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Betty Frandsen | Mar 18, 2015
Although our facility is designated as “smoke free,” we were cited at a high level for unsafe smoking on our recent survey. A resident deemed independent was smoking outside without supervision or a smoking apron in an area not approved for smoking. The citation said our assessment of this resident was not current, the care plan was inadequate regarding smoking for five residents, and we were not able to show that new admissions understood that we are a smoke free facility. Please share our story and tell others what the Department of Health expects. Thank you.
Smoke Free and Still Cited
Dear Smoke Free,
Thank you for your comments. Smoking presents a potential serious problem in nursing facilities, even when designated as a “smoke free” setting. Residents with “grandfathered” permission continue smoking despite the decision not to allow smoking for individuals admitted after a selected date. Many residents have smoked for most of their lifetime, and now experience declining physical or mental status that makes smoking inadvisable. The United States Fire Administration determined that the older adult population represents the highest fire risk group in the United States, with a risk more than twice the national average, and that increases to three times the average in persons 75 and older, and four times the average for individuals 85 and older. Residents who smoke and do not adhere to safety policies present a significant risk. As providers of quality care, we are obligated to establish and enforce safe smoking rules and practices.
CMS released an alert on November 10, 2011, titledSmoking Safety in Long Term Care Facilities,which includes the following summarized recommendations:
Designate safe smoking areas which include protection of smoking residents from inclement weather, and protection of non-smokers from second hand smoke. Each smoking area must include safe, non-combustible ashtrays and metal containers with self-closing covers into which the ashtrays can be emptied. Portable fire extinguishers must be available.
Allow smoking only in designated areas.
Prohibit oxygen use in smoking areas.
Assess each smoking resident’s capabilities and deficits to determine if supervision is required. If a resident is deemed capable of independent smoking, document this in the care plan and other designated location so staff know the correct procedure for each individual. Keep this information current, and update if the individuals’ capabilities and needs change. Err on the side of caution when unsure if the person can be designated as a safe smoker.
Supervise residents whose assessment and plans of care indicate a need for supervised smoking.
Limit accessibility of matches and lighters by residents who need supervision when smoking.
Revise facility policies to describe the methods by which residents are deemed safe to smoke without supervision, including review of their cognitive abilities, judgment, manual dexterity, and mobility.
Be ready to provide surveyors with documentation of the assessment that resulted in a resident being permitted to smoke without supervision.
Inform visitors of smoking policies and hazards and enlist their help in preventing smoking incidents.
Electronic cigarettes are not considered smoking devices, and their heating element does not pose the same dangers as regular cigarettes.
For more information on this topic, you can obtain the full CMS memo fromwww.aanac.org by visiting “What’s New,”Smoking Safety in Long Term care Facilities Alert, 11/11. Also, review F323 Accidents and Supervision in the State Operations Manual, Appendix PP. ~ Betty
Betty Frandsen RN, NHA, MHA, C-NE has worked in long term care for over 30 years, including 14 years as aDirector of Nursing, and as an Administrator in both Pennsylvania and New York. She served as Vice President of Education and Regulatory Affairs for AANAC, and is a past president of NADONA/LTC.
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