Anyone work in a "no smoking " facility?

BookwormRN · Aug 21, 2008

We absolutely have a person sign out AMA---you CANNOT have a person on a Morphine PCA leaving the floor unattended to go smoke! You are still responsible for them.

If they demand to go smoke, we bring the AMA papers and explain that we will remove the IV, etc, because we are a non-smoking campus and they cannot leave the facility with the IV, etc and we cannot allow staff to accompany them off-campus. (Staff must punch out and be off the clock in order to leave and smoke, as well!)

Christen, ANP · Aug 21, 2008

I work in a "smoke free facility," but as my patients are in critical care and usually can't...walk... I haven't had to deal with this directly. So I won't be much help. But I think we're to call security to deal with them. Or maybe a gentle reminder before they leave the floor?

We have had pt's families bring in cigarettes and once while I was working a pt actually lit up a cig in the step-down ICU area! While on O2!! Gahh!! Needless to say, we freaked out.

RNsRWe, ASN, RN · Aug 21, 2008

We have a non-smoking campus and of course have patients that don't believe it applies to them. Every patient learns on admission that there is no smoking on campus, and that they will not be allowed to leave the building for any reason unless specifically authorized by their MD. And no MD is going to write an order allowing the patient to leave the building and leave themselves liable for whatever might happen to that patient so....everyone understands they are NEVER permitted to leave while still a patient.

That said, people disappear off the floor all the time. If we find them gone (and of course we know where they went), we call security to escort them back into the building, inform them their doctor will be notified, etc etc. Sometimes once is enough to stop the behavior, sometimes nothing will stop it. But at least our hides are covered legally, in that we NEVER allowed them to go and smoke, or "get air".

Patients are not prisoners, this is true. However, continued care at the hospital under the care of a doctor also means that they are abiding by certain basic rules, and if they choose to NOT obey them, they are certainly free to go. They can leave AMA anytime their little ol' hearts desire. They are also informed that the bill will likely come straight to them, since their insurance will very likely refuse payment for services on a patient who disregards care and leaves AMA.

I chart that the patient was found off the floor. I chart that security escorted them back in, and any comments the patient might have upon returning. I chart everything that I said about their not having medical permission to leave, nor nursing permission.

For what it's worth, with a chronic abuser, I also inform them that I will NOT be giving pain medications when I see that they are about ready to hot foot it out of the unit for a smoke. After all, I can't monitor their reactions to the narcs, now can I? And someone on a PCA? They are not permitted to take hospital equipment off our floor, PERIOD, and if security has to escort them back once, they are told that the MD might choose to discontinue use of said equipment since the patient is "taking" it without authorization. There's a full vial of morphine in that PCA and you want to leave the building? Sorry...you're gonna have to leave that here, pal.

nurseshepherd · Aug 21, 2008

We have a waiver the patient has to sign on admission as well as an information sheet about smoking cessation. They must totally leave the hospital premises (walk or roll out to the street) in order to smoke which IMHO is suitable criteria for discharge. For those truly unable to get out of bed we offer nictine patches unless contraindicated by their diagnosis. Our hospital adopted this policy a couple years ago and so far we have not had a bad outcome as far as injuries or untoward events go, even the 6 to 12 hour c/sections manage to make it out and back.....truly a powerful addiction.

CritterLover, BSN, RN · Aug 21, 2008

i work for a "no smoking" facility.

it's a joke ... staff, patients, and visitors all still smoke in front of the building.

security? yeah, they're out there smoking with them.

no one signs out ama. they just leave. sometimes they tell the nurse where they are going, sometimes they don't. sometimes they come back, sometimes they don't. (seriously)

as for the patients, it isn't just cigarettes they're smoking when they go out for a "smoke break."

for what it's worth, they do sign a form on admission stating they know it is a non-smoking facility. a little hard to enforce it on the patients when they aren't even enforcing it for the employees.

Pediatric Critical Care Columnist · Aug 21, 2008

A patient froze to death when she was locked out of the Seven Oaks Hospital in Winnipeg, Manitoba a year or so ago. She left the building to smoke sometime after midnight, after all the entrances except Emergency were locked from the inside, then could not get back in. She was found next to the building, by an entrance, some time later.

I've seen bariatric patients on oversized stretchers parked outside the main entrance to the hospital, people with frozen IV lines, people with PCAs walking on the sidewalk, people with clamped NGs, lots of interesting things. And we've had a couple of patients set themselves on fire by lighting up in their rooms while on O2 by non-rebreather. My sister-in-law, who died of lung cancer 5 weeks ago, left the floor of the hospital she was a patient of on her own, wheeled herself to the spot where she'd be off hospital property and then couldn't wheel herself back up the 30 degree incline in the 100 degree heat. When my brother arrived no one knew where she was... he had to go find her and get her back up the hill. He was NOT impressed.

I work in PICU and haven't had to deal with this, but I know it's a huge problem, especially here in northern Canada where the weather extremes are hard enough on healthy people.

ruralnurs · Aug 21, 2008

"a patient froze to death when she was locked out of the seven oaks hospital in winnipeg, manitoba a year or so ago. she left the building to smoke sometime after midnight, after all the entrances except emergency were locked from the inside, then could not get back in. she was found next to the building, by an entrance, some time later.

i've seen bariatric patients on oversized stretchers parked outside the main entrance to the hospital, people with frozen iv lines, people with pcas walking on the sidewalk, people with clamped ngs, lots of interesting things. and we've had a couple of patients set themselves on fire by lighting up in their rooms while on o2 by non-rebreather. my sister-in-law, who died of lung cancer 5 weeks ago, left the floor of the hospital she was a patient of on her own, wheeled herself to the spot where she'd be off hospital property and then couldn't wheel herself back up the 30 degree incline in the 100 degree heat. when my brother arrived no one knew where she was... he had to go find her and get her back up the hill. he was not impressed."

wow!!! so what is the answers??? to let people smoke with nursing staff to escort? we don't have enough nurses to do pt care let alone take outside. i realize this is a free country, but there must be a happy medium. if a pt goes out to smoke in a w/c and it tips over the hosp could be sued, we are in a sue-happy country so it is not unlikely to happen. but then again to freeze to death, how sad! if we clamp ngs or give wheel chairs ot gurneys then we are facilitating them to go out and could be responsible, if we don't they go out alone and can end up hurt or dead! we can't lock people up.

does anyone allow pt's family or fiends escort to off campus to smoke? as far as smoking in the rooms, does anyone go through a pts things to see if they have lighters or matches?

oramar · Aug 21, 2008

sister-in-law, who died of lung cancer 5 weeks ago, left the floor of the hospital she was a patient of on her own, wheeled herself to the spot where she'd be off hospital property and then couldn't wheel herself back up the 30 degree incline in the 100 degree heat. When my brother arrived no one knew where she was... he had to go find her and get her back up the hill. He was NOT impressed.

The situation has been created here and in a lot of places by managment and politicians that have unrealistic expectations about human behavior. It causes the nurses to be in the wrong no matter how they respond. If your SIL insist upon sneaking out for a smoke in spite of the fact that she is dying of cancer, why not put the blame where it belongs on her.

BelleKat, BSN, RN · Aug 21, 2008

This is a hard thing to deal with,at my facility I heard about someone who went outside with a pca and "shared" it with someone who was allergic. The pt with the allergy ended up being OK but after that no one was allowed outside w/ a pca. The facility dealt with problems like this by adding a "smoking gazebo" inside the building in an open air atrium sort of thing,of course that doesn't address who accompanies them,etc. They are really liberal with the smoking patches those don't work very well imo.

Pediatric Critical Care Columnist · Aug 21, 2008

The situation has been created here and in a lot of places by managment and politicians that have unrealistic expectations about human behavior. It causes the nurses to be in the wrong no matter how they respond. If your SIL insist upon sneaking out for a smoke in spite of the fact that she is dying of cancer, why not put the blame where it belongs on her.

The point I was trying to make here in talking about my sister-in-law is that people who smoke are addicted and can no more control their addiction that someone hooked on crack. Denise knew that her smoking was the cause of her cancer, and really, what would she have gained form quitting after her diagnosis? Nothing. Patches and gum are very nice, but there's much more to addiction than physical cravings. In our zeal to tell others what they should do with their own bodies, we're creating problems that could have been predicted. And now, Alberta has gone smoke-free in our prisons. So far there have only been a few violent uprisings, but I suspect there are more in the offing.

I don't know how this problem can be solved. There aren't enough nurses to do basic care, true, so there can't be that added burden placed on the front-line staff. Smoking cessation programs might be a partial solution, but they have to be entered into freely, and because they take time to be effective they need to be started ahead of time, but who can predict a sudden and lengthy hospital admission? Perhaps a return to an enclosed and carefully ventilated smoking room within the building would satisfy the my-rights-are-more-valuable-than-your-rights people and keep the smokers safer.

CHATSDALE · Aug 21, 2008

if smoking patches worked no one would be smoking and all the tobacco companys would be broke

i hae worked at a rehab where the nurses who smoked would take a patient who was in a wheel chair downstairs for a smoke, of course this got the patients mad when the nurses, like me, who didn't smoke and wouldn't accompany them

i know that these patients are in a very stressful situation but we are resposible for their health

as for ama papers, you can REQUEST it be signed but if they refuse what are you going to do