Planning Stage	Ensure that the closure plan is endorsed by the Capital health (CH) corporate office and medical leaders. Inform CH staff members of the plan (ongoing). Offer cessation assistance to all new inpatients. Establish a steering committee at each site with a designated smoking room (DSR). Consult with facility staff and physicians to establish a protocol for smoking-cessation services. Estimate the prevalence of tobacco dependence among facility staff members. Disseminate the process by which staff members can access smoking-cessation assistance. Encourage staff members who smoke to engage in cessation efforts (ongoing). Inform patients of the dangers of smoking and of the imminent closure of DSRs. Establish the full range of nicotine replacement therapy (NRT) products on hospital formularies across the region. Coordinate proposed DSR closures with the tobacco committees at each affected hospital. Conduct a media campaign to inform the public of the imminent DSR closures. Cease spending on ventilation technology. Use grand rounds to inform to inform CH personnel throughout the region of the new no-smoking policy.
Three months before closure	Announce the closure process to patients and staff. Place visible reminders of the date that smoking rooms will close. Allow only patients with no off-ward privileges into designated smoking rooms (DSRs). Place clear tobacco-related health messages in all DSRs. Remove all smoking-related social cues from DSRs. Disseminate to all staff members information about the 5A approach (ask, advise, assess, assist, arrange), as well as about nicotine replacement therapy (NRT) and bupropion guidelines. Obtain permission from the Registered Nurses Association of Toronto to use a set of e-learning modules that it developed for nursing staff. Disseminate protocols of cessation interventions to all CH staff members. Initiate weekly cessation group sessions for patients on each ward. Increase the availability of smoking-cessation self-help materials for staff members and patients. Start monitoring NRT usage. Establish a consultation service that allows physicians and nurses to consult with a tobacco specialist on tobacco-related clinical matters. Close DSRs 25% of the time. Discontinue selling or dispensing tobacco products to patients. Implement standing orders for NRT. Provide a Ward Atmosphere Scale in all units. Obtain a legal opinion concerning the legality of closing the DSRs.
Two months  before	Conduct staff focus groups at each site where a DSR is to be closed. Consult with a council representing patients. Provide written information about the impending no-smoking policy to all prospective inpatients. Discuss proposed changes with housekeeping, security, maintenance, and other departments and provide departments with updates at 2-week intervals. Close DSRs 50% of the time.
One month before	Close DSRs 75% of the time, and close them entirely during evening hours. Discuss the DSR closures with physicians at grand rounds.
Three weeks before	Continue gradually reducing the amount of time that DSRs are open (ongoing).
Two weeks before	Establish groups in which patients can vent their reactions about the no-smoking policy.
One week before	Conduct ward-level community meetings. Offer voluntary discharges to psychiatric patients unless their admission was involuntary.
Closure of Designated Smoking Rooms
One day after	Clean former DSRs and if necessary repaint them. Inform staff members that the current "fragrance policy" barring them from wearing strong perfumes or colognes may be expanded to include tobacco odor.
Seven days after	Monitor violations of the no-smoking policy and refine protocols for enforcing it. Monitor patient complaints and discuss these complaints with patient representatives.
One month after	Collect formal feedback from staff regarding contraband, violations, patient reactions, and Ward Atmosphere Scale results.
Two months after	Implement a protocol for dealing with violations of the no-smoking policy.
Three months after	Begin conducting daily searches for contraband.
Four months after	Offer staff members refresher courses on cessation methods.
Five months after	Assess staff members' attitudes, skills, and knowledge concerning the tobacco ban and smoking-cessation methods. Reassess the prevalence of smoking among staff members. Begin ongoing education for staff members about accessing the effectiveness of smoking-cessation interventions.
Six months after	Conduct community meetings to discuss the no-smoking policy and implementation protocols and to find solutions to any problems that may have arisen. Conduct an occupational health and safety assessment to compare the occupational health status in affected hospitals before the DSR closures with the status after the closures. Review the amount of medication used to restrain patients before and after the DSR closures, as well as the number of patients using NRT and the number of critical incidents that threatened the safety of patients or staff members. Celebrate the facility's 6-month smoke-free status.
Twelve months after	Celebrate the first anniversary of the facility's smoke-free status. Plan an event and medical release to publicize the number of lives and health care dollars saved by the new policy. Administer the Ward Atmosphere Scale in wards across the region.