Table 3.

Examples of Trusts' innovative Approaches

Topic	Innovative Approaches to address Challenges
Challenges: Exemptions to policy	Written guidance to decide whether exemptions on a case-by-case basis can be made, has been developed for ward managers
Challenges: Enforcement	Cards stating the Trusts' smoke-free policy and giving contact details of NHS stop smoking service have been developed to hand over to smokers (risk-free alternative to approaching them verbally)*
	Step-by-step guide regarding enforcement/breeches of policy for staff/visitors/patients has been drafted*
	Areas in front of A&E and Maternity have been targeted through extended signage, thorough cleaning, & challenging smokers*
Support for Staff	Theatre staff have been supported through targeted support in smoking cessation in view of the "logistic" difficulties in leaving the premises to smoke
	A "Big Action Plan" with a focus on extended support for staff is being developed in a joint effort with the community (PCT, pharmacists)
Support of Patients	Smoking status/willingness to stop smoking are assessed on admission and recorded in standard documentation*
	A clinical pathway for smoking cessation has been developed (Mental health Trust)
	A holistic approach towards physical well-being is taken through combined exercise/stop-smoking programs (Mental health Trust)*
	Former smoking rooms have been transformed into recreational spaces for patients (Mental health Trust)
Impacts	Impact of the policy is going to be reviewed for a) smoking prevalence among staff before and after, b) cleanliness of premises, c) Trust image by means of repeated surveys

* mentioned by more than one respondent