Many communities around the country are “smoke free” but we have discovered that “smoke free” varies from one community to the next.  For some communities smoking is strictly prohibited on the physical property while to others it means there is no smoking indoors.  What does “smoke free” mean to you and your community?

On November 4, 2011 CMS issued a memo that discusses the risks associated with smoking and the expectations regarding how we as providers maintain safety for our residents.  The federal regulation F323 discusses accident prevention, supervision, safety and resident well being.  The goal of this regulation is to maintain resident safety through assessment and policies/procedures that meet or exceed the industry standard.  The CMS bulletin Ref: S&C: 12-04-NH clearly outlines the facility obligations:  “facilities must include assessment of smoking areas and provision of emergency equipment in the designated smoking areas.  Facilities should also document the means by which individual residents are assessed as safe to smoke without supervision.”  Known hazards include oxygen use and smoking.

• What is your community’s process for determining if a resident is at risk? 
• Do you assess cognitive ability, judgment, manual dexterity and mobility? 
• How often is each resident who engages in smoking activities assessed?
• Are residents required to leave smoking paraphernalia at the nurse’s station or in a supervised, secured location (not in their private apartments/rooms?)
• Is there a process in place to prevent residents from entering designated smoking areas with oxygen tanks and/or tubing?
• Has your facility purchased a smoking genie or similar ash receptacle that self extinguishes smoking materials when dropped into the decanter?
• Is your designated smoking area posted clearly so there is no confusion as to where a resident/guest may engage in smoking activities?
• Are your residents protected from weather conditions while in designated smoking areas including the hot summer sun?
• Does the designated smoking area have portable fire extinguishers, smoking aprons and noncombustible, self closing metal containers for emptying ashtrays?
• In the event of a fire is the smoking area equipped to extinguish the fire quickly, preventing loss of life? 

HealthCap Risk Management reminds you to review your current process to determine if you have appropriate policies and equipment in place.  Residents are not static their status may change quickly and often go unnoticed.  The old adage “rules are made to be broken” often applies so are you monitoring your systems through the Quality Assurance Committee to ensure compliance? 

Remember, residents live in our communities for various reasons, but most often due to their inability to maintain personal safety outside of a structured community.  Please set aside some time to discuss this “hot” topic at your next stand up meeting.  Take a walk around your property and observe for

evidence of unsafe smoking (i.e., burn marks on furniture, burn holes in resident clothing, cigarette butts outside the designated smoking area, etc.)   Only you can prevent unsafe smoking in your community, stay the course, empower your staff to enforce the facility policies and as always, if you need additional resources feel free to contact your  HealthCap Risk Manager!  Thanks and be safe!