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We definitely have caffeine available at one of our inpatient units. It's been too long since I rotated at the other to remember accurately.

The argument for this practice is that you want patients to be doing the same habits they do as outpatients so that they don't crash when they go back to drinking 10 cups a day and smoking 2 ppd and now their clozapine dose is too low...
 
I have worked on three inpatient units and all have allowed caffeine (except when clinically contraindicated like @WisNeuro said).
 
2/3 Units i rotated at didn't allow caffeine, the VA did however
 
The units I have worked in allow caffeine. In most cases denying caffeine seems unnecesarily cruel (many will experience caffeine withdrawal for no reason, as quitting is not a goal for them).
 
Yeah, I would re-examine the policy. I can see caffeine restriction for cardiac diets, significant mania, that kind of thing. But for everyone?

Our inpatient unit didn't allow smoke breaks as it was hospital policy so no one in the hospital could take a smoke break. I'd be curious to see how many inpatient psych units allow smoke breaks.
 
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We let patients have coffee. Not all hours of the day and night but I think they can get it during most of the day. Really f’s up your insulin orders when somebody puts 5 packs of sugar in their coffee and has a BG of 300 next check.

No smoking we’re pretty aggressive about nicotine replacement therapy though.
 
Never seen a unit allow smoke breaks, almost all had freely available caffeine.
 
PGY2 here on inpatient psych. Our patients are all allowed coffee with breakfast (and lunch if they ask for it). If a patient has a cardiac condition or other reason then we would put in a diet order to indicate no caffeine. We don't restrict caffeine for our manic patients--since noon is the last time they can get caffeine it wouldn't really affect their sleep (and let's be real, it's the mania, not the caffeine that has been doing them in before they even got to the hospital). For all patients, no coffee or other caffeinated beverages with dinner or with their PM snack.
 
I worked at 6 or 7 different inpatient units and all prohibited coffee or caffeine, at least on the acute units.
 
We definitely allow coffee. It's not great coffee. It comes with your meal order or you can buy it from the hospital store during an outing off the locked unit.

I remember fondly this one man and I did our daily check-ins by going off the unit. He always wanted to go to the hospital coffee kiosk, where I'd sweat bullets everyday watching him order a large iced coffee with two sugars at 3pm in the afternoon. Then he'd follow it up with a cookies n' cream pudding. By the end I think we compromised on decaf past lunch.
 
Depends on the units from what I've seen.

Bear in mind that decaf still has caffeine in it, just less of it, often times on an order of around 10% I've seen a few cases where patients would get decaf coffee and try to drink over 10 cups of it trying to get a caffeine high and in some causes it worked.

I wonder how much less PRN Haldol / Ativan / restraints would be needed if these poor people could just have a smoke and a cup of joe
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Completely agree, but also how many malingerers also want in on the unit cause of the increased amenities. When smoking was made illegal in NJ when I was a resident no malingerer went to the ER for several weeks or walked out when they found out they couldn't smoke. The problem is that if you make individualistic rules (e.g. that guy gets no coffee, this guy can) it gets too confusing for staff members and brings back a heck of a lot of unfairness complaints.
 
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The unit on my sub-I allowed coffee with breakfast only. Cigs/smoking were banned but nicotine replacement was ordered for everyone prn (gum/patch/lozenge).
 
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I worked on an inpatient unit some years back that allowed smoke breaks. Definitely doesn’t seem like the norm though.
 
mistafab said:
The unit on my sub-I allowed coffee with breakfast only. Cigs/smoking were banned but nicotine replacement was ordered for everyone prn (gum/patch/lozenge).
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I'd like to have thought this resembled standard of care these days, but it appears I was significantly mistaken. I don't want to devolve this thread but smoking is such a driver of morbidity and mortality in the mentally ill and getting to go outside to smoke is positively reinforcing this behavior. Reminds me of hospitals giving beer to alcoholics instead of Ativan.
 
Starting about 2008 NY became the first state, then NJ then all the other fell like a swoop of dominoes. Perhaps there's a small handful I don't know about that are exceptions but in general you cannot smoke inside a healthcare facility, even outside of one so long as it's within a certain distance.

When this went into effect, many staff members had to drive their car to the edge of the property of the hospital and smoke in their cars.

Everytime I saw someone have to drive out to smoke it was like a mark of shame. Whenever I looked into this car parked on the shoulder right outside the hospital on the edge of the property it was as if there was a huge neon sign on top of their car blaring, "I have to actually drive to the edge of the hospital to smoke."
 
FatherPsychiatry said:
I wonder how much less PRN Haldol / Ativan / restraints would be needed if these poor people could just have a smoke and a cup of joe
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I have to disagree. I have a problem with hospitals allowing patients to smoke. I get the argument for it, especially in the mentally ill and in terms of drug levels, but I think it's pretty absurd, to tell you the truth. With everything we know about smoking, there's just no reason we should be allowing it. That's like allowing our dual diagnosis patients to enjoy a beer with dinner.

If a patient came into the hospital on 10 mg of Xanax a day, we wouldn't give them 10 mg of Xanax in order to recreate the outpatient environment or to avoid restraints. We'd taper them and put them on a responsible treatment plan. Just as I would think not tapering the Xanax would be equivalent to saying we're ok with that dosage, I think allowing patients to go downstairs for a smoke break is equivalent to telling them that we're okay with them smoking.

When I admit a smoker, they get a nicotine patch and/or gum and we discuss the problems with smoking, especially when on psych meds. Sure, some won't listen or they'll roll their eyes, but some appreciate the education and in at least 2 cases, the patients were off cigarettes the next time they were admitted. May not be a lot, but it's something.
 
Hospitals often times can't give highly individualized care. Of course a nicotine dependent patient not being allowed to smoke on a unit will cause them to experience more stress than had they been allowed to smoke. Hospitals have to usually allow everyone or no one to smoke cause if you allow one, all the others start getting ticked off and threaten to complain.

So when NJ made it illegal to smoke in a hospital, yes I knew it was something some patients didn't need to happen to them. The first month it happened, a suicidal patient who was truly depressed and a smoker, it made it that much more difficult for her in the hospital, but for every patient I had like her, that I wished we could've allowed a smoke break, it pretty much got rid of about 1-2.day malingerers in the inpatient unit, and about 10 malingerers in the ER a day.

In fact the next 6 months the amount of people trying to get into inpatient went to all-time lows. The psych emergency section to the ER was placidly comfortable during that time.

Patients who we knew were malingerers went from dysphorically claiming they were suicidal (whining, crying, screaming, threatening) to upon finding out they couldn't smoke inpatient, saying they never were suicidal and just walking out.
 
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