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1ENSH WCTOH 2002
European smoke free hospital Netwok
Stefano Nardini
Anne Marie Schoelcher
Ann 0’riordan
Ariadni Ouranou
François Chieze
Bertrand Dautzenberg
Audit of smoke free hospital
ENSH WCTOH 20022
European code1. Engage decision-makers. Inform all personnel and patients. 2. Appoint an action group. Propose 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 provide continuity outside the hospital. 5. Indicate smoking zones clearly, for as long as they are considered
necessary, and keep them away from clinical and reception areas. 6. Adopt appropriate signs, including posters, signposts, etc. 7. Remove all incentives to smoke -such as ashtrays, tobacco sales, etc.. 8. Renew and broaden information to maintain commitment to the policy. 9. Ensure follow-up and quality assurance. 10.First convince, constrain considering legislation if needed. Have patience!
ENSH WCTOH 20023
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
ENSH WCTOH 20024
Smoke-free Hospital : Bronze levelThis 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.
gold
silver
bronze
ENSH WCTOH 20025
Smoke-free Hospital : Silver level
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.
gold
Silver
bronze
First convince, constrain considering legislation if needed. Have patience!
ENSH WCTOH 20026
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.
ENSH WCTOH 20027
Auto audit process
A volontary process of hospitals to assess tobacco policies
A one page self audit questionnaireThe questionnaire could be repeat each yearThe questionnaire follow the European codeAfter a first validation of questionnaire, 3
countries of ENSH are volontaire to test the questionnaire
ENSH WCTOH 20028
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
ENSH WCTOH 20029
Questionnaire
For each item the answer is
0 non implemented
1
2
3
4 totally implemented
NA non applicable
ENSH WCTOH 200210
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 WCTOH 200211
ENSH Code : 1 - Engage decision makers
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
4 3 2 1 0 NA
4 3 2 1 0 NA
ENSH WCTOH 200212
1. Policy : response from Italy
0
2
4
6
8
10
12
num
ber o
f res
pons
es
1 2
0 (no)
1
2
3
4 (yes)
Policy on official documents Information to patients and staff
ENSH WCTOH 200213
Policy : response from Ireland
0
5
10
15
20
Policy on official documents Information to patients & staff
0 1 2 3 4 NA
ENSH WCTOH 200214
Policy : response from France
0 02
46
4
18
24
44
36
0
5
10
15
20
25
30
35
40
45
50
Policy on official documents Information to patients & staff
0
1
2
3
4
ENSH WCTOH 200215
0
5
10
15
20
num
ber o
f re
spon
ses
1 2 3 4 5
0 (no)
1
2
3
4 (yes)
non applicable
no response
2. Working Group : response from Ireland
Working group
appointed
Audit results
Previous plans auditedin 2002
New strategylaunched in 2002
Chair fromtop
manag.
ENSH WCTOH 200216
3. Staff Education and Training : response from Ireland
0
5
10
15
num
ber o
f re
spon
ses
1 2
0 (no)
1
2
3
4 (yes)
non-applicable
Education planned
Time allowed
ENSH WCTOH 200217
Results from Italy
ENSH WCTOH 200218
Results from Italy
ENSH WCTOH 200219
Results from Italy
ENSH WCTOH 200220
Results from Italy
ENSH WCTOH 200221
Results from Italy
ENSH WCTOH 200222
Results from Italy
ENSH WCTOH 200223
Results from Italy
ENSH WCTOH 200224
Results from Italy
ENSH WCTOH 200225
Results from Italy
ENSH WCTOH 200226
Results from Italy
ENSH WCTOH 200227
Comparison of individual score for 28 hospitals in 3 countries
Audit score for each test hospital
0
20
40
60
80
100
120
140
1 4 7 10
13
16
19
22
25
N° of hospital
Ireland
France
Italie
ENSH WCTOH 200228
Comparison of individual score for 28 hospitals in 3 countries
Audit score for each test hospital
0
20
40
60
80
100
120
140
1 4 7 10 13 16 19 22 25
N° of hospital
Ireland
France
Italie
Very important variation are observed in the same country The score decrease from north to southIrland>France>Italy
ENSH WCTOH 200229
Joint us