The importance of a smoking policy
Betty Norman, BSN, MBA, CPHRM
In one case, a resident told staff he was going outside to smoke on a windy day. A nurse observed him attempting to pick up a cigarette and tried to convince him to go in the building to smoke instead. He refused. The nurse handed him the cigarette and went indoors. Just five minutes later, aids noticed smoke outside the building and found the resident covered in flames. After suffering second and third degree burns, the man passed away.
In another incident, an assisted living resident deemed appropriate to smoke unsupervised was smoking outside her building and was not wearing a smoking apron. Cigarette ashes lit her clothing and nurses could not reach the patient in time. Her wheelchair was blocking the fire extinguisher.
In response to these and other fatalities and injuries caused by resident smoking fires, the Centers for Medicare & Medicaid (CMS) has been re-evaluating smoking policies—from the screening of patients' supervision limits to the locations of designated smoking areas. In its most recent evaluation conducted in November 2011, CMS highlighted the need to closely review smoking safety policies and practices (found at 42 CFR, Part 483.25 (h), F323, Accidents and Supervision.)
In short, CMS said an organization should assess each resident's capabilities and deficits to determine whether or not supervision is needed when they smoke. Those deemed incapable should have this documented in their care plan and updated when their plan changes. In addition, policies should detail the methods by which residents are deemed safe to smoke without supervision.
Senior living facilities must recognize smoking is a high-risk activity and closely evaluate their existing resident smoking policies and procedures. We recommend the following safety guidelines:
- When clients/residents are admitted, assess their smoking history and habits.
- Develop written policies. Well-defined policies can guide behavior and assure a consistent approach.
- If you allow smoking, consider a policy to protect residents and staff who do not smoke from secondary smoke. The Center for Social Gerontology (www.tcsg.org) has sample policies when establishing a smoke-free environment,
- Identify designated smoking areas in the residential setting and ensure their safety by including protection from weather conditions, protection of non-smokers from second hand smoke and easy accessibility to fire extinguishers.
- Identify those individuals who require supervision when smoking, and limit access to cigarettes, matches and lighters for those residents who need supervision.
- If you allow residents to smoke, make smoking aprons available for their protection.
- Prohibit oxygen use in areas where smoking is allowed. An oxygen-rich environment facilitates ignition and combustion of any material, especially smoking products such as matches and cigarettes.
- Provide ashtrays made of noncombustible material in smoking areas.
Most importantly, enforce these guidelines within your facility at all times. According to the National Fire Protection Association (NPFA), persons 75 and older are three times as likely, and persons 85 and older are four times as likely, to die in a fire than younger adults. Closely evaluating your existing policies and procedures for resident smoking can help ensure resident safety.
Betty Norman, BSN, MBA, CPHRM, is Risk Control Director at Glatfelter Healthcare Practice.