Overview of Policy & Resources

1. Overview of Policy & Resources

2. What is OHSU’s tobacco-free policy? • How was the policy implemented? • What about the rights of tobacco users? Introduction To Tobacco-Free Managing Without Tobacco • What happens when people quit tobacco? • What are the options for managing without using tobacco? • What are the costs? All About Compliance • How is the policy enforced? • What is the new enforcement plan? • How should we talk to tobacco users? • What about families under stress? Getting Help To Quit • What help is available for employees and students? • What help is available for patients? • What help is available for visitors Additional information available through OHSU Tobacco-Free Initiative “At A Glance”

3. Introduction To Tobacco-Free • What is OHSU’s tobacco-free policy? • How was the policy implemented? • What about the rights of tobacco users?

4. What is OHSU’s tobacco-free policy? • OHSU revised its Tobacco-Free Environment policy to make OHSU 100% tobacco-free. The revised policy went into effect September 17, 2007. Since the tobacco-free policy went into effect, we have reduced second-hand smoke on campus by 65 percent. • OHSU undertook this policy change as part of its mission to create a healthier environment on the campus and to help protect the health of patients, employees, and visitors. The evidence of the harmfulness of both smoking and second hand smoke is compelling, making this policy change necessary.

5. What is OHSU’s tobacco-free policy? • The policy prohibits use of all tobacco products including cigarettes, cigars, pipes, all forms of smokeless tobacco, clove cigarettes, and other products made with tobacco. • The tobacco-free environment covers all Portland-area property owned or leased and occupied by OHSU and applies to everyone while they are at any Portland-area OHSU facility or on OHSU grounds.

6. What is OHSU’s tobacco-free policy? There are three neighboring facilities next to the OHSU Marquam Hill campus: the Portland VA Medical Center, Shriners Hospital for Children - Portland, and the Ronald McDonald House. Shriner’s Hospital and the Ronald McDonald House are 100% tobacco free. The VA has limited smoking areas that they are required to keep by federal regulations.

7. How was the policy implemented? Central to the success of the tobacco-free policy is to promote a cultural change on the OHSU campus that promotes health over tobacco use and promotes help over punishment for everyone who is tobacco dependent. The first step was an extensive communication effort to inform employees, patients, students, and visitors BEFORE they arrive on campus that OHSU is completely tobacco free. The communications plan featured a website (www.ohsu.edu/tobaccofree) and frequent email, payroll stuffers, and posters to inform the OHSU community. The communications

8. How was the policy implemented? plan also featured a “Countdown Campaign” that began on June 11th through September 17th. Next, when someone is observed smoking while on campus, they are approached with courtesy and respect with an emphasis first on education and support. Patients and family members in crisis are handled with compassion and support. Visitors who need help managing cravings are offered, “support packs” containing nicotine lozenges and information about how to get help to quit are available.

9. How was the policy implemented? For employees, students and patients, significant new resources are available to help them quit. To help staff prepare, managers were strongly encouraged to access available educational programs on the policy. A plan was developed to reach OHSU staff in need of specialized, in-person training including frontline staff. If employees repeatedly violate the policy, they are referred to their managers for follow-up. Patients who are resistant are referred to their care providers. If a visitor is highly resistant, public safety is contacted.

10. How was the policy implemented? For more information about the Tobacco-Free Initiative’s strategic plan, go to www.ohsu.edu/tobaccofree.

11. What about the rights of tobacco users? • Tobacco is still a legal product for adults. Today, about 1 out of 5 adult Oregonians use tobacco. OHSU will not try to force anyone to quit tobacco use entirely. However, OHSU will continue to set policies regarding activity on our premises and to create an environment that we believe is in the best interest of the health and well-being of our employees, students, patients and visitors. • Support is available through OHSU Employee Wellness for employees, students, volunteers who want to quit or need help managing cravings. Visit www.ohsu.edu/tobaccofreesupport or call 1-800-941-5590 for more information.

12. What about the rights of tobacco users? Nicotine replacement lozenges to help manage cravings are available to outpatients, visitors and the families of patients at no charge while on OHSU property.

13. All About Compliance • How is the policy enforced? • What is new enforcement plan? • How should we talk to tobacco users? • What about families under stress?

14. How is the policy enforced? • The University encourages all employees to assist in maintaining a tobacco-free environment by helping to ensure that everyone is aware of the policy and directing them to the appropriate resources when needed. • The enforcement plan begins with communication. • People applying for positions at OHSU are told up front that University has a 100% tobacco-free policy. • Patients and their families are informed of the policy before they arrive at OHSU through the scheduling of appointments, at the time of appointment reminders, and at the time of hospital registration or check-in at the outpatient clinics.

15. How is the policy enforced? • On campus, tobacco-free signs are posted at all entrances and in strategic locations to inform and remind everyone of the policy. • If someone is observed using tobacco, an employee, student or volunteer should approach the tobacco user, in a clear and firm manner that is courteous and respectful, to inform them that, “in order to promote a healthy environment for its patients, staff and visitors OHSU are not permitted to use tobacco on its property.” • The University’s emphasis for compliance is on education and support rather than on punishment.

16. How is the policy enforced? • If a visitor refuses to comply, simply walk away and contact Public Safety for assistance (503 494-7744). • For visitors who need help managing cravings, “support packs” containing nicotine lozenges and information about how to get help to quit are available at the outpatient pharmacies, in the hospital cafeteria, most registration and information desks and in the Emergency Department. A supply is also available on the West Campus.

17. How is the policy enforced? • A business-size “compliance card” describing the policy and where to find nicotine support packs are available. • Referral Card Nicotine “Support Pack”

18. What is the new enforcement plan? 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. To help improve compliance, OHSU Public Safety is beginning a new enforcement plan.

19. What is the new enforcement plan? Starting July 13, 2009, employees who are repeatedly observed smoking on campus will be reported to their managers for follow-up by Public Safety. 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. Public Safety will continue to approach anyone observed smoking on campus and remind them that OHSU is tobacco-free. They will also respond to reports of “hot spots” with more signs, monitoring and clean-up.

20. What is the new enforcement plan? OHSU is tobacco-free in order to create a healthier, more healing environment, not to punish smokers. We recognize that tobacco is a powerful addiction. OHSU is committed to supporting our employees, students, patients and visitors in quitting tobacco if they choose, or managing their craving during the time they spend at OHSU.

21. How should we talk to tobacco users? Here are some sample scripts for talking with a patient, visitor, or employee who is using tobacco or wants to use tobacco while on OHSU property. If you see a person using tobacco: Hi. I noticed that you were smoking/chewing tobacco. I just wanted to let you know that all tobacco use is now prohibited on this campus both indoors and outdoors. Also, there are no longer any designated smoking areas. Here is some information about where you can find nicotine lozenges to help you while you are here. Thank you for your cooperation.

22. How should we talk to tobacco users? Response to questions. Q: [visitor] Where am I allowed to smoke? A: I’m sorry, but tobacco use is not permitted anywhere on the OHSU campus. You will need to leave the campus if you wish to smoke, or we can provide nicotine lozenges that will help you with cravings. Q: Why aren’t there any designated smoking areas? A: OHSU has chosen to protect the safety and health of our patients, visitors, and employees and this includes protection from second-hand smoke. Many of our patients have cancer, heart disease and respiratory disease. Second-hand smoke affects their health. OHSU does not provide a designated smoking area to protect everyone’s health. Thank you for your understanding.

23. How should we talk to tobacco users? Response to questions. Q: Can I smoke in my car? A: Your car is your personal property. However, we ask that you drive off campus if you choose to smoke in your vehicle. Q: What are you going to do if I smoke? A: I understand that you might be frustrated by not being able to smoke. However, I need to remind you of the rules and requirements of being on the OHSU campus and that includes not using tobacco. I appreciate you choosing to cooperate with our policyand not smoking.

24. How should we talk to tobacco users? Response to questions. Q: I am very stressed right now and really need to smoke. Can’t you make an exception? A: I am sorry that this is a difficult time. Is there something I can do to help? There are no exceptions to the policy. You can, however, leave the campus if you must smoke. I can also direct you to where you can get nicotine lozenges that can help.

25. How should we talk to tobacco users? Demonstration Click here to download and view the training video Communicating OHSU’s Tobacco-Free Environment Policy (10MB Windows Media file; Requires Microsoft Windows Media Player) Running time: 6 min 20 sec

26. What about families under stress? OHSU health care professionals are trained to deal with families in crisis every day, with compassion and support. OHSU’s staff is dedicated to helping people through tough times and the university has every confidence that the members of its community will be able to help family members through this transition as well. There will be times when staff will have to use their best judgment in how they approach patients’ families and visitors in tragic and stressful situations. But, in general, OHSU asks everyone to refrain from using tobacco on OHSU premises.

27. What about families under stress? Tobacco cessation resources are available to assist patients and family members while they are on campus. Support packs, to help alleviate the stress of withdrawal, are readily available at the OHSU outpatient pharmacies, at the hospital cafeteria, most registration and information desks and in the Emergency Department.

29. What happens when people quit using tobacco? Most tobacco users have seriously tried to quit, usually several times. Nicotine withdrawal is the biggest reason people go back to smoking soon after trying to quit. Nicotine is a powerful drug that physically changes the way the brain functions which changes the way people feel. Nicotine helps people feel more relaxed, less down or depressed, more alert, less hungry and can even give a little “buzz” from time to time. The effect of nicotine helps people cope with both day-to-day life stress, as well as high-level “emergency” stress.

30. What happens when people quit using tobacco? As more nicotine is used, it changes how the brain functions, creating dependence on nicotine to function normally. When people stop using nicotine, withdrawal symptoms begin within 1-2 hours and peaks within 3-5 days. Withdrawal makes people feel “not normal,” and possibly anxious, restless, sad or depressed, frustrated, or angry. It can make people feel hungrier and make it harder to sleep and think clearly. When people under stress can’t smoke, these symptoms can increase. Most withdrawal symptoms will go away after 3-6 weeks, although cravings can last longer.

31. What happens when people quit using tobacco? People who have other physical, mental, or emotional health problems may have more withdrawal. This may be part of the reason why some people have more difficulty quitting and need more assistance. There are effective, evidence-based treatments available to help people stop. These include a combination of an FDA approved medication to reduce withdrawal and behavioral coaching to help change long standing patterns. When tobacco-dependent individuals use these effective treatments, they are 2-3 times more likely to quit.

32. What are the options for managingwithout using tobacco? OHSU does not expect nor require anyone quit tobacco use. That said, employees are not be permitted to use tobacco anywhere on the campus. Employees who use tobacco need to find a tobacco-free way to manage their need for nicotine during the work day. To help those who are ready to quit, OHSU offers free and low cost-resources. For those not ready to quit but want help to manage while at work, FREE coaching is available through Employee Wellness. OHSU employees, students or volunteers interested in quitting tobacco should visit www.ohsu.edu/tobaccofreesupport for information and assistance.

33. Getting Help To Quit • What help is available to employees and • students? • What help is available to patients? • What help is available to visitors?

34. What help is available to employees and students? • OHSU provides a comprehensive package of freetobacco cessation coaching through Employee Wellness and free OTC medications for all employees, covered dependents, and students. Access to free, non-prescription medications is available ONLY at an OHSU Pharmacy. • Prescription medications may also be available at no cost depending on one’s insurance provider. • NOTE: Employees covered under a Kaiser health plan and students covered under Kaiser or ODS plans will need to pay the standard co-pays charged by their plan.

35. What help is available to employees and students? • For more information on benefits, visit the Tobacco Free website at www.ohsu.edu/tobaccofree • There are three ways to access services – through Employee Wellness, through OHSU outpatient pharmacies, and through your primary care provider (PCP). • Access through Wellness: Call Wellness at 1-800-941-5590 or go online to www.ohsu.edu/tobaccofreesupport and make an appointment to talk to a health coach. Health coaches will complete an assessment, develop a treatment plan, and send the plan to the OHSU outpatient pharmacy or your PCP. The pharmacy can prescribe and fill prescriptions (no co-pay).

36. What help is available to employees and students? • Access through the OHSU outpatient pharmacy: Call 503 494-8563, email rxfree@ohsu.edu or visit the OHSU Pavilion pharmacy between the hours of 9 AM and 3 PM. The pharmacist will complete an assessment, prescribe the correct medications and make a referral for coaching. • Access through a primary care physician: Contact a personal physician for advice and a prescription to be filled at any pharmacy (note: nicotine patches and lozenges are not covered by OHSU when purchased outside of the University’s program however, prescription medications are).

37. What help is available to patients? • 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. • The consult includes an assessment of the patient’s tobacco use history and current circumstances and makes recommendations, including referrals, for treatment.

38. What help is available to patients? • Ambulatory 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. All patients can be referred to the Oregon Tobacco Quitline for more assistance. A fax referral program is also available to help link patients with the Quitline and provide feedback to the referring provider.

39. OHSU Tobacco-Free Initiative “At A Glance” Implementation date:September 17, 2007 Initiative website:www.ohsu.edu/tobaccofree Comments and questions:free@ohsu.edu Employee and student benefits:Employee Wellness Program, 503 494-9355 (4-WELL) or www.ohsu.edu/tobaccofreesupport Patient programs and professional training:OHSU Smoking Cessation Center, 503 418-1659 or www.ohsu.edu/smokingcessation Prescriber medication questions:Pharmacy Drug Information Service, 503 494-7530 or druginfo@ohsu.edu