"Mrs Smith, in room 702, admitted with COPD and pneumonia was caught smoking in the bathroom of her hospital room last night."
The goat rodeo of American medicine continues... The greatest thing in Happy's hospital was creating a hospital smoking ban policy. We now have smoking bans in public beaches and parks. Of course we should have hospital smoking bans, especially in the hospital rooms. I haven't had a single argument with a patient, in over a year, about allowing them (as If I'm their father) to go out and smoke. Especially now that hospital acquired fires/burn injuries are a never event. If you're healthy enough to smoke, you are healthy enough to go home. My vote is for discharge. What would you do?
I did something similar when I attended on a long-term psych ward. Patients would occasionally c/o chest pain or other cardiac/pulm syxs. I took away their cigarettes and told them they could have them back when their symptoms were gone. This resulted in a high cure rate.
ReplyDeleteWe have a no smoking campus also. I'm on a large medical campus consisting of 2 large hospitals, several offices, and a few other buildings. The entire campus is non-smoking and security from all facilities are good at enforcing it.
ReplyDeleteI've never seen anyone pitch a fit if explained this and offered nicotine replacement. I have seen a few people leave AMA because of it.
I would promptly place their chart in the "GTFO" rack.
ReplyDeletePage me when you make all your patients with BMI >30 NPO...
ReplyDeleteYou got beat up alot as a kid, didn't you??
Frank
I had a pt sneak out to smoke and get a nice little shot of heroin at the same time. She was admitted for a large MRSA abscess compliments of IVDA. I caught her myself. Watched her smoking from the window and was shaking my head, then saw her friend pull up and give her a dose. I just let her know that the heroin interfered with the morphine I was giving her and until she was clean I would have to be super cautious with other narcotics. She left AMA.
ReplyDeleteMy hospital has smoke free policy. If the nurses report smoking patients to me, I advice my patients , as their physician that it is in their best interest of health not to smoke. Then I tell the nurse taht I have adviced the patient not to smoke, if the patient continues to smoke within the hospital premises, please report it to the hospital supervisor, who can report it to the hospital security, who can choose to call the cops if the patient continues to endanger other patients by causing fire hazard in the hospital. But I will not spend another second to chastize them for their actions, it is a collective responsibility. I am not their father, I am not the CEO of the hospital, I am not the security in charge, I am not the senator.... I am just a hospitalist who looks out for your best interest.
ReplyDeleteMy theory is that if they're well enough to walk out to smoke, they're well enough to walk out the door discharged. But I'm just a nurse...
ReplyDeleteIt's hard at my facility though because once you walk out the doors you're on city streets (no big sprawling campus for us) so that a no-smoking policy is hard to enforce.
I work in drug and alcohol inpatient unit. I advise them not to smoke. I tell them that they have access to patch and nicotine gum and well as the counselors. A lot of the patients on the floor are on medications for sleep. The staff will do room searches for nicotine contraband and if found confiscated. Random nicotine breathalyzer test are held on unit. I will usually order it 2 hrs after meals. Or randomly in morning before AM meds. If levels of nicotine are consistent with use nicotine replacement is withheld until levels return to baseline. There sleep med will be held. Patients by then are irritated. Usually yell and screen. I have advised staff to discharge those patients after one warning. My original recommendations are to discharge patient based on my original evaluation.
ReplyDeleteIf they get angry and they do, I tell them we would hate to lose you as a patient but if your not happy with the care you should leave.
I have also held sleep meds such as benadryl or trazodone if there using nicotine on the unit in addition to nicotine replacement. Surprisingly the staff have allowed the smoking on inpatient chemical dependency unit to continue. At $900/day per patient for 21 day program, hospital does not want to lose money. This has been a effective deterrent to nicotine. We have had less incidents of nicotine use on unit.
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