What’s New in the Patient Safety World
December 2012
Just Went to Have a Smoke…
Recently we went to
see Denzel Washington’s new movie “Flight”. In one scene there are 3 hospital inpatients
who happen to come to the same hospital stairwell to smoke. One is a trauma
patient, another an oncology patient, and the other a substance abuse patient
recovering from an overdose. We wondered how often that scene might actually
take place. To our amazement the same week a study came out in the Archives of
Internal Medicine (Regan
2012) that answered our question! The answer: 18.4% of patients who smoke
will smoke at some time during their inpatient hospitalization!
Smoking craving,
rather than the number of cigarettes previously smoked per day, was a big risk
factor for smoking while hospitalized.
Desire to smoke is a
well-known risk factor for patients leaving emergency departments without being
seen or for leaving against medical advice. We also suspect it is a risk factor
for elopement from behavioral health units even though that has received little
attention in the literature. Patient smoking is obviously also a risk factor
for hospital fires, increases the MI risk, increases pulmonary complications,
and impairs wound healing among other adverse effects.
One message in the
Regan study is clear: just assessing tobacco cessation issues and offering
nicotine replacement therapy and counseling on admission is not enough.
Ordering nicotine replacement therapy on the day of admission was associated
with less smoking before the counselor’s visit but not for the entire hospital
stay. So it is really incumbent upon hospitals to incorporate continued
assessment, perhaps even daily, of tobacco issues into their care plans.
References:
Regan S, Viana JC,
Reyen M, Rigotti NA. Prevalence and Predictors of Smoking by Inpatients During
a Hospital Stay. Arch Intern Med 2012; ():1-5, Published online ahead of print
November 5, 2012
http://archinte.jamanetwork.com/article.aspx?articleid=1389239
Schroeder SA. Smoking
Among Hospitalized PatientsComment on “Prevalence and Predictors of Smoking by
Inpatients During a Hospital Stay” Arch Intern Med 2012; (): 1-2 published
online November 5, 2012
http://archinte.jamanetwork.com/article.aspx?articleid=1389240
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