patients smoking

[spitfire]

We had an issue tonight and was interested in how others deal with patients being allowed to go out to smoke cigarettes, usually patients are offered a nicotine patch and are told our hospital is a non- smoking facility,I believe here it is a state law also. Today a patient was permitted(by the nurse manager) to go outside-with a staff member to smoke every 4 hours, he is being treated(antibiotics-I&D-dressing changes) for an infected AC from using needles. Well 4 hours turned into when ever he wanted and then he was outside in someones car smoking, when I went out to ask him to come back into the building he went off on me. Now I realize- after he elaborated on his drug abuse - that he is going through heroin/ oxycontin withdrawl and the issue for now is resolved.Does anyone here permit patients to go out to smoke with a staff member or how do you deal with these issues. There was not a written order for him to go out but I was told the MD said it was ok and to leave his nicotine patch on too.

[bargainhound, RN]

nicotine patch in place and continued smoking can cause heart attack...I am surprised physician okayed that.

[hogan4736, BSN, RN]

We have a 27 year old quad (some left hand use, enough to use the remote control and smoke) who is in a HEAVY sand/waterbed...He just had a skin graft placed over a stage 4 left hip ulcer...He insisted on smoking, so 3 of us wheel him out to the smoker's patio...

Live and let live! (except when on cannulated oxygen...it will blow up in the face while smoking!!)

sean

[SJSU_Mami]

There's only so much we can do to persuade people to live healthy lives.. what they do with that information is all up to them. He's heard the smoking is bad for you lecture tons of times. We can suggest, ask, educate, and explain, but we can't force..

[Spidey's mom, ADN, BSN, RN]

We are struggling with the same issue. The "rule" is that the patient is told on admit that we are a non-smoking facility and that they may have a nicotine patch. But there are exceptions, especially on night shift when there is no administration or physicians around.

I say if you are well enough to go out and smoke, you are well enough to go home.

And you should never smoke and use the patch. Big no-no.

steph

[nialloh, RN]

In my hospital, pt's are told on admit that there is no smoking. We had one pt who wouldn't accept that, and was constently yelling at staff who told her no. On day 3, her Dr was on the floor and heard her carry on. He went into the room and gave her a lecture on how to treat a nurse and then discharged her.

[Nursie30]

Well I remember the days we could smoke in our hospital rooms..... I think that hospitals should offer them a place to smoke and let them smoke......Pts are nervous in hospitals and feining for a cig for a day or a week doesn't help the nerves much.... But then again, I ALMOST quit when I was in the hospital becuz I decided to not go outside and just see if I could do it, if a patch was offered I probably would have quit smoking and been a lot healthier, so who knows?

[sixes]

I work in a LTC faciltiy

We have a smoke room that is open 4 times a day and smoking is supervised on monitors

We can only do so much teaching

Some of our residents have smoked for over 5o years and probably won't live for more then 1-5 years, even though most of them are on inhalation therapies and O2 nothing is going to stop them at this point in time

[spitfire]

What is the legal aspect of a pt going out to smoke and falling- or using drugs - this pt had IV access and was not asking staff to go out with him, he is a know IV drug user and is being treated for a raging infection. I feel set up by the nursing manager in that the staffs safety was not considered and if something did happen my licence would be brought in to question.

[Havin' A Party!, ASN, RN]

Regarding SJSU's point, it also cuts to the many nurses we all might work with that leave periodically for their smoking break?

Obviously a hard habit to break.

[purplemania, BSN, RN]

must be great to have enough staff to accompany people outside in order to perform a task that is life-threatening. Sounds weird to me. We offer patches. No one, not even employees, allowed to smoke on campus anywhere. If patient insists, we call MD and get order for DC or they may go AMA, but we do not promote smoking.

[Rapheal]

We have a smoking area for visitors and employees but I have never seen an order to allow a patient out to smoke nor do we send staff out with a patient to allow them to smoke. I just tell them that we discourage smoking because of the health risks associated with smoking and also our concern for the safety of said patient because they will be ambulating (by foot or wheelchair) without supervision. When they argue I tell them that although I would suggest they do not go out I can not make them stay in their room. If they choose to go out I document it thoroughly and inform the house doctor. Let the doc decide to discharge them if they want. I can't keep them a prisoner- but I never give them permission either.