Health Professional Health Professional Monitoring Programs in Monitoring Programs in

KentuckyKentucky

CAPTASA CAPTASA Lexington, KYLexington, KY

January 26, 2013January 26, 2013

Health Professional Monitoring Health Professional Monitoring Programs in KYPrograms in KY

KPHFKPHFKYPRNKYPRNKARE for NursesKARE for Nurses

There is a unique disconnectbetween the scientific facts

and the public’s perception aboutdrug abuse and addiction

““The 12-step model of The 12-step model of recovery recovery isis the core the core

technology in the short and technology in the short and long term treatment of long term treatment of

alcoholism and addiction… alcoholism and addiction… the standard of care”the standard of care”

Garrett O’Connor, MDGarrett O’Connor, MDCAPTASA 2005CAPTASA 2005

Pamela Fleck MSNPamela Fleck MSN

Case Manger Case Manger Kentucky Alternative Kentucky Alternative

Recovery Effort Recovery Effort KAREKARE

KYPRNKYPRN

Brian Fingerson, RPh, Inc. Brian Fingerson, RPh, Inc. KY Professionals Recovery Network KY Professionals Recovery Network KYPRN KYPRN 202 Bellemeade Road 202 Bellemeade Road Louisville, KY 40222 Louisville, KY 40222 O/H: 502-749-8385, F: 502-749-8389O/H: 502-749-8385, F: 502-749-8389

kyprn@att.net

Greg L Jones, MDGreg L Jones, MD

Kentucky Physicians Health Kentucky Physicians Health FoundationFoundation

9000 Wessex Place, Suite 3059000 Wessex Place, Suite 305Louisville, KY 40222Louisville, KY 40222

gregj@kyrecovery.orggregj@kyrecovery.org(502)425-7761(502)425-7761

Wow!Wow!Fifteen Percent of U.S. Workers Report Fifteen Percent of U.S. Workers Report Workplace Alcohol Use or Impairment in Past Workplace Alcohol Use or Impairment in Past Year February 15, 2006Year February 15, 2006

An estimated 19.2 million U.S. workers (15.3%) An estimated 19.2 million U.S. workers (15.3%) reported using or being impaired by alcohol at reported using or being impaired by alcohol at work at least once in the past year, according to work at least once in the past year, according to recently released data from the National Survey recently released data from the National Survey of Workplace Health and Safety. of Workplace Health and Safety.

Why are Nurses at RISKWhy are Nurses at RISK

1. Long Hours2. Extra Shifts3. Staffing Shortage4. Availability of medication5. Need to CARE for others6. Work Hard Party Hard7. Knowledge of Drugs & how they work8. Knowledge It will never happen to me9. Stress

Is Is demanding of selfdemanding of self; denies stress, ; denies stress, depression, unhappinessdepression, unhappinessExpresses more Expresses more guilt/shame about drug guilt/shame about drug usageusageUsually graduated in Usually graduated in upper portionupper portion of of nursing programnursing programHave demanding and responsible jobsHave demanding and responsible jobsAre highly respected for Are highly respected for excellent workexcellent work

Profile of a Chemically Profile of a Chemically Dependent NurseDependent Nurse

Intervention and Assistance for Intervention and Assistance for NursesNurses

Refer to Employee Assistance ProgramRefer to Employee Assistance ProgramEncourage nurse to contact KARE for Encourage nurse to contact KARE for Nurses Program at time of meetingNurses Program at time of meetingInform nurse that information will be Inform nurse that information will be submitted to KBN as required by KRS submitted to KBN as required by KRS 314.031314.031

Warning SignsWarning Signs1. Changes in personality and mood swings2. Defensiveness when confronted about

chemical use – excuses, promises, lying, denying, blaming

3. Changes in lifestyle to one more centered on chemical use

4. Trouble at home, school and/or work5. Withdrawal from family, friends, colleagues

and activities

Signs and Symptoms – Job Signs and Symptoms – Job PerformancePerformance

Too many medication errorsToo many medication errorsToo many controlled drugs spilled or Too many controlled drugs spilled or brokenbrokenIllogical or sloppy chartingIllogical or sloppy chartingAbsence of chartingAbsence of chartingFrequently absent from unitFrequently absent from unitFrequent bathroom breaksFrequent bathroom breaksComes to work early and stays lateComes to work early and stays lateUses sick leave lavishlyUses sick leave lavishly

Forms of DiversionForms of Diversion

MD, pharmacist diversionMD, pharmacist diversionDoctor shoppers in ERDoctor shoppers in ERStolen script pads and forged Stolen script pads and forged prescriptionsprescriptionsPatient’s familyPatient’s familyUnauthorized drug cabinet Unauthorized drug cabinet access (ie,unit secretary)access (ie,unit secretary)Handlers of sharps containersHandlers of sharps containers

Common Methods of DiversionCommon Methods of DiversionFor Health ProfessionalsFor Health Professionals

Removal of duplicate doseRemoval of duplicate doseRemoval of fentanyl patchesRemoval of fentanyl patchesRemoval too frequently (range order Removal too frequently (range order issues)issues)

Ordered q 4 hrs, removed q 2 hrsOrdered q 4 hrs, removed q 2 hrsRemoval of medication without orderRemoval of medication without orderMedication overrideMedication overrideFalsification of “verbal order”Falsification of “verbal order”Handlers of sharp containersHandlers of sharp containers

Mandatory Reporting

Kentucky is a Mandatory Reporting Jurisdiction -- KRS 314.031(4)

Who?-- Any nurse-- Employer of nurses-- Any person having knowledge of a violation

KARE for Nurses ProgramKARE for Nurses Program

……Identify and assist nurses whose Identify and assist nurses whose abilities to practice nursing are abilities to practice nursing are compromised by dependency on drugs compromised by dependency on drugs or alcohol . Allow these nurses to get or alcohol . Allow these nurses to get treatment and recovery so they may treatment and recovery so they may return to competent and safe nursing return to competent and safe nursing practice.practice.

Admission RequirementsAdmission Requirements

Current license in KY or have applied for Current license in KY or have applied for licensure in KYlicensure in KYRequest participation in KARE for Nurses Request participation in KARE for Nurses Program in writingProgram in writingSubmit to Chemical Dependency Submit to Chemical Dependency EvaluationEvaluationAdmit to misuse/abuse of ETOH or drugsAdmit to misuse/abuse of ETOH or drugsAgree not to practice until approved to do Agree not to practice until approved to do so by KARE for Nurses Program staffso by KARE for Nurses Program staff

Drug abuse is a preventable behavior

Partnership for a Drug-Free Americahttp://www.drugfree.org/

Drug addiction is a treatable disease

What do we do with them then?What do we do with them then?

Assessment Assessment Treatment Treatment Monitoring Monitoring Contractual RelationshipContractual Relationship5 Yrs of aftercare & monitoring5 Yrs of aftercare & monitoringHelp them get ready for return to “life”Help them get ready for return to “life”

Health issues Impairing ProfessionalsHealth issues Impairing Professionals

Substance Use DisordersSubstance Use DisordersMood DisordersMood DisordersPersonality DisordersPersonality DisordersSexual Acting Out Behaviors Sexual Acting Out Behaviors Dementia & Medical DisabilitiesDementia & Medical DisabilitiesBurnout-Anger & FatigueBurnout-Anger & Fatigue

How can you tell if someone has this Disease

UseUse of Alcohol or some other of Alcohol or some other Addictive substance (Opiates, Addictive substance (Opiates, Sedatives, Amphetamines, Cocaine, Sedatives, Amphetamines, Cocaine, Marijuana)Marijuana)ProblemsProblems occurring while using occurring while using these or as a result of usingthese or as a result of usingContinued UseContinued Use of any Addictive of any Addictive substance after problems beginsubstance after problems begin

TREATMENTTREATMENT InpatientInpatient Time enough and Gender Time enough and Gender specificspecific OutpatientOutpatient Self-Help and 12-Step GroupsSelf-Help and 12-Step Groups Therapy- Individual and GroupTherapy- Individual and GroupAbstinence ContractAbstinence Contract

PRN contracts typically include:PRN contracts typically include:

Specific number of AA/NA or other 12 step Specific number of AA/NA or other 12 step meetingsmeetingsWho is their primary care physician?Who is their primary care physician?What medications are they taking?What medications are they taking?No additional medications without notification to No additional medications without notification to the PRN (including OTC)the PRN (including OTC)Urine drug screensUrine drug screensNotification of where they live and work to PRNNotification of where they live and work to PRN

October 2003October 2003 February 2006February 2006

KBML ObligationsKBML Obligations

KBML Policy Regarding The Required KBML Policy Regarding The Required Reporting Of Impaired Physicians By Other Reporting Of Impaired Physicians By Other Physicians And Hospitals Physicians And Hospitals Adopted: Adopted: March 27, 2003 March 27, 2003

Reporting impaired physicians directly to the Reporting impaired physicians directly to the Kentucky Physicians Health Foundation’s Kentucky Physicians Health Foundation’s Impaired Physicians Program is not sufficient Impaired Physicians Program is not sufficient to satisfy the statutory reporting to satisfy the statutory reporting requirements. requirements.

Self-Reporting is still the best Self-Reporting is still the best betbet

This policy revision makes no change This policy revision makes no change regarding the procedures followed in those regarding the procedures followed in those instances where an affected individual instances where an affected individual voluntarily self-reports to the Foundation. voluntarily self-reports to the Foundation.

ResponseResponse

House Bill 1House Bill 1

What is a relapse?What is a relapse?

What does it “cost” you?What does it “cost” you?

AftercareAftercare

•What is done?What is done?•How much and how long?How much and how long?

Drug and Alcohol testingDrug and Alcohol testing

•What tests?What tests?•How often?How often?•Random?Random?

•For cause?For cause?

RESULTSRESULTS

80% Recovery Rate 80% Recovery Rate at 5 Yrs with our at 5 Yrs with our oversight for those oversight for those with a substance Dxwith a substance Dx

How can we help and How can we help and support?support?

•Let’s take care of each otherLet’s take care of each other•Confidential reportingConfidential reporting

•Recovering Professionals are hard Recovering Professionals are hard workingworking

•They are monitored closelyThey are monitored closely