The idea of smoking on-site at a healthcare facility seems laughable with the advent of no-smoking campaigns and smoke-free campuses. But seeing to the needs of in-patient smokers can result in frustrations for staff and increased risks of injuries to those patients. Facilities usually don’t have the ability to allow a staff member to accompany the patient for the duration of the smoke break. In this case, the staff brought a wheelchair-bound patient outside to the smoking area where he allegedly sustained a significant sunburn.
The patient’s family filed a PCF complaint citing several issues with the facility’s care of the patient. The chief allegation was that facility staff had placed the wheelchair-bound patient in the sun when he went outside to smoke. The complaint said that, due to medication he was on, the patient was not allowed to be in direct sunlight.
The facility’s written policy in effect at the time of the incident states that patients who smoke could only do so with a doctor’s order and patient smoking was restricted to a specific patio area. According to facility documentation, staff always placed the patient in the shaded area to smoke, but he would go into the sun for extended periods despite being advised not to do so.
Facility staff informed his treating physician of all changes in patient status as they occurred. On one date, the patient’s arms were noted to be red and blistered, presumably due to the patient’s prolonged exposure to sunlight despite staff warnings. Facility staff contacted the treating physician the same day to report this development. As a result, the patient was further encouraged to stay out of the sun and the conversations documented in the medical record.
While the Medical Review Panel found no deviation on the part of the facility’s staff or the physician, civil suit has been filed and is currently ongoing. The panel stated that facility personnel followed the physician’s orders. The decision did not address the question of whether facility staff are required to supervise patients who smoke for the duration of their time in designated smoking areas.
Many patients know to avoid alcohol or certain foods when taking specific medications. However, many are truly unaware of the effects medications can have when their skin is exposed to sunlight. Prescription medications such as diuretics, antibiotics, antihistamines, anti-arrhythmics, antiseizure medications and antidepressants can cause a reaction when the patient experiences sun exposure.
Medications that make the skin especially sensitive to the sun’s radiation are known as photosensitizers. When a patient taking a photosensitizer medication experiences sun exposure, they may see red sunburned skin, hives, swelling and itchy skin. Not all patients will experience the same degree of sun sensitivity from the photosensitizer medications, but some may experience exposure symptoms with even short intervals of sun exposure. Patients who have fair skin, light-colored hair and blue eyes, work outside, live near the equator or have an autoimmune disease are more likely to experience a higher risk of sun exposure symptoms when on photosensitizer medications.
Here are some tips that can help facility staff handle patients who take photosensitizer medications and may be exposed to the sun’s radiation:
- Review the patient’s current medication listing to determine if any are photosensitizing medications.
- Educate the patient and family on the specific medications and the side effects.
- Encourage the patient to wear a broad-spectrum sunscreen with an SPF of at least 30 when experiencing sun exposure. Even if the day is cloudy or cool, sunscreen is recommended.
- Sunscreen should be applied 30 minutes prior to going outdoors and reapplied at least every two hours.
- Ensure the organization has an adequate supply of sunscreen available for patients.
- Encourage patients to avoid the sun during the peak hours of 10 a.m. and 4 p.m. when ultraviolet rays are the strongest.
- Encourage the patients to wear sun-protective clothing when going outside. Sun-protective clothing consists of shirts with high collars and long sleeves, pants or long skirts, socks, shoes, hats and sunglasses.
- If the patient has privileges to go outside, find a shady or covered area and encourage the patient to remain in that designated area.
- If the patient does go outside, assess and document the condition of the skin upon return to the patient’s room and notify the physician if any skin changes have occurred.
- Remember to include sun exposure education upon discharge.
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