Arkansas hospital easily goes smoke free’

Months of planning paid off

The campus of the University of Arkansas for Medical Sciences (UAMS) Medical Center in Little Rock went "smoke free" last summer in a seamless transition that surprised and delighted access management. "We had thought it was going to be a bigger problem than it really was," says Mary Nellums, CHAM, admissions manager for the medical center.

While she had been concerned that her staff might be faced with people angry about no longer being able to grab a smoke just outside the hospital exits, that situation never materialized, Nellums explains. "There was not one single complaint. It turned out to be a minor problem for patients and families. I was really, really shocked."

The smooth implementation of the smoking ban might have been due, in part, to extensive preparation on the part of hospital officials, who began planning for the event months before the effective date of July 6, 2004.

"Support came from the top," notes Holly Hiryak, MNSc, RN, CHAM, director of hospital admissions. "They actually hired a part-time temporary employee to implement the program, and her role was to meet with people to identify potential problems and develop fliers and other marketing materials. "She came in with a limited focus, and then her role ended in August," she adds. "It did take the energy of having someone dedicated to [the implementation]."

Weeks in advance, signs heralding the transition to a smoke-free campus were posted throughout the campus, Hiryak says, with maps outlining smoke-free areas. Notices were put on the UAMS web site, included in mailings to patients with clinic appointments, and placed "pretty much anywhere a patient might access information."

Access personnel were trained to handle patients or family members who were upset about the ban, Nellums says, and access areas were provided with nicotine gum to distribute to those who requested it.

A process for signing out was devised so the hospital could track who was getting the gum, Hiryak says. "I don’t think we had to use any, or if we did, it was minimal," she says. "We had guidelines in place, such as patients waiting for admission or to be seen in the emergency department would not be given gum. That would be a clinical decision.

"However, if a family member or friend needed the gum, we could provide it," Hiryak explains. A script was prepared for access personnel, she adds, suggesting language for reminding people of the smoking ban and explaining how to use the gum. "We could only dispense a limited amount," she adds, "and there was a disclaimer they had to sign, accepting responsibility for taking the gum. It mentioned possible side effects."

Hiryak says she remembers nothing more than "a little grumbling" in response to the smoking ban. "I was concerned that our frontline employees who deal with waiting families — people in crisis — would take the brunt" of what could be a strong negative reaction. "But we did all that education, and it just never was an issue."

"We put the nicotine gum in a safe, and never had to use it," adds Nellums. "I can’t remember one patient or family member challenging us."

The UAMS administration eventually provided a "smoke shelter" for patient use, which required a written order, Hiryak says. "For the first few weeks, I saw people in that area, but now I hardly ever see anyone there. It’s almost like people have gotten over it. I think employees had more problems with it than patients and families," she notes. "However, there were some employees who actually quit smoking."

To aid in that effort, UAMS began conducting a four-level smoking cessation program in April 2004, three months before the effective date of the ban, Hiryak says. A notice on the organization’s web site, on tent cards in waiting areas, and in other locations offered four options for kicking the habit:

Level 1
Six-week, over-the-counter nicotine replacement therapy (NRT). This level is designed for those who feel they need no assistance other than NRT.

Level 2
Cessation materials provided with a brief assessment for alternative NRT and use of the toll-free Quitline cessation counseling service offered by the Arkansas Department of Health.

Level 3
This level is designed for employees and students who need additional help. It includes smoking cessation counseling through the employee assistance program, as well as mental health services for students.

Level 4
Smoking cessation program. Components of this comprehensive model include a trained facilitator who provides support with cessation materials, behavior modification principles, information on prescription management, and group/peer support. A six-week free membership at War Memorial Fitness Center also is included at this level.

Levels 1-4 were offered free of charge to UAMS employees and students, while non-UAMS employees were eligible only for Level 4.

Even employees who expressed no interest in quitting have had to cut down, Nellums points out. "They couldn’t go that far to smoke."

[Editor’s note: Holly Hiryak can be reached at (501) 686-8170 or by e-mail at hiryakhollym@uams.edu. Mary Nellums can be reached at (501) 686-6789 or by e-mail at nellumsmaryc@uams.edu.]