Patient's rights dilemma

[newgraduategal]

We have a pt. Because of pt condition, the MD advises pt not to smoke.

To make a long story short, the manager pt not to smoke and reminded the charge nurse to make sure that pt is not smoking because of the complication of smoking to health.But a few days later, pt was seen smoking.

Is it really a patient's bill of right to do whatever they want to do while doing something that is risking their health?

[Kyrshamarks, BSN, RN]

Smoke free places can enforce for their employees, but not for patients. The hospital cannot threaten to discharge them AMA. That would be a MAJOR EMTALA violation if they did discharge a pt for smoking. Nor can they consider them AMA if they leave the grounds. Only if the patient abandons their room and leaves without the intention of returning, can the pt be discharged AMA, if they intend to return, you cannot discharge AMA.

[JustBeachyNurse, LPN]

Smoke free facilities designated by fire Marshall, state or municipal regulation can be enforced to staff, visitors & patients. I've seen it done, most often by fire Marshall.

It's a fallacy that insurance will refuse to pay for the entire stay if you sign out AMA. Insurance is obligated to pay until you leave or are discharged assuming the stay was covered in the first place.

[imintrouble, BSN, RN]

The whole no smoking policy makes my job 100% harder.

Added to everything else I have to do, is the repsonsibility to babysit somebody who wants to sneak outside to smoke.

I hate it. I wish they'd just remove the whole no smoking thing for the patient.

I can't tie them to the bed. I can't physically stop them from leaving the unit. I can't take their lighter and smokes. I can't even keep them out of the bathroom if they choose to smoke there. Patients who have a lot of experience with hospitals, know we can't stop them. It just makes me feel stupid spouting theats the patient knows we won't enforce.

[SionainnRN]

Smoke free places can enforce for their employees, but not for patients. The hospital cannot threaten to discharge them AMA. That would be a MAJOR EMTALA violation if they did discharge a pt for smoking. Nor can they consider them AMA if they leave the grounds. Only if the patient abandons their room and leaves without the intention of returning, can the pt be discharged AMA, if they intend to return, you cannot discharge AMA.

How is it an EMTALA violation? That is for ERs.

[MissyWrite]

If there is an area designated for smokers...whether on campus or right off, pt's do have the right to smoke. It is not illegal to smoke and he is within his rights under the law to say I am going to smoke, as long as it is where the fire marshall or law allows it. ie. such as not in buildings ect. The hospital cannot kick him out for smoking...

^^ THIS^^

[MunoRN, RN]

How is it an EMTALA violation? That is for ERs. This pt is in a SNF.

EMTALA starts in the ER (usually) but actually continues throughout their hospitalization and even to a transfer to a SNF or ECF if the patient requires ongoing continuous care to avoid an imminent harm. Typically that wouldn't actually apply to the patient described and the patient could be discharged for violating facility rules without it being an EMTALA violation.

Excuse my assumptions, but this patient sounds suspicious for someone who's developed endocarditis related to IV drug use (Hx hep C combined with endocarditis). If that's the case the whole reason we usually send these patients to an ECF or SNF isn't so they can get their antibiotics since there are other ways of doing that, but it's usually to ensure the patient is supervised to some degree (A PICC in an IV drug user is a risky combo). So quite often the rule is that they can't go outside unsupervised, if they can't follow that rule then in my experience they are at risk of getting discharged after the PICC is removed and may also no longer be a candidate for a new valve due to compliance concerns.

[newgraduategal]

Thanks for all the information! Very much appreciated.:thumbup::)

[firstinfamily, RN]

As stated above it is a patient's right to smoke, drink, whatever. The facility cannot kick him out for smoking even though it is a smoke-free facility. If smoke-free was endorsed for the employees as well as the patients then that might be a different issue. However, because employees are smoking how can they enforce the patient does not smoke?? If he refuses to comply with medical treatment he can chose to go home AMA, however, even with this there needs to be some conversation with the MD about what choices the patient has. The patient can refuse any medical treatment at any time unless he is not his own responsible party.

[tyvin, BSN, RN]

EMTALA starts in the ER (usually) but actually continues throughout their hospitalization and even to a transfer to a SNF or ECF if the patient requires ongoing continuous care to avoid an imminent harm. Typically that wouldn't actually apply to the patient described and the patient could be discharged for violating facility rules without it being an EMTALA violation.

Excuse my assumptions, but this patient sounds suspicious for someone who's developed endocarditis related to IV drug use (Hx hep C combined with endocarditis). If that's the case the whole reason we usually send these patients to an ECF or SNF isn't so they can get their antibiotics since there are other ways of doing that, but it's usually to ensure the patient is supervised to some degree (A PICC in an IV drug user is a risky combo). So quite often the rule is that they can't go outside unsupervised, if they can't follow that rule then in my experience they are at risk of getting discharged after the PICC is removed and may also no longer be a candidate for a new valve due to compliance concerns.

MunoRN quote from above pp "...endocarditis related to IV drug use (Hx hep C combined with endocarditis)."

Forgive my ignorance; how do you know this gentleman acquired HCV via drug IV use?

[TheCommuter, BSN, RN]

Forgive my ignorance; how do you know this gentleman acquired HCV via drug IV use?

I'm assured he doesn't know for certain that the patient contracted HCV through intravenous drug use, but he said that the patient sounds suspicious for one who's developed endocarditis related to IV drug use combined with the HCV+ history. Based on the patient's behaviors, I'd have to agree.

[AdamantiteEnigma]

MunoRN quote from above pp "...endocarditis related to IV drug use (Hx hep C combined with endocarditis)."

Forgive my ignorance; how do you know this gentleman acquired HCV via drug IV use?

No one knows for sure. But it's very likely that is the case based off of the history. I'm guessing based on what I've seen so far in my experiences that would be the case also. So, reasonable and highly probable assumption I guess.

[kool-aide, RN]

If your facility is smoke-free, he has no right to smoke there. End of story