Failure to Supervise Resident Smoking with Oxygen
Penalty
Summary
The facility failed to implement and enforce a process to supervise and monitor a resident who was known to smoke while using oxygen, despite clear risks associated with this behavior. The resident had a history of acute respiratory failure with hypoxia, heart failure, asthma, and tobacco use, and was cognitively intact. The resident's care plan and a signed smoking contract required that oxygen tanks be left inside the facility or at the entrance to the smoking patio, with staff assistance if needed, and indicated that non-compliance would result in a review of smoking privileges. However, there was no evidence of follow-up smoking assessments after a prior incident, and progress notes indicated the resident was observed smoking at unassigned times. Multiple observations and interviews confirmed that the resident continued to smoke on the designated patio while using oxygen, including a family member providing photographic evidence and reporting the behavior to the facility. The resident himself acknowledged being aware of the risks but did not believe his personal oxygen tank posed a danger and refused to comply with the policy. Other residents also reported witnessing similar unsafe behaviors. Staff interviews revealed there was no established plan to monitor the smoking area, and the designated patio was not directly supervised by staff, with only video surveillance available in the administrator's office and not accessible to other staff members. The facility's smoking policy stated that non-compliance could result in loss of smoking privileges but did not specifically address smoking with oxygen. The administrator confirmed that the resident had previously been observed smoking with oxygen and had been educated on the risks, but no consistent monitoring or enforcement measures were in place. The lack of direct supervision, absence of regular assessments, and failure to enforce the smoking contract led to ongoing unsafe smoking practices involving oxygen use.
Removal Plan
- Conduct a smoking assessment for R3
- Revoke R3's smoking privileges at the facility
- Revise R3's care plan to indicate his smoking privileges have been revoked
- Review the smoking policy with R3
- Notify R3's nurse practitioner
- Receive an order for nicotine lozenges for R3
- Place R3 on safety checks
- Provide education to all staff regarding designated smoking areas of the facility
- Educate staff that no oxygen is allowed on the smoking patio
- Assign the nurse on the unit closest to the smoking patio responsibility to monitor the smoking patio and document
- Require any resident who uses oxygen to exchange their oxygen for their smoking materials with the nurse
- Hold a quality assessment performance quality improvement (QAPI) meeting to review and determine a process to monitor for safe smoking practices
- Instruct staff to provide education to residents regarding safe smoking
- Instruct staff to notify the nurse if residents are non-compliant with smoking safety
- Instruct staff to document instances of non-compliance
- Instruct staff to notify the administrator or nurse on-call of non-compliance
- Post the smoking policy on the door to the smoking patio
- Post a sign indicating no oxygen allowed in the smoking patio area