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M A I N E T O B A C C O - F R E E H O S P I T A L N E T W O R K

Creating Tobacco-Free Hospitals

Who We Are

The Maine Tobacco-Free Hospital Network (MTFHN) is dedicated to providing Maine medical institutions with the information and resources needed to make all hospitals smoke- and/or tobacco-free. MTFHN is a program of the Breathe Easy Coalition of Maine, which is able to provide free resources and technical assistance through a grant from the Partnership For A Tobacco-Free Maine, Maine CDC/DHHS.

W H Y I T ’ S I M P O R T A N T T O A D D R E S S T O B A C C O U S E I N H E A L T H C A R E S E T T I N G S

The Case for Tobacco-Free Hospitals

Dangers of Tobacco Use

Tobacco use continues to be the leading cause of preventable disease and death in the United States.

Smoking causes 443,000 premature deaths in the U.S. each year.

Smokeless tobacco can cause cancer, oral health problems and nicotine addiction.

Quitting smoking at any age and at any time is beneficial – tobacco-free policies encourage users to quit.

Harmful Effects of Secondhand Smoke

There is no risk-free level of exposure to secondhand smoke. Even brief exposure causes damages that can lead to serious disease and death.

Nonsmokers exposed to secondhand smoke increase their risk of developing heart disease by 25-30% and for developing lung cancer by 20-30%.

Secondhand smoke poses a health risk in outdoor settings – smoking within 20-feet of a nonsmoker outside can cause harmful levels of exposure equivalent to those found in indoor settings.

Children exposed to secondhand smoke are at higher risk for health issues, including: SIDS, respiratory infections, asthma, learning disabilities, behavioral problems and ear infections.

An Emerging Issue: Thirdhand Smoke

Thirdhand smoke is the tobacco contamination, or smoke residue, that remains after a cigarette, cigar or other tobacco product has been extinguished. The toxins linger on clothes, hair, skin and other surfaces long after smoking has ceased.

Dangers of thirdhand smoke exposure include a higher risk of heart disease, stroke and smoking-related illnesses.

Infants and children and particularly vulnerable to thirdhand smoke and it has been linked to increased risk of asthma (or worsening symptoms) and increased risk of Sudden Infant Death Syndrome (SIDS).

Additional Reasons to Go Tobacco-Free

Tobacco-free policies are a best practice and proven concept – at least 26 hospitals in Maine have already adopted 100% tobacco-free policies.

Tobacco related items are among the most littered items in the United States – not only are they an unsightly addition to the campus, they are expensive to clean up and can be harmful to the environment.

R E C O G N I T I O N P R O G R A M A I M E D A T H E L P I N G H O S P I T A L S M E E T B E S T P R A C T I C E

S T A N D A R D S F O R G O I N G T O B A C C O - F R E E

Gold Star Standards of Excellence

Standard #1

“The hospital campus is 100% tobacco-free, well-marked with clear signage communicating the policy at all campus and building entrances and other high traffic areas. Tobacco use by staff, patients, and visitors is prohibited at all times in and on the hospital’s property including in vehicles, in parking lots, at satellite facilities or other properties the hospital owns and rents, including off-site meetings and conferences.”

Why It is Important

Tobacco-free campus policies are a great example of a hospital’s commitment to providing a safe and healthy environment for patients, employees, visitors and the community as a whole.

Adopting a 100% tobacco-free campus policy will reduce exposure to tobacco smoke to those on your campus.

Tips for Implementing

Sample Answer: “Charles A. Dean Memorial Hospital is committed to the promotion and prevention of disease. To maintain a safe and healthful environment for patients, visitors, and employees, CA Dean adopted a tobacco-free campus policy. Enforcement procedures are included in the attached, written policy.” – Charles A. Dean Memorial Hospital

Standard #2

“The hospital has implemented policies and procedures to reduce patient and employee exposure to thirdhand tobacco smoke.”

Why It is Important

Exposure to thirdhand tobacco smoke is potentially harmful to patients and visitors suffering from breathing issues, such as asthma or COPD, and heart disease – including lingering tobacco smoke in your scent-free/fragrance-free or tobacco-free policy reduces exposures to these toxins.`

Tips for Implementing

To reduce exposure to tobacco smoke residue, Millinocket Regional Hospital has included protections against this known irritant in the scent portion of their written tobacco-free campus policy. The policy states: “Employees who do smoke on designated breaks must:

Ensure they are off the MRH campus Wear Coverage over their clothing (coat, lab coat, etc.) Ensure they wash their hands thoroughly upon return to work. Utilize mints, gum, mouthwash

Tobacco smoke residue is a known irritant for Reactive Airway Disease, Asthma, and COPD. These steps are necessary for protection of our

patients.” – Millinocket Regional Hospital

Standard #3

“Written policies and procedures exist that detail the hospital’s tobacco-free policy, including enforcement and employee expectations.”

Why It is Important

The key to successfully implementing a tobacco-free policy is solid enforcement and community member buy-in. Using proven policy and procedure strategies will ensure enforcement success.

Tips for Implementing

Examples for how to meet this standard: All staff are required to sign-off that they have read/understand the tobacco

policy New staff orientations include education about the hospital’s tobacco policy Progressive discipline for employee violators is written into the policy and

made clear to all employees Information about the tobacco policy is readily available on the hospital

website and/or through the HR department The written tobacco policy defines staff members or departments

responsible for enforcing the policy and handling employee infractions Employee training on how to handle policy violations with employees,

patients, and visitors is provided for all staff Patients receive information on the hospital’s tobacco-free policy on

admission or during their hospitalization.

Standard #4

“Advertising or promotion of tobacco products is not allowed on the hospital’s campus or satellite facilities. This includes hospital publications and magazines subscribed to by the hospital for placement in waiting rooms.”

Why It is Important

Tobacco companies spend $1 million dollars an hour on advertising!

Making a stand against this tobacco use marketing helps show that the hospital doesn’t support these behaviors that may be show in magazines.

Tips for Implementing

Examples of ways to meet this standard: Our hospital only allows magazines without tobacco advertising.

Maine Tobacco-Free Hospital Network stickers are placed on donated or subscribed magazines that may contain tobacco advertising.

Our hospital removes tobacco advertising from magazines before allowing them in our waiting rooms or other facility areas.

Notices (posters, signage, etc) are placed in magazine areas that the hospital does not support tobacco advertising.

Standard #5

“Information about tobacco dependence and treatment, secondhand smoke and local/statewide treatment resources are readily available to patients and visitors.”

Why It is Important

As role models for health, patients and visitors will look to the hospital for information.

Tips for Implementing

Direct patient care employees provide tobacco cessation resources to all patients when identified as tobacco users. Hallways at EMMC are equipped with signs that state “visitors guide to a tobacco free EMMC.” Each sign has front and back flyers attached that spell out the general policy, what can be done “while you’re here…” to remain comfortable when nicotine cravings arise, and the Maine Tobacco Free Helpline Number for counseling. All employees and their family members have access to a free, inconspicuous “quit gift” that includes information on the Maine Tobacco Helpline and other important cessation materials. Employees have access to online information about tobacco treatment, secondhand smoke and cessation resources on the employee wellness intranet page.” -Eastern Maine Medical Center

Standard #6

“All patients admitted to the hospital are screened for tobacco use, tobacco status is documented and patients are offered comprehensive treatment services during their stay. This includes tobacco dependency counseling/coaching, bedside interventions, clinical assessment and management for patients experiencing nicotine withdrawal, offering FDA-approved tobacco treatment medications and referral to counseling post-discharge.”

Why It is Important

Treating patients using evidence-based strategies will help increase their odds of successfully quitting tobacco.

http://www.ahrq.gov/clinic/tobacco/treating_tobacco_use08.pdf

Tips for Implementing

“MMC supports a very robust tobacco treatment program that is available for all patients admitted to the hospital. There is a 0.2 FTE program manager, a 0.2 FTE administrative support and two 0.6 FTE nurse practitioners who deliver the bedside service on a daily basis.

Patients are screened on admission by the admitting nurse and submit orders for a referral to the tobacco treatment specialist. The specialist visits the patient at the bedside and delivers an intervention which includes: a comprehensive assessment, treatment for nicotine withdrawal, motivational interviewing, advice to quit, tailored quit assistance, and support after discharge such as prescriptions for medication and referrals to counseling services. Patients may be referred at any time during their hospital visit but their doctor or the nursing staff.”

- Maine Medical Center

Standard #7

“The hospital supports evidence-based education and training on tobacco dependency and treatment for employees who provide counseling and education to tobacco users.”

Why It is Important

Make sure your staff are trained on the latest evidence-based practices, so they can be helpful in treating tobacco use.

http://www.tobaccofreemaine.org/channels/providers/cessation_training.php

Tips for Implementing

“An inservice was held by a representative from the Center for Tobacco Independence/Partnership For A Tobacco Free Maine providing training to 22 staff on “Tobacco Intervention in Clinical Settings.”

– Calais Regional Hospital

Standard #8

“Tobacco treatment services are a covered benefit in the hospital health insurance package for employees and dependents. Benefits include coverage for counseling and medication therapy for quitting tobacco, with minimal, or no barriers to utilization (ie copays, out of pocket costs, limits).”

Why It is Important

About 70% of smokers want to quit – offering tobacco treatment support to employees and dependents reduces a barrier to quitting!

Tips for Implementing

“Inland’s HR policy number 80 states that, “all employees who are interested in tobacco cessation will be directed to available resource.” Resources listed in the policy include the Maine Tobacco Helpline and the Employee Assistance Program (3 free visits) for all staff. For employees who receive insurance through the hospital, counseling and nicotine replacement therapy are available at no cost. Additionally, a link to EMHS’ Total Health page can be found on our intranet with links to additional resources. Employees are educated on the resources at orientation, upon request, during annual benefits fairs and occasionally as a Total Health “daily” message on the homepage of our intranet.”

– Inland Regional Hospital

Standard #9

“The hospital makes available information about 100% smoke-free local lodging to allow visiting patients and families to make health choices regarding their lodging.”

Why It is Important

There is no safe level of exposure to secondhand smoke and smoke can drift between units in a building.

Tips for Implementing

“Two of four hotels in the area are 100% smoke-free, we highlight these smoke-free establishments to visitors. To ensure that all staff are aware of smoke-free lodging options in the community, Public Relations/The Wellness Team have sent emails out to all staff highlighting these healthy options for patients and visitors. This way, if any staff in the hospital is asked for a referral, they are equipped to provide appropriate information.”

– Franklin Memorial Hospital

Standard #10

“The hospital has a written policy stating it refuses donations from the tobacco industry, and divests itself from tobacco company stock.”

Why It is Important

Tobacco use is the leading cause of preventable disease and death – having a written policy against accepting funding from the tobacco industry shows the hospital’s commitment to the health of their community.

Tips for Implementing

“The SVH policy refuses all donations from the tobacco industry and divests itself from any tobacco stock. The SVH tobacco free policy was communicated to the SVH governing board at the time of approval in 2011. (please see attached tobacco policy)” – Sebasticook Valley Health

Additional Tools and Tips for TF Hospitals

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