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Do E-Cigarettes Fit Into Your Smoking Policy?

The use of electronic cigarettes, or e-cigarettes, has grown in popularity among smokers in recent years. So much so, that some residents in healthcare facilities, as well as staff and visitors can be seen using them. This phenomenon is fairly new, and many facilities have not taken the time to address it in their smoking policy.
E-cigarettes are battery-powered devices that provide small doses of nicotine and other additives to the user in aerosol form. They are designed to mimic real cigarettes by the way they look and are used; some can even reproduce the taste and glowing light at the end when the cigarette is inhaled. Unlike real cigarettes, they are tobacco-free and run on a lithium battery that powers the device to heat liquid within a cartridge that produces vapors. There's no smoke, no carbon-monoxide and no odor.

Besides being less of a health and safety risk, e-cigarettes are cheaper to use as the batteries are rechargeable, and new or re-filled cartridges can be purchased at a substantially lower cost than real cigarettes. A typical starter kit, containing the e-cigarette device, a battery and several cartridges can cost between $30 to $100, depending on the manufacturer, model and style.

E-cigarettes are not regulated medicines, so the ingredients and amount of nicotine contained in each e-cigarette can vary. Despite being on the U.S. market since 2007, many regulatory agencies and health experts aren't sure how safe e-cigarettes really are, since little is known about their long-term use or the effects of second-hand vapor. However, most agree that it's a healthier alternative than tobacco-smoking.

As such, many manufacturers market their products as cigarettes that can be smoked anywhere without any health risks. However, some U.S. cities have banned e-cigarettes or restricted their use in public venues. Laws governing the use and sale, as well as the accompanying liquid solutions, currently vary widely, with pending legislation and ongoing debate in many regions.

Clearly, the use of e-cigarettes is controversial, even within healthcare facilities; some allow its use freely, while others not at all. If a facility chooses to allow it, they should address it in their policy. Some items to consider are:

  • Designated "vaping" area. Many buildings are smoke-free, so areas outside are designated for tobacco-smokers to use. Those facilities will need to decide if they are going to make a distinction between real and artificial cigarette use, or treat everyone the same regarding where they go, even though there are profound health and safety differences between the two. Aesthetically, they may "look" the same, but they are not. Consider the resident using e-cigarettes as a means to satisfy a habit without exposing themselves to the dire effects of tobacco; is it counter-productive to ask them to use an area where second-hand smoke is prevalent and possibly a temptation to resume their old habit?

  • Smoking evaluation. Currently, the use of e-cigarettes is much safer and less of a risk for harm than using real tobacco products, primarily because fire and tobacco are not involved. However, the user must be able to handle them correctly, so an evaluation should be performed and documented. Though prescriptions are not required, the resident's attending physician should be included in the evaluation and decision-making process, and orders received accordingly.

  • Storage of the device. Who should be responsible? Most facilities allowing e-cigarette use keep the charging device at the nurses' station in order to monitor for safety.

  • Scheduled times for e-cigarette use. Given the relative safety of the device, is it necessary to restrict how often it's used?

  • Staff supervision. Along with determining where and when e-cigarette use is to be permitted, the administrative staff will need to consider how much monitoring the user requires, taking into consideration the results of the smoking evaluation.

  • Consulting the Medical Director. As with most policies, the facility should seek their Medical Director's feedback and approval before implementing their policy if she/he was not already involved in the process.

  • Communicate the policy. This should be done by discussing it with new residents and family members. It's a good idea to present the information in the form of a handout or shared-risk agreement specifying the terms, conditions, expectations, and responsibilities of each party. Then, obtain signatures acknowledging that they understand and will comply with the policy.

Finally, with all the controversy pending health-risk studies and potential for increased regulation, it is prudent for staff to keep on top of local and state regulations concerning e-cigarette use, and review and update their policies and practices accordingly.


Dornberger, S. (2012). How are SNFs handling residents who use e-cigarettes? Retrieved July 2, 2014 from http://www.mcknights.com/how-are-snfs-handling-residents-who-use-e-cigarettes/article/238754/.

Preston, W., & Ayre, S. (2014). Are e-cigarettes a safer alternative to smoking? Retrieved July 2, 2014 from http://www.nursingtimes.net/nursing-practice/clinical-zones/smoking-cessation/are-e-cigarettes-a-safer-alternative-to-smoking/5067780.article.

Trimarchi, M. & Cassidy, S. (2014). 10 Little-known Facts about E-cigarettes. Retrieved July 2, 2014 from http://health.howstuffworks.com/wellness/smoking-cessation/10-facts-about-e-cigarettes.htm.

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