1. 1 ENSH 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

2. ENSH WCTOH 2002 2 European code 1.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!

3. ENSH WCTOH 2002 3 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

4. ENSH WCTOH 2002 4 Smoke-free Hospital : Bronze level 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. gold silver bronze

5. ENSH WCTOH 2002 5 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!

6. ENSH WCTOH 2002 6 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.

7. ENSH WCTOH 2002 7 Auto audit process zA volontary process of hospitals to assess tobacco policies zA one page self audit questionnaire zThe questionnaire could be repeat each year zThe questionnaire follow the European code zAfter a first validation of questionnaire, 3 countries of ENSH are volontaire to test the questionnaire

8. ENSH WCTOH 2002 8 Methods zIreland, Italy and France corerspondant of ENSH selected 25-50 hospitals to participate z. zEach country analyse his data and propose change in the audit questionnaire. zAll the data are pulled as excell file then analysed

9. ENSH WCTOH 2002 9 Questionnaire For each item the answer is 0 non implemented 1 2 3 4 totally implemented NA non applicable

10. ENSH WCTOH 2002 10 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

11. ENSH WCTOH 2002 11 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 43210NA43210

12. ENSH WCTOH 2002 12 1. Policy : response from Italy Policy on official documentsInformation to patients and staff

13. ENSH WCTOH 2002 13 Policy : response from Ireland

14. ENSH WCTOH 2002 14 Policy : response from France 00 2 4 6 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

15. ENSH WCTOH 2002 15 2. Working Group : response from Ireland Working group appointed Audit results Previous plans audited in 2002 New strategy launched in 2002 Chair from top manag.

16. ENSH WCTOH 2002 16 3. Staff Education and Training : response from Ireland Education plannedTime allowed

17. ENSH WCTOH 2002 17 Results from Italy

18. ENSH WCTOH 2002 18 Results from Italy

19. ENSH WCTOH 2002 19 Results from Italy

20. ENSH WCTOH 2002 20 Results from Italy

21. ENSH WCTOH 2002 21 Results from Italy

22. ENSH WCTOH 2002 22 Results from Italy

23. ENSH WCTOH 2002 23 Results from Italy

24. ENSH WCTOH 2002 24 Results from Italy

25. ENSH WCTOH 2002 25 Results from Italy

26. ENSH WCTOH 2002 26 Results from Italy

27. ENSH WCTOH 2002 27 Comparison of individual score for 28 hospitals in 3 countries

28. ENSH WCTOH 2002 28 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

29. ENSH WCTOH 2002 29 Joint us