Audit of Galway University Hospitals tobacco free campus policy

The National Tobacco Free Campus Policy (Health Service Executive Tobacco Control Framework Implementation Group 2012) was developed in recognition of the fundamental role health services and health professionals can have in reducing the impact of smoking both at an individual and community level. This was utilised to develop a policy for Galway University Hospitals (GUH) which was introduced in February 2012 (Galway University Hospitals Tobacco Free Campus Working Group 2012). The policy prohibits smoking anywhere within the hospital campus including the hospital grounds. The study aimed to assess the level of compliance with the 2012 GUH Tobacco Free Campus Policy at UHG and Merlin Park Hospital. The study methodology incorporated an observation audit of compliance and a count of cigarette butts at GRH. Data was collected in July 2013. The key findings are summarised as follows: 11% of people observed within the hospital grounds were smoking. 35 cigarette butts on average were collected within the hospital grounds during each observation period (approximately one hour and 30 minutes). 55% of those observed outside the hospital perimeter were smoking. An average of 28 butts were collected outside the hospital perimeter during each observation period. 52% of all smokers were observed outside the perimeter entrance with 48% within the hospital grounds. 57% of those observed smoking within the hospital grounds were visitors, 33% were patients, and 10% were staff. 3 68% of those observed smoking outside the hospital perimeter were staff, 31% visitors and 1% were patients. Main entrances and secondary entrances were the main areas within the perimeter of GRH hospitals where outside smoking was observed and where cigarette butts were collected. In terms of smoking outside the perimeter of hospitals, significantly more people were observed and cigarette butts collected at UHG. The overall proportion of smokers observed on hospital grounds did not significantly differ between UHG (11%) and Merlin Park (10%) hospitals. The average number of smokers observed outside the main entrance and at the perimeter entrance was significantly greater at UHG. The issue of discarded cigarette butts outside hospital entrances and the main perimeter entrance is significantly greater at UHG. The study has demonstrated that over half of those observed smoking are compliant with the GRH Tobacco Free Campus Policy. This is positive yet also demonstrates scope for improvement. The following recommendations are made: 1. Compliance level targets should be set to facilitate the achievement of 100% compliance. Observation audits should be undertaken on an annual basis to assess the degree to which compliance level targets have been met. 2. The current systems for enforcing the Tobacco Free Campus policy should be reviewed to identify if new enforcement mechanisms are required.3. A specific system of proactive enforcement by key members of staff at main and secondary entrances should be considered. 4. The specific duties of security staff in relation to the policy needs to be made explicit. This should be based on agreement with security management and the relevant unions. 5. The feasibility of modifying existing and new employee contracts to not allow staff to smoke during working hours or when recognisable as an employee should be explored. 6. Consideration should be given to updating the GRH uniform policy with a directive that does not permit smoking whilst wearing a staff uniform or badge. 7. Current initiatives to raise awareness of the policy should also be examined to determine the need for additional initiatives to help maintain awareness. 8. A system to provide safe access to hospital perimeter entrances that addresses liability issues needs to be established for patients that choose to continue to smoke. 9. Due to the larger volume of smokers, specific initiatives for UHG need to be developed. In particular these should aim to address the large number of observed smokers and cigarette butts outside main, secondary, and perimeter entrances. 10. All signage referring to the outdoor smoking ban at GRH should be reviewed to determine if the information on signs and the citing of signs could be improved. 11. Consideration should be given to providing additional smoking areas along the perimeter of hospitals.