campuses Non-smoking policies Wellness program incentives for employees Smoking cessation for outpatients Collective voice for advocacy Inpatient cessation»adults»pediatrics

5 Why a Smoke Free Campus? Mission Focus Safe, Healthy, Clean Environment Visitors, Employees, Patients

6 Mission Focus To improve the health of the community The Facts about smoking #1 cause of preventable death & illness A primary cause of the 4 leading causes of death Increased LOS, recovery time, wound healing #1 addiction in the United States Elimination of smoking is the single most important factor in improving health.

7 Hospital Smoke-Free History Late 1970 s Hospital sales of tobacco products eliminated % hospitals with smoking restrictions indoors 1987 Mayo Clinic first smoke-free campus in US 1991 JCAHO policy to ban indoor smoking nationally Michigan History 1996 United Memorial Hospital first smoke-free campus in Michigan 2000 MDCH grant for smoke-free campus task force University of Michigan,, Northern Michigan Health System, Holland Community, United Memorial 2003 Grand Rapids with first multi-hospital smoke-free campus collaborative (Saint Mary s Health, Metropolitan Hospital, and ) 2006 MHA, MDCH, and Smoke-Free Campus Task Force combined efforts and MHA committed all hospitals have smoke-free campuses by January 1, 2008 JCAHO next?

8 Current Collaboratives In Michigan Oakwood/Henry Ford/Saint Johns/Detroit Medical Center/Detroit Children s Lansing area hospitals Kalamazoo Bronson and Borgess Hospitals

9 Michigan Smoke-Free Hospital Initiative Begun in 2000 Assisted over 130 hospitals in Michigan Provided 8 statewide trainings on smoking cessation for hospital staff and health care providers Developed 4 versions of Smoke-free Campus CD, now used nationally Provided nursing and physician education for over 50 hospitals Reference and resource for over 600 hospitals nationally and 5 countries

10 A Tobacco-Free Campus Should Include: Total ban on smoking indoors and outdoor campus Identify and treat all admitted patients who are tobacco users Provide outpatient smoking cessation resources for patients, visitors and employees

11 The Opportunities of Acute Care Hospitals Inpatients Parents of children Adults Pregnant patients Long term care Urgent care ED Home health care Pharmacies Outpatient procedures OT/PT/occ med

12 Employees Decrease smoking prevalence of employees Improve overall wellness of employees, incentives to quit Limit public exposure of hospital employees who smoke Decrease absenteeism and improve productivity Tighten smoking policies of employees Over 80% regularly favor policy change

13 What the Employer Really Pays for Smoking Increased direct medical costs per smoking employee per year Increased indirect medical costs to employees family Lost productivity costs per employee per year Increased overall health costs to the business

14 Costs to Employer (con.) Each year, smokers have 6.5 more days absence Each year, smokers have 6 more visits to health care facilities for themselves Each year, smokers make 4 more visits to health care facilities for their dependents Annual cost per smoker to employer is: $1,200 - $1,600 per year

15 Example of Employee Incentives and Resources Free classes offered onsite, all shifts Reimbursement for nicotine replacement therapies, medications, therapies Non-Smoking Incentive for employees Access to a counselor Free community classes Free quit line access

16 Effect on Smoking Prevalence of Employees Hospital» %» % University of Michigan Health System» %» % Mayo Clinic» %» %

17 Visitors Decreasing exposure to all visitors and employees to second hand smoke Improve image of hospital Designated smoking areas do not work ( butt huts, 30 feet from door, etc) Provide assistance to current smoking visitors and family of inpatients

18 Patients

19 Asking is the first step.. Similar to obesity, you are dealing with a process, not a cure. Assessing patients readiness to change and sustainability are the keys! You must respond appropriately to their state of readiness

20 Who is Ready? Pre-contemplation 40% Contemplation 40% Action/Preparation 20%

21 Patient Care Improve assessment and treatment of all inpatients smokers Approx 25-35% of inpatients are smokers (including parents of pediatric admissions) Improve treatment and referrals post DC of patients addicted to nicotine Improve JCAHO core measures Improves overall quality of care» Wound healing» Surgical outcomes» Post op complications» Newborns and pediatrics» GI, cardiac and pulmonary

22 Inpatient Opportunities 243 interventions with inpatient smokers 85% received at least 2 individual counseling sessions Individual information Advice regarding quit aids Support during quit attempt 32% 12 month quit rate¹ 71 of 126 eligible parents of admitted children with respiratory disease received counseling, free NRT and 2 month follow up call At 2 months 49% had made a 24 hour quit attempt 21% had not smoked in past 7 days 37% had made a visit with their PCP ² 1-Fung et al, Chest 2005 Jul;128: Winickoff, Jour Pediatrics, 2003, 111;140-45

23 A Children s s Hospital Helen DeVos Children s Cessation Team Cessation specialist All parents of admitted patients and 12 year and older teens are asked of smoking status, exposure to children If yes,» assessed of readiness to quit, advice given All receive informational brochure, smoke-free campus information, access to gum and medication information All ready to quit receive intervention by cessation specialist Approx 32% of admitted children are exposed to ETS at home Outcomes:» Over 94% of inpatients (parents) on all units are asked» Approximately interventions given annually (7,000+ admissions)» 2 month follow up phone call assesses quit attempts (>24 hr), 7 day quit attempts and outdoor smoking

24 Community Health care institution Mission statement Image Opportunity Right thing to do

25 It is a 2 Phase Project: Implementation And Sustainability

26 SMOKE-FREE CAMPUS OBSTACLES Employees Physicians Risk Management/Security Dying Patient Psychiatric and Detox Units Neighborhoods Sustainability Family member stress City Property Patient s Rights Unions Long Term Care Changes in upper administration

27 Innovative Ways to Avoid Obstacles City ordinances for smoking restriction feet from doors City agreements to allow businesses to claim city property in front of buildings as smoke-free Nicotine gum availability Proactive efforts to assist employees (incentives, classes, quitlines, etc) Training of staff /orientation priority Treat inpatients aggressively! Educate physician staff Smoke-free work day

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33 Needed Components for Comprehensive Program Smoke-free campus Inpatient smoking policy Identification of users Specific process for OB, pediatric, and adult Identified staff for intervention Post DC follow up process Communication with PCP Standard education materials Electronic forms, orders Interdepartmental support

34 Smoke-Free Campus: Implementation Develop a plan Identify task force Set budget (as creative as possible) Gain administrative support Set date for implementation

35 Implementation (con.) Decide on details (ie policy verbiage, cars, campus, gum, signage, etc) Extensively educate staff, physicians, nurses, pharmacists, and patients) and communicate regularly Meet regularly throughout run up to implementation date Include key players in process

36 Keys to Successful Implementation Early commitment of upper administration Physician champion Coordinated, regular planning meetings Continuous communication with staff, physicians and community

37 Keys to Sustainability Commitment of staff/budget by each hospital to operate process Ongoing supportive efforts and resources to assist patients, visitors and staff in quitting smoking Make policy ongoing part of your culture (educational, protocols, orientation and QI processes) Administrative support!

38 Help Sustainability Do not allow smoking of on site construction workers» currently has $400 million+ occurring, no smoking by workers allowed Do not allow EMS employees to smoke on your campus Progress in policy changes» Smoke-free Workday -Everyday Offer nicotine gum to visitors Provide ongoing resources for employees to quit (cessation classes, quitlines, pharm coverage)

39 Grand Rapids Collaborative 2000 Non-profit coalition formed to provide free, year round smoking cessation classes for the community Average of classes offered annually Supported by all 3 hospitals, 2 largest health plans, and 2 largest physicians groups Multiple locations 2003 Smoke-Free Campus Policy 2007 Smoke-Free Work Day Everyday Policy No smoking for employees allowed on or off campus during individuals work hours

40 moke-free Hospitals by State Michigan Missouri Arkansas North Carolina Collaboratives: Seton Health Center, New York Cleveland Clinic, OH Indianapolis, IN Cincinnati, OH Detroit, MI

41 What s s New with JCAHO? As of 2007, Joint Commission to fund a project looking at effects of smoke-free campuses in the US

42 Our Many Opportunities in Cessation Prenatal OB, Family Practice, Midwives, Prenatal educators Post partum/infant- Pediatrics, OB, FP Children - Pediatrics, FP Teenagers Pediatrics, FP, schools Adults Outpatient IM, FP, OB, all specialists Inpatients Respiratory care, hospitalists, nursing, physicians, cessation specialists Long term care, Nursing homes, Extending living facilities staff, nursing

43 2008 Tobacco Update Smoke-free ordinances and state bills New medication Smoke-free states and countries New policies Smoke-Free Hospital Campuses Smoke-free Congress US Health and Human Services Guidelines

44 Concluding Recommendations Consistent identification, documentation and treatment of all tobacco users in all health care and related settings (5 As and medications) View tobacco treatment as both clinically and cost-effective Treatment should be offered to all parents/patients at every encounter Even brief treatment has proven effective Dose-response relationship: intensity-effectiveness

45 Recommendations (con.) Enlist help of parents or family members to motivate other smokers in the family Hospital systems can play a significant role in tobacco control Smoke-free campuses can be a catalyst to involvement All types of providers can be very effective in helping smokers of all ages quit all forms of nicotine addiction

46 Tobacco Cessation All Ages, Inpatient and Outpatient

47 Summary Effective implementation process Plan for sustainability Be flexible Expect issues, but be proactive to minimize them It is being done virtually everywhere, so we are basically following a norm Measure success with employee prevalence and quit rates, patient interventions (all patients, not just JCAHO requirements), and set example for other health care institutions

48 What Really Works? Increase in cigarette prices Smoke-free worksites (schools, restaurants, bars, hospitals, etc,) Health care provider intervention Aggressive anti-tobacco advertising Easy access to cessation counseling and resources (classes, phone, medications, etc.) Illnesses or adverse events Less parents, less kids

49 Summary for Smoke-Free Campus Effective implementation process Plan for sustainability Be flexible Expect issues, but be proactive to minimize them It is being done virtually everywhere, so we are basically following a norm Measure success with employee prevalence and quit rates, patient interventions (all patients, not just JCAHO requirements), and set example for other health care institutions

50 It s s Never Too Early to Intervene!

51 It s s Never Too Late to Quit!