Can you believe this?

**canoehead, BSN, RN** · Mar 20, 2004

If the patient gets up and goes out to smoke in spite of knowing the policy what do you all do about it. Are they considered AMA? Do they just come back and there is no problem?

nursemaa · Mar 20, 2004

According to our hospital's legal counsel, the best thing to do is explain the risks of leaving the unit to smoke, notify the physician, document this, and if the patient still leaves it's their problem. Remember, the hospital isn't a prison and if the patient is competent to make the decision to go outside to smoke, there's really nothing you can do about it. If the patient isn't competent, that's another story. Seems like some nurses waste a whole shift trying to convince this one patient not to go out to smoke.

We've taken a stand, though, that we will NOT accompany patients outside to smoke, even if the doc writes an order to do so (some docs do that!). It is at their own risk. We're developing a form for patients to sign that they have been told the risks and choose to do it anyway. Bottom line is, people have the right to make a bad decision.

Providing cigs to a patient certainly seems like a dangerous thing to do- what if they go outside, smoke, fall down and injure themselves- could the cigarette provider be considered liable?

P_RN, ADN, RN · Mar 20, 2004

3 RNs 2 LPNs 1 tech 30 patients (7 postop epidural total joint on Q 30 min vitals) WHO is going to get that patient down to the smoking area?

Plus it was very dramatic seeing a presentation made in our hospital of a 10th floor room, burned to the concrete walls, ceiling tiles gone, overbed light fused to the skeleton of the Hil-Rom bed.......that bed was on the loading dock for quite a while......

The RN on the floor suffered a broken arm from the window glass giving away. The night time tech crawled into the room and pulled the patient to "safety." The patient was "saved" and sent to the burn center where he expired.

Every hospital in the area has been non-smoking for a long time......nicotine patches or Zyban are offered. Or other arrangements need to be made.

It is not a matter of the patient choice. I'm not an enabler and don't believe other nurses should be either. Compassion and help are admirable attributes but the good of the many (those 29 other patients) over rides the habit of the one.

Oh and BTW the longest ladder the fire department had only reaches the 5th floor.

Pediatric Critical Care Columnist · Mar 20, 2004

I just thought of this, on the subject of patients leaving the building to smoke. About 14 months ago, a woman left her ward bed of the Seven Oaks General Hospital in Winnipeg, Manitoba to have a smoke in the middle of the night. (Manitoba's hospitals have had a no-smoking-in-the-building policy for about eight years. Manitoba in winter makes Siberia look like the tropics... tons of snow, high winds and extremely cold temperatures are all normal there.) She left the hospital unaccompanied via the ER entrance doors. Unbeknownst to her, these doors were locked between the hours of 0100 and 0500 hrs, with entry only permitted via the ambulance entrance. She was found FOUR HOURS LATER, halfway around the building, frozen to death. Apparently, when she found the door locked, she started looking for a door that was open, and went the wrong direction, getting lost in the undeveloped area around the hospital.

Patients in Winnipeg have also returned to their wards with frozen IV lines, frozen Foleys and other such interesting complications.

nursemaa · Mar 20, 2004

So...I wonder what the answer is? Have security make the patient stay on the unit (could this be false imprisonment?)...Spend huge amounts of valuable nursing time pleading with the patient to stay on the unit?...Offer nicotine replacement products to patients who don't want them and will probably sneak down to smoke anyway?...doesn't seem to be a good answer to the problem. I'm not saying patients should be allowed to do it, just not sure how to prevent it...

Gompers, BSN, RN · Mar 20, 2004

It's getting a little off the original topic, but I have more than once had patients who had an order for a glass of wine with their dinner tray, or later in the evening. We kept it locked in the Med refrigerator. It never had anything to do with detox, just 'the amenities of home' while in the hospital!

I, too, have experienced this when I was a CNA. Most were older patients who were very set in their ways and in the hospital for problems not related to drinking. I specifically remember a very sweet older Italian woman who was just so depressed - she was on Orthopedics for a couple of months after a bilateral knee replacement, and she just hated being there and could barely eat the food. The only joy she had was her styrofoam cup of cheap red wine in the evenings, provided by nutrition. She said that she had a glass every day since she was a teenager, and to keep that routine was priceless to her.

teeituptom, BSN, RN · Mar 21, 2004

I just thought of this, on the subject of patients leaving the building to smoke. About 14 months ago, a woman left her ward bed of the Seven Oaks General Hospital in Winnipeg, Manitoba to have a smoke in the middle of the night. (Manitoba's hospitals have had a no-smoking-in-the-building policy for about eight years. Manitoba in winter makes Siberia look like the tropics... tons of snow, high winds and extremely cold temperatures are all normal there.) She left the hospital unaccompanied via the ER entrance doors. Unbeknownst to her, these doors were locked between the hours of 0100 and 0500 hrs, with entry only permitted via the ambulance entrance. She was found FOUR HOURS LATER, halfway around the building, frozen to death. Apparently, when she found the door locked, she started looking for a door that was open, and went the wrong direction, getting lost in the undeveloped area around the hospital.
Patients in Winnipeg have also returned to their wards with frozen IV lines, frozen Foleys and other such interesting complications.

So she was met with a cold reception

LolaRN · Mar 22, 2004

I guess that my issue with the whole situation is more that the supervisor provided the cigarettes-even the right type. Usually we have them sign a release and then you are on your own, except for the few smokers that you can harass into taking you outside with them. But to provide cigarettes and waste nurses time by trying to find the right kind just seems incredibly stupid.

trudlebug · Oct 24, 2004

wrong thread

purplemania, BSN, RN · Oct 24, 2004

we stopped this whole silly process by making the facility "non-smoking". Patients are told on admit they will not be allowed to smoke, but will be given patches, etc. as prescribed by MD. We also give out sugarfree gum and candy (if appropriate to pt). If they insist on leavning, they go AMA. We do not allow people to come and go, especially with equipment. Had a pt. get his friend to shoot up drugs in his saline lock and another was caught aspirating a narcotic from PCA. SO, no more smoking. It is contrary to good health anyway.

BadBird, BSN, RN · Oct 24, 2004

I do not smoke and I do not take patients out to smoke. End of story! The situation you described is beyond ridiclious.

virmm1, LPN · Oct 25, 2004

I worked in a LTC several yrs ago where admin allowed rsd to be in the smoke room on the first floor by themselves. Rsd rooms were on the 2nd and 3rd floors

some of the nurses had tried to have tht practice stopped but Its the pts right to smoke. they had their own cigs, could do for themselves. The ppl would be down there 2-3AM,would come up stairs to get coffee and go back down.

Anyway, one rsd had the misfortune to drop the fire from her cigarette onto herself and couldn't stand up,was in a w/c. She ended up dying from the burns. That did away w/ the rsd smoking into the wee hrs of the am. Sad, someone had to die before they stopped it. :scrying: :angryfire at tht I was.