Best Practices for Resident Smoking & Oxygen Safety

The impact of residents smoking while on oxygen is important to those in hospice, home health, and assisted living facilities. While patients are often given information on proper use of oxygen, including smoking safety, some of them continue to smoke without yielding to the education provided. In doing so, the patient puts themselves and those close to them at risk for injury or even death. This bulletin provides best practices to help prepare for oxygen use and mitigate the risks when smoking is a factor.

Smoking and Oxygen Incident Examples

A patient receiving home hospice services for end stage COPD was smoking while oxygen was in use. Despite education of smoking cessation and fire safety warnings provided by the interdisciplinary team, the patient continued to smoke at home while utilizing oxygen. A few days into services, the patient caught fire and was rushed to the Emergency Department with what appeared to be minor superficial burns. The patient later died at the inpatient unit after suffering from third and fourth degree burns to their lungs.
A resident was smoking outside the building and ashes from the cigarette ignited their clothing. The resident had been deemed appropriate to smoke unsupervised; however, at the time of the incident, they were not wearing a smoking apron and their wheelchair was blocking the closest fire extinguisher in the area. Staff members, who were inside the building, attempted to assist, but could not reach the resident in time. The resident later died as a result of injuries.

Oxygen Safety
It is important to conduct an environmental risk assessment whenever oxygen will be in use to ensure a safe environment that is free of potential ignition sources and has appropriate response equipment in the event of a fire.

Be prepared and ready for the oxygen that will be in use.
Ensure there are operational smoke detectors, fire alarms, and fire extinguishers (Cooper, 2015).
Maintain a clear uncluttered evacuation route in the event of an emergency.
Alert local fire rescue and the utility company of oxygen use to expedite power restoration should an outage occur.
Be sure that oxygen cylinders are stored upright and secured.

Smoking Controls/Restrictions
Smoking presents significant hazards when oxygen is in use. While smoking cessation is ideal for eliminating these risks, it is not always feasible. It is crucial to have controls in place for residents who continue to smoke in hospice, home health, and assisted living settings.

Assess residents upon admission regarding their smoking history and habits.
Develop and disseminate written policies regarding resident smoking that includes guidelines on resident behavior.
Identify designated smoking areas in the residential setting and ensure the areas are free from clutter, away from electrical panels and outlets, and away from resident/pedestrian areas to minimize inhalation of second hand smoke.
Identify those individuals who require supervision when smoking and limit their access to cigarettes, matches, and lighters. Assess their function and ability per organization policy and procedure manual.
Prohibit oxygen use in areas where smoking is allowed.

Resident Education and Documentation

Education on smoking and oxygen safety is of utmost importance, as is documentation of the provided education.
Educate the patient/family about smoking around the patient or in the same room as the patient.
Review and educate the patient/family on concentrator and cylinder storage.
Implement “No Smoking” signs in all the rooms where oxygen may be in use as well as on the front door of the residence to alert emergency personnel of the risks upon entering and to advise visitors of their responsibility upon entering.
Document the education provided and the names of those who received the information. If the family/caregiver is not present, provide education via phone and document that accordingly.
Ensure documentation is clear, concise, and complete (Selvi, 2017).

Summary
Smoking while using oxygen is a high-risk area that has resulted in injury and death when policies/procedures and education are not followed. Take the time to review current policies and procedures and provide educational materials to help ensure patient and resident safety. Make sure to document patient/resident charts accordingly. Remember, if it wasn’t documented, it never happened!