Smoke Free Campus and

High Risk Behavior

Management Planning

Education

for Non-Clinical Team Members

Purpose of this Module

Discuss Smoke Free facilities/campuses and what team members can do to help make them safer

List High Risk Behaviors and the roles that the various team members play in the process to address these behaviors and patient safety

Discuss the Specialized Treatment Plan

• It’s harmful to our patients’ health and impedes their

healing process.

• It interferes with the patients’ ability to fully

participate in their care; delaying their ability to go

home as soon as they would like

• It’s the right thing to do for our patients, our staff

and our community!

Why go Smoke Free?

• Washington County Facilities are smoke-free.

• For their health and safety, patients are not permitted to smoke while hospitalized - this includes vaping and e-cigarettes.

• Smoking is not allowed in any common areas on campus such as sidewalks or parking lots.

• Visitors who wish to smoke must go to their cars or leave the campus to do so.

Smoke Free Hospitals and Campuses

• Patients are no longer authorized to go outside to smoke. (The Smoking Release Form is no longer applicable in Washington County.)

• Physicians expect patients to remain on their unit and in order to be an active partner in their care.

Smoke Free Hospitals and Campuses

Patients will be reminded during the admission process that the facility is smoke free - this includes vaping and e-cigarettes.

Patients who are nicotine-dependent will be offered nicotine replacement options while under facility care.

For their own safety and the safety of other patients, patients are required to have their provider’s permission to leave their unit.

Patients will be asked not leave the building with any hospital property i.e. patient gowns, IV or central lines/ports, IV pumps, wheel chairs, or other hospital property.

Patients Not Permitted to Smoke

It is everyone’s responsibility to help make our facility and campus smoke free:

o Remind patients and visitors that the campus is Smoke Free

o Ask patients found wandering in the hospital or outside to return to their unit for their health and safety, and assist them in their return to their unit if needed

o Ask visitors to refrain from smoking in areas other than their car

o Escalate issues to security and leadership if not resolved with a discussion

Team Member Expectations

UNDERSTANDING HIGH RISK

BEHAVIORS AND

THE ROLE OF THE HIGH RISK

TEAM

High Risk Behaviors are behaviors that

can negatively affect the patient’s

health or hospital outcome.

o Examples might include (but are not limited to):

o Leaving the unit

o Smoking

o Tampering with/accessing their IV/central line

o Taking medications not prescribed by the hospital provider

What are High Risk Behaviors

• The High Risk Team addresses a patient with

High Risk Behaviors.

• The High risk team is a multidisciplinary team

meetings coordinated by House Supervisor with

patient’s care team

• If a team member or provider has a patient who

is exhibiting a high risk behavior that cannot be

resolved by an initial discussion with the patient,

the House Supervisor should be contacted for

assistance.

• The House Supervisor will initiate the

procedures for involving the High Risk Team.

• Behavior Contracts – may be used to address

patients engaging in high risk behaviors.

What is the High Risk Team?

The Behavior Contract Shall Include the Following:

– Identified High Risk Behavior(s)

– The provider’s / hospital staff’s expectations of the patient

– Risk / benefits of High Risk Behavior(s) and behavior

modification

– Plan / Interventions for addressing the High Risk Behavior

Behavior Contracts

• Every effort will be made by the treating physicians, nursing staff

and administration to develop a mutually agreed upon Behavior

Contract with the patient.

• If the patient does not follow the agreed upon Behavior Contract, the

High Risk Team will be called upon to meet again with the physician

and decide next steps for the patient, up to and including discharging

the patient AMA if their actions/continued hospitalization would be

harmful or futile.

• For more information, please click on this link to access the High Risk

Team Policy PC 600-436. You will be asked to confirm you have read

this policy at the end of this module.

What if the Patient does not Follow the

Behavior Contract?

Special Circumstances for Addressing High Risk Behavior

Against Medical Advice (AMA), Off-Unit without Permission

(OWOP) and OWOP “at –risk”: Adult Patients Leaving Prior to

Completion of Evaluation or Treatment Policy.

• This policy provides guidelines for managing situations

where an adult patient leaves or attempts to leave the

hospital after being admitted prior to completion of a

medical and/or psychiatric evaluation and/or treatment.

For additional information click on the link to access the Against Medical Advice

(AMA), Off-Unit without Permission (OWOP) and OWOP “at –risk”: Adult

Patients Leaving Prior to Completion of Evaluation or Treatment Policy. You

will be asked to confirm that you have reviewed this policy at the end of this

module

Other Important Policies Addressing

High Risk Behavior

Importance of patients adhering to their treatment plan and that they not leave their unit without provider permission

• Caregivers should communicate to patients the reasons for this expectation, which include, but are not limited to:

o Ensuring patients are present for examination and treatment

o Ensuring patients are available for medication administration, diagnostic tests, therapies and other procedures ordered by their Providers

o Helping to reduce the spread of infection or other illness

o Ensuring appropriate monitoring by clinical staff, promoting patient safety

o Ensuring proper function of hospital equipment being utilized for patients’ care

o Promoting the efficient operation of clinical services

AMA OWOP Policy Highlights

• This policy describes actions to be taken when

a patient is discovered to be off-unit without

permission (OWOP):

• OWOP/ Found in < 1hour

• OWOP/ Not found

• OWOP/Returns > 1 hour and after removal from

Inpatient status

AMA OWOP Policy Highlights

• Describes what is to be done when a

vulnerable patient is found to be OWOP:

– OWOP Vulnerable - Those patients who are missing

from the unit without permission and have exhibited

behavior indicating compromised mental status that

may cause him/her to be in danger and requires further

assessment.

• Follow Code Green Policy

AMA OWOP Policy Highlights

o Describes what is to be done when patient leaves

before completion of evaluation or treatment

o Try to redirect

o Notify House Supervisor/Security

o Code 6

o Lack Capacity - Direct patient back to unit

o Have Capacity – Attempt to direct back to

unit

AMA OWOP Policy Highlights

What if a patient wants to leave the floor AMA or is refusing treatments? • They make that decision if they have capacity and are informed

of the risks

• If they have capacity to make medical decisions, we cannot prevent or prohibit them from leaving

What if patients that may not be declared to lack capacity to make decisions, however are displaying questionable behavior and wanting to leave?

• Reasonable and appropriate measures will be taken to encourage these patients to remain until their course of treatment/discharge planning is complete

AMA OWOP and Code Green

• Policy Manager - Policies PC 600-324, PC 600-

434 and PC 600-436

• Forms Site - High Risk Behavior Contract Form

• MSHA Intranet – Look under “H” for High Risk

Washington County Site – reference tools

Where can you find more information

about Smoke Free, High Risk Behavior

and Specialized Treatment Plans?

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