1.Engage decision-makers. Inform all personnel and patients.

2.Appoint a working group. Develop a strategy and an implementation plan.

3.Set up a training plan to instruct all staff on how best to approach smokers.

4.Organise cessation support facilities for patients and staff in the hospital and ensure

5.Continuity of support on discharge into the community.

6.Indicate smoking zones clearly, for as long as they are considered necessary, and keep them away from clinical and reception areas.

7.Adopt appropriate signage, including posters, signposts, etc and remove all incentives to smoke (such as ashtrays, tobacco sales, etc.).

8.Support systems are in place to protect and promote the health of all that work in the hospital. Promote smoke-free actions in the community setting.

9.Renew and broaden information to maintain commitment to the policy. Ensure follow-up and quality assurance.

10.First convince, then constrain considering legislation if needed. Have patience!

European Code for Smoke-free hospitals

KEY Aim of the studyAudit the current situation of smoking control in all European hospitals and Health districts

Helps to identify

areas needing attention

Provides a guide

for policy development

By administrating it periodicaly

ensures that progress is kept

on tracj

The audit tool

Self Audit Process of Smoke free Hospitals

Self audit of Smoke-Free Hospital

A standard auto audit questionnaire has been dressed to assess implementation of the code

1. Commitment 0 1 2 3 NA Observations 1.1 Organisation documents (general contracts, public documents, etc.) specify

the smoke-free policy

1.2 A designated committee is appointed to co-ordinate tobacco policy 1.3 The chairperson of the committee is of senior management level 1.4 Financial and human resources are allocated in the organisation’s

operational plan and/or contract

1.5 Members of staff know the have the responsibility to take action in the control of the non smoking policy

2. Communication 2.1 Staff, patients, and visitors are informed of the organisation’s smoke-free

policy

3. Education & Training 3.1 Staff have been instructed on how to approach and inform smokers in

accordance with the policy

3.2 Brief intervention training is offered to all staff 3.3 Key clinical staff have been trained in motivational and/or cessation

techniques

3.4 Policy briefings/training is facilitated within staff working time 4. Identification & Cessation Support 4.1 There is a systematic procedure in place for identifying smoking patients 4.2 Motivational interviewing technique is applied during hospital stay 4.3 NRT/pharmacological therapy is available

4.3 There is a smoking cessation service available for hospital staff 4.4 There is a smoking cessation service available for patients (in-patients and

out-patients)

4.5 There are information on smoking cessation available for visitors (parents, caregivers)

4.6 There are specific resources allocated for cessation support activities 4.7 There is a systematic follow-up procedure of the patients at one year 5. Tobacco Control 5.1 Smoking is prohibited in all eating, work and common areas used by staff, patients and visitors

5.2 If smoking areas are designated, they are completely separate from non smoking areas

6. Environment 6.1 There is signage in all areas for staff, visitors and patients explaining the

smoke free policy and indicating smoke free areas

6.2 Ashtrays are only found in designated smoking areas 6.3 Tobacco is sold within hospital buildings (0= yes, 3 = no sold) 6.4 Visitors and patients are never exposed to passive smoking

7. Healthy Workplace 7.1 Staff are informed of tobacco policy during the recruitment process 7.2 Ongoing education programmes regarding tobacco policy exist for staff 7.3 Smoking habits of staff are monitored regularly 7.4 Staff receive continuous support towards smoking cessation 7.5 Members of staff are never exposed to passive smoking 7.6 Tobacco policy has been incorporated into and enforced according to

existing disciplinary procedures

The audit survey showed that very important variation is observed in hospitals in the same country.

Results

Comparison of individual scores for hospitals in 4 European countries

Audit score

0

20

40

60

80

100

120

140

1 3 5 7 9

11 13 15 17 19 21 23 25

France

Italie

Finland

Ireland

Smoke free hospital is a continuous process

Point 1 and 2 : engagement of hospital : Member

silver

bronze

gold

ANNUAL EPIDEMIOLOGY SURVEY OF THE TOBACCO RATE OF HOSPITAL STAFF

KEY Aim of the study• To assess the prevalence of smoking among health

professionals Conclusions There persists a high level of smokers amongst the medical

staff. Hospitals must be exemplary places of smoke-free health. Nurses must be the first target in the hospitals. Products to assist quitting smoking made free-of-charge

for medical staff.

Study Among Health Care Workers Co-ordinated by theEuropean Network for Smoke-free Hospitals

Questionnaire strictly confidential and anonymous

COUNTRY:

HOSPITAL IDENTIFICATION: |_____________________________________________

AGE GROUP: Years old

SEX: Female Male

JOB: Doctor Nurse Student Administrative Other Non-Health Professional Other Health Professional

YOU ARE: Non-smoker Ex-smoker Daily smoker Occasional smoker (non every day)

------- If you have never smoker, the questionnaire is finished, thank you for your participation ----------

IF YOU ARE DAILY SMOKER

HOW LONG AFTER WAKING UP DO YOU SMOKE ? < 5 minutes 6-30 minutes 31-60 minutes > 60 minutes

ON AVERAGE HOW MANY CIGARETTES, CIGARS OR PIPES DO YOU SMOKE PERDAY?

cigarettes/day cigars/day pipes/day

ARE YOU PLANNING TO QUIT? no In the next month In the next 3-6 months in the next 6-24 months someday

IF YOU ARE AN EX-SMOKER

AT WHAT AGE DID YOU STOP SMOKING? Years old

IF YOU ARE A SMOKER OR EX-SMOKER

HOW OLD WERE YOU WHEN YOU STARTED TO SMOKE? Years old

HAVE YOU RECEIVED SMOKING CESSATION HELP FROM YOUR ORGANISATION? Yes Not existing not desired not easily accessible

HOW MANY TIMES DID YOU SERIOUSLY ATTEMPT TO QUIT? 0 1 2-5 more than 5

Thank you to answer to these questions

OFFICE USE ONLY

E000E001

E010

E011

E020

E030

E031

E032

E40

E041

E050

E042

E043

The ENSH members agree to have 13 common questions questionnaire.

This questionnaire

was tested in small

groups in 6 countries

and in a large group

in one.

Distribution referring to the smoking habit

0%10%20%30%40%50%60%70%80%90%

100%

Belgium France Spain Ireland Romania Greece

No response

Non-smoker

Ex-smoker

Smoker

In all the samples,

there is a predominance

of women

The level of

dependency is medium

Interdictions of

smoking in hospitals

exist but are not

respected,

mainly in South and East

Results