smoking cessation policy december 2017 · • all frontline staff need to be trained to deliver...

SMOKING CESSATION POLICY_CL20_DECEMBER 2017

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SMOKING CESSATION POLICY

DECEMBER 2017

This policy supersedes the Nicotine Management Policy and the

Tobacco Control Policy (both policies merged)


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Policy title Nicotine Management Policy

Policy reference

CL20

Policy category Clinical

Relevant to All Staff

Date published December 2017

Implementation date

December 2017

Date last reviewed

November 2017

Next review date

January 2020

Policy lead Frank Ryan

Contact details Email: [email protected]

Accountable director

Caroline Harris-Birtles, Director of Nursing and Quality

Approved by: Physical Health and Nutrition Group Health and Safety Committee

Ratified by: Quality Governance Committee

Document history

Date Version Summary of amendments

Dec 2017 1 Tobacco Control and Nicotine

Management policies merged

Membership of the policy development/ review team

Frank Ryan – Lead for Smoking Cessation Ashling Clifford –Interim Deputy Director of Nursing Smoking Cessation Policy review Group ( Including Service Users) Practice Development Team

Consultation Director of Nursing, Deputy Director of Nursing, Medical Director, Deputy Medical Director, Chief Operating Officer, Deputy Chief Operating Officer, Associate Divisional Directors, Associate Director of HR, AD Governance and Quality Assurance, Clinical Directors, Head of HR & BP, HR Business Partner (Policies), Head of Facilities Management, Health and Safety Manager, Interim Head of Learning and OD, Deputy MHL Manager, Head of Patient Experience, LSMS, Islington Borough User Group; Camden Borough User Group Chief Pharmacist, identified staff in Divisions and departments, Quality Review Group

DO NOT AMEND THIS DOCUMENT Further copies of this document can be found on the Foundation Trust intranet.


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Contents

1 Trust priorities and values 4

2 Policy statement 4

3 Aims and objectives 5

4 Scope of the policy 6

5 Helping people stop smoking 7

6 Definitions 9

7 Duties and responsibilities 11

8 Very Brief Advice (VBA) 15

9 Care Planning 17

10 Facilitated smoking 19

11 Nicotine Replacement Therapy (NRT) 20

12 Local Specialist Smoking Cessation Service 22

13 E-cigarettes 22

14 Building concordance with Service Users 26

15 Working with service users who smoke in their house 27

16 Incident reporting 28

17 Smoking and tobacco control in the workplace 29

18 Further reading 34

19 Dissemination 34

20 Monitoring and audit arrangements 35

21 Review of the policy 37

22 References 37

23 Associated documents 39

Appendices: 40


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1. Trust priorities and values

Our three key priorities are:

Early and Effective Intervention;

Helping People to Live Well and

Research and Innovation

The cultural pillars that help us achieve these are:

We value each other; We are empowered; We keep things simple; We are connected

2. Policy statement

The policy should be read in conjunction with the, relevant prescribing guidelines, clinical

protocols and the Trust Search Policy.

3. Aims and objectives

The policy applies to all staff, including bank and agency workers, to service users,

visitors, volunteers, contractors, students, trainees, and other persons visiting Trust

owned and operated premises for any reason and seeks to:. A strategic aim for the

NHS is to reduce the prevalence of smoking in people with mental health conditions,

currently 40.5% compared to 15.5% in the general population. This is supported with

a directive to ensure all inpatient and community mental health sites are smoke-free

by 2018. This affirms C&I’s early adoption of becoming smoke free in 2015, but the

challenges remain. Accordingly, the policy aim to:

Ensure that all service users have adequate support to stop smoking, or

abstain while using Trust services

Promote a healthy working and treatment environment and protect the current

and future health of staff, service users, volunteers, contractors and visitors

by ensuring that it is smoke-free


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Protect the right of everyone to breathe air free from tobacco smoke, in and

around Trust buildings, grounds and property. In particular, exposure to

smoking can

Provide advice and guidance for staff and managers in enabling smokers to

quit, either temporarily while in treatment or in the longer term.

Provide advice and guidance for staff and managers in services working with

people who smoke in their own homes

Raise awareness of the dangers associated with exposure to tobacco smoke.

Guarantee a healthy working environment (including vehicles), free from

tobacco smoke and e-cigarette vapour to safeguard the health of staff,

service users, volunteers, contractors and visitors.

Provide advice and guidance for staff and managers in the management of

smoking related risks in Trust operated and owned residential properties.

Provide advice and guidance for staff and managers to reduce the risk of

smoking activity related fires in Trust owned or operated properties

Comply with the Health Bill, Health & Safety Legislation and Employment Law

Raise awareness of the dangers associated with exposure to tobacco smoke.

Take account of the needs of those who are unable to commit to stopping

smoking while remaining vigilant to opportunities for offering help.

Smoking cessation should be a primary therapeutic goal for people who access and work in

C&I services. This is because smoking contributes to the onset and maintenance of mental

health problems (Cuijpers et al, 2007), disrupts or extends therapeutic intervention and

compromises treatment outcomes. Smoking is also a cause of premature death and chronic

illness.

Smoking by members of staff is inconsistent with the aspiration to reduce smoking related

harm among the client population. Therefore, promoting smoking cessation is also essential

to protect service users, staff, students and visitors from the harmful effects of second-hand

tobacco smoke and attendant risks of fire.


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Workers who quit smoking also benefit from health gains and improved wellbeing that have

the potential to enhance quality of care.

4. Scope of the policy

4.1 Overview

This policy applies to the management of nicotine dependence in service users and staff in

all properties and services where Camden & Islington NHS Foundation Trust has

management responsibilities. Restrictions on possession of tobacco and smoking in bedrooms

and gardens do not apply to properties owned by Anglia 33 Housing Association.

The current policy should be read in conjunction with the following Trust documents:

Prescribing guidelines for smoking cessation

Protocol for the supply of nicotine replacement therapies.

Nicotine replacement therapy Standard Operating Procedure

1.2 Legal Requirements

Section 2(2) of the Health and Safety at Work Act 1974 places a duty on employers to

provide a workplace that is, as far as is practicable:

‘safe, without risks to health and adequate as regards facilities and arrangements for their

welfare at work.’

The Health Act ( 2006) introduced the legal requirement for smoke free premises

across England, intended to remove second-hand smoke from enclosed workplaces and

public places. This prohibits smoking tobacco:

In places of work

In places that the public access to obtain goods and services, including

private clubs

In other places designed by statutory instrument

This policy addresses issues predominantly relating to clinical aspects of smoking cessation

, with Chapter 19 addressing smoking in the workforce and the workplace.


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Smoking cessation should be included as part of the standard treatment for mental health

conditions. This requires systematic recording of smoking status of all service users before

or at referral or admission and subsequent identification of treatment goal. The policy aims to

ensure:

People with a mental health condition are empowered to take action to reduce their

smoking.

Staff working in all mental health settings see reducing smoking among service users

as part of their core role.

Staff should be encouraged to quit smoking and actively supported when engaged in

smoking cessation.

Accordingly, all staff with clinical roles should

ask about smoking status and be able to instigate a quit attempt, or enable access to

nicotine replacement therapy (NRT) or other treatments.

staff trained to facilitate a quit attempt, or help a service user manage a sustained

period of abstinence, should be available In practice, whether a service user is

willing to commit to an episode of abstinence (e.g. during an inpatient admission) or

is aiming for long term abstinence, the initial steps are the same.

5.0 Helping people stop smoking

5.1 Withdrawal Management in Inpatient Settings

The challenge many smokers will encounter on admission to inpatient services is that they

will be obliged to stop smoking for the duration of their stay. This will often be in the context

of high levels nicotine dependence, with associated acute nicotine withdrawal symptoms.

Withdrawal effects can occur within 30 minutes of nicotine deprivation and peak at 12 hours.

Withdrawal effects are clustered around craving and negative affect (e.g. dysphoria, anxiety,

irritability) The inpatient population are a priority as they sometimes abruptly, and sometimes

involuntarily, enter a smoke free environment. Harm reduction e.g. reducing frequency of


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smoking in advance of a quit attempt, or temporary abstinence while an inpatient or in

residential care, is also viewed as a valid and valued approach, as outlined in NICE

Guidelines QS 92 https://www.nice.org.uk/guidance/qs92. and PH 48

https://www.nice.org.uk/guidance/ph48. and PH 45 https://www.nice.org.uk/guidance/ph45

The Care Quality Commission (CQC) specifies standards including:

• Staff aware of and compliant with local Trust policy, including knowing their own role, in

promoting smoking cessation and reducing tobacco related harms.

• All frontline staff need to be trained to deliver advice around stopping smoking and

referral to smoking cessation services.

• Be confident to engage with and talk to people in a sensitive manner about the risks of

smoking , the benefits of quitting, which include requiring less medication, increased

engagement in therapeutic and recovery focused activities, improved health and mood and

financial saving.

5.2. Smoking by users of community based services

Service users who access community based services do not encounter a barrier to smoking

when they present, apart from when actually on C&I premises or grounds. However,

smoking remains a likely contributory factor to their psychological difficulties: smokers are,

for example, more likely to develop depression (Bakhshaie et al 2015) and anxiety (Cuijpers

et al, 2007) disorders. People who smoke are also more likely to develop psychosis, with an

earlier age of onset (Gurillo et al 2015) Cigarette smoke interacts with some medicines,

mostly due to polycyclic aromatic hydrocarbons in cigarette smoke that stimulate cytochrome

P450 enzymes, particularly CYP1A2; some medicines are therefore more rapidly

metabolised in smokers. The enzyme inducing effect is removed when people stop smoking,

potentially giving rise to higher plasma levels. Nicotine (NRT) has no effect on this process. .

Conversely, simply quitting smoking has been found to generate improvements in mood

similar to the effect of anti-depressant medication (Taylor et al 2014).

The policy promotes the engagement of service users in smoking cessation at the earliest

possible opportunity. In practice this will be at the first contact or when an appointment is

offered. Prospective service users who are smokers should be advised in advance that a)

https://www.nice.org.uk/guidance/qs92

https://www.nice.org.uk/guidance/ph48


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smoking is a precursor or contributory factor to many common mental health problems and

b) effective help is available to enable them to quit. ( see appendix 2 for a draft of an

appointment letter raising awareness about smoking and the importance of addressing this

pre-emptively in order to maximise therapeutic gain.)

6. Definitions

6.1Specialist smoking cessation services

Local smoking cessation services are available to all staff and service users. Details are

available at https://www.breathestopsmoking.org/. The service offers support in various

settings, such as pharmacies, GPs, and community clinics, and a range of interventions,

depending on the persons needs and preferences. These interventions can go from

providing information and guided self-help, brief counselling interventions, group support,

face to face support, telephone support or longer, more intensive, clinical interventions by

highly trained specialists. It is envisaged that more intensive support will be needed for

people with mental health problems wishing to stop smoking.

6.2 Smoking cessation advisors

‘Level 1’ smoking cessation advisors are staff members who have undergone training to

deliver very brief advice on smoking cessation, and signposting for smoking cessation

treatment. This role entails initiating or triggering an episode of smoking cessation.

‘Level 2’ smoking cessation advisors are staff members trained by local specialist smoking

cessation services to provide smoking cessation advice, and offer behavioural support.

“Level 3” smoking cessation advisors have advance training and can supervise and monitor

Level 2 staff.Level 2 and 3 smoking cessation advisers may supply NRT under the trust

protocol on successful completion of the training and competence assessment.

All level 2 advisors will be registered with their local specialist smoking cessation service

provider. Advisors will be expected to attend an annual update after accreditation in order to

remain an accredited level 2 advisor.

6.3 Complete abstinence


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Smokers who are motivated to stop smoking and are willing to work with a smoking

cessation advisor to achieve lasting abstinence.

6.4 Temporary abstinence

Smokers who need NRT ( and / or e-cigarettes), to manage the symptoms of nicotine

withdrawal for the duration of an admission but do not wish to quit smoking in the longer

term.

6.5 Harm Reduction

Interventions aimed at reducing the harms associated with smoking, especially with people

unable to commit to abstinence by:

Ensuring they know that licensed nicotine-containing products (such as nicotine

patches, gum, or spray) make it easier to cut down prior to stopping, or to reduce the

amount they smoke.

Advise service users that they can continue to use licensed nicotine-containing

products in the long term, rather than risk relapsing after they have stopped, or

reduced their smoking.

6.6 Electronic cigarettes ( E-cigarettes)

For the purpose of this policy, all Electronic Nicotine Delivery Systems ( ENDS) or

vapourising devices for consuming nicotine will be referred to as e-cigarettes. The products

available on the market are all currently unlicensed. However, producers must submit

information about their products to Medicines and Healthcare Regulatory Authority (MHRA)

via a European Common Entry Gate (EU-CEG) notification portal.

7. Duties and responsibilities

7.1 The Trust will ensure that:

staff, patients, visitors and contractors are made aware of the smoke free policy.

resources are available to ensure effective implementation.

In addition

https://www.gov.uk/guidance/e-cigarettes-regulations-for-consumer-products


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tThe smoking cessation lead will have responsibility for reporting on the programme

to the Physical Health and Nutrition Group

The chair of the Physical Health and Nutrition Group will have responsibility for

monitoring compliance

7.2 Responsibilities of Divisions

Divisional clinical directors will hold ultimate responsibility for the implementation of the

smoking cessation policy in their division, delegating implementation to individual team

managers. There is a need to ensure that smoking cessation is a standard item on

supervision protocols.

7.3 Team Managers must:

Ensure that their team has a representation of smoking cessation advisors adequate to

support their service users (see section 10.2), and that they are supported to carry out their

smoking cessation role.

Ensure access to level 2 trained smoking cessation advisors is provided for all service

users who decide to quit smoking.

Promote access to level 2 advisors within their services and ensure service users

and staff are aware of other smoking cessation pathways and options to quit

Ensure that staff are fully supported in promoting smoking cessation with

service users and other staff. This includes addressing non-compliant

smoking in a sensit ive and therapeut ic manner.

Comply fully with the policy and provide a suitable role model for staff and

patients

Ensure that smoking cessation training is promoted, attended, and

translated into practice in the workplace. Include smoking cessation as a core

component of planned supervision sessions.


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Ensure adequate quantities of nicotine replacement therapies are available

in services that supply medicines directly to service users.

Ensure that facilitating “smoking breaks”, purchasing tobacco for service

users or other mechanisms of supporting smoking for service users are not

permitted

Ensure that patient information regarding the relationship between smoking

and illness (both physical and mental) is available in patient areas

Ensure that information on smoking cessation and medication interactions

is available in all clinical areas

Inpatient managers will ensure that information on nicotine replacement

therapies (NRT), e-cigarettes and the Trust policy is available to all inpatients

Will ensure that ‘Smoke Free” signs and information on accessing local

Smoking Cessation Services are placed in their buildings

Ensure that information on the smoke free policy is readily available to staff,

service users and visitors in their building

7.4 Level 2 Smoking cessation advisors will:

Provide smoking cessation interventions including one to one motivational

sessions engaging service users in smoking cessation.

Attend annual level 2 updates to ensure practice is up to date

Will record all smok ing cessat ion activity with service users, including carbon

monoxide (CO) monitoring, the type of support offered, follow-up on smoking

cessation interventions and outcomes for those who have achieved a four -week

quit/relapsed to smoking/lost to follow up, using the Trust electronic patient record

(EPR) and any other locally agreed reporting mechanisms.

7.5 Crisis services and liaison staff:

All service users being admitted to inpatient or residential crisis services must be

made aware of the policy on tobacco use prior to admission. Users should

additionally be made aware that the Trust offers nicotine replacement therapy to all

service users, including those who continue to smoke.

Provision of this information is the responsibility of:


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a) The liaison team if a service user is being admitted via A&E

b) The crisis team if the service user is being admitted by the team from their own

home

c) The AMHP if the service user is being admitted via mental health act assessment

in the community

All liaison and crisis team assessments should include an assessment of smoking

behaviour (See Appendix 1)

All inpatient and crisis team staff are responsible for explaining the benefits of

smoking cessation, including improved physical health and mental health.

‘Level 2’ smoking cessation advisors in each team will provide motivational

interviewing support for service users making an attempt to quit

In Camden Crisis Houses, NRT prescribing will be supported by their local CRT

In Drayton Park Women’s Crisis Centre, supply of NRT will be managed by Level

2 advisors using letters of recommendation, or SSS, or GP’s

7.6 Inpatient staff

All staff will be responsible for supporting service users to abstain from smoking,

explaining the policy and rationale and promoting the benefits of becoming smoke

free. This will be supported by the Practice Development Team which includes

specialist smoking cessation colleagues.

All staff will be responsible for facilitating one-to-one and group therapeutic activities

in their area.

Cigarettes and lighters are prohibited items that should be removed and either

disposed of or returned to the service user at discharge. If found on the ward, or in

the course of searches ( see ‘Trust Search policy, these items should also be

disposed of. )

All registered nursing staff are responsible for undertaking training in using the

Protocol for the supply of nicotine replacement therapies and Nicotine replacement

therapy Standard Operating Procedure.

Registered nurses assessed as competent in using the protocol, will have their

competency reviewed every 3 years as part of the medicines management

competence assessment process.


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Nurses assessed as competent in using the protocol for NRT, will supply a limited

range of NRT to service users on admission.

Medical colleagues will have full access to Trust formulary and will manage ongoing

prescribing following this initial administration (See ‘Prescribing Guidelines for

Smoking Cessation’

‘Level 2’ smoking cessation advisors on each ward will provide motivational

interviewing support throughout the attempt to quit.

7.7 Primary nurses

All primary nurses will ensure that all smokers have a smoking

cessation/reduction/abstinence care plan in their EPR records as described in section

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The primary nurse is responsible for referring the patient to a community smoking

cessation advisor/service on discharge see section 11

Primary nurses will maintain vigilant with regard to those patients who are observed

smoking and address this at the earliest appropriate time, or immediately if

necessary.

7.8 Community staff

All community healthcare staff are responsible for re-assessing smoking status and

providing very brief advice as defined in section 7, plus updating the status on

Carenotes at each CPA review

For service users not subject to CPA, smoking status should be reviewed and brief

advice provided at every available opportunity. In practice, clinical judgment will

apply. If a service user expresses little or no motivation to change their smoking

behaviour less frequent advice can be given, but the clinician needs to be mindful of

changes in motivation or readiness to change.

All staff must ensure that all service users who wish to stop smoking are referred

to level 2 smoking cessation support.

Ensure that service users are aware of the need to adjust medication if required

on smoking cessation, and this is reflected within individuals’ care plan (see

Prescribing Guidelines for Smoking Cessation)


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‘Level 2’ smoking cessation advisors in each team will be available to provide

motivational interviewing to initiate a quit attempt and behavioural support throughout

the intervention, including making NRT available and monitoring progress..

7.9 All Staff

All staff will be responsible for establishing smoking status and providing very brief

advice on smoking cessation during every assessment (see section 6)

All staff will be responsible for addressing smoking in restricted areas and working

with service users to engage them to support the policy on any Trust premises

Staff must not purchase tobacco products for patients in any setting. However, they

should offer e-cigarettes when available and /or facilitate their purchase of e-

cigarettes.

Staff must not escort patients to smoke either on Trust property, or in the community,

including during escorted S17 leave

8.0 Very Brief Advice (VBA)

Offering support to quit, rather than merely asking a smoker if they are interested in stopping

or telling them they should stop, leads to more people making a quit attempt. Repeated

delivery of VBA by health professionals is a clinically effective smoking cessation

intervention.

Access to e-learning on how to deliver very brief advice is available here:

http://www.ncsct.co.uk/publication_very-brief-advice.php

8.1 For community staff:

At every patient assessment and CPA review, in every service, all staff should follow the

protocol below for providing very brief advice to service users on smoking cessation.

1) Ask – “Do you smoke?” (Record or update smoking status on Carenotes)

2) Advise – “Stopping smoking is the most important thing you can do to improve your

health and the best way of stopping smoking is with a combination of medication and

specialist support.”

http://www.ncsct.co.uk/publication_very-brief-advice.php


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3) Act – “Would you like me to put you in touch with a specialist stop smoking advisor who

can provide this support?” – Make a referral to the stop smoking advisor within your

service, or to local community services if preferred (see section 11).

8.2 For inpatient and residential crisis service staff:

At every admission, and when constructing and/or reviewing care plans for patients who

smoke, all nursing staff should follow the protocol below for providing very brief advice to

service users on smoking cessation.

1) Ask – Do you smoke? (Record or update smoking status on Carenotes)

Or

Ask – I see from your notes that you smoke?

2) Advise – Stopping smoking is the most important thing you can do to improve your

health. During your stay, we can support you to temporarily or permanently stop

smoking. The most effective and comfortable way to do this is by using stop smoking

medication and having support from a stop smoking specialist.

Would you like me to arrange for you to have nicotine replacement therapy?

Would you like to speak to our smoking cessation advisor?

3) Act – Give information leaflet on the Smoking Cessation Policy and on e-cigarettes to

the service user. Make a referral to the smoking cessation advisor within your unit, or to

local community services if preferred and accessible to the service user (see section 11).

9. Care planning

9.1 Inpatient smokers

All smokers in inpatient services should have a care plan detailing:

i. Smoking status, quantity smoked per day, motivation to quit. Motivation can be

assessed by asking about how important it is for the individual to stop temporarily or

in the longer term: On a scale from 0 to 10, where 0 means “not at all important” and

10 means “the most important thing for me right now”, how important would you say it

is for you to stop smoking?” Note that even low scores of 2, 3 or 4 still enable the


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clinican to ask “why not lower?” which steers the service user towards identifying

reasons to change.

ii. Their choice of NRT product, or e-cigarette use. If a nicotine dependent service user

refuses a nicotine product at the point of admission, a plan to re-offer at regular

intervals should be included

iii. Outcome of capacity and risk assessments for self-managing nicotine replacement

therapies should be note.

iv. A record of acceptance or refusal of contact with a smoking cessation advisor, and

the local advisors details. If a nicotine dependent service user refuses contact with a

smoking cessation advisor, the process for re-offering to engage them with a

smoking cessation advisor during their admission should be recorded.

v. A plan to engage the service user in activities to distract them from over-reliance on

nicotine replacement products should be included.

vi. To support relapse prevention, coordination of smoking cessation service provision

should occur in the transition between inpatient and community settings. The primary

nurse is responsible for ensuring the service user is referred to a community smoking

cessation advisor at the point of discharge or overnight leave from the ward. (See section

11). Where applicable the smoking cessation advisor should be invited to a discharge

planning meeting.

9.2 Residential care smokers

All smokers in residential services (Trust or local authority/housing association) should have

a care plan detailing:

i. Smoking status, quantity smoked per day

ii. A record of acceptance or refusal of contact with a smoking cessation advisor, and

the local advisor’s details

iii. if the service user declines referral to smoking cessation support, a plan to re-offer at

regular intervals should be included


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iv. If a service user elects to use an e-cigarette for reduction or cessation, this should be

recorded, advice on safe use should be provided, and risk management protocols

described in section 12 must be followed

v. A link to a care plan describing structured activities should be included.


should occur in the transition between care settings. At the point of transfer from a

hospital or crisis setting, the level 2 advisor in the residential setting should continue

any smoking cessation work.

9.3 Smokers in the community

All service users should have a care plan detailing:

i. Smoking status, quantity smoked per day.

ii. Motivation should be explored as above.

iii. A record of acceptance or refusal of contact with a smoking cessation advisor, and

the local advisor’s details. If a nicotine dependent service user refuses contact with a

smoking cessation advisor, the process for re-offering to engage them with a

smoking cessation advisor should be recorded.

iv. If a service user chooses to use an e-cigarette for reduction or cessation, this should

be recorded, advice on safe use should be provided

v. If attempting reduction/cessation, a plan to engage the service user in activities to

distract them from cravings should be included.


should occur in the transition between care settings. At the point of transfer from a

hospital or crisis setting, the care coordinator should check that a referral to smoking

cessation service has been made.

10. Facilitated smoking

Staff are prohibited from facilitating smoking for service users. This includes:

The purchase of tobacco for service users


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Permitting smoking to occur on Trust sites

Facilitating ‘smoking breaks’ either on or off Trust premises

Facilitating smoking during escorted leave from Trust premises, includingSetion17

leave and other therapeutic activities such as Occupational

Therapy and other activity groups in the community

To ensure facilitated smoking does not occur, inpatient staff must not return tobacco held in

safekeeping prior escorting service users for an activity off the ward, including Section 17

leave and activity groups. Escorted Section 17 leave activities should be planned with

service users in advance, and service users should be made aware of the terms of this

policy prior to granting leave. Breaches of the policy by service users during section 17 leave

should be addressed using the protocols described in section 14 below, and care plans to

support adherence to the policy should be formulated by the multidisciplinary team.

For extended periods of leave, typically entailing an overnight absence from the Unit,

tobacco products may be returned. Service users should be reminded that any tobacco

brought back after the absence will be taken and stored until the next extended break or

discharge.

11 Nicotine replacement therapy ( NRT)

11.1 Supply of NRT

Nicotine dependence is a substance use disorder, which can be safely and effectively

medically managed using nicotine replacement therapies, irrespective of intent to quit

smoking.

Inpatient nursing staff assessed as competent in using the relevant protocol are able to

supply a limited range of NRT ( including e-cigarettes) to patients at the point of admission,

without a prescription. This will ensure patients admitted out of hours are rapidly supported

in managing potential nicotine withdrawal on admission to smokefree sites. Please see the

current prescribing guidelines and protocol. The medical team are responsible for ensuring

that all smokers have adequate levels of NRT prescribed to meet their dependency needs

throughout their admission.


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11.2 Provision of level 2 smoking cessation advisors

All community services should have at least one level 2 Advisor, larger services and

those providing a 24hr service will require more

All inpatient and 24 hour services should have at least two level 2 advisors available.

11.3 Restricting tobacco access

Possession of tobacco products and tobacco paraphernalia by service users will not be

permitted on inpatient units. Visitors to Trust sites will be provided with information on the

policy and its rationale, and encouraged not to attempt to bring tobacco onto the premises.

Service users in residential care settings, or using community or crisis services will not be

prohibited from possessing tobacco products or paraphernalia, but must not smoke within

the building or grounds.

Service users who illicitly smoke in prohibited areas are risking the health and safety of all

other occupants of the unit, and policy breaches should be addressed as described in

section 14 below. Individuals in residential settings who breach this policy should have an

individualised care plan to support compliance with the policy, and an individualised risk

management plan within their risk assessment. This may include controlled access to

tobacco products while in the unit.

11.4 Mental state monitoring during smoking cessation

A minority of people who stop smoking may experience a temporary dip in mood,

irrespective of the presence or absence of pre-existing mental illness. Inpatients and service

users in crisis or Trust owned residential services should have their mental state reviewed

on a daily basis. Service users in community teams should be supported by their smoking

cessation advisor, and receive additional support from their care co-ordinator where

available.

11.5 Treatment monitoring during smoking cessation

Smoking promotes CYP1A2, an enzyme that potentiates the metabolism of many used

medicines used to treat mental health conditions. Accordingly, when someone stops

smoking, plasma concentrations can significantly increase for medications affected by


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CYP1A2. Therefore, quitting smoking or exposure to smoke-free environments may increase

the efficiency of treatment for service users, which in turn may require dose reductions of

many widely used medicines.

Patients taking any of the medicines above must be reviewed by a medical colleague within

48 hours of admission to an inpatient unit, and the ‘Prescribing Guidelines for Smoking

Cessation’ (2016) should be used to guide the treatment review.

Particular attention must be paid to monitoring the treatment of service users stopping

smoking while taking clozapine or olanzapine, where plasma levels may increase by up to

50%. The management protocols for these drugs, as described in the ‘Prescribing

Guidelines for Smoking Cessation’ (2015) must be followed.

Information for service users

Information on the following should be available to service users in all clinical areas:

The effects of smoking on physical and mental health

The Trust policy on managing nicotine dependence

The support available to service users who smoke, local SSS

Information on NRT and e-cigarettes

12. Local specialist smoking cessation services (SSS)

All staff and service users are able to access the local SSS in Camden and Islington

(website) The service trains and supervises the network of level 2 advisors in the Trust, GP

practices, pharmacies as well as seeing service users directly.

https://www.breathestopsmoking.org/

Service users can also self-refer to any of the above services via telephone or email.

13 E-cigarettes

E-cigarettes do not pose any known immediate risk of harm to users, and the vapour

released does not cause a passive exposure risk, However, the vapour can be intrusive,

especially to non- smokers and non-vapers, and needs to be restricted especially in indoor

communal areas. As a general principle, the onus is on the vaper to seek permission to vape

and ensure that they are not adversely affecting the immediate environment of fellow service



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users and staff. If a service user appears to not fully appreciate the impact of their vaping the

onus is on staff to suggest alternative locations.

The European Tobacco Products Directive which came into force in May 2017 specifies that

products meet certain standards, which include:

the maximum volume of e-liquid for sale in one refill container must not exceed 10ml

e-liquids must be sold to a nicotine strength of no more than 20mg/ml

Tank and cartridge sizes must be no more than 2ml in volume

nicotine-containing products or their packaging must be child-resistant and tamper

evident

certain ingredients including colourings, caffeine and taurine are banned

new labeling requirements and health warnings are required on packaging

all e-cigarettes and e-liquids must be notified to MHRA before they can be sold

In support of efforts to promote the use of e-cigarettes as an alternative to tobacco, leaflets

should be provided to all service users admitted to inpatient sites as part of the welcome

pack.

Information on e-cigarettes should be provided to all service users in Trust

residential services

Information on e-cigarettes should be made available to all community service users

who smoke

Service users who choose to use e-cigarettes must not be excluded from receiving

support from level 2 advisors in any setting.

13.1 E-cigarette use in inpatient settings

Patients may use e-cigarettes in single occupancy bedrooms.

E-cigarettes can be used in designated areas of grounds or gardens. These areas

can be identified at local and site level with the participation of service users and their

representatives. For infection control reasons, and to avoid diversion of nicotine

delivery products, patients should not share e-cigarettes


23

Only devices with pre-filled cartridges may be used. Both disposable and

rechargeable devices of this type are permitted, however for rechargeable devices

the protocols described in section 12.3 must be followed to manage the risks

associated with charging

Spent e-cigarettes and their cartridges should be disposed of via e-cigarette recycling

boxes.

In the absence of a recycling box, disposable e-cigarettes, and any discarded

batteries from the rechargeable type devices should be disposed of via the battery

recycling box

In the absence of a recycling box, spent cartridges from rechargeable type devices

should be disposed of via the yellow sharps bin

Liquid refillable types and liquid nicotine refill bottles are not permitted for use due to

risks associated with the ingestion of nicotine liquid, and risks associated with the

devices being used to consume illicit substances.

There are electronic devices on the market that look like pipes, cigars etc. Devices

which are not easily identified as either a disposable or re-chargeble, are not

permitted for use.

13.2 Managing charging risks in inpatient and residential settings

The following protocols should be used to manage the risks associated with e-cigarette

charging:

All E-cigarettes units to be the subject of a visual inspection when being brought on

to the ward to ensure that the unit is in good electrical condition (no visible wires,

plugs secure) and being used with the correct associated charger i.e.: not a phone

charger unit.

Chargers must be held by nursing staff and charging must be supervised in the

nursing station

To prevent chargers being confused, each charger must be labeled with the patient’s

name

Check and follow the instructions for each individual brand of e-cigarette

Only use the battery and charger which comes with the e-cigarette


24

When charging is complete, disconnect the battery and remove the device from the

charger

When the charge is complete disconnect battery and remove charger from the USB

port/socket – this is usually indicated by a light on the device.

Do not charge or use batteries which appear to be leaking, discoloured, rusty or

deformed or otherwise appear abnormal

Store batteries and chargers in a cool dry place at normal room temperature. Do not

leave in hot places such as direct sunlight, or on a radiator

Keep away from any source of ignition and accelerants such as flammable objects

and liquids, oxygen supply systems/cylinders, sparks and electrical equipment.

Do not immerse batteries or chargers in water or otherwise get them wet

Do not disassemble, puncture, modify, throw, drop or cause any other unnecessary

shocks to the batteries or chargers

All E-cigarettes units will be included in to the Portable appliance testing cycle for the

unit, to ensure electrical safety when they reach the twelve monthly requirement.

13.3 E-cigarette use in residential services

Service users in residential services are permitted to use e-cigarettes in accordance with the

requirements set out in section 12. Above. . Accordingly, e-cigarettes may be used in single

occupancy bedrooms and in gardens or grounds. Vaping is only permitted in designated

areas of indoor communal spaces following operational management, Health and Safety

and service user consultation Risks associated with any rechargeable devices should be

managed using the protocols described in section 12.. , and devices should also be Portable

Appliance Tested (PAT) annually.

13.4 E-cigarette use in community services

Users of Trust community services such as the recovery centres and R&R teams/CMHT’s

are not generally permitted to use e-cigarettes in any indoor spaces of Trust property,

however site managers and service user representatives may designate appropriate areas


25

or rooms where e-cigarettes can be used. E-cigarettes can be in outside spaces such as

gardens or patios where available, although the views and preferences of non-smoking

service users should be carefully considered. In all cases Health and Safety policy should be

adhered to with advice from advisers sought as needed.

14. Building concordance with service users

Smoking is an addiction and therefore resistant to self-control. When service users

contravene the smoke free policy this is likely to reflect either: a) compulsion (craving for a

tobacco/nicotine), b) negative feelings associated with nicotine deprivation or c) negative

emotions that would previously have been a cue for smoking as a means of “self-

medication”. These factors can interact and combine to drive the pursuit of smoking

regardless of the sanctions. If a service user is found to be smoking covertly this is an

opportunity to engage in a therapeutic dialogue that can identify the triggers (e.g. nicotine

withdrawal symptoms or craving; negative emotions; boredom; stress.

Smoking also poses a risk of harm to the health and safety of staff and other service users,

and all staff should address any service users smoking in areas where it is not permitted

using the following protocols. If the smoking incident has been inside a Trust building, and/or

resulted in potential second-hand smoke exposure to staff or service users, a Datix (incident)

form should be completed. Staff reporting breaches of the policy should use the following

coding to report on Datix (Estates and Facilities Issues: Smoking inappropriately or in

restricted areas)

Asking someone to stop doing something is a potential source of conflict, which requires

careful management. The ‘Policy and Guidance on the Prevention and Management of

Violence and Aggression describes the processes and principles that should be used to

support service users when managing policy breaches.

The ‘Positive Behavioural Support (PBS)’ framework’ described in the PMVA policy

acknowledges challenging behaviours as resulting from a ‘combination of unmet needs, poor

quality of life and exposure to challenging environments’. Identifying the triggers for illicit


26

smoking should therefore be a priority if policy breaches occur. In the event of policy

breaches, follow the following protocol:

Engage the service user in a conversation about the reasons they were unable to

refrain from smoking

Remind the service user of the benefits of smoking cessation or temporary restraint

and the reasons for the smoke free policy. Further information about enabling service

users to modify behaviour can be found on www.safewards.net

Review the pre-admission smoking behaviour of the service user to establish their

level of nicotine dependence.

Consider whether current NRT prescription is adequately managing their

dependence and ask the patient if they feel cravings.

Offer an e-cigarette or facilitate the acquisition of one.

Medical staff to review NRT dose if required.

Review the level of engagement in activities, encourage engagement in 1-1

and/or current ward-based group activities to distract from any cravings and

access competing rewarding activities and experiences.

Tobacco products, and tobacco paraphernalia are prohibited items for service users on

inpatient units. The presence of illicit tobacco should be monitored, and their removal

facilitated using the principles and protocols defined in the ‘Search Policy. Staff must also

immediately remove any items found being used as inappropriate ashtrays such as cigarette

packets, drink cans, cups, plates etc. All searches and inappropriate ashtray incidents

should be recorded on Datix.

15. Working with service users who smoke in their homes

When care is offered to service users of the Trust in their own home, it is essential that a

request be made to provide a smoke free environment whilst the visit is taking place, and in

the hour preceding a visit.

This request should be made in the text of all appointment letters, wherever possible. A

verbal request and provision of the leaflet can be accessed from the Trust intranet through

this pathway:

http://www.safewards.net/


27

Clinical >> Smoking Cessation >>Leaflets/Posters

This request can also be made at the time of the visit and the service user should be

respectfully asked not to smoke whilst the employee is working within that environment.

All staff visiting or treating service users in their own homes are entitled to the same level of

protection as those working in Trust facilities, and staff should assure themselves as to their

own safety when working in the service users home environment.

Staff are encouraged to promote the London Fire Brigade free safety assessment and

advice. http://www.london-fire.gov.uk/HomeFireSafetyVisit.asp

If a member of staff believes that smoking that recent ( i.e. within the past two hours) or current

smoking is eviident in a patient’s home she/he has the full support of the Trust to make decisions

about services in these circumstances. Each case should be judged on individual circumstances and

staff should seek support in decision making around these issues with their manager. Specifically:

They have the discretion to make alternative arrangements for the provision of

services, ensuring that the immediate safety and welfare of the patient is not

compromised.

Should minimise their exposure to ambient smoke by either re-arranging the visit with the

proviso that the service user refrains from smoking for at least an hour prior, or finding a

smoke-free location near the home. At the next available opportunity the service user

should be offered support to stop smoking, either on an episodic basis prior to any

visit, or a more permanent basis.

Provision of care to service users who decline to provide a smoke-free environment

for staff should be reviewed within the clinical team to evaluate the options available

to balance the duty of care, and the protection of staff. The decision making process

should be documented.

16. Incident Reporting

Smoking related incidents, in particular those that involve the following are to be

reported using Datix:


28

People smoking in areas that are in breach of the Health Act (2006)

If a violent or aggressive incident occurs that is related to smoking or nicotine

withdrawal

Where a restrictive intervention is required in a smoking related incident

Where any patient safety issue has occurred, such as an accidental fire attributed

to smoking.

17. Smoking and tobacco control in the workplace . The Trust actively encourages its employees to refrain from smoking, both in their own

interests and as representatives of a major public body, whose purpose is to improve

health. The Health Bill 2006 introduced the legal requirement for smoke free

premises across England.

From 11th March 2015 smoking has not been permitted anywhere in the buildings or

grounds of any Trust owned or managed site. Specific requirements are :

Staff do not smoke whilst on or off duty anywhere on any Trust owned or operated

premises. This also applies to a l l workers, employees of contractors working on

site, members of voluntary organisations and to students undertaking training.

Additionally, staff must not smoke whilst travelling in a Trust vehicle or while

working for the Trust in the community including in service users homes.

Staff wishing to reduce or stop smoking will be supported to attend Occupational

Health or the Stop Smoking Service nearest to their workplace during their normal

working hours for advice and treatment

Staff will not smoke anywhere whilst wearing a uniform or badge that identifies them

as an NHS or Trust employee, or as an employee of a Trust sub-contracted agency.

Staff will not smoke within visibility of Trust sites or premises at any time.

Staff should not smell of tobacco smoke after smoking at any point during their

working hours, including at the start of their shift.


29

Trust staff and staff employed by sub-contracted agencies are not permitted to use

e-cigarettes on Trust premises.

Staff are not permitted to smoke when accompanying service users outside of

Trust premises.

All inpatient staff with responsibility for clinical care, of all disciplines, will be required

to complete brief training in management of nicotine dependence, which will be

provided on site by a member of the practice development nurse team.

Service managers will assess how many registered healthcare staff will be required

to complete training to Level 2 smoking cessation advisors in use of the Protocol for

Nicotine Replacement Therapy

Service users are asked to provide a smoke free environment when Trust staff are

visiting them in their homes, by refraining from smoking inside the premises whilst

the visit is taking place and in the two hours preceding a visit. Staff should assure

themselves as to their own safety when working in the service users’ home

environment. They should leave the premises if the smoking related risk is deemed

to be too high.

All visitors have responsibilities to:

Observe smoke free policies and to refrain from smoking whilst on Trust premises.

This includes all visitors who attend the Trust’s premises either on business or to

accompany or visit relatives or friends who are service users.

17.1 Support for smokers

The Trust recognises its duty towards those who wish to give up smoking and actively

supports this life style choice. Information on stopping smoking with support from

occupational health and from local cessation services is provided for smokers, both

service users and staff, in the Trust. The NHS Smoking Helpline number can be given to

service users and staff:


30

Smokers can also receive specialist advice by calling the Stop Smoking London Helpline

0300 123 1044 or find out more information about stopping smoking at

https://london.stopsmokingportal.com/

Tel: 0300 123 1044

17.2 Sales of tobacco products

It is a criminal offence for anyone to sell, transport or possess illegal tobacco products.

Penalties for such offences may include imprisonment and/or fines including fines of up to

£5000 for any manager allowing their premises to be used for such activities.

The selling/storing and dealing in any way of illegal cigarettes and tobacco on Trust

premises will not be tolerated.

The Trust will fully co-operate with Law Enforcement agencies, such as HM Revenue

and Customs, in their investigations. Any such illegal activity will be considered as gross

misconduct and will result in appropriate disciplinary action.

17.3 Managing risks associated with smoking activity

Staff should remove themselves from any smoke filled location. . Such occurrences

should be reported immediately using the Trust incident reporting system, and to the

appropriate manager. If illicit smoking has been inside a Trust building, and/or resulted in

potential second-hand smoke exposure to staff or service users, a Datix (incident) form

should be completed. Staff reporting breaches of the policy should use the following coding

to report on Datix:

0CAT17 – Estates and Facilities Issues, Smoking inappropriately/illegally SMK1

17.4 Cooperation and Coordinat ion with Landlords, Housing

Assoc iat ions and Charities.


31

Some of the properties in which Trust staff work are owned by third parties such as

housing associations and charities. The risk of smoking related fires is common to all

organisations who work within residential health care provision. The management team on

site, with the assistance of the Health and Safety manager, should seek to coordinate the

risk control measures across all organisations. Measures may include the review of

tenancy agreement to specify that smoking actively is restricted to designated smoking

areas only and that a formal appropriate warning system will be operated for those unable to

comply.

17.5 Procurement of soft furnishings

All soft furnishing in the house shall be purchased to conform to the Crib five (5) fire

rating system.

17.6 Cigarette lighters and matches

At locations where inpatients services are provided, it may be necessary to ensure that

cigarette lighters and matches are not brought in to the ward because of the risk of fire.

Staff should undertake searches of patients’ possessions and clothing being worn, in

order to remove such sources of ignition from the ward environment for the safety of all.

Refer to the Searching premises, patients and property policy (2017).

17.7 Fire detection and firefighting equipment

All firef ighting and detection systems must be serviced and maintained in full working

order at all times regardless of ownership. Details of all servicing of fire detection and

firefighting equipment is to be recorded in the onsite logbook. Any issues relating to the

maintenance of such equipment that cannot be resolved locally are to be notified to the

Health and Safety Manager for resolution.

17.8 Smoking risk assessment


32

At each residential site a smoking risk assessment should be completed. This risk

assessment should identify the fire and passive smoking risks from smoking and clearly

set out the control measures that are to be implemented at the site to reduce the risks.

A generic risk assessment is provided in Appendix 3 for information purposes. The

Health and Safety Manager is available to assist sites with this action. The Health

and Safety Manager is available to assist sites with this action.

17.9 Staff smoking activity

Foundation Trust staff are expected to comply with all our policies including those

around the control of smoking.

Sub-contracting agencies are required to comply with Trust regulations and to inform their

staff of the requirements of the policy.

17.10 Dissemination and implementation arrangements

This document will be circulated to all managers who will be required to cascade the

information to members of their teams and to confirm receipt of the procedure and

destruction of previous procedures/policies which this supersedes. It will be available to

all staff via the Trust intranet. Managers will ensure that all staff are briefed on its contents

and on what it means for them.

17.11 Training requirements

For training requirements please refer to the Trust’s Mandatory Training Policy (Intranet)

and Learning and Development Guide (Intranet). All staff must attend the mandatory one

hour fire awareness course every two years. This course provides staff with a basic

awareness of fire risks and appropriate actions.

In addition staff working in inpatient and residential services are required to undertake

additional f ire marshal training to act as a control measure for service user’s smoking

activities.


33

Learning and Development should be contracted in the first instance to make the course

arrangements. The course is delivered by external consultants and will be delivered on

site. All staff must be familiar with the use of fire extinguishers and fire blankets. The

details of the training, i n c l u d i n g names and dates of attendance, are to be recorded

in the site fire log. Refresher fire marshal training is required every three years.

The site manager must ensure that regular fire evacuation drills are held on site (a drill is

required every six months). The details of the drill are to be recorded in the site fire log.

All services need to have enough trained fire marshal staff availed on shift to deal with a

fire emergency. It is recommended that all clinical staff attend the Fire marshal training

course.

18. Further reading

National Centre for Smoking Cessation and Training (NCSCT) Smoking Cessation and

Mental Health – A Briefing for Front Line Staff

http://www.ncsct.co.uk/publication_Smoking_cessation_and_Mental_Health_briefing.php

Royal College of Physicians/Royal College of Psychiatrists – Smoking and Mental Health

https://www.rcplondon.ac.uk/sites/default/files/smoking_and_mental_health_-

_key_recommendations.pdf

Cope, G.F. Smoking: What all healthcare professionals need to know MK Publishing 2016

19. Dissemination and implementation arrangements

This document will be circulated to all managers who will be required to cascade the

information to members of their teams and to confirm receipt of the procedure and

destruction of previous procedures/policies, which this supersedes. It will be available to

all staff via the Trust intranet. Managers will ensure that all staff are briefed on its contents

and on what it means for them.

http://www.ncsct.co.uk/publication_Smoking_cessation_and_Mental_Health_briefing.php

https://www.rcplondon.ac.uk/sites/default/files/smoking_and_mental_health_-_key_recommendations.pdf

https://www.rcplondon.ac.uk/sites/default/files/smoking_and_mental_health_-_key_recommendations.pdf


34

20 Monitoring and audit arrangements

Elements to be

monitored

Lead How trust will monitor

compliance

Frequency Reporting Parent Committee (Board sub-committee that receives assurance)

Parent Committee (Board sub-committee that receives assurance)

Care planning

Audits coordinated by

clinical governance and

performance

EPR audit Quarterly

Physical Health

and Nutrition

Group (PHNG)

Quality Committee

Staff training

L&D

Audit of training records Quarterly

Prescribing for

smoking

Medicines Management

Lead

Pharmacy drug

expenditure audit 6 months


35

cessation

Referrals to

SSS

Audits coordinated by

clinical governance and

performance

Audit of referrals to SSS Quarterly

Smoking

Activities

H&S Manager Controls working in

practice

Health and

Safety

Manager to

review on a 3

monthly

basis

Health,

Fire and

Safety

Committee

37

21 Review of the policy

This policy will be reviewed in January 2020 or earlier should a significant

change came to light.

22 References

Action on Smoking and Health (ASH), National Asthma Campaign, Trades Union

Congress (November, 2001) Smoking in the Workplace UK Edition.

Ash, (2004) Section 2(2)(e) of the Health and Safety at Work Act. The

Management of Health and Safety at Work Regulations 1992(Regulation 3(1)).

Action on Smoking and Health (ASH) Scotland (1998) Effective Tobacco Policy In

The Health Service. Guidelines for Action. ASH Scotland. Edinburgh.

Adult psychiatric morbidity in England, 2007 Results of a household survey. The

Health and Social Care Information Centre

Bakhshaie, J., Zvolensky, M. J., & Goodwin, R. D. (2015). Cigarette smoking and

the onset and persistence of depression among adults in the United States:

1994–2005. Comprehensive psychiatry, 60, 142-148.

Burning Injustice Reducing tobacco-driven harm and inequality

Recommendations to the government (2017)

Campion, J., Checinski, K., & Nurse, J. (2008). Review of smoking cessation

treatments for people with mental illness. Advances in psychiatric treatment,

14(3), 208-216.

Cuijpers, P., Smit, F., ten Have, M., et al (2007) Smoking is associated with first-

ever incidence of mental disorders: a prospective population-based study.

Addiction, 102, 1303–1309

Department of Health (2017) Towards a Smokefree Generation

38

- A Tobacco Control Plan for England

https://www.gov.uk/government/uploads/system/uploads/attach

ment_data/file/630217/Towards_a_Smoke_free_Generation_-

_A_Tobacco_Control_Plan_for_England_2017-2022__2_.pdf

Department of Health (1999) Smoking kills: A White Paper on tobacco. The

Stationery Office. London.

Does a combination of stop smoking medication and behavioural support help

smokers to stop? Cochrane Database of Systematic Reviews, March 2016

Five Year Forward View for Mental Health: A report from the independent Mental

Health Taskforce to the NHS in England, February 2016; 73. Harker K,

Cheeseman H.

Gurillo, P., Jauhar, S., Murray, R. M., & MacCabe, J. H. (2015). Does tobacco use

cause psychosis? Systematic review and meta-analysis. The Lancet Psychiatry,

2(8), 718-725.

Health Development Agency (2005) Guidance for smokefree hospital trusts

Lawn, S., & Campion, J. (2010). Factors associated with success of smoke-free

initiatives in Australian psychiatric inpatient units. Psychiatric Services, 61(3),

300-305.

McManus S, Meltzer H, Campion J. Cigarette smoking and mental health in

England. Data from the Adult Psychiatric Morbidity Survey. National Centre for

Social Research, 2010 72.

Opinions and Lifestyle Survey, ONS Adult smoking habits in Great Britain, 2014.

Smoking: Harm reduction https://www.nice.org.uk/guidance/ph45 2013

Smoking cessation - acute, maternity and mental health services. NICE ( 2013)



39

Statistics on Smoking, England 2015. Health and Social Care Information Centre.

WHO Report on the Global Tobacco Epidemic, 2009: Implementing smoke-free

environments. In: n WHO, Geneva; 2009.

National Clean Air Award (2004) Model Smoking Policy

Board of Science and Education and Tobacco Control Resource Centre

(2002).

Taylor, G., McNeill, A., Girling, A., Farley, A., Lindson-Hawley, N., & Aveyard, P.

(2014). Change in mental health after smoking: systematic review and meta-

analysis. Bmj, 348, 1151.

The Stolen Years: The Mental Health and Smoking Report. ASH, 2016; 74. Stead

LF, Koilpillai P, Fanshawe TR, Lancaster T.

Towards smoke-free public places. British Medical Association. London.

Smoke Free London & London Health Observatory (2004) Tobacco in London -

The preventable burden. Smoke Free London, London. ISBN 0 -9542956-2-5.

23 Associated documents

Smoking cessation Prescribing guidelines

Nicotine replacement therapy protocol

Protocol for nicotine replacement therapy

Health and Safety policy

Search policy

Patient Leave policy

Property policy

40

Appendix 1

Draft Appointment Letter promoting smoking cessation ( this needs to be

tailored to individual client populations)

Dear Mr/Ms

You have been referred/thank you for making contact with Camden &

Islington NHS (or local team/specific service). We promise that you will be

offered a warm welcome and we will work with you to deliver the best

possible outcome. The section below is important only if you are current

smoker, so you can go straight to the details of your appointment if you are a

non-smoker.

If you smoke! ( this can be tailored to specific issues, anxiety, depression

mentioned for illustrative purposes)

Smoking can offer short term relief or distraction from your worries or stress

but is actually bad for your mental health (you probably don’t need to be

reminded that smoking also damages your physical health). Heavy smokers

are three times more likely to develop problems with anxiety (especially panic

disorder) and people who feel depressed are three times more likely to be

smokers. Smoking also affects how your body processes any drugs you are

prescribed, smokers typically require higher doses to gain the same

therapeutic benefit.

You are of course free to choose and you will receive the same warm

welcome whether you decide to carry on smoking or avail of the support to

help you stop.. The best way to stop smoking is to obtain specialist help from

your local stop smoking service, which is free to use. Details are at:

https://www.breathestopsmoking.org/ call 020 3633 2609 or text 66777. Or

you can speak to one of our specially trained staff. Whichever path you might

choose you will get support to help you quit using nicotine replacement

therapy and other tried and tested remedies.

Appendix 2 Equality Impact Assessment Tool


41

1. Does the policy/guidance affect one group

less or more favourably than another on the

basis of:

Race No

Ethnic origins (including gypsies and travellers) No

Nationality No

Gender No

Culture No

Religion or belief No

Sexual orientation including lesbian, gay and

bisexual people

No

Age No

Disability - learning disabilities, physical disability,

sensory impairment and mental health problems

No

2. Is there any evidence that some groups are

affected differently?

No

3. If you have identified potential discrimination, are

any exceptions valid, legal and/or justifiable?

N/A

4. Is the impact of the policy/guidance likely to be

negative?

No

5. If so can the impact be avoided? N/A

6. What alternatives are there to achieving the

policy/guidance without the impact?

N/A

7. Can we reduce the impact by taking different

action?

N/A

42

BLANK PAGE

1

Appendix 3

Generic Risk Assessment Template

2

TASKS

PERSONS INVOLVED

HAZARDS

RISK OR HARM

RISK SCORE

REMEDIAL ACTIONS

BY WHOM

BY

WHEN

Control

s in

Place

UNMET

Re-

Source

C L Score C X L

Inpatient .

support

Service users and staff

Fire Smoking on

site by

service users

Service users to be reminded that they cannot smoke in any area other than the designated smoking area Landlord to instigate system of verbal and written warnings about smoking in non-designated smoking areas. Staff to record all incidents where smoking activity is being undertaken outside of the designated area in a log for reference and on Datix/IR1 form

Staff are to immediately remove any items being inappropriately utilised as receptacles

Manager to ensure that all fire detection and firefighting equipment is present and serviced.

Manager to ensure that staff has attended the Foundation Trust fire marshal training course. Ensure that all soft furnishings purchased for the site are at Crib 5 standard (fire retardance)

smoking cessation policy december 2017 · • all frontline staff need to be trained to deliver...

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