Tragic deaths in care homes caused by smoking.

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An inquest has opened into the recent death of 60 year old Malcolm Brown, who was found on fire in his wheelchair outside a care home, Derbyshire.

It is understood that Mr Brown, a resident of the care home, had gone outside in his wheelchair, unsupervised, to have a cigarette shortly before he caught alight.

Derby and South Derbyshire Coroners court heard how a healthcare assistant was alerted to the scene by Mr Browns screams shortly before 1pm on Monday 15th February.

The man used an extinguisher to put out the flames, but tragically Mr Brown was declared dead by Paramedics shortly after.

Derbyshire Police are investigating the man's death on behalf of the coroner, however, there are not thought to be any suspicious circumstances.

A spokeswoman for Derbyshire Fire and Rescue Service said: "A fire investigation into the cause of a fire at a care home on the 15 February 2016 has concluded that the most probable cause of the fire is discarded smoking materials."

Sadly, this incident is not an isolated case of a death in a care facility due to smoking materials.

On 13th February 2013 a 99-year-old woman was seriously injured during the blaze in a smoking room at a residential care home in Stirling city centre. It is believed the woman’s hair caught fire as she lit a cigarette. She later died in hospital from her injuries.

On 16th November 2014, a 72 year old man died after sustaining severe burns following a tragic accident at a residential care home in East Sussex. It is believed that the gentleman was outside the home smoking when his clothes caught fire.

Another Incident happened on 15th February 2015 at a care home in Dundee, when a 78 year old male was seriously injured after a fire broke out in his room. It is believed that the fire was caused by a cigarette. Tragically, he too later died in hospital due to his injuries.

The events surrounding this latest tragedy will further highlight the issues of patient/resident safety when smoking in/around care facilities.

Residential care homes, nursing homes, hospices, mental health units and prisons are all exempt under the new 2007 smoke free legislation. These facilities must still technically be seen as ‘smoke free’ but designated areas can be provided for residents to smoke in, such as well-ventilated smoking rooms.

Many facilities do not allow in-door smoking and have opted for designated outdoor/open area smoking points, however, some allow residents to smoke in designated rooms and in their bedrooms.

It may seem strange allowing smoking in a nursing home and even crazier in a hospice as this is a place dedicated to palliative care. But, for someone suffering from a terminal illness or who is unable to care for themselves, this is their last chance to enjoy a few forbidden pleasures - it is unlikely to do any harm at this stage.

So, what is being done to protect these individuals?

The Regulatory Reform (Fire Safety) Order 2005 requires the ‘responsible’ person - such as the care home operator, to identify persons at risk as part of the fire safety risk assessment process for the premises and to take appropriate action to remove or reduce the risk.

Individual fire risk assessments for each resident are critical for their own safety and that of other residents and staff. Each assessment should be carried out by someone with sufficient understanding of the service user’s needs and of the wider impact on fire and health and safety. These should be review regularly.

This is particularly crucial where residents are known to be smokers and may be in possession of ignition sources such as lighters and matches as these add greatly to the risk of fire.

These assessments should consider the service user’s physical ability and mental capacity to undertake smoking activities safely, the risks to others, any physical precautions needed, as well as their environment.

Once the Individual fire risk assessment has been completed, care home operators and other ‘responsible’ individuals must identify and put in to place the appropriate control measures- to best manage the risk of fire or possible injury to residents, and support those individuals at greater risk.

Control measures may include supervision of smokers/smoking areas, removal/ control of ignition sources and ensuring furnishings and fixtures are fire retardant. Additional equipment may also be required such as fire blankets, extinguishers and telecom systems.

Fire retardant, protective clothing should also be taken into consideration, such as the smoker’s protective apron/cover, manufactured by Hospital Aids, designed to protect smokers from causing burns to themselves, clothes and furniture.

These protective covers are an ideal safety solution for individuals suffering with conditions such as Parkinsons and Huntingdons disease, who may be more prone to dropping cigarettes as a result of their condition.

The covers offer the smoker a large area of protection at the front and sides, preventing cigarettes from burning clothes and slipping between a chair and the smoker - they can also be quickly removed if necessary, to smother a fire.

As part of the ongoing Individual fire risk assessment, routine smoking evaluations should be done on all residents who request permission to smoke. Making sure that all aspects of the assessments are completed and documented.

Smoking policies should be documented and discussed with residents and family members and a shared-risk agreement drawn up, specifying the terms, conditions, expectations, and responsibilities of each party. If residents do not comply with the terms and conditions, it should be clearly determined what actions will be taken.

If care facilities follow the correct procedures and take every step possible to protect vulnerable individuals, we can’t help but wonder, why these tragedies continue to happen? Who is to blame - if anyone and what else can be done to prevent them from happening in the future?

Can a nursing home force its residents to quit smoking by no longer accommodating their needs? That is a question which poses many arguments for and against.

Middle ground is often hard to find, and sometimes the best intentions are not enough to keep residents safe.

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