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CAMH Stories Centre for Addiction
and Mental Health

A tobacco-free hospital – CAMH innovates to lead the way

TORONTO, January 13, 2017 - Ontario hospitals must eliminate designated smoking areas by 2018, as part of legislation that has already prohibited smoking on all hospital grounds.

While hospitals take action to prepare for this major change, CAMH is already there. In fact, CAMH has moved beyond a smoke-free environment to lead the hospital sector by becoming completely tobacco-free.

“We recognize the impact of smoking on our patients’ health, and that no level of second-hand smoke is safe,” says Kim Bellissimo, VP of Human Resources and Organizational Development. “We’ve been Tobacco-Free since 2014 and we continue to innovate to sustain a fresh-air environment for our hospital.”

Innovating for a Tobacco-Free environment

For continuous improvement, CAMH’s Tobacco-Free Sustainability Project has launched several new initiatives over the past year, says Project Manager Colleen Burns. “We’re continuing to innovate to address specific issues, support our patients and work together to sustain a tobacco-free environment,” she says. These initiatives include:

•    An expanded Tobacco-Free Consultation Team, which provides an interdisciplinary approach to addressing specific situations and challenges, such as patient non-compliance. CAMH Advanced Practice Clinical Leaders Sandra Cushing and Mike Pett, and Psychologist Dr. Yarissa Herman, provide formal assessment and recommendations, as well as best-practice advice. All three team members have expertise in concurrent mental health and addiction issues.

Sandra Cushing, Dr. Yarissa Herman and Mike Pett
Sandra Cushing, Dr. Yarissa Herman and Mike Pett deliver an inter-professional consultation service.

•    Improved access to Nicotine Replacement Therapy, so that CAMH outpatients can continue their smoking cessation efforts beyond CAMH’s inpatient programs. “We want to support and empower our patients with tobacco cessation activities when they are outside CAMH,” says Pharmacist Amy Rajan. She notes there are two kits (nicotine gum, or a combo kits including the nicotine patch and gum) available to help clients who want to quit. Clients who smoke may also be referred to CAMH’s Nicotine Dependence Clinic. “For a patient who has successfully quit smoking as an inpatient, for example -- they have come so far to be tobacco-free. We want them to continue to be supported when they leave CAMH.”

Pharmacist Amy Rajan
Pharmacist Amy Rajan expanded the Nicotine Replacement Therapy (NRT) kit option to CAMH outpatient programs.

•    Rollout of the standardized Safe Search Protocol which has been highly effective in removing unsafe items, including tobacco products/lighters, from inpatient units. Frances Abela-Dimech and Patti Socha are clinical leads on CAMH’s Safe Search Taskforce as part of the Tobacco-Free Sustainability Initiative. “We’ve seen great results to date showing how Safe Search minimizes smoking-related incidents on units. The process starts with a strong focus on prevention, says Patti. “It’s like a safe neighbourhood in a community. Everyone keeps an eye out to prevent incidents and keep themselves and their neighbours safe.”

Frances Abela-Dimech and Patti Socha
Frances Abela-Dimech and Patti Socha introduced the Safe Search Protocol.

All CAMH employees play a key role in tobacco-free. In addition to CAMH’s First Impressions Ambassadors, who speak to many patients, clients, guests and visitors at CAMH sites, staff learn how to approach someone smoking on CAMH grounds, or indoors, and how to interact with a patient or guest who is frustrated with the policy.

Leading change

As a tobacco-free pioneer, CAMH continues to share its innovations, knowledge and best advice with other hospitals. For example, Kim Bellissimo and her colleague Dr. Tony George, Chief of Addictions and Concurrent Disorders, presented an Ontario Hospital Association webinar to hospital leaders last year. “It’s about a process to engage, foster innovation and sustain success,” says Tony. Key principles include a sound governance structure, engaging the community early, getting clinical staff on board, and setting clear incentives and consequences. “Hospitals must also commit resources to sustaining the change.”

With a sustained effort, CAMH has seen a rapid cultural change among both patients and staff on this issue. Surveys completed by a total of 1,173 staff and 422 patients -- both before, and up to 10-12 months after CAMH’s tobacco-free implementation in 2014 – showed positive attitudinal changes over time and a statistically significant decrease in patient agitation. The study by Senior Performance Improvement Specialist Lilian Riad-Allen is being finalized and submitted to a leading addictions journal, with publication anticipated in early 2017.

“We are also excited about CAMH’s recent launch of the Tobacco-Free Community of Practice (COP) for external partners across Canada,” says Tobacco-Free Sustainability Project Manager Colleen Burns. COP will enable nation-wide collaboration to optimize the implementation and sustainability of smoke-free environments. Developed through CAMH’s Portico Network, “the site has seen significant uptake with more than 100 subscribers since its launch in 2016. It’s quickly becoming an information hub for clinicians across Canada.”

New regulations of both the Smoke-Free Ontario Act and the Electronic Cigarettes Act not only reinforce CAMH’s proactive stance to Tobacco-Free, “but also validate our leadership on this critical issue,” said CAMH’s Kim Bellissimo. “By sustaining our fresh air zone and reducing triggers for smoking, we support a Safe and Well CAMH for all of our patients and staff.”

Colleen Burns, Kim Bellissimo and Dr. Tony George
CAMH Tobacco-Free Sustainability Project Manager Colleen Burns (at left) with Co-Sponsors Kim Bellissimo and Dr. Tony George.

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