AGING AND DISABILITY SERVICES ADMINISTRATION

December 17, 2001

AASA:? NH #2001-030

SUBJECT:??? OXYGEN USE AND SMOKING HAZARDS

Dear Nursing Home/Facility Administrator:

In the past year, a number of long-term care residents have been observed smoking while using oxygen.? Although many nursing homes are no smoking facilities, some do allow residents to smoke.? I am therefore taking this opportunity to remind you of the general hazards associated with smoking, and of the danger of using oxygen at the same time.

The department was informed, this past year, of three incidents where residents had sustained facial burns while smoking and using oxygen at the same time.? Other injuries resulting from residents smoking, but without concurrent oxygen use, were burns on resident hands, holes burned in resident clothing, and residents? hair being singed.

The department consulted with the State Fire Marshal?s office, which provided the following information regarding smoking and oxygen:

? No smoking should take place in any area where liquid oxygen tanks are filled.

? No oxygen supply or container should be in use within 10 feet of residents who are smoking.

? At minimum, if residents who use oxygen wish to smoke, the oxygen supply must be turned off and the nasal cannula removed from the resident?s face while smoking.? This applies to any type of oxygen supply or container.

Both federal and state regulations require nursing homes/facilities to assess residents in a number of areas.? Those assessments include a determination of a resident?s cognitive and functional status, both of which influence the degree of risk associated with the task of resident smoking, and resident smoking while oxygen is also being used.? An assessment of a resident?s ability to smoke and smoke safely should also consider the resident?s ability to safely dispose of ashes and cigarette butts.

The federal regulations at 42 CFR 483.25(h)(2) also require facilities to ensure ?That each resident receives adequate supervision and assistance devices to prevent accidents.?? One of the probes under the interpretive guidelines asks if residents who smoke are properly supervised and monitored.? The supervision and monitoring a resident requires would be based on their assessed abilities and needs.

Washington Administrative Code (WAC) 388-97-195 requires that policies and procedures be developed and implemented for all services provided to residents.? These would include safety issues related to resident smoking, and issues related to residents who use oxygen and who also smoke.? The policies and procedures should provide staff with sufficient detail to ensure that residents who smoke are enabled to do so safely, and that non-smokers are protected.

The facility must ensure that staff know, understand, and implement these policies and procedures.? This would include, at a minimum, the need for assessment, informing residents of the safety risks related to smoking, and the resident?s plan of care around the issues of safety related to smoking, oxygen use if any, supervision required, and interventions to mitigate risks.

If you have any questions please contact your local Residential Care Services (RCS) Field Manager.

Sincerely

Patricia K. Lashway, Director

Residential Care Services

cc: RCS Regional Administrators