Implementation Guidance: NHS Grampian Tobacco Policy 2014

Site Maps Now Available

Smoking will not be permitted on NHS sites in Scotland after March 2015. Please see the NHS Grampian Site Maps webpage to find out about the smoke free grounds in NHS Grampian.

Smoke Free Sites: Do’s and Don’ts
The Smoke Free Sites Do’s and Don’ts document is now available. The document provides information about your responsibility as a staff member and guidance for implementing the NHS Grampian Tobacco Policy.


Find out more about Smoke free grounds at www.smokefreegrounds.org

Tobacco Control is a public health discipline which aims to systematically reduce the illness, early death and health inequality caused by tobacco smoking. The Scottish Government has developed an ambitious national tobacco control strategy, Creating a Tobacco Free Generation. A key measure in the Strategy is a requirement that smoking will not be permitted on NHS sites and premises in Scotland after March 2015. All NHS Boards must implement and enforce smoke-free grounds by April 1st- this means removal of designated smoking areas by that date.

In NHS Grampian this should be implemented by each sector to a timescale which they may define. To support this, the NHS Grampian Tobacco Policy 2014 has been developed and was endorsed through the Grampian Area Partnership Forum and was endorsed in May 2014 following a comprehensive public consultation. To implement the Policy, considerable work has taken place on the Foresterhill Campus over the past two years and in the Mental Health and Learning Disability Directorate. Many sites are already smoke-free, notably in Aberdeenshire CHP where early implementation projects have resulted in useful learning that other sectors may apply.

This web page is intended to guide sector managers to the resources they will need to fully implement the policy on their sites and premises by 31st of March 2015. It will be updated regularly to take account of learning from the implementation process.

Implementing the Tobacco Policy: What do I need to do?

You need to make sure that your sector is fully implementing the NHS Grampian Tobacco Policy on 1st April 2015.

This is most likely to happen if you establish a lead group and lead person in your sector. This could be an existing group, for example your partnership group or management group.

The lead person should be part of the Tobacco Policy Implementation Short Life Working Group (Secretary: Sheila.robertson@nhs.net, 01224 558466) as it provides useful learning and networking.

Your group should have sound partnership representation.
If your sector has several sites, groups for each site may be helpful.

Make sure that the Policy has been circulated to all your departments: NHS Grampian Tobacco Policy 2014

Put in place a plan to complete the process by the 1st of April

A very useful example of a risk-based plan has been developed though the early implementation work in Aberdeenshire CHP. This format is being adapted by other sectors: Risk Assessment Example and Smoke Free Hospital Grounds

An excellent manual for implementing smoke free mental health services is available: Smoke Free Mental Health Services in Scotland.

Here it is applied to a plan developed by the lead group at Royal Cornhill Hospital. The manual is very sound and useful in any hospital setting: Smoke Free Cornhill Hospital Implementation Plan

Make sure that support is in place for people who smoke: staff, patients and visitors

  •  Patients who smoke will find that they cannot do so during admission. The Policy requires that NRT is made available to them during their stay so that withdrawal symptoms are prevented. Protocols have been developed to enable this (see below). To prevent withdrawals it will be necessary to ensure that stocks of NRT are available in each area when smoke-free status is introduced.
  • Patients who smoke should be referred to the NHS Grampian Smoking Advice Service.
  • Staff will not be able to smoke on NHS sites. It is important that they are warned of this in good time to plan. For many people, not smoking during a whole shift will cause nicotine withdrawal symptoms and they will need to use another form of nicotine to prevent this. Advice on choosing a nicotine product is available from the NHS Grampian Smoking Advice Service.
  • Information on the NHS Grampian (SAS) Smoking Advice Service should be made available to staff, patients and visitors who smoke.
  • Contact details are: Freephone 08085 20 20 30  or  email grampiansas@nhs.net.
  • Do you want to stop smoking resources are available for distribution. A calling card with SAS contact details (CGD140008) and a Z-card giving more detail of the service (CGD130639) are available by contacting the Health Information Resource Service at grampian.resources@nhs.net.

Consider Any Estate Issues

Designated smoking areas should not be available after April 1st 2015. These should be removed as part of your risk-based plan but some will be re-purposed as bicycle shelters. Bicycle racks available as part of the Commonwealth games legacy will be installed. This is a partnership initiative through SUSTRANS, for details contact Katherine Hale (Katherine.hale@nhs.net).

Site Signage

External signage will be acquired and installed at entrances to all sites owned by NHS Grampian by 31st March. This is one project carried out by Estates and Physical Planning. Timescales are updated through the Tobacco Policy Implementation short-life working group.

Internal no-smoking signs are of mandatory design and must be displayed. These are required to satisfy the requirements of the legislation which bans smoking in public places. These signs must display the phone number of someone to whom a complaint can be made if smoking is noticed. The telephone number on many signs currently displayed is out of date and these must be replaced by new signs ordered through PECOS. They must be displayed in all sections and subsections of NHS premises and in vehicles and are available through order codes ZKM001, ZKM002 and ZKM003. These display a current telephone number – a local number may be added to ease reporting.

Local information about tobacco policy implementation may be displayed on this interactive PDF poster. These may be edited and printed in colour locally: We Care About Your Fresh Air Poster

This poster translated into Russian, Polish and Lithuanian may also be printed locally in colour: We Care About Your Fresh Air Poster Translations

Assess the Need for Staff Training

Several training needs have been identified as the policy implementation process has developed including:

  • Understanding why the policy has been put in place
  • Understanding what the policy says.
  • Knowing what your responsibilities are.
  • Knowing what to say and how to speak to people without causing upset or risking an angry response.
  • Knowing how to help people affected by the policy.

Several learning opportunities have been provided to meet these needs:

  • An E-learning course called Tobacco and Smoking has been developed which covers each of these points. This can be accessed as follows:
  • From the NHS Grampian Intranet homepage, click on ‘learning zone’ and from there select ‘AT Learning’.
  • Sign in using your eKSF log-in & password
  • Select ‘book activities’
  • From the menu select ‘Book eLearning activities’ (make sure to select ‘book eLearning activities’ and NOT the ‘book an activity’ option)
  • In ‘Activity Name’ type ‘Tobacco and Smoking ‘Click on ‘Search’
  • A page should appear with ‘Tobacco and Smoking eLearning’ in the left hand column – scroll along to the right and select ‘Book Independently
  • ‘A menu will come up – insert the date you wish to complete the training and save. It is best to select today’s date so the training becomes immediately available.
  • Click ‘home’ on the menu bar which will take you back to the list of your courses – you can then start the eLearning training – by clicking ‘launch activity’.

The ‘Tobacco and Smoking’ elearning package can also be accessed from home via AT Learning. It is recommended you use Internet Explorer 7 or above to access the course and ensure pop ups are blocked.

For staff groups with limited access to e-learning the course can be delivered face to face.

Nursing staff who are applying the Protocol for provision of NRT for Nicotine withdrawal symptoms in Community Hospital In-patients by Registered Nurses will require training.. This can be provided face to face by the Tobacco Training and Development Coordinator.

Where new training needs are identified or to request courses please contact Sheila Robertson, Tobacco Training and Development Administrator. Sheila.robertson@nhs.net. Tel: 01224 556018 or Denise Kazmierczak, Tobacco Training and Development Coordinator. denise.kazmierczak@nhs.net. 01224 558671.

For tobacco training in mental health settings please contact Maria Nika, Smoking Cessation Specialist (Mental Health) m.nika@nhs.net. Tel: 01224 551211

Establish New Protocols or Adjust Existing Ones Where Required

The main development of a new protocol has been related to administration of Nicotine Replacement Therapy to prevent nicotine withdrawals. This is likely when patients who smoke regularly are prevented from doing so by our Tobacco Policy.  This can be very uncomfortable and result in irritable behaviour or hidden smoking. Both may be prevented by taking a safe source of nicotine.

There are currently 3 protocols:

The Protocol for Provision of NRT for nicotine withdrawal symptoms in Community Hospital In-patients by Registered Nurses is intended for use in community hospitals in Aberdeenshire and Moray. This enables nurses to administer NRT in these settings: Protocol for Provision of NRT for Nicotine Withdrawal Symptoms in Community Hospitals

NHS Grampian Staff Guidance for the In-patient prescribing of NRT for nicotine withdrawal symptoms in Acute settings has been produced and will be uploaded here when endorsed by the Medicine Guideline and Policies Group. This guidance advises existing prescribers on provision of NRT and applies to Aberdeen Royal Infirmary, Aberdeen Maternity Hospital, Royal Aberdeen Childrens Hospital, Dr Grays Hospital and Woodend Hospital.

NHS Grampian Mental Health Staff Guidance For The Inpatient Prescribing And Administration Of Nicotine Replacement Therapy (NRT) For Nicotine Withdrawal Symptoms is in place and is on the intranet  document silo and can be accessed here:  Medication and NRT Staff Update. This covers all aspects on the prescribing and administration required for the prescribing of NRT treatments and the products available in NHS Grampian.

Patients who are on Clozapine should be carefully monitored on stopping smoking as increased plasma levels are possible. In addition other medications can be affected. Guidance is available on the effects on smoking cessation on psychotropic medications and it is important to all medical staff are familiar with this. Guidance For NHS Grampian Staff On Smoking Cessation And  Psychotropic Drug Interactions can also be found on the intranet document silo and can be accessed here: Guidance for NHS Grampian Staff on Smoking Cessation and Psychotropic Drug Interactions

Monitoring breaches of the Policy

Breaches of the Policy should be reported and monitored through Datix reporting. It is thought that three main categories are likely to cover the most likely incidents. The following codes may be useful to staff when completing an incident Coding section of the form:

Type of incident Incident Category Detail Adverse event
Individuals smoking in an inappropriate area. Fire Fires, Fire alarms and fire risks Event that could have led to fire/explosion
Verbal/physical abuse as a result of challenging smokers Abusive, violent, disruptive or self-harming behaviour Abuse etc. of staff by other staff and public Option selected depending on nature of incident
Exposure to second-hand smoke Accident Exposure to electricity, hazardous substance, infection etc Hazardous exposure  to smoke or fire

 

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