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European smoke free hospital Netwok. Stefano Nardini Anne Marie Schoelcher Ann 0’riordan Ariadni Ouranou François Chieze Bertrand Dautzenberg. Audit of smoke free hospital. European code. Engage decision-makers. Inform all personnel and patients.
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European smoke free hospital Netwok Stefano Nardini Anne Marie Schoelcher Ann 0’riordan Ariadni Ouranou François Chieze Bertrand Dautzenberg Audit of smoke free hospital
European code • Engage decision-makers. Inform all personnel and patients. • Appoint an action group. Propose a strategy and an implementation plan. • Set up a training plan to instruct all staff on how best to approach smokers. • Organise cessation support facilities for patients and staff in the hospital and provide continuity outside the hospital. • Indicate smoking zones clearly, for as long as they are considered necessary, and keep them away from clinical and reception areas. • Adopt appropriate signs, including posters, signposts, etc. • Remove all incentives to smoke -such as ashtrays, tobacco sales, etc.. • Renew and broaden information to maintain commitment to the policy. • Ensure follow-up and quality assurance. • First convince, constrain considering legislation if needed. Have patience!
Smoke-free Hospital membership • Initial Phase: • Membership of a Smoke-free Hospital Network is acquired by : • A letter of commitment from hospital management • The designation of a tobacco prevention correspondent for the hospital
Smoke-free Hospital : Bronze level gold silver bronze • This first phase outlines what a hospital must achieve in order to awarded the bronze level. It is the first step towards becoming a smoke-free hospital label. • This stage can be reached in less than 1 year, or in a trimester if a clear engagement of hospital management exists, especially when re-organizing, moving or building are planned, or if a new organization is to be implemented or if any other positive changes are planned within the hospital. • On the other hand, when the hospital has problems, it may take longer for it to reach bronze level. • For a hospital to reach the bronze level, points 1 and 2 of the European code must be achieved.
Smoke-free Hospital : Silver level gold Silver bronze • Reaching this level will take longer - from 1 to 10 years. • Implementation will proceed in a step-by-step progression. • Successful implementation of the minimum standard Smoke-free Hospital policy means that the hospital is fully committed to the minimum smoke-free requirements. • The progressive implementation of this stage requires positive and continuous pressure, along with a search for consensus. Constraint needs to be used only as an ultimate action, but may be considered necessary as stated in point 10 of European code. First convince, constrain considering legislation if needed. Have patience!
Smoke-free hospital : Gold level gold Silver bronze • This stage is the ultimate goal to be reached, with no smoking either inside the hospital buildings or in open areas around the hospital. • This ultimate goal will take a long time, often more than 10 years. • When this goal is reached, there will still be a need for: • Periodic reviews, audits and preventive measures to remain at this level of quality. • Provide help to other non-hospital based communities in order to implement further smoke-free places.
Auto audit process • A volontary process of hospitals to assess tobacco policies • A one page self audit questionnaire • The questionnaire could be repeat each year • The questionnaire follow the European code • After a first validation of questionnaire, 3 countries of ENSH are volontaire to test the questionnaire
Methods • Ireland, Italy and France corerspondant of ENSH selected 25-50 hospitals to participate • . • Each country analyse his data and propose change in the audit questionnaire. • All the data are pulled as excell file then analysed
Questionnaire • For each item the answer is • 0 non implemented • 1 • 2 • 3 • 4 totally implemented • NA non applicable
Self audit questionnaire in Ireland • Irish Smoke-free Health Service Initiative developed in line with the European Code for Smoke-free Hospitals and national legislation was established 2000. • ENSH Self audit questionnaire was incorporated into the Irish Smoke-free Health Service Initiative in 2001. • The Irish Initiative has four distinct stages, hospitals that reach stage four can categorise themselves as being bronze, silver or gold by using the self audit questionnaire. • Results presented here are from 25 (68%) of the initial 37 hospitals invited to use the self audit questionnaire
ENSH Code : 1 - Engage decision makers 4 4 3 3 2 2 1 1 0 0 NA NA Two questions in the self audit : 1 - 1 Hospital documents (general contracts, public documents etc) specify the hospital smoke free policy 1 - 2 Staff and patients are clearly informed of smoke-free policies
1. Policy : response from Italy Policy on official documents Information to patients and staff
Policy : response from France 50 44 45 40 36 35 0 30 1 24 25 2 18 20 3 4 15 10 6 4 4 2 5 0 0 0 Information to patients & staff Policy on official documents
2. Working Group : response from Ireland Working group appointed Chair from top manag. New strategy launched in 2002 Previous plans audited in 2002 Audit results
3. Staff Education and Training : response from Ireland Education planned Timeallowed
Comparison of individual score for 28 hospitals in 3 countries
Comparison of individual score for 28 hospitals in 3 countries Very important variation are observed in the same country The score decrease from north to south Irland>France>Italy
