the impaired health care professional “focus on addiction”
DESCRIPTION
MARGARET THOMPSON PMHCNS –NP, BC. The Impaired Health Care Professional “Focus on Addiction”. Objectives. Understand the disease m odel of addiction Identity risk f actors for healthcare p rofessionals Review enabling b ehaviors - PowerPoint PPT PresentationTRANSCRIPT
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MARGARET THOMPSONMARGARET THOMPSONPMHCNS –NP, BCPMHCNS –NP, BC
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Understand the disease model of addiction
Identity risk factors for healthcare professionals
Review enabling behaviors Recognize behaviors that accompany
increasing Alcohol / Drug usage Review legal implications and treatment
resources
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To feel good
To do better
Because everyone else is taking them
Curiosity
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Experience of pleasure / award
Involved in reinforcement of basic instincts
Drugs / intoxicants over-stimulate this system
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The award system if modified
Memory systems are modified
Higher brain functions are impacted, resulting in behavior of addiction
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Drugs effect other neurotransmitters
GABA
Dopamine
Endorphins
Norepinephrine
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Chronic relapsing disorder Progressive - serious detrimental health outcomes.
Characterized by frequent episodes of intoxication / highs
Preoccupation with usage
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Usage despite adverse consequences
Compulsion to seek and consume Loss of control in limiting intake
Emergence of a negative emotional state in the absence of the drug
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Tolerance
Withdrawal
Legal Problems
Black Outs
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NursesPsychologyCounselorsPhysiciansDentistryPharmacyChiropractorOther Health Professions
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Same Prevalence as the General Population
Inability to Practice
State Monitoring Programs
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Providers well-being affects safety of the community
High level of denial
Difficulty with self-observation
Fearful of the consequences on professional lives
Taught to feel Unique – “grandiosity”
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Long work days Fatigue Problems balancing career and
family Low self esteem Emotionally charged patient
situations
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Control Issues Increased risk of becoming
cross addicted Death and Illness are ever
present Staff Shortages / Mandatory
overtime Unnatural work shifts
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Demands of practice Lack of time for leisure, family and
self Perfectionism Excessive dedication to work Guilt The beeper and the telephone Preoccupation and emotionally
unavailable
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BurnoutCompassion Fatigue
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One study has shown that up to 80% of nurses come from
families with at least one alcoholic member
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Highly caring by nature Caretaking: Highly emotional and draining
Superhero role Unique draw of profession
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Professional Risks - Physicians
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Final decision maker Medicine often dictates workaholics
Sense of control Ego
Professional Risks - Physicians
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Training that workplace is sacred
Office / hospital last place that addiction manifests itself
Hospital setting remains protected
The Medical Marriage
Professional Risks - Physicians
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PHARMACOLOGIC OPTIMISM
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Self Prescribing Behavior
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ACCESS AND KNOWLEDGE
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Geographic Mobility
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Myth of Immunity
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Myth of Entitlement
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REFERS TO THOSE REACTIONS OR BEHAVIORS OF FAMILY MEMBERS, FRIENDS,
INSTITUTIONS, OR PEERS OF ADDICTS THAT SHIELD THEM
FROM EXPERIENCING THE HARMFUL CONSEQUENCES OF
THEIR ALCOHOL OR OTHER DRUG USE
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Denial Family Secrets Maintain image of stability Loyalty Motivation Rationalization Ultimatums
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Humanistic and Caretaking Missions Dedication / Commitment Common bond Alignment – Extended Family Shared Experiences Secrets unknown to laymen Graveyard Humor
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Face Uncertainly and Death Excessive time Together / Long
Hours Professional Family Membership : Legal
Documentation / Licensure Maintain image of Prestigious Group Protection
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FACT: Any Addict is a Potential Suicide
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Appearance
Absenteeism
Difficulty concentrating
Confusion
Memory problems
Lability of mood / Irritability
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POOR DOCUMENTATION RELATED TO WASTING / ADMINISTRATION
UNOBSERVED WASTE WITHOUT SIGNATURES
ERRORS IN ADMINISTRATION
EXCESSIVE WASTE, SPILLAGE, BREAKAGE OF CONTROLLED SUBSTANCES
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Signs out more controlled drugs then anyone else
Volunteers for additional shifts and work on unfamiliar units
Medicates other’s patients while they are on break
Patients being cared for report ineffective efficacy of pain medications
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Seeks out MD on Duty for Personal Complaints of Pain
Doctor Shopping
Always Uses IM or IV and Maximum Dosages
Diversion
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Possession
Possession
SaleSale
Manufacture
Manufacture
Distribution and Trafficking
Distribution and Trafficking
ForgeryForgery
Prescription Fraud
Prescription Fraud
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Tool to assist prescribers in making more informed dispensing decisions
Law enforcement - assists with investigations of drug abuse and diversion
Covers schedule ii-iv controlled substances dispensed prescriptions
24/7 access within minutes
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Thorough assessment Specialty treatment Aftercare Monitoring High accountability
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Legislated in 1998 as an alternative to disciplinary action
Monitoring services Operated by Virginia Commonwealth
University department of psychiatry, under contract with department of health professions
Eligibility Nature of impairments
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Strong peer group setting board involvement Drug testing Licensure restrictions
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Contract Abstinence Practice Restrictions Individualized drug screening
protocol Peer monitoring 12 step meetings Caduceus
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