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The experience of a smoke-free policy in a medium secure hospital

  • Abhijeeth Shetty (a1), Rajesh Alex (a1) and Darran Bloye (a2)
Abstract
Aims and method

A Trust-wide smoke-free policy was introduced in March 2007. This service evaluation retrospectively reviewed the outcome by focusing on recorded changes in behaviour, incidents and prescribing.

Results

The majority of patients (89%) smoked before the smoke-free policy. There was no significant change in the rate of clinical incidents or the use of tranquillising medication at 3 months and 12 months post-implementation. Clozapine serum levels were raised significantly, necessitating dose reduction in 17% of patients. Fifty-four per cent of patients used nicotine replacement therapy and a small minority continued this treatment for 12 months.

Clinical implications

Despite initial concerns there were no significant problems in implementation of the smoke-free policy. This was assisted by extensive preparation, education, patient advocacy and access to treatment beforehand.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Darran Bloye (Darran.Bloye@nottshc.nhs.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 World Health Organization. Tobacco: Deadly in Any Form or Disguise. WHO, 2006 (http://www.who.int/tobacco/communications/events/wntd/2006/Tfi_Rapport.pdf).
2 Department of Health. Smoke-free Premises and Vehicles. Consultation on Proposed Regulations to be Made Under the Powers in the Health Bill. TSO (The Stationery Office), 2006.
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4 Coulthard, M, Farrell, M, Singleton, N, Meltzer, H. Tobacco, Alcohol and Drug Use and Mental Health. TSO (The Stationery Office), 2002.
5 Kelly, C, McCreadie, RG. Smoking habits, current symptoms and premorbid characteristics of schizophrenic patients in Nithsdale, Scotland. Am J Psychiatry 1999; 156: 1751–7.
6 Jochelson, K, Majrowski, W. Clearing the Air: Debating Smoke-Free Policies in Psychiatric Units. King's Fund, 2006.
7 Lawn, SJ, Pols, RG, Barber, JG. Smoking and quitting: a qualitative study with community-living psychiatric clients. Soc Sci Med 2002; 54: 93104.
8 Jochelson, K. Smoke-free legislation and mental health units: the challenges ahead. Br J Psychiatry 2006; 189: 479–80.
9 Lawn, SJ. Systemic barriers to quitting smoking among institutionalised public mental health service populations: a comparison of two Australian sites. Int J Soc Psychiatry 2004; 50: 204–15.
10 Hempel, AG, Kowanacki, R, Malin, DH, Ozone, SJ, Cormack, TS, Sandoval, BG, et al. Effect of a total smoking ban in a maximum security psychiatric hospital. Behav Sci Law 2002; 20: 507–22.
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12 Molyneux, A. ABC of smoking cessation: nicotine replacement therapy. BMJ 2004; 328: 454–6.
13 De Leon, J. Atypical antipsychotic dosing: the effect of smoking and caffeine. Psychiatr Serv 2004; 55: 491–3.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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The experience of a smoke-free policy in a medium secure hospital

  • Abhijeeth Shetty (a1), Rajesh Alex (a1) and Darran Bloye (a2)
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