Supporting visitor compliance with a smoke‐free policy at hospital using a nicotine replacement therapy vending machine

Abstract

Issue addressed: To support visitors to comply with CentralCoast Local Health District's (CCLHD) smoke-free hospital grounds policy, a need was identified for round-the-clock availability of nicotine replacement therapy (NRT). Providing NRT through a vending machine was identified as a possible solution. This initiative complemented other strategies that provide staff and patients who smoke with NRT.Methods: NRT was originally provided through a snack vending machine; however, there were commercial and regulatory concerns with this method.In 2015, dedicated NRT vending machines were installed at Gosford and Wyong Hospitals, and were operated by the Health Promotion Service. The appropriate regulatory permission was gained to supply a specific brand of NRT. Sales and incident data were recorded, and ongoing smoking counts were performed both before and after installation.Results: In all, 247 sales of NRT gum were made through the vending machines from early 2017 to late 2019. Smoking counts show that there are very low rates of visitor smoking (<1%) in the approximately 4.5 years pre-and post-installation of dedicated vending machines. There was no statistically significant change in the smoking rate of visitors since the vending machine was installed at Wyong Hospital. Conclusions:While NRT is generally provided to patients and staff within health settings to support compliance with smoke-free policies, alternatives to smoking for visitors are typically overlooked. A NRT vending machine achieves this. However, because there are few purchases made, the vending machines as currently operating are unlikely to make any significant impact on smoke-free policy compliance at these hospitals.So what? While vending machines have limited effectiveness on overall smoke-free policy compliance, this strategy may have applicability to all sectors with smoke-free policies, especially those operating 24 hours a day, as a means of providing an alternative to smoking for visitors.

Assessing the responses of smokers to requests to stop smoking on hospital grounds

“…Enforcement patrols were conducted within normal business hours (Monday to Friday, 8 am ‐5 pm ). HPS staff approached smokers in pairs and conducted interactions using the following protocol: Greet the smoker, introduce yourself and colleague, and conduct the interaction in a polite manner. Inform the smoker of the smoke‐free by‐law, and that a fine can be issued for smoking on hospital grounds. Ask the smoker to extinguish their cigarette, and to move off site if they wish to smoke. Provide the smoker with a pocket‐sized cigarette butt bin to extinguish their cigarette. If the smoker is a patient, advise them that Nicotine Replacement Therapy (NRT) is available through their medical team. If the smoker is a visitor, advise them that NRT gum is available for purchase from vending machines (located at Wyong Hospital Emergency Department and Gosford Hospital after‐hours entry) 12 If the smoker is a staff member, advise them that smoking on site is in breach of the smoke‐free by‐law and the NSW Health Code of Conduct, and that NRT is available for staff through Staff Health and Wellbeing. …”

“…• If the smoker is a visitor, advise them that NRT gum is available for purchase from vending machines (located at Wyong Hospital Emergency Department and Gosford Hospital after-hours entry). 12 • If the smoker is a staff member, advise them that smoking on site is in breach of the smoke-free by-law and the NSW Health Code of Conduct, and that NRT is available for staff through Staff Health and Wellbeing.…”