Overview Why tobacco control at TBRHSC? Smoke-Free Grounds Policy Implementation plan Supports for staff Supports for patients Question & Answer

Why tobacco control at TBRHSC? Demonstrates commitment to improving health of people in NWO Puts health of patients first Part of an academic and research-based, acute care environment Favours those committed to healthy lifestyles Smoke-Free Grounds are supported by the majority of community and partners We held engagement sessions with the community, staff, patients late in 2011 and early 2012 where it was made clear that we should keep our grounds smoke-free – this also meant without building designated smoking sections.

Tobacco Control Strategy TBRHSC Board of Directors TBRHSC Senior Management Council Chronic Disease Prevention & Management Prevention & Screening Council Steering Committee (PFA) Plan has received approval from the Board, Senior Management Council, endorsement from the Medical Advisory Committee, and has also received support at the Director and Management levels when we presented at a manager engagement session in March. There are about 50 people working on this project between the Steering Committee and 3-sub Working Groups. Smoke-Free Grounds Working Group (PFA) In-patient Working Group Out-patient Working Group

Smoke-Free Grounds Policy Policy defines tobacco products not allowed on grounds Map of TBRHSC Grounds Includes our parking lots and vehicles on our grounds Expectations & Responsibilities of TBRHSC Staff Smoke-Free Ontario Act Compliance Guidelines Policy revised and approved by the Policy and Procedures Committee in March. Tobacco products included: tobacco in any processed or unprocessed form that may be smoked, inhaled, or chewed, including but not limited to snuff, chewing tobacco, snus, cigarettes, contraband cigarettes, cigarillos, cigars, pipe tobacco, hookah pipe, herbal cigarettes, or any products which can be smoked legally or otherwise (e.g., Marijuana); E-cigarettes are also prohibited. We expect that all staff uphold and demonstrate the values of our organization, including our smoke-free grounds. Compliance guidelines in the back of the policy used to help guide us as we move forward.

Map includes our parking lots, and the vehicles in them, as well as the new Health Services Building on Oliver Road.

Implementation Plan Launch Date – May 31 Education and Awareness Go Live – Sept. 30 Compliance April May June July Aug. Sept. Manager training Staff information, awareness, education

Supports for Staff Greenshield Benefits for Full-and Part-time staff $500 each per Lifetime for benefit holder and spouse Community pharmacists and Occupational Health & Safety Community partners Thunder Bay District Health Unit: Take Control, Smokers’ Helpline, The Quit Coach Pharmacists are now able to provide cessation support through counseling and prescribing NRT to patients as part of their scope of practice. Best practice evidence shows NRT + counseling has the best quit results. We’re not asking you to quit smoking, we’re asking staff not to smoke while they’re at work.

Supports for Patients Inpatients Outpatients Brief intervention (5A’s) Nicotine replacement therapy medical directive Bedside smoking cessation counseling and follow-up Smokers’ Helpline referral Outpatients Working to provide counseling in outpatient clinics RNAO best practice spotlight project at TBRHSC

Supports for Visitors Care kits at Information Desk Information pamphlets with support Internet page

Smoking Cessation and Cancer Patients Improves post-surgical would healing and lowers risk of pneumonia and respiratory failure Radiation therapy and chemotherapy – improves response of treatment and survival Lowers risk of complications, recurrence, and a second primary cancer Cancer diagnosis is a teachable moment for the patient and family members While some perceive smoking cessation following a cancer diagnosis as a little too late, smoking cessation activities in the regional cancer program have great potential to decrease the burden of illness resulting from tobacco use – especially in NWO where our rates of smoking are so high. References: McBride & Ostroff, 2003 USDH, 2004 Parsons, Daley, Begh, & Aveyard, 2010 Travis et al, 2006 McBride et al, 2003 Patterson et al, 2010

Smoking Cessation – Regional Cancer Programs Screen all new ambulatory cancer patients Standardize screening questions, referral questions, and data collection Monitor effectiveness of the Smoking Cessation Framework Develop and maintain an inventory of smoking cessation services available within each LHIN Establish partnerships Take steps to minimize risks to implementation and increase sustainability Cancer Care Ontario initiative - Cancer risk reduction is a priority in Ontario Cancer Plan III Regional Cancer Programs are to be role models for risk reduction by 2015 - Smoking Cessation Framework recommendations from the Smoking Cessation Steering Committee (formed in 2012) Purpose was to recommend an approach to smoking cessation for ambulatory care patients in RCPs, outlining minimum standards of service and expected outcomes.

RCP’s are required to: Identify all current and recent tobacco users among new ambulatory patients, offer brief advice on benefits of quitting and referral to internal or external cessation service Adhere to standardized questions Identify and establish referral relationships with partners Provide data to Cancer Care Ontario for analysis and evaluation

Standardized Data Proportion of new patients asked the tobacco use screening question Proportion of screened patients who are current or recent tobacco users Proportion of current or recent tobacco users given a referral offer Proportion of current or recent tobacco users who accept the offered referral for cessation advice Data will be collected quarterly by CCO.

RCC-NW Process Train staff in brief intervention and revised patient assessment in Mosaiq Designate trained staff to identify and complete the patient assessment Crystal report to be built for data to be sent to CCO Reports to be shared with RCCNW staff for ongoing process improvement and sharing quit success stories - Share care kits, CCS booklets, and ask for feedback about needs for resources and further education

Question & Answer