patients smoking

EastCoast · Nov 9, 2003

Originally posted by petunia
However, he would go off the unit for 1/2 hr at a time several times on nights. He signed an AMA to do this but stated he needed "some fresh air" because he couldn't sleep. The doc was aware. The pt would walk with a w/c for support and take his oxygen with him and go off the unit. .

I'm just wondering ...if he signed out AMA how come you all didn't make him go thru the pain and aggravation of going thru the ER for readmisssion. I think this is called enabling. And he took oxygen with him?? AMA is your on your own in my hospital. The oxygen is not the patients and we would no more give him an oxygen tank on departure than we would give a big dose of morphine. I think the doctor is doing a lousy job. I think the doctor is placing the hospital in a vulnerable postion and actually endangering others but allowing a patient to smoke around an extremely flammable gas.

Whether this patient is at the end of their life is inconsequential to what is actually going on. I don't even care that this guy is lying to everyone. It seems that everyone knows what he is doing regardless so what he says doesn't really matter.

IMO If he is at the end of his life he should be home on hospice smoking in his own living room.

I would strongly advise you to send off a note with your concerns to risk management.

And i'm with you cannoli....what about the other patients who need attention?

Burnt Out, ASN, RN · Nov 9, 2003

At my hospital, we DO NOT go out with the patients when they want to smoke. We are a non-smoking facility..they are told this on admission and they are also told that if they go outside-they are doing so on their own free will...then I document. Our MDs know better than to write an order saying the patient can go out and smoke-and must have a staff member go with them. We also do not have the staff and I have asthma-I can't go into a restaurant where the smoking section is upfront without starting to wheeze..you can be sure I would never go out with one of my patients-too risky for my own health. We try to tell the docs to discharge these people if they keep missing meds, tx., etc while "going out"...some do, some don't... :rolleyes:

We also have patients that smoke with the nicotine patch on...they are told of the ramifications of this. Also on our COPD and pneumonia orders, if the patient is not allergic, we start them on Wellbutrin...sometimes it helps...

spitfire · Nov 10, 2003

Originally posted by shodobe
Patients here are allowed to go outside to smoke without an escort. Really stupid in my opinion. I had a patient 6-7 years ago that was always "sneaking" down to smoke. She was constantly told by her doc not to go out. She went down one night and fell hitting her head. She wasn't found right away. She ended up with a subdural and I had to do a cranie, which I had not scrubbed one for many years. Lucky for me the Neuro was very nice and patient! Unfortunately the patient died the next day and since then I cringe when I see a patient downstairs smoking. Mike

I am interested in hearing if the hospital or you the nurse were held responsible for this patients outcome. Are we held responsible if our patient has an OK from the docs to smoke and then falls?Or would we not be responsible if the patients does go out without permission if we document that. This is the original question that I was posting.I do not want my licence brought into question because my patient had an injury or worse while they are out of the hospital smoking.

shodobe · Nov 10, 2003

A real quick answer. No the hospital was not held responsible. The family accepted the outcome of her hospital stay. There was plenty of documentation to show the patient was warned time and time again. The MD even put in his progress notes about the warnings. The staff was not able to watch this patient 24/7 so the family understood. Mike

hogan4736, BSN, RN · Nov 10, 2003

give a little

some of these people are dying.

who are we to take away their pleasure (I do hate smoking though)

document, document, document

acknowledge, and move on...

educate (or berate, it's a fine line people, I'm just as guilty as the next) if you must, but they've likely heard it...

give your best care to all, period

sean

jadednurse · Nov 10, 2003

Originally posted by cannoli
Yea, I bet the patient with COPD was angry, "dying and all"; the poster also said he needed a lot of nursing time too after going out to smoke, nursing time that was taken away from other patients who probably were compliant with taking care of their own health.

And so b/c this pt was non-compliant by smoking you judge that he isn't worthy of the extra nursing care??? Let's stop treating the alcolholics and the people who get in car/motorcycle accidents too while we're at it.

Sheesh, who are you to judge?

BadBird, BSN, RN · Nov 10, 2003

I don't smoke, can't stand the smell of smoke and I don't leave my unit for a break so forget about taking a smoker outside. The hospitals I work in have a NO smoking policy, if the patients don't adhere to the rules they can sign out AMA.

cannoli · Nov 10, 2003

I'm not judging, are you putting words in my mouth that I never said?, or are you co-dependent and enabling?, or maybe both.

And in answer to your question, is he "worthy" of the extra nursing care?, not if it's at the expense of another patient.

BayMae10 · Nov 11, 2003

this has always been a big deal at any of the hospitals i have worked at, so places let ya...the bigger inner city ones, and then so don't.....i feel like saying ok we all know the risks and what is involved if we dont by this point then we have been living in the woods in a box! its the person choice to smoke and i have no say in what is right for them, not my life. yes people are here cause they are sick....but they are scared too and if that takes the edge off then so be it. i have no problem with pt smoking if i have the time then i'll go, if family wants to yep let em.

when we enter the hospital doors 9 times out of 10 or rights and controll go out the door, lets not make someone crazy just for a few smokes a day set limits....

freelancer · Nov 28, 2003

a patient under care has higher risk of diseases, especially those acquired from the hospital... The more a patient smokes, the more he/she losses vitamin C, thus reducing the resistance... In effect, making him/her self much more vulnerable to diseases

vemiliob · Nov 29, 2003

I remember a night shift few days ago, getting in my first pts double-bed-room to take their vitals and get acquainted with them.

I saw a middle age fatty lady lying pleasantly on her bed while smoking a cigarette. On the other bed an old lady saying just nothing.

Astonished I closed the door and asked her: What are you doing madam?

-I can't walk, I'm sorry! - She answered.

My reply was: I am sorry madam, but you cannot smoke here! Besides, you're not alone. You've got NO EXCUSE...

Often young patients ask for permission to go out to smoke and we remember them that while they're under our institution's responsibility, they must remain in.

If they want to go out, this responsibility ends. Therefore, they can't return back. If they insist we say: next, security will take care of you so... make your choice!

No way!

It happens almost every week, even parents trying to, or, just smoking in his/her child's room, while everybody else is sleeping.

I remember a night getting in a girl's room (post appendectomy), finding very difficult to breath because her father was smoking just few seconds before. "I could not avoid remember him who's that room".

In big hospitals, some patients use to go down for a while, to drink a coffee and smoke a cigarette at the hospital's bar. (Especially terminal-cancer-pts). It is forbidden of course, but... who would stop them? I certainly not!