No Smoking Protocol in Hospitals

Many hospitals enforce a smoking protocol. Frequently, signs are placed around the property declaring the hospital a tobacco-free facility. Some hospitals allow smoking in specific areas, such as smoke huts or in personal vehicles. This seems largely accepted by the general public, and most people have come to expect this of hospitals in general. However, to some areas of the US, this is a new rule. And it is not embraced by the surrounding population.

Smoking: Still the Leading Cause of COPD

According to a web-based survey released by the National Heart, Lung, and Blood Institute of the National Institutes of Health, COPD (chronic obstructive pulmonary disease) was recognized as the nation’s third leading killer in 2011We now know that smoking contributes materially to the development of COPD in men and women. Therefore, numerous hospitals chose to enforce a tobacco-free environment. While this facility-initiated protocol protects patients and employees alike from the effects of cigarette smoke, it isn’t accepted in areas of the country where smoking is commonplace.

The facility in which I work recently initiated a no-smoking protocol. I live in an area where smoking and drug use is an epidemic. More than half of the patients I serve in this hospital habitually smoke. Most have similar medical histories that include COPD, PNA, CAD, MI, and CVA. In consequence, hospital readmissions concerning these ailments are on the rise. In order to protect their financial base, Medicare and insurance companies began cutting benefits paid to hospitals for readmissions. This contributed significantly to our hospital becoming a tobacco-free facility.

Full Enforcement of The No Smoking Policy

Our hospital didn’t merely place signs around the premises directing guests and patients to a designated smoking area. Smoking huts were torn down. Guests are allowed to smoke in their personal vehicles off the main hospital property. Patients are not allowed to smoke at all and are given nicotine patches as part of their hospital medication regimen. Patients and their families are educated about the new protocol on admission to the hospital. All patients that are admitted with a history of tobacco use are given printed information about the benefits of quitting, and tips to help stop smoking.

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I’m sure you’re wondering how we prevent patients from smoking. The protocol states that patients are not allowed to leave their hospital unit for any reason, unless a doctor’s order is obtained and placed in the patient’s medical record, allowing the patient to visit the cafeteria, gift shop, etc.

Image via: amsvans.com
Image via: amsvans.com

Security officers regularly patrol hospital property looking for people smoking against policy. If a patient is caught smoking, administration, as well as, security intervenes and the patient is educated again about our no-smoking policy and the dangers of smoking inside the hospital. If the patient continues the same behaviors, he or she is asked to leave the hospital. Guests at our facility are also re-educated about our policies. If the behavior continues, guests are asked to leave the hospital premises and are redirected to their personal vehicles.

At times, there has a been a guest that has refused to comply with the protocol and leave the area; the local police department had to get involved at that point. If the patient is allowed to leave the floor, they have a strict time limit. If the patient does not return within the time limit, the doctor is notified. The doctor may then discharge the patient from his or her care. If a patient leaves without permission, they are considered to have left against medical advice (AMA) and may then be discharged from the hospital. Said patient must be readmitted through the ER.

Not A Welcome Change

As you can imagine, this caused an uproar with patients and guests alike. One issue of concern is the number of patients smoking in hospital bathrooms or patient rooms. Obviously, this is a huge safety concern requiring close monitoring by already-overworked nursing staff. I’ve been asked how a hospital can restrict a patient to their assigned unit or effectively enforce a no-smoking policy throughout the facility. On numerous occasions, Hospital Security becomes involved when a patient or guest becomes irate and threatens medical staff.

Now more than ever, the staff are subject to threats and violence from patients and visitors. Instead of promoting a safe work environment for staff, at least initially, the protocol has done the opposite. Eventually, the uproar will abate. Patients and guests will become accustomed to the protocol, leading to a safer environment for staff and patients. Until then, we continue to face issues with patients and visitors opposed to the new policy.

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The Joint Commission provides a guideline on their website containing tips for keeping hospitals smoke-free. In the article, it is suggested that hospitals take a firm, but flexible approach to the initiation of a no-smoking policy. My facility has taken this advice and has remained as respectful as possible to guests and patients. Oftentimes, guests that are politely redirected to other areas, leave the premises and are compliant with the protocol. It will simply take time for this change at our hospital to become well-known and accepted by the surrounding population.

Is there a similar controversial protocol where you work? Do healthcare personnel really have the right to ban patients from leaving the hospital to smoke?

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