COPD patient wanting to leave to smoke

Published

Just want to vent. Does anyone else have a major problem with this?? Patient admitted for COPD exacerbation. Patient is on home nebulizer treatments, inhalers, etc.. for the treatment of his COPD. Patient admitted tonight and told the nurse he would be leaving to go smoke and there is no way we can stop him (I know we can). Patient is a medicaid patient which basically means I (along with the rest of tax-paying America) is paying for his hospital admission and medications for his respiratory disease..and he is insisting he is going to smoke. makes me soooo mad!!:mad::mad:

I tell patients who want to smoke that the hospital is a smoke free campus and I cannot condone the activity. Then I get the NM or supervisor involved and call the primary for an update. Done. It's a hospital, not a prison and I'm not going to put myself in harms way to police policy.

Up Vote Up Vote ×
Specializes in Leadership, Psych, HomeCare, Amb. Care.
We have no policy concerning smokers who go outside with no MD order. We can tell them they can't go, but if they insist we can't stop them. We can't even threaten them with discharge. They know we are powerless. I've even had them look at me and say "What are you going to do about it?"

Some will tough it out with a patch and some Ativan.

Some will get on the elevator with the patch and the Ativan, smoke and come back. Smirking at me the whole time knowing NOTHING is going to happen to them.

Some will smoke in their room which is the worst scenario of all. I can't even stop them from doing that.

I can't stop the diabetic's family from bringing in "snacks" of cookies and chips.

I can't stop the CP's family from bringing in KFC for supper.

I can't stop the NPO pt from going to the bathroom and drinking from the faucet.

After too many years of trying to make my patients well, I've decided I can't if they don't want to. I give the warnings and advisories, hope for the best, and let it go when the sick don't want to get better. Otherwise I just make myself as sick as them.

Why can't you stop someone from smoking in their room? If someone dies due to a fire under your watch, what will your defense be? State fire laws probably forbid it, so you have the obligation & right to remove matches, lighters, and smoking materials from their rooms.

Up Vote Up Vote ×
Specializes in L&D; GI; Fam Med; Home H; Case mgmt.
I had a person who was on home O2, in with COPD exacerbation, 3 ppd smoker. Got her a nicotine patch. Did a med pass, she wasn't in the room. Now, this is someone who desats into the 70's if she's not on O2. She'd called hubby, he'd come and got her and wheeled her out to smoke with the nicotine patch on. This is after we'd told her she could not go out to smoke (liability, we had someone who was still drunk go out to smoke, trip, and then sue the hospital). I told her to stop smoking, she could give herself a heart attack, and she told me to leave her alone and called me everything under the sun. I'm telling her, "you could have a heart attack and DIE, stop smoking or take off the patch, RIGHT NOW." She refused to do either, so I reached over, took off the nicotine patch, and went back up stairs to call her doc. Unfortunately for her, this doc didn't like stupid.

She came back 30 minutes later to find her stuff in a bag and her AMA paper stapled to it (doc's verbatim order) and her room in the process of being cleaned. She threw a screaming fit, and when we told her she was discharged, she had hubby wheel her to the ER to be readmitted. ER doc refused. So, she went to the car, called 911, and they brought her by ambulance all of 50 feet from the car back to the ER. She threw another fit when the ER doc pointed out if she could get up to all that, she didn't need hospitalization. Finally the cops came and got her after she slapped the ER doc.

You can't fix stupid.

I think I know that person... :coollook:

Up Vote Up Vote ×
sorry, i don't agree with this. abuse of health care dollars. we don't let our dt patients go outside and drink a 5th of vodka, do we?

free will is fine. you can freely sign yourself out ama if you are going to be non-compliant and have to go out and smoke.

but some of our md's will order 3-4 beers daily prn. some even have it scheduled for meals. guess who has to walk to pharmacy to pick them up?? lol

Up Vote Up Vote ×
Specializes in HH, Peds, Rehab, Clinical.
Just want to vent. Does anyone else have a major problem with this?? Patient admitted for COPD exacerbation. Patient is on home nebulizer treatments, inhalers, etc.. for the treatment of his COPD. Patient admitted tonight and told the nurse he would be leaving to go smoke and there is no way we can stop him (I know we can). Patient is a medicaid patient which basically means I (along with the rest of tax-paying America) is paying for his hospital admission and medications for his respiratory disease..and he is insisting he is going to smoke. makes me soooo mad!!:mad::mad:

At every facility I did clinicals in, smokers were automatically Rx'd nicotine patches. If they refused them and wanted to go outside to smoke, they were considered AMA and in order to come back inside as a patient, they had to be re-admitted.

Up Vote Up Vote ×
Specializes in neuro/ortho med surge 4.

Such a terribly hard habit to break. I knew of someone who was a drug, alcohol and cigarette addict. They were able to quit the drugs and alcohol but not the cigarettes. This is a really hard group to handle. It is especially hard for the alcoholics and drug abusers to not smoke while in the hospital detoxing. It is really hard to fight one addiction at a time- never mind two. My hospital is smoke free also but I wish there was a place for these people to smoke to take off some of their anxiety. Even if there was a place to smoke for patients there would never be enough staff to go with them to let them smoke.

I smoked for 20 years so I know how hard it is to stop. I also realize that people are aware of the risks of smoking so I just pass along the information as a matter of fact.

If people want to smoke I say let them. Who are we to judge? It it was easy to quit no one would smoke. The analogy about the diabetic eating cakes and the heart patients eating french fries is the same thing as a COPDer smoking. The difference is that smokers are restricted from their drug of choice while in the hospital which makes their anxiety worse. If the diabetic wants sweets they have only to call their families to get them. The nurse would be none the wiser unless evidence of wrappers are left or we have witnessed the eating of the food.

Up Vote Up Vote ×
Specializes in LTC Rehab Med/Surg.
Why can't you stop someone from smoking in their room? If someone dies due to a fire under your watch, what will your defense be? State fire laws probably forbid it, so you have the obligation & right to remove matches, lighters, and smoking materials from their rooms.

The pt denies smoking even though there is the smell of smoke. As absurd as it sounds I have to catch them red handed. I can't catch them when they smoke in the bathroom with the door closed. Then hospital policy forbids me from forcibly searching a pt's belongings when they deny having smokes and lighter. Most people who are brazen enough to smoke in a hospital room, are brazen enough to lie to your face. I then report to the house sup who also knows we are powerless. I can't even threaten to throw the smoking pt out of the room because the hospital won't back me up.

Up Vote Up Vote ×
Patient admitted tonight and told the nurse he would be leaving to go smoke and there is no way we can stop him (I know we can). :mad:

no you can't. if you do it is unlawful imprisonment, which is a felony in every state.

there goes your liscense, and jail time is not out of the question.

Up Vote Up Vote ×
Just want to vent. Does anyone else have a major problem with this?? Patient admitted for COPD exacerbation. Patient is on home nebulizer treatments, inhalers, etc.. for the treatment of his COPD. Patient admitted tonight and told the nurse he would be leaving to go smoke and there is no way we can stop him (I know we can). Patient is a medicaid patient which basically means I (along with the rest of tax-paying America) is paying for his hospital admission and medications for his respiratory disease..and he is insisting he is going to smoke. makes me soooo mad!!:mad::mad:

if they want to go out to smoke, they do . i can't really stop them. how can i chase down my own walkie talkie while dealing with more serious issues. if u are annoyed that you are paying for all of this while he smokes anyway. there is plenty of that, like diabetics popping candy left and right,

Up Vote Up Vote ×
Specializes in ICU.
But some of our MD's will order 3-4 beers daily PRN. Some even have it scheduled for meals. Guess who has to walk to pharmacy to pick them up?? lol

I have heard of that happening, but not for some time. But that was kind of like "weaning" the patient because withdrawl is very dangerous.

Nicotine withdrawl just sucks, it's not dangerous. I was a smoker, I know.

Up Vote Up Vote ×
if they want to go out to smoke, they do . i can't really stop them. how can i chase down my own walkie talkie while dealing with more serious issues. if u are annoyed that you are paying for all of this while he smokes anyway. there is plenty of that, like diabetics popping candy left and right,

and unwed women popping little bow-leggers out all over the place.

Up Vote Up Vote ×

another disgusting example of everythign is the nurse's responsibility. if a walkie talkie can walk themselves off hte unit to go smoke and i have told them we are smoke free campus, smoking is bad for you etc all detailed reasons why, told them i cna page for a nicotine patch etc. how am i to stop them from walking out to smoke? i cant restrain them or sit by their room to prevent them from, "going for a walk" .

Up Vote Up Vote ×
+ Join the Discussion