Protecting patients from themselves...

Nurses Relations

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I had a patient who had just come back from and angiogram and was on the flat bedrest until 2000. At 2001 she announces to me that she is going down for a cigarette, at which point I suggested that she needed to stay on the floor at least a few more hours so I could monitor her groin site and pulses. Pt stated she didn't want to wait to long since the doors would be locked and stated she would take a wheelchair. I told the patient I would be more than happy to call the MD and get a nicotine patch but that I really didn't feel comfortable having her leave the floor. She refused the patch but did not leave the floor to smoke.

My question is, how far do we have to go to protect patients from themselves? I understand if they are confused or disoriented and I realize smoking is an addiction...but when should their common sense kick-in? Has anyone else had this type of problem or an I just burning out? :confused:

This is a neverending issue. Just last night I had a 19 year old who was admitted for abdominal pain. She does have Chron's. Anyway she was started on a PCA on admission. Well, her mother called the next day and explained to the doc that her daughter is a drug abuser and she has kicked her out. Her mother actually works at the hospital. Anyway the doctor really gave it to the patient. Dc'd the PCA but we are still giving IV Demerol. There are social serivce issues so she can not be dc'd yet. Anyway she is a clockwatcher and whines all the time. Rates her pain at a 10 no matter what. Last night her friend came and they got all ready to go outside. I was like absolutely not!!! If your pain is still at a 10 and you need this Demerol around the clock there is no way you are going out to smoke. She was so mad!!! I did not care. I am so sick of this. Her friend comes and she is cured!!

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We are not smoke free on the premises, (yet) but we do have a smoking policy form they must sign if they have orders to NOT smoke and do so anyways. Also covers removal of risk from us...that we are NOT liable for their noncompliance in any way and are NOT to escort them out of the hospital to smoke.

Someone post angiogram who got OOB and outside against orders... I would be tempted to document as AMA. But if they bleed and come back to the unit, (and I know they do) it's a hassle..... (sigh)Hopefully a nurse has done her/his CYA CYA CYA.

I know doctors and facilities tend to want to hold us responsible for everything but some pts just will not listen. A reason I like critical care is I have standing orders to sedate IV to maintain bedrest post arteriogram PTCA/sheaths, and my docs support it for safety. I also use family to supervise whenever possible.

I admit I tell horror stories to patients and families..of patients needing transfusions and surgical repair of their femoral arteries (risk of death if not caught quickly) to get them to see the seriousness of noncompliance.

I know I would not be patient enough to deal with this smoking issue on the floors so my sympathies are definitely with those of you who do. I would push for policies that protect the nurses from liability, if there are none in place.

Dontcha all hate the noncompliant frequent flyers?? Wish we could keep a list at the ER...and just turn them away...GRRR. Seems a waste of nursing and medical resources sometimes....

One reason why our insurance rates are so blasted high is the treatment and retreatment of irresponsible healthcare consumers. Personally I think THEIR rates should go up, not mine But it just don't work that way, we ALL pay in America. :(

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i love when patients on tele want to leave the floor and go smoke....they say "im going to go smoke" and what can you say "i cant stop you from smoking because the hospital isnt prison; but i can tell you that i dont reccomend it and the heart monitor doesnt pick up off the floor so we cant see if something happens" then the doctor writes an order "NO SMOKING" and orders nicotine patch...

i love when the patient takes the patch off and goes downstairs to smoke and comes back and puts the patch back on!!! a r/o MI patient!!

~yanks out all her hair~

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Originally posted by mattsmom81

Dontcha all hate the noncompliant frequent flyers?? Wish we could keep a list at the ER...and just turn them away...GRRR. Seems a waste of nursing and medical resources sometimes....

One reason why our insurance rates are so blasted high is the treatment and retreatment of irresponsible healthcare consumers. Personally I think THEIR rates should go up, not mine But it just don't work that way, we ALL pay in America. :(

No kidding. I worked at a clinic where if they had repetitive drug seeking we put a sticker of an airplane on their chart and they were sent a letter saying they had 30 dayss to find another provider. We would often call pharmacy's before giving scripts to find out if they were filling mx. scripts from different providers.

Speaking of a lousy system....how about the fact that your tax dollars are paying prescription junkies to stay out of work on disability when many of them are just sucking up healthcare dollars. To top it off your next patient is a LOL who had an MI or is hyperglycemic b/c she can't afford her meds and she worked her whole life. GRRRRRRRRR

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