HSE Tobacco Free Campus Policy Working towards a Tobacco Free Ireland by

2025

Ms. Miriam Gunning,

HSE National TFC Lead

miriam.gunning@hse.ie

1st Smoke Free Hospital Campus 1st January 2009

2007: Commitment from Senior management

Legal advice sought

Meetings with Unions

Presentations to Hospital Executive & Medical Board

St Vincent’s University Hospital

• Established 1834 by Irish Sisters of Charity

Teaching hospital affiliated to University College Dublin

• Capacity: 478 beds

• Duration of stay 10.8 days

• Health Service Executive (publicly funded)

porters

ward assistants catering

staff

allied health staff

patient information

leaflet ambulance

hospital

signage

Admission

desk

A&E

discharge

Smoke-Free Campus – Patient Pathway

GP

doctors

nurses

ward

Admission

desk

Out-patient

clinics

GP GP

International/National

Tobacco Management in Irish health services 2010-2015

Tobacco Free Campus Policy in ALL health services

• Huge engagement with stakeholders

• Internal consultation with each directorate

• External consultation with the joint council of unions

• Labour court decision affirmed and commended the HSE on this policy initiative

Intends to minimize and eliminate: • Tobacco addiction in all it’s

forms • Nicotine addiction • Exposure to tobacco smoke

TFC policy aims

• Treat tobacco use as a care issue thus providing a better outcome for patients

• Denormalise tobacco use in healthcare settings

• Senior Management Commitment, Education/Training and Cessation support are key elements of the policy all of which are integral to the ENSH-Global standards

• On going monitoring and evaluation of the policy/tobacco control generally is vital

Organisational Considerations

• Health and wellbeing of staff & service users

• Delivery of Safe Quality care

• A person centred approach & risk management

• Local considerations

• A change model built on collaboration with staff,

service users, and HP personnel

• Promote local ownership of the policy

• Identify Champions and harness existing supports

National Policy Priorities

ENSH-Global Quality Standards

• Standard 1 - Governance and Commitment

• Standard 2 - Communication

• Standard 3 - Education and Training

• Standard 4 - Identification, Diagnosis and Tobacco Cessation

• Standard 5 - Tobacco-Free Environment

• Standard 6 - Healthy Workplace

• Standard 7 - Community Engagement

• Standard 8 - Monitoring and Evaluation

Social Marketing Campaign

1 in 2 stories; reality of loss = why to quit

Support services; peer to peer = how to quit

Trained cessation

support staff

Our QUIT Service

Freephone

Freetext

Social Media

Webchat

Health Professional

Referrals

Proactive phone

counselling

Daily texts & emails

Social media

Online QUITplan

1-1 Clinics

& Groups

1. NSP BISC training targets

2. On-line registration http://www.hse.ie/bisc

http://hsenet.hse.ie/Feedback

Server/fs-2016BISC.aspx

2016 BISC target Mental Health = 4.5% frontline staff

CHO 1 CHO 2

CHO 3

CHO 4

CHO 5

CHO 6

CHO 7

CHO 8

CHO 9

35 43 28 50 44 20 42 37 44

Resources and Tools 8 Quality Standards - for tobacco management in healthcare Self Audit Tool – translated & available for online use Recognition Process – GOLD Forum Process Networking – sharing and learning events, website

Assessing the size of the problem!

Centre Staff % Participants %

Admin 0 0% 0 0%

Thomas Court 1 17% 22 52%

Airdnua 1 17% 28 57%

Castleview 1 25% 17 63%

Cherryfield 1 25% 25 39%

Conai 0 0% 33 56%

Estuary 4 36% 22 33%

Goirtin 2 40% 14 56%

Harvest 2 67% 12 38%

HSE Print 1 11% 0 0%

Larine 1 20% 27 63%

SAOL 1 33% 15 31%

New Dawn 0 0% 23 43%

New Horizon 1 25% 15 47%

Phoenix 1 25% 30 47%

Plantmarket VT 1 20% 16 55%

Platinum 0 0% 30 34%

Riverview 2 40% 6 32%

Suaimhneas 1 20% 39 48%

Tuiscint 1 14% 5 16%

Rainbow 1 17% 17 26%

TOTALS 23 19% 396 41%

Challenging the Rights Issue

• A Rights Issue

Right to accurate information regarding tobacco use and options for quitting

Right to achieve optimal health and well being

Right to achieve personal recovery

• Implement HSE TFC Policy in All acute hospitals & 35% of PC centers (82% Acute sites/35% PCC achieved)

•Commitment to train 1,350 HC staff in BISC (1395 trained)

•9000 clients to receive intensive SC support (10,525 clients)

2013 HSE NSP

• Implement HSE TFC Policy in 100% Hospitals & 70% PC (100% Acute/72% PCC achieved)

• Commitment to train 1,350 healthcare staff in BISC (1303 ↓ trained plus 165 undergrad)

• 9,000 clients to receive intensive SC support (9,309 clients)

•No. of smokers quit at 1 month (2,450) (2,184 ↓)

•QPS Audit of Tobacco F Campus 8 sites (complete)

2013 HSE NSP

Tobacco Free Campus journey

•Implement HSE TFC Policy in 100% Approved MH, (39% achieved) 25% Residential MH (24% achieved), 20% Older Persons Residential (↑45% achieved), 25% Disability Residential) (↓14.7% achieved)

•Train 1,350 HC staff in BISC (1,279 - 5.2% on target)

• 9,000 clients to receive intensive smoking cessation support (11,950 + 32.8%)

•No. of smokers quit at 1 month (2,450) (achieved 2,490)

2015 HSE NSP

Tobacco Free Campus journey

Tobacco Free Campus journey

2016 HSE NSP

• Implement HSE TFC Policy in 100% Approved MH, 25% Residential MH, 75% Older Persons Residential, 25% Disability Residential)

• Train 1,350 HC staff in BISC

• 11,500 clients to receive intensive smoking cessation support

• % of smokers quit at 1 month (45%)

• Launch Toolkit for TFC, Mental health Briefing resource

• Host 6 National TFC support workshops

Challenges to Policy Implementation

• Shared campuses with other HSE facilities, with residential facilities and with commercial companies

• Managing risk

• Managing inconsistency in addressing policy implementation issues/challenges

• Changing ‘hearts and minds’ among professional and health care worker staff and the culture and acceptance of smoking “as just a bad habit” within some services

• Lack of consistent monitoring and review once policy has been implemented initially

HSE have to continuously……..

• Acknowledge and address local organisational barriers

• Ensure cessation options are made available to our service users

• Incorporate tobacco management into our programmes & services

• Acknowledge & address staff attitudes/concerns regarding tobacco use/cessation among clients

Doing the right thing isn’t always easy!!

• Both staff & service users all acknowledge the benefits of smoking cessation

• Many are dealing with life long addiction & challenge of living in homes where smoking is the norm

• Organisationally selling a “health and wellness” message is key

• Important to see this initiative in a broader context of personal wellness

Treating tobacco as a care issue

• WHO 1994 Classification of Disease ICD-10: Nicotine Dependence – a chronic relapsing disease –

• Diagnosis code

• Z72.0 current tobacco use,

• Z86.43 past history of tobacco use,

• F17.1 harmful tobacco use,

• F17.2 tobacco dependence o

• F17.3 withdrawal state

• Treatment code Z 71.6

New TFC Supports

• A suite of tools available on-line in the TFC Toolkit & Implementation Guide

http://www.hse.ie/eng/about/Who/TobaccoControl/campus/

• 6 TFC Workshops

Sligo: Thursday April 7th - 9.30 – 1pm

Wexford: Monday April 18th – 1pm – 4.30pm

Limerick: Tuesday April 19th – 12.30 – 4pm

Ardee: Wednesday April 20th 12.30 – 4pm

Cork: Friday April 22nd – 12.30 – 4pm

Dublin: Monday April 25th – 12.30 – 4pm

Next steps

• Individual Care Plans – Quality ‘Compassionate’ Care

• Individual Risk Assessment – Quality & Patient Safety

• Statement of Purpose – External Audit Proposed

• Reward system – Acknowledge innovation

• Staff incentives/H& WB for staff – NRT for staff/cessation support

• Professional bodies - buy - in of Doctors & HR (addressing the culture of smoking breaks)

• SLAs

• Money follows the patient/Activity based funding

• Tobacco actions clearly embedded in CHO and Hospital group HI plans

Thank you for listening

Any Questions?