Michigan’s Smoke-free Hospital Campuses: Steps to Implementation

1. Michigan’s Smoke-free Hospital Campuses: Steps to Implementation Linda A. Thomas, MS Tobacco Consultation Service University of Michigan Health System

2. The charges for a longer stay in the recovery room are at least 20% higher for smokers than for nonsmokers SIlverstein, P: Smoking and wound healing. Paper presented at the Medical Leadership Conference, Effects of smoking: A global perspective, Washington, DC, July, 1991.

3. Smoking will retard wound healing, whether the wound is surgical or the result of trauma or burns. SIlverstein, P: Smoking and wound healing. Paper presented at the Medical Leadership Conference, Effects of smoking: A global perspective, Washington, DC, July, 1991.

4. Patients who smoked regularly before surgery had twice the risk of wound infection as nonsmokers Jones, R. M. (1985). Smoking before surgery: The case for stopping. British Medical Journal, 290, 1873-1764.

5. Smoking is the most common cause of pulmonary morbidity during surgery and anesthesia SIlverstein, P: Smoking and wound healing. Paper presented at the Medical Leadership Conference, Effects of smoking: A global perspective, Washington, DC, July, 1991.

6. The Problem • The mission of healthcare facilities is at odds with current practices • Movement to a smoke-free environment requires significant change and commitment

7. Pros for a Smoke-free Environment • Sets a clear example of good health practices • Puts employees, patients and guests first by providing a healthy, smoke-free atmosphere • Lower clean-up costs • Encourages both employees and patients to quit tobacco use • Lower long-term health care cost

8. Cons to a Smoke-free Campus • Creating a major cultural change • More difficult to implement due to compliance problems • No place for the stressed, addicted smoker to go

9. Obstacles • Hospitals • tradition • confrontation • short-term interest • Insurance Plans • turn over of customers • up front cost • Physicians • reimbursement • lack of tobacco related education

10. Obstacles • Employees • Risk Management/Security • Dying Patients • Psychiatric Unit/Long Term Care • Family member stress • Patient rights • JCAHO • Unions

11. Multi-Action Plan • Total ban on smoking both indoors and outdoors • Identify and treat all admitted patients who are tobacco users • Provide outpatient smoking cessation for all patients, visitors, and employees

12. Multi-Action Plan Will: • Allow cessation efforts to reach broad base of population • Improve health, productivity, and cost of employees • Set example for community and the rest of health care system

13. Most Important First Steps to Implement SFE • Change attitudes • Change people’s roles • Change standards of health care

14. Project Summary • Sponsored by the Michigan Department of Community Health • Project began April, 2000 • Six MI hospitals had implemented smoke-free environment (SFE) at time project began • First step was to survey 166 MI hospitals • 95% return rate

15. Project Personnel Jodie Faber , BS – United Memorial Hospital, Greenville Therese Green, MHS – Northern Michigan Hospital, Petoskey Mishelle Bakewell, MA – Holland Hospital Lisa Roberts – University of Michigan Health System, Ann Arbor Thomas Peterson, MD – Michigan Medical PC, Grand Rapids Linda Thomas, MS – University of Michigan Health System, Ann Arbor Jake Weirich – University of Michigan Health System, Ann Arbor

16. Results to Date • 26 hospitals with SFE as of 12/1/03 • 5 hospitals in stages of implementation • Materials sent to 73 non-MI hospitals • Information sent to 4 international hospitals: Britain, India, Australia, and Japan • User friendly CD provides framework for implementing a SFE

17. SFE Implementation CD-Rom

18. Introduction Page of CD

19. CD Topics Include • Contact Information and project personnel credentials • SFE Implementation Checklist • Typical Concerns and Suggested Solutions • Adaptable Powerpoint presentation • Suggestion/material examples for staff education

20. Topics Included in CD continued • Ideas for implementing an Outpatient Tobacco Cessation program • Ideas for implementing an Inpatient (bedside) Tobacco Cessation program • Policy, signage, media examples • Section on legal issues • SFE Implementation examples • JCAHO Core measures • AHRQ Guidelines • ACCESS program for cessation program and follow-up data

21. Implementing an Inpatient Program

22. For Information or CD Contact: Linda Thomas, MS UMHS Tobacco Consultation Service 300 N. Ingalls 2D19/0430 Ann Arbor, MI 48109/0430 ph.734-936-5988 fax 734-647-1516 quitsmoking@med.umich.edu www.med.umich.edu/mfit/tobacco