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WHO IS THE SMOKER AT THE HOSPITAL FRONT DOOR?
Dr Jiliu Pan (FY2 doctor)
Dr Rob Fowler (retired consultant respiratory physician)
11 June 2015
First steps to tackling the most visible challenge to
smokefree hospitals.
WHY FRONT DOOR SMOKERS?• It’s obvious!
• Harm to patients, visitors, staff passing by
• A challenge to the positive messages of a smokefree environment
• Close to maternity unit
QUEEN’S HOSPITAL MAIN ENTRANCE
NICE (2013) – SMOKEFREE
• Recommendation 11: Develop smokefree policies• involve + train staff• removal of smoking shelters• facilitate compliance and support staff
• Recommendation 12: Communicate the smokefree policy• clear + positive messages on smokefree environment• information on access to stop smoking support• ensure staff do not smoke
BUT…
• Difference between policy and outcome
WHAT DO WE KNOW?
• County Galway audit (2014): 48% of smokers non-compliant, 1 year after smokefree policy
• Sabido et al. (2006): inpatients more likely to be compliant if: They believe current illness related to smoking mild withdrawal symptoms confidence in post-discharge abstinence
QUESTIONS
• Who are the smokers at the hospital front door?
• Why do they continue to smoke?
• What can we do to stop smoking at the front door?
?
… WE ASKED THE SMOKERS
• Interviewed 50 smokers outside the hospital main entrance
• Questionnaire designed to encourage open answers
• Included specific questions and subjective level of cooperation
• All interviewees offered a referral to stop smoking services
RESULTS:
Not everyone wanted to be approached about their smoking…
RESULTS:
• Most smokers were visitors
• Some outpatients
• Small minority were inpatients or staff
WHO IS THE FRONT-DOOR SMOKER?• A heterogeneous group, mostly visitors
• A majority will be cooperative with requests to stop smoking
• At least some will be uncooperative or even confrontational
• A sizeable proportion are patients
WHY DO THEY CONTINUE TO SMOKE?• Only 23% knew of the Trust’s new smokefree policy
• 72% of smokers would choose to smoke away from the maternity department But only 50% were aware maternity is right next to the front door
• Common response: point at other smokers + “but they are smoking here”
RESULTS
Figure 3
HOW CAN WE STOP THEM SMOKING?• More, better and clearer signs
• Signs are not enough, need physical presence (from security)
• Clarify the smokefree perimeter
• ?a designated area for those that cannot stop smoking
- ACCORDING TO THE SMOKERS
WHAT ELSE DID THEY TELL US?• bins designed to facilitate smoking
• removal would give consistent message
Figure 4
Figure 5
Figure 6
CONCLUSIONS
• Front door smokers are a heterogeneous group
• Good quality signs and an unambiguous perimeter are needed
• Static signs are not enough – we need PEOPLE to ENFORCE
• We should promote and make available NRT to visitors
REFERENCES
1. NICE (2013): Smoking cessation in secondary care: acute, maternity and mental health services.
2. Evans, David S; Faney, Maria; McHugh, Laura;O'Byrne, Irene; Goggin, Deirdre: "Audit of Galway University Hospitals tobacco free campus policy:final report prepared on behalf of the Tobacco Free Campus Audit Group", Health Service Executive Galway 2014.
•3. Sabido M, Sunyer J, Masuet C, Masip J: Hospitalized smokers: Compliance with a nonsmoking policy and its predictors. Prev Med 2006, 43(2):113-6.
