Surveyor CMS Guidance Re-Issue: Smoking in NHs

CMS has issued its guidance on resident smoking in Nursing Homes.

Contact Bonnie Blachly at Aging Services of Washington, for information and assistance.

Given the interplay between CMS and the International Fire and Life Safety Codes, it is to be expected that our state Fire Marshal begin reviewing the following in their own inspections of nursing homes.  While CMS’ regulations are not applicable in Washington’s licensed boarding homes, you may wish to consider the relevance of the issues raised for your practices within that setting.

F323 Accidents and Supervision describes appropriate precautions such as smoking only in designated areas, supervision of residents based on an assessment and plan of care and limiting the accessibility of matches and lighters to residents who need supervision.  The resident’s capability to smoke must be based on an assessment and documented on the plan of care.  Information must be kept current and updated with any variance in the resident’s capabilities and needs.

Nursing homes are advised to review their policies and procedures related to smoking to ensure practices are in place for determining those residents deemed safe to smoke without supervision.  Areas to consider are cognitive ability, judgment, manual dexterity and mobility.  The frequency of reassessment should be determined and placed into policy. 

Be prepared for the surveyors to ask for your community’s policy and procedure as well as the individual assessments of a resident’s ability to smoke independently

Nursing homes must also ensure the safety of the designated smoking areas.  This includes protection of residents from weather conditions and non-smoking residents from second-hand smoke. Portable fire extinguishers should be readily available as needed.  Ashtrays must be made of noncombustible material and have a safe design.  Metal containers with self-closing covers into which ashtrays can be emptied must also be available. 

Oxygen use is prohibited in smoking areas.  State law related to smoking in public areas is to be followed, and continue to be addressed in your policies and procedures.

CMS has now addressed the use of electronic cigarettes.  E-cigarettes are not considered smoking devices; their heating element does not pose the same danger of ignition as regular cigarettes.

Based on this information, you should consider the following:

• Review your smoking policies and procedures.  Non-smoking nursing homes should have a method to communicate these to potential residents.  Where smoking is allowed, policies and procedures must meet current CMS guidelines.
• Policies and procedures must include the frequency of reassessments and methods by which plans of care are kept current.  Review your current assessment tool and revise as needed. 
• Review the assessments of all residents who have been deemed able to smoke independently to ensure identified criteria have been incorporated that allows for independent smoking.
• Re-assess current designated smoking areas to ensure residents are protected from the weather, second hand smoke, fire extinguishers are readily available and proper ashtrays and metal containers are accessible.
• Address in your policies and procedures the use of e-cigarettes