Resident smoking is a high-risk area. When staff are required to supervise residents who smoke, they should know the residents’ individualized plan of care. Staff will need to observe the resident during the entire time it takes for the resident to smoke. Once the resident has finished, the staff member should inspect the item smoked, as well as the resident, and report any negative findings to the nurse. In this situation smoking the cigarette down to the filter placed the resident at risk for burns. In addition to fire safety, staff should receive training on how to inspect the smoked item and the resident for issues that would require re-assessment or further interventions. Staff should be trained on how to address a resident who refuses to follow his/her smoking care plan. Additionally, this training should include any historical issues that happened in the facility related to resident smoking that will increase staff awareness and oversight and ensure resident safety.
I. Risk Exposure:
A resident who is a supervised smoker was noted to have burns between his fingers. The resident has had a safe smoking assessment and was designated to have a smoking apron during smoking. The resident does smoke daily with supervision; however, he frequently smokes cigarettes down to the filter.
II. Potential Reason:
Although the resident is supervised, it is difficult for the staff member who is supervising multiple resident to ensure that the resident is not smoking the cigarette to the filter, and thus risking burns.
III. Mitigation Strategy:
A cigarette holder was purchased for the resident to ensure that when he smokes the cigarette too close to the filter, he will not burn his fingers. This resident’s safe smoking assessment will be reviewed to determine it is still accurate. Other residents who smoke will have their safe smoking assessments reviewed as well. Also consider doing hot liquid assessments as needed for residents who consume hot liquids without staff assistance, as it would fall into the category for review during a complaint survey for burns.
IV. Potential F-Tags:
F323 – Accidents and Supervision
V. Performance Improvement/Education:
Ensure all staff caring for this resident are aware that he requires a holder to smoke a cigarette. Review the safe smoking assessment process with all staff, and determine that they understand they must observe a resident to smoke an entire cigarette before they can determine that the individual can safely smoke.
