STANDARD 1: Governance and commitment The healthcare organisation has clear and strong leadership to systematically implement a tobacco-free policy SELF AUDIT 0 = No / not implemented 1 = Less than half implemented 2 = More than half implemented 3 = Yes / Fully implemented IMPLEMENTATION CRITERIA REFLECTION Summary of current situation (Please describe the current situation for each implementation criteria. This will provide a context for your planned actions for the next 12 months) 0 1 2 3 PRIORITIES Summarize the actions flowing from the audit process for each criterion (These will inform a more detailed planning process) The healthcare organisation has clear policy documents towards the implementation of all the Global Standards. Policy documents of the healthcare organisation show commitment to implement all Global Standards. The healthcare organisation prohibits the acceptance of any sponsorship or funding from the tobacco industry, as well as the sale of their products and associated devices/ The healthcare organisation prohibits the acceptance of tobacco industry sponsorship and funding. The healthcare organisation prohibits the sale of tobacco products and associated devices/e-cigarettes. The healthcare organisation identifies clear accountability for all levels and aspects of policy implementation. A senior manager has responsibility for the implementation of the tobacco-free policy. Accountability is assigned at all levels and for all aspects of policy implementation. The healthcare organisation’s staff employment documents (including subcontracts and documents with other agencies that work within the healthcare organisation) require commitment by all staff to the organisation’s tobacco-free policy. Staff employment documents require staff commitment to the healthcare organisation’s tobacco-free policy. Subcontractor documents require staff adherence to the healthcare organisation’s tobacco-free policy.
The healthcare organisation seeks relevant representation to develop and to implement a strategy and action plan based on the self-audit and policy monitoring and evaluation results. The strategy and action plan is developed and managed by an implementation team. The strategy and action plan is reviewed annually taking into account the results of the monitoring and evaluation results. The healthcare organisation allocates the human and financial resources necessary for all aspects of policy implementation. Financial and human resources are allocated according the strategy and action plan. Current audit: Subtotal score for Standard 1: (Maximum possible score: 30)
The service user’s care plan identifies and meets the needs of the tobacco and associated devices/e-cigarette user and those identified as exposed to secondhand smoke/e-cigarette vapour. Tobacco and associated devices/e-cigarette users and those exposed to secondhand vapour have their needs identified and documented in the care plan. The healthcare organisation has a tobacco cessation service or a referral system to a service that provides treatment for tobacco addiction/dependence in line with researched best practice. All tobacco and associated devices/e-cigarette users have access to a tobacco cessation service that provides treatment in line with researched best practice. The tobacco cessation service considers the therapeutic requirements of different groups (i.e. pregnancy, mental illness, disability) in line with researched best practice. The tobacco cessation service addresses the needs of different service-user groups through specific treatment guidelines or protocols in line with researched best practice. Pharmacological support is available for the treatment of tobacco addiction/dependence, in line with researched best practice. Pharmacological support is available to tobacco users in line with researched best practice. The tobacco cessation service used by the organisation follows up cessation service users in line with researched best practice. The tobacco cessation service has a procedure to follow up cessation service users in line with researched
STANDARD 5: Tobacco-free environment The healthcare organisation has strategies in place to achieve a tobacco-free campus. SELF AUDIT 0 = No / not implemented 1 = Less than half implemented 2 = More than half implemented 3 = Yes / Fully implemented IMPLEMENTATION CRITERIA REFLECTION & ACTION PLAN Summary of current situation (Please describe the current situation for each implementation criteria. This will provide a context for your planned actions for the next 12 months) 0 1 2 3 ACTION PLAN Summary of plans for next 12 months The healthcare organisation has completely tobacco-free buildings (including associated devices/e-cigarettes). All buildings within the organisation are completely tobacco-free (including associated The healthcare organisation has completely tobacco-free grounds and transport systems (including associated devices/e-cigarettes). The grounds and transports systems of the organisation are completely tobacco-free (including associated devices/e-cigarettes). The healthcare organisation has clear and unambiguous signage that defines the products prohibited and identifies boundaries for buildings and grounds of the tobacco-free campus. Signage identifies prohibited products and the campus boundaries for buildings and grounds. The healthcare organisation prohibits the sale, distribution and advertisement of tobacco products and associated devices/ e–cigarettes, anywhere within the organisation. Tobacco and associated devices/e-cigarettes are not sold, distributed or advertised within the organisation. The healthcare organisation has a procedure in place to ensure that all service users, staff and visitors are never exposed to secondhand smoke/e-cigarette vapour within the boundaries of the tobacco-free campus. There is a procedure to record and prevent secondhand vapour exposure.
STANDARD 7: Community engagement The healthcare organisation contributes to and promotes tobacco control/prevention in the local community according to the WHO FCTC and and/or national public health strategy SELF AUDIT 0 = No / not implemented 1 = Less than half implemented 2 = More than half implemented 3 = Yes / Fully implemented IMPLEMENTATION CRITERIA REFLECTION & ACTION PLAN Summary of current situation (Please describe the current situation for each implementation criteria. This will provide a context for your planned actions for the next 12 months) 0 1 2 3 ACTION PLAN Summary of plans for next 12 months The healthcare organisation works with community partners and other organisations to promote and contribute to local, national and international activities. The healthcare organisation works with community partners and other organisations to promote and contribute to national and international tobacco-free activities. The healthcare organisation works with community partners to encourage and support the users of tobacco and associated to quit; it takes into account the needs of specific target groups (women, adolescents, migrants, disadvantaged and other cultural groups). The organisation works with community partners to encourage and support tobacco and associated users to quit. The organisation works with community partners to address the needs of specific target groups (women, adolescents, migrants, disadvantaged and other cultural groups). The healthcare organisation shares best practice to support others in the development and implementation of policies. The healthcare organisation shares best practice in the development and implementation of tobacco-free policies. Current audit score: Subtotal score for Standard 7: (Maximum possible score: 12)
STANDARD 8: Monitoring and evaluation The healthcare organisation monitors and evaluates the implementation of all the Global Standards at regular intervals. SELF AUDIT 0 = No / not implemented 1 = Less than half implemented 2 = More than half implemented 3 = Yes / Fully implemented IMPLEMENTATION CRITERIA REFLECTION & ACTION PLAN Summary of current situation (Please describe the current situation for each implementation criteria. This will provide a context for your planned actions for the next 12 months) 0 1 2 3 ACTION PLAN Summary of plans for next 12 months The healthcare organisation has internal and external review processes to monitor the implementation of all standards and takes into account feedback from staff and service users. An internal process is in place to review the implementation of the Global Standards at least annually. The review process takes into account feedback from service users and staff. The healthcare organisation participates in external review activities. The healthcare organisation has processes to collect key data, including the results, to inform the annual action plan and to ensure quality improvement. Data collection processes are in place, including the self-audit, to monitor implementation of the tobacco free policy. Data collected is used to improve implementation and the annual policy action plan. Current audit score: Subtotal score for Standard 8: (Maximum possible score: 15) GRAND TOTAL: / 144 (Maximum possible score: 144)