IMPACT OF A SMOKING BAN ON A LOCKED PSYCHIATRIC UNIT

Background: This study prospectively evaluated the impact of a complet e smoking ban on a locked psychiatric unit. Method: The setting was a 16-bed inpatient unit with 83% (134/162) involuntary patients, no off- unit smoking area, no possibility of granting smoking passes, and a me an length of stay of 2 weeks. The effect of a complete smoking ban was measured by surveys of both staff and patients before and after the b an. In addition, objective indicators of ward disruption were measured , including rates of aggression, use of p.r.n. medications, need for s eclusion and restraints, elopement, and discharges against medical adv ice. Results: Although staff initially expressed concern about the ban 's potential negative impact, after it began, t tests revealed that st aff were significantly (p < .05) less concerned about patients' needin g more medication, becoming restless, being too fragile to cope with w ithdrawal, leaving the unit against medical advice, or trying to elope . Staff were significantly (p < .02) more positive about the ban than were patients. Although patients, overall, had negative views toward t he new policy, their opinions were somewhat less negative after its im plementation. Rates of assaultive behavior, use of seclusion and restr aints, use of p.r.n. medication, and against-medical-advice or elopeme nt discharges did not change after the ban was in effect. When polled, 78% (40/51) of the staff voted to keep the ban. Conclusion: This stud y found that staff anticipated negative consequences to a total smokin g ban; however, their attitudes changed after it began. The ban had no significant impact on the ward milieu, and although patients were not in favor of it, they felt less negative over time.