A resident has a wound that he claims is related to a cigarette burn that occurred a couple of weeks earlier. When asked about it, he said that his cigarette (which he called a cherry) rolled off his protective apron and fell into his shoes. However, the resident was seen right after the incident happened and no wound was noted. The resident has a history of picking at wounds; so, he may have received a slight burn from a cigarette which he irritated and made worse by picking at the area where the cigarette fell. The RNAC looked at the wound and said that it did not look like a wound from a burn.
The resident’s physician assessed the injury and provided orders to treat the wound. Staff will monitor the resident for pain every shift; evaluate his skin, track his bodily functions, monitor his food and fluid intake daily and weigh the resident weekly. The resident’s care plan will be reviewed for additional smoking safety that will include having two aprons on to cover him completely. A person will be assigned to sit next to the him during the smoking break and to check his clothing and shoes after the break. The resident will also be assessed regarding his ability to alert the staff of his needs.
Residents and family members will be updated about interventions taken by the facility regarding smoking to ensure the safety of all residents. All residents will be required to wear smoking aprons when on a smoking break.
Staff will receive education on the facility’s wound and skin policy. The smoking area will be cleaned daily and will be audited daily to ensure that a Fire Extinguisher and Fire Blanket are accessible during smoking breaks. Staff will assist residents with cigarette extenders, and the facility will assure that there are an adequate number of staff to monitor smokers in the smoking area.
The facility will perform a chart audit for risk assessments prior to injury, and risk assessments will be revised as needed. The facility will perform audits of the TAR, 24-hour reports, incident reports and grievance logs with the goal that no new injuries from cigarette burns would be revealed. Completed audits will be summarized and submitted to QAPI for review and recommendations.
