Patient smokers!!

Lahryn04 · Jul 29, 2011

WOW! typos galore! Thanks droid for failing to read my mind! Sorry guys... I can't stand to read out myself because of that!

xtxrn, ASN, RN · Jul 29, 2011

I was just wondering what you all do when a pt wants to leave the floor to go smoke? I work at a facility that has strict no smoking policies in place for patients who smoke, visitors and staff. There is no smoking on hospital grounds period. I always have pts who seem to go thru nicotine withdrawals at the sight of the hospital!! They always ask me if they can go outside with their friend/family/significant other/whoever, to "get some fresh air"! I'm not stupid and I will catch on to you! Today I had a.straight up telll me he was going out top smoke! Tried to tell him not to, he had just had morphine, post appy, and fluids running! He kept asking me if it was ok to smoke... Repeaed myself multiple times but he just wanted some one to tell him he want going to get in trouble! I obviously wasnt going to restrain him, he is a grown ass man and theres really nothing I could do to stop him... Anyway he ended up leaving the floor, iv pole and all... Right before he go on the elevator I caught him and disconnected him from his iv pump... I want going to let him take it out side with him! He finally came back but I'm just wondering, what would you have done of this was your pt? Was I wrong to unhook the fluids, making it easier for him to walk? I felt so trapped by him, I was screwed either way! Sorry if there stre other posts similar to this, just had to vent! I truly appreciate your time and any comments/insights you'd be willing to give! Thanks so much!

When I was admitted for many multiple PEs, I could see a good portion of the parking lot and adjacent school yard...The patients would go to the school property, and the kids would sneak over to the hospital property... security would chase them off periodically (especially the kids)... but with the adults physically off the hospital grounds, there wasn't much they could do. :uhoh3: I used to smoke (had 2 cigarettes before I drove myself to the hospital for the PEs...I thought it was a heart attack- like that's any better- right lung was so full of clots it was causing ischemia to the apex of my heart-- spooky to think about now) , but had to get the last ones in before getting 'stuck' in the hospital. I get that the cravings are INTENSE. The patches don't work for everyone... There's a new gizmo that uses water vapor and flavorings in a cigarette shaped thingamabob....I could have gone for one of those. No carcinogens- just the hand motions and oral fixation 'fix'... After those two butts en route to the ED, I quit smoking (one partial lapse a few months later- but it grossed me out- I was lucky).

resumecpr · Jul 29, 2011

I fear that patients who leave hospital property with a working IV in place may subject themselves to other means of IV therapy (if you catch my drift).

I used to work in an ED where if the patient eloped with an IV in, we would have the police sent to their house, bring the patient back to the ED, and have the IV removed.

You never know what some people will try to inject in there!!

Trekfan · Jul 29, 2011

Now this was maybe 7 years ago when my dad was in the hospital and that place had a smokeing room on each floor ! I can remeber going to see him and always being told he was out on the smoking deck? the last time he was in the hospital they just gave him patchs but I did see a lot of pts out side with there ivs .

jesskidding, LPN · Jul 29, 2011

Patches.

Crux1024 · Jul 29, 2011

Signs out AMA and are readmitted through the ER, if its that bad. The only ones I smell the smoky odor on are the ones who are walky/ talky and then disappear for a bit while we are busy. Some go do far as to smoke in the bathroom and thats when security is called to explain things. The docs are really good about prescribing alternate therapy though.

CareteamRN70 · Jul 29, 2011

There's a new gizmo that uses water vapor and flavorings in a cigarette shaped thingamabob....I could have gone for one of those. No carcinogens- just the hand motions and oral fixation 'fix'.

Congrats on quiting smoking! :yeah:

I still smoke..I had a story very much like yours in that I had a TIA and was smoking up to the ER doors. As for what you were talking about..the water vapor gizmos, those are e-cigarettes.

It isnt really water vapor, it's propylene glycol, nicotine, and flavoring agents. I switched to them because it has no 2nd hand effects at all, the flavors i choose are more pleasant to be around (fireball my fav - think cinnamon red hots).

I will admit so far the jury is out on if they are "safe"...or just safer then regular cigarettes but for me they are cheaper (good e-cig cost $50-70 for unit and liquid another $10-20 and will last you close to 3 months), have less stigma attatched, and I can still smoke them in bars or places the state has banned cigarettes.

I've often wondered if they could be proven safe if they might be more effective then the patch for patients in LTC that have smoked all their lives and now have to quit plus the added benefit of no lighters or open flames.

For those interested, I feel 100% better..can breathe again and regular cigarettes taste like cellophane wrapped mouse droppings lit on fire the few times i relapsed.

Tait, MSN, RN · Jul 29, 2011

1. Nicotine patch (I love the patients that tell me they are "allergic" to them, or the guy that told me they gave him "nightmares". Oh and cigarettes don't?)

2. Let security escort them back to their room.

psu_213, BSN, RN · Jul 29, 2011

For the ED: we will not in any way assist them outside. If they are a walkie/talkie they may lose their place in line to be seen, but, otherwise, if they are an adult they are free to do whatever they want. If they are gone long enough, they would be considered an 'elopement' and they would have to re-check in to come back.

merlee · Jul 29, 2011

Most places have a policy about allowing patients off the floor. Find yours. And many require a doctor's order. If the patient is adamant about leaving the floor unescorted, they may be ready to go home (they think!). Ask if they would like to sign out AMA. And tell them if they leave the floor unescorted, that you may have to remove their IV before they leave, and will replace it when they come back. According to facility policy, of course.

But you probably need that MD's order!

Best wishes!!!

MelEpiRN · Jul 29, 2011

Yup, check your policy. It may be considered AMA/ elopement if the patient leaves the floor.

I learned the hard way...it's just not worth it to have a patient start screaming at you because you tell them they can't leave. Disconnect the IV and let them go. Let the MD know and document it.