A question about smokers, hospitals and nicotine replacement therapy

[Aparecium]

This is not a TAAT, but a question triggered by a thread about smokers going off to have a smoke while in hospital being treated for a smoking-related illness.

Why don't smokers admitted to hospital automatically get nicotine patches (or other nicotine replacement therapy) for at least the duration of their stay?

I don’t know, but it’s a good question.

If they're bed bound, they can be prescribed patches etc.

They do, at least round our way, they get offered nicotine replacement therapy for the hospital stay and then 14 days worth for when they are home. It’s just whether or not they accept it, or whether they prefer to still go out to smoke.

they are usually offered nicotine replacement. And if they aren't they can always ask for it. Can count on probably one hand the number of times in the last 19 years that that prescription has been accepted though. (TBF, getting up and going out for a fag is a decent bit of physio so it's not all bad!)

A nurse once told me smokers are typically up and about much quicker than non smokers after operations because they're keen to go outside for a smoke.

It's available if they want it, but nobody can force them to use it.

They get offered, only a small minority want it. Most prefer going to sit in the rain/cold and have a real fag or a vape.

The trust I worked for offered this.

They do in mine. We have an electronic patient record. If a nurse or doctor ticks that the person is a smoker they have an automatic referral to a smoking cessation nurse who visits them. Nicotine tablets are also prescribed as needed until then.

I also don’t allow my patients to smoke unless they can physically get there themselves, or have a relative to take them. So this encourages them to take up nicotine replacement therapy.

I think they do - I've been in hospital where people in the next bed have been offered it and have refused. One of them went wandering around outside for a smoke with a drip stand and got detained by security because thy thought they were stealing hospital equipment

I was in hospital recently. People were offered nicotine patches and no hospital staff would take a patient for a smoke. All the hospitals in our area are completely non smoking on the whole of the site.

I was last time I was in a few years ago.
I've given up now.

I think more people would take it up if hospital staff/security had more power to stop people from smoking right at the front door.

There are signs all over the place in NHS Scotland stating that you must not smoke anywhere on NHS property but everyone ignores it.

People smoke at the front door of our local hospital and use the wheelchairs for a seat as there are no beaches.

It's normal here too, my Dad was in a few years ago and declined then wanted me to take him out in a wheelchair for a smoke every time I visited. The problem with smokers is they need to be prepared and ready to tackle stopping, a hospital admission is not usually the optimal time.

I didn't mean the hospital admission should impose giving up smoking. I meant in terms of how much harder it must make therapy targeting the lungs or circulation, if that therapy is then being subverted by the patient inhaling smoke. Wouldn't preventing that smoke from entering the lungs be part of the therapy? At least until they no longer needed that therapy?

It never occurred to me that smoking could actually be a factor in speeding up people's recovery!

I didn't mean the hospital admission should impose giving up smoking.

From a smokers POV though, if you are giving then nicotine replacement that's exactly what they will be doing.

As pps have said, they are offered nicotine replacement, lots turn it down. And no smoking doesn’t speed recovery, it often slows it down due to vulnerability to chest infections, blood clots etc…

Wanting to go for a vape was a motivation for me getting up quickly! I quit smoking 8 years ago but haven't managed to quit nicotine

Only temporarily, and they would still be getting the nicotine.

I’ve got a feeling there’s some research from years ago that showed that those people that have up smoking before or around the time of a procedure were less likely to survive than those that carried on. Something to do with stress on the body I think, but maybe getting up and about sooner has something to do with it.

I think people are allowed to smoke in prison still (?) this sometimes surprises me. I don't think people have some sort of human right to smoke so why don't they just ban it for the sake of the staff. I suppose it might increase violence initially but then it'll fade (?)

it takes a good few weeks of not smoking to make a difference to lung physiology so, although in very general terms stopping smoking is good, it might not change the course of an acute illness that much (and actually although oxygen binding may improve after stopping for a short while, airway irritability often gets a bit worse before it gets better).

There's also rather more to addiction than just replacing the addictive chemical and job's done - there's the social/psychological elements too. A lot of smokers who end up on ICU, ventilated and sedated will be clear of their physiological need for nicotine by the time they're extubated, but an awful lot of them still go straight back to it once they're able to walk far enough because it's part of 'them'/their coping mechanisms for stress/how they socialise. We can keep on offering nicotine replacement, but adults with capacity will keep on declining it, as is their right. Same with all sorts of other things.

It is banned, at least where I am anyway. Nobody (staff, patients, general public) is allowed to smoke on NHS property - this includes the car park, bus stops etc within the hospital grounds. You would need to walk for around 10 minutes to the nearest layby to smoke legally.

The rule is ignored and other than signs everywhere, nothing done to actually enforce it so people loiter at the main entrance smoking with no consequences.

it takes a good few weeks of not smoking to make a difference to lung physiology so, although in very general terms stopping smoking is good, it might not change the course of an acute illness that much (and actually although oxygen binding may improve after stopping for a short while, airway irritability often gets a bit worse before it gets better).

I see.