[Department/meeting group name and date goes here]

1. [Department/meeting group name and date goes here]

2. Overview • Key Points • Directly tied to our health mission. • OHSU is 100% tobacco-free • Applies to all Portland-area facilities, indoors and outdoors. • Compliance • New enforcement plan • Emphasis is on communication and support: inform and direct to resources. • Tools available to help everyone feel comfortable approaching smokers. • Special considerations need to be given to patients/patient families under stress. • Employee compliance is ultimately responsibility of the manager. • Support for Tobacco Users • Expanded benefits for employees and students who want to quit. • Nicotine replacement and referral to cessation resources for patients (hospital and ambulatory). • Free lozenge support packs for visitors.

3. OHSU’s mission is directly tied to improving health and quality of life. Tobacco use is the leading cause of preventable illness and death. There is no safe level of exposure to second-hand smoke. Growing trend among hospitals, health systems and universities. Why pursue a tobacco-free environment?

4. OHSU’s tobacco-free environment policy (07-90-021) went into effect Sept. 17, 2007. No smoking or other tobacco use is permitted indoors or outdoors on OHSU premises. All employees, students, volunteers, contractors, patients and visitors are expected to refrain from any tobacco use while at OHSU. What do we mean by “tobacco-free”?

5. Ongoing communication to current employees and students. Focus of external communication is notifying people in advance so they are aware before coming to OHSU. Permanent, tobacco-free signs. Communicating our policy

6. The intent of the policy is to create a healthier, more healing environment, not to punish smokers: “change the culture.” Emphasis of enforcement is offering support for quitting, if desired, or managing cravings while at OHSU. Support for tobacco users

7. For employees and studentswho would like to quit tobacco use: Free coaching and self-guided program Free over-the-counter medications (ONLY available at OHSU Pharmacies) Free prescription medications for those covered under CVS/Caremark (including employees’ covered family members) Support for tobacco users

8. For employees and studentswho are not ready to quit: FREE coaching is available through OHSU Employee Wellness to help with a plan to manage during the workday. Support for tobacco users

9. For patients admitted to the hospital: Patients are asked about their tobacco use at the time of admission. Patients who are currently smoking are offered medications to help manage cravings during their hospital stay and, for those interested in quitting, a consult with a Tobacco Treatment Specialist can be ordered by physicians and nurses to help set up a treatment plan following discharge. Support for tobacco users

10. Support for tobacco users • For patients admitted to the hospital: • The consult includes an assessment of the patient’s tobacco use history and current circumstances and makes recommendations, including referrals, for treatment. The smoking cessation medications and the Tobacco Cessation Consult order are included in the EPIC orders manager.  The consult is completed within 48 hours and a consult note is written in the patient’s chart. A follow-up call is made to all patients who agree to be contacted.

11. Support for tobacco users • For patients withoutpatient clinic appointments: • Patients are asked about their tobacco use at clinic visits. • For patients interested in quitting, a tobacco use history is included in the review of systems and patients are offered treatment and referrals (or appointments) for tobacco cessation services. • Free lozenge support packs available at nearby outpatient pharmacies.

12. Support for tobacco users • For patient families andvisitors: • Free lozenge support packs available during their time at OHSU. • Oregon Tobacco Quit Line information. • Interaction with OHSU staff who can offer advice and direct to appropriate resources.

13. Nicotine helps people feel: more relaxed less down or depressed less hungry more alert, can even give a little “buzz” from time to time. Nicotine helps people cope with both day-to-day life stress, as well as high-level “emergency” stress. Understanding nicotine withdrawal

14. Withdrawal can make people feel: anxious, restless sad, depressed frustrated, angry hungrier, harder to sleep and think clearly. Withdrawal symptoms begin within 1-2 hours after stopping nicotine and peak within 3-5 days. Most withdrawal symptoms will go away after 3-6 weeks, although cravings can last longer. Understanding nicotine withdrawal

15. It takes everyone! All employees are encouraged to assist by helping ensure people are aware of policy. Our emphasis for compliance is on education and support rather than punishment. Maintaining a tobacco-free OHSU

16. Our general approach to those smoking on campus will be: Informing them courteously and respectfully that OHSU no longer permits tobacco use on its property. Directing them to resources available to manage cravings during their time at OHSU. Maintaining a tobacco-free OHSU

17. Tools for approaching tobacco users: Sample scripts. Video demonstration. Referral card that directs people to resources. For visitors, “support packs” containing nicotine lozenges. If a visitor refuses to comply, simply walk away and contact Public Safety for assistance (503 494-7744). Maintaining a tobacco-free OHSU

18. Referral Card Nicotine “Support Pack”

19. Helping patientfamilies under stress: Compliance must go hand-in-hand with compassion. Nicotine lozenge support packs and cessation resources will be available. Staff should use their best judgment in how they approach people in tragic and stressful situations. Maintaining a tobacco-free OHSU

20. Although smoking on campus has been substantially reduced, some employees are continuing to smoke on campus. Continued smoking by employees on campus models non-compliance for our patients and visitors. All employees are expected to comply with the tobacco-free policy, which prohibits tobacco use indoors and outdoors on OHSU premises in the Portland area. New enforcement plan

21. New enforcement plan To help improve compliance, OHSU Public Safety is beginning a new enforcement plan that requires a close partnership with managers to jointly address employee smoking on the OHSU campus. As part of this plan, beginning July 13th, 2009, Public Safety will report employees who are repeatedly observed smoking on campus to their managers for follow-up.

22. New enforcement plan It is each manager’s responsibility to address any employee violations of the tobacco-free policy, as with all OHSU policies. Repeated violations are the responsibility of the manager and will result in progressive disciplinary action similar to that taken if when employees violate any other OHSU policy.

23. New enforcement plan • Role of Public Safety: • Continue to approach anyone observed smoking on campus and remind them that OHSU is tobacco-free. • Respond to reports of “hot spots” with more signs, more monitoring, and clean up. • Beginning July 13, 2009, report employees who are repeatedly observed smoking to their manager for follow-up.

24. New enforcement plan • Role of Managers: • Speak to people smoking on campus or call Public Safety (4-7744). • Report “hot spot” areas, where people are repeatedly seen smoking, to Public Safety (4-7744). • Address employee violations of the tobacco-free policy, working out solutions with employees who are not complying.

25. New enforcement plan • Role of Managers: • Remind employees who smoke and are leaving the campus on their breaks NOT TO LITTER with their cigarette butts. • Make sure employees are aware of available resources and how to access them.

26. Resources available to employees: For quitting tobacco: Contact Employee Wellness at 1-800-941-5590 or visit: www.ohsu.edu/tobaccofreesupport OR Contact the OHSU Pharmacy at 503 494-8563 or e-mail Rxfree@ohsu.edu Managing employee compliance

27. Resources available to employees: For employees who are not ready to quit: FREE coaching is available through OHSU Employee Wellness to help with a plan to manage during the workday. Managing employee compliance

28. Addressing non-compliance: Meet one-on-one with employee to discuss concerns, provide coaching and counseling. Document your conversations and any follow-up actions. If non-compliance persists, consult your HR business partner to discuss next steps. Managing employee compliance

29. Tips for coaching and counseling: Gain agreement that a problem exists; discuss possible solutions. Acknowledge that tobacco is a powerful addiction and managing without nicotine can be difficult. Emphasize that you do not expect nor require the employee to quit tobacco use, only to comply with the policy by not smoking on campus. Managing employee compliance

30. Managing employee compliance • Tips for coaching and counseling: • Mention that others have found a way to manage, so it is possible to do so. • If the employee indicates interest in quitting, make sure he/she is aware of OHSU’s smoking cessation program and how to access it. • If the employee indicates a need for help in learning how to manage while at work, encourage the employee to contact Employee Wellness at 1-800-941-5590.

31. Visit www.ohsu.edu/tobaccofree E-mail free@ohsu.edu with questions or comments Call 503 494-FREE (3733) For more information …