The Institut Philippe-Pinel de Montréal has been a smoke-free hospital since October 31, 2005. This outcome is the result of nearly two years of effort by the Smoke-Free Hospital Committee and the desire to promote the health of patients and staff.
In 2006, the Institut received a Prix d'excellence from the Réseau de la santé et des services sociaux for this initiative.
In December 2003, the Institut contemplated becoming an entirely smoke-free hospital to promote the health of patients and hospital staff and to comply with the Tobacco Act (R.S.Q., chapter T-0.01). The Institut's administrators then began discussing not only how to comply with the act but also how to proactively meet its requirements. A team was created by the General Directorate to implement the project-this team became the Smoke-Free Hospital Committee.
A bold project
It was long believed unreasonable, even unthinkable, to ask individuals suffering from a psychiatric illness to stop smoking. Concerns about the project were numerous, as patients can stay at the Institut for a relatively long period of time and it was presumed that smoking cessation would increase the rate of violent acts or delinquency.
Mobilizing made easy
The ad hoc committee, formed at the Director General's request and comprised of different professional representatives from within the Institut, succeeded despite these concerns: Within a year, the committee was able to convince each unit of the Institut to participate. The project was carried out progressively and with everyone's cooperation.
A first smoke-free unit
In the spring of 2004, a first unit volunteered to start a pilot project. The staff of an admission-readmission-psychiatric consultation unit ensured that admitted patients would benefit from a smoke-free environment while receiving the necessary support to optimize their level of physical and mental health. On October 4, 2004, this unit became the first in the Institut to go smoke-free.
One victory leads to another
Gradually, the idea gained ground and other units came on board. The joint efforts of the administration, committee, employees and patients have allowed the Institut Philippe-Pinel de Montréal to provide an entirely smoke-free environment since October 31, 2005, and this without a subsequent increase in violent acts by patients or in complaints about smokers' rights.
The Smoke-Free Hospital Committee implemented the tools and means to help individuals stop smoking, organized awareness-raising activities, and used all available resources to achieve its objectives. With the committee's support, staff retained the necessary latitude and autonomy to meet the specific needs of patients in their units. When a unit made the decision to become smoke-free, all costs associated with smoking cessation (for nicotine patches, kits, documentation, special snacks, gum, etc.) were covered by the Institut.
Smoke-free: Unexpected side effects
The Smoke-Free Hospital Project also contributed to a research study on clozapine carried out at the Institut Philippe-Pinel de Montréal. This psychiatric medication, whose dosage is in fact greatly affected by smoking cessation, requires careful monitoring. The research project is on-going, but clinical estimates reveal that the overall amount of prescribed clozapine has decreased by 20%, with a proportional decrease in side effects related to its use. This means that patients can achieve the same clinical outcomes with lower doses, which has led to a decrease in the Institut's medication budget.
Pursuing an active lifestyle
Staff have noticed a general increase in physical activity and have had to tailor activity programs to patients' increased fitness levels, particularly to limit any periods of inactivity that might cause them to crave smoking again. Improved cardiovascular capacity is yet another benefit of an active lifestyle, which many patients achieve through walking. In fact, nurses have been able to measure increases in this activity from pedometers that are distributed to patients as an incentive to walk.
Financial benefits for patients
A non-clinical measurement of success following smoking cessation has definitely been patients' bank accounts. Many smokers devote almost all of their meagre budgets to smoking, leaving them with little money to buy anything else. By eliminating this costly habit, they can now afford other personal goods (such as clothing, leisure activities, or treats), which adds to their quality of life.
A first experiment for the network
Since May 31, 2006, the date when the new Tobacco Act came into effect, awareness of the Smoke-Free Hospital Project has continued to grow. In addition to creating interest among many health care network partners, the project has been the subject of scientific presentations in Quebec, Europe and elsewhere in the world. The Institut's expertise is now cited as a reference on this topic.