Smoking and Oxygen policy

[AKRN63]

Wondering what your agencies' policies are with respect to patients smoking in the home with oxygen present? The agency I'm currently working for allows this as long as they 1) have been educated re: risks and 2) don't smoke with oxygen present. The last agency I worked for would not take patients who smoked and had O2 or would discharge for cause if patients were educated on risks but continued to smoke.

[caliotter3]

I remember, as a student, being alarmed when a client smoked in her chair next to her oxygen tank. Got out of there as fast as I could. Supervisor told me all about non compliance and providing education and thorough documentation. Didn’t quell my misgivings at the time.

[amoLucia]

Fire safety issues aside, it must be remembered that it is the pt's home. Regardless of whatever WE perceive as right or wrong, the issue is at the pt's level.

It must be remembered also that homes have stoves with flames in spite of O2 tanks. Should home cooking be restricted at these oxygen pts' homes? Well???

Or maybe might there be some realllly deeply hidden discrimination against the pt's smoking habit that is really at the crux of the matter??? Like some indignant reason that NOW is the time of all times to stop smoking?

Methinks this mentality might have some truth. JMHO

[AKRN63]

amoLucia if you re-read my post you'll see I was asking a question about policy - not stating my opinion, nor asking for yours. I requested information about policies because opinions - fortunately - no longer guide nursing care.

[Val_998, BSN, RN]

On 6/13/2020 at 5:45 PM, amoLucia said:

Fire safety issues aside, it must be remembered that it is the pt's home. Regardless of whatever WE perceive as right or wrong, the issue is at the pt's level.

It must be remembered also that homes have stoves with flames in spite of O2 tanks. Should home cooking be restricted at these oxygen pts' homes? Well???

Or maybe might there be some realllly deeply hidden discrimination against the pt's smoking habit that is really at the crux of the matter??? Like some indignant reason that NOW is the time of all times to stop smoking?

Methinks this mentality might have some truth. JMHO

You are not looking at this from the perspective that the OP is asking. This isn't about some ethical dilemma or hypothetical situations (pt's don't hold their faces up to flaming stoves while wearing cannula)

I had a pt once who smoked at home, and was O2 dependent. I was a newb and was still precepting. Turns out, our policy was a 3 strikes rule, education and reeducation, then ultimately discharge for noncompliance with instruction as this becomes a safety risk for more than just the patient ie visiting staff, family members etc.

Even more importantly, he lived in an apartment building. Well guess what, it exploded in his face, injured him, lit the whole floor on fire, whole building had to be evacuated and several others were injured. We all got in BIG trouble for not following policy, on top of that for not informing building management.

All it takes is one cigarette with the cannula on. I stand by the policy of your last employer.

[NRSKarenRN, BSN, RN]

Some resources for you.

Home Oxygen Therapy and Cigarette Smoking: a Dangerous Practice.

Oxygen Safety Webinar - The Joint Commission

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How are we supposed to notify Medicare when there is non-compliance?

Answer: Your responsibility is to notify the prescriber, I.e. the physician or health plan case-manager that the patient was engaging in a high risk behavior. It is important to document this discussion and revise the patient’s plan of care so that the team knows what interventions to use to mitigate this risk. Don’t forget to evaluate the effectiveness of these interventions and document that as well.

https://www.jointcommission.org/-/media/tjc/documents/accred-and-cert/ome-and-phmcy/092514_oxygen_safety_webinar_qa-finalpdf.pdf?db=web&hash=AB376E17FAD8CFCC56CE894815C49F59

 

Oxygen Safety Agreement

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My prior agency used a patient agreement similar to this one to document patient education and no smoking with patient/caregiver signature. In addition to notifying PCP, insurance case manager, also notified DME company,  local fire department -especially if no smoke detectors found.

We usually only discharged  when O2 dependent with smoking in bed identified unless high risk situation noted.

Smoking and Oxygen - Pikes Peak Hospice and Palliative Care

Fundamentals of Oxygen Safety and Management in Home Care and Hospice

 

[vampiregirl, BSN, RN]

The hospice I work for allows smokers with oxygen to be admitted. This is assessed for and discussed upon admission. We implement several items to the care plan including assessing for safety risks every visit and education. Prescriber must be notified and updated if risks identified. Another tool we use is any oxysafe device - there are several different brand names I believe. The nice thing is these devices can be used in the place of a standard tubing connector so they are not hard to place. We have not had anyone who has flagrantly disregarded our smoking safety concerns (since I've been here - going on 2 years now) so I'm not sure what the outcome (regarding discharge) would be. We have had to instruct some caregivers to keep possession of smoking materials unless patient is being directly supervised with condition decline, patients weren't happy but agreed. 

While this device doesn't eliminate the potential risks to the smoker, it does help to reduce to the risk of fire spreading and to other occupants.