role of occupational health professionals in managing ... · learning outcomes 1. list three common...
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Role of Occupational Health
Professionals in managing
substance use disorder among
health care workers.
Dr Lija Gireesh, DNP, APRN, FNP-BC, COHN-S
Lead Nurse Practitioner
Employee Health Services, Christiana Care Health Systems
AOHP 2019 National Conference
Learning Outcomes
1. List three common manifestations
observed in people with substance use
disorders.
2. Identify two resources for help for
workers with substance use disorders.
3. Describe at least two elements for a
successful workplace substance use
disorder prevention program
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Scenarios
Definition
Substance use disorders occurs when the
recurrent use of alcohol and/or drugs
causes clinically and functionally significant
impairment, such as health problems,
disability, and failure to meet major
responsibilities at work, school, or home
(SAMSHA).
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Significance
Leading cause of missed workdays over the past year
◦ Pain medication use (29 days)
◦ Illicit drug use (unspecified) (18 days)
◦ Marijuana use disorder (15 days)
◦ Alcohol use disorder (14 days)
Employer costs related to substance use disorders costs nearly $81billion.
Employees who abuse drugs are more than three and a half times as likely to have an accident on the job, and five times more likely to have an off-the-job accident that impacts workplace performance
Five times more likely to allege worker’s compensation
https://www.areadevelopment.com/workplace-trends/workforce-q4-2017/impact-of-substance-abuse-on-finding-a-quality-workforce.shtml
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Drug of abuse at workplace
Alcohol
Prescription stimulants
Illegal stimulants
Antidepressants
Prescription sedatives
Benzodiazepines
Herbal drugs
Opioids
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Physical signs of Substance Use
Disorder Changes in sleep patterns.
Changes in eating habits
Cold sweaty palms
Red, watery eyes, pupils larger or smaller than usual
Extreme hyperactivity, excessive talkativeness.
Slowed or staggering walk, poor physical coordination.
Tremors or shakes of hands, feet or head.
Irregular heartbeat.
Runny nose, hacking cough
Puffy face, blushing, or paleness
Deterioration of hygiene or physical health
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Behavioral signs of Substance Use
Disorder Unusual smells on breath, body or clothes.
Needle marks on lower arm, leg or bottom of feet.
Frequent rubbing of the nose
Frequent twisting of the jaw, back and forth
Changes in attitude and activities
Excessive need of privacy
Changes in social networks
Unexplained need of money
Anxiety
Depression
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Drug Diversionary Behaviors
Reports that drugs have been wasted or containers broken without witness
Administer prn medications at maximum dosages when other nurses don’t
Have patients report variance in pain relief in the absence of change in dosage or frequency
Frequently volunteers to get medications out of secured cabinets and administer them
Request transfers to night shift or to areas with minimal supervision
Seek assignments to areas where opioids are used extensively
Routinely administer controlled substances to confused patients
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Red Flags
Appearance changes
Loose fitting clothes with multiple pockets
Often cannot be located in his or her assigned area
Volunteers, frequently, to work overtime, extra days
Opioid shift count errors that arise repeatedly when the same nurse is on duty
Patients repeatedly fail to achieve the expected level of pain relief from their prescribed analgesics
DRAMA
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Signs and Symptoms of Substance
Use Disorders in Health Care
Workers
In 10% of cases presenting symptom is
death
Signs and symptoms too difficult to
appreciate until it is too severe to ignore.
Substance use disorder relapse rate is
high (30-60%)
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• Neurobiological factors: Alterations in neurotransmitters
of the reward system
• Genetic Predisposition: Accounts for 50% of alcohol
addiction
• Psychological factors: Comorbid psychiatric conditions
• Personality: Impulsivity and sensation seeking
• Occupational factors: Exposure and access to
substances of abuse
» Stressful nature of work
» Attitude/Personality
» Occupational exposure
Risk factors for Substance Use
Disorder
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Resources
SAMSHA: Substance Abuse and Mental
Health Services Administration
HHS: Department of Health and Human
services; Opioid initiative
White House Office of National Drug
Control Policy (ONDCP)
NIDA: National Institute on Drug Abuse
American Nurses Association: code of ethics
Workplace monitoring programs
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SAMSHA: Substance Abuse and
Mental Health Services
Administration
Behavioral Health is
essential to Health
Prevention works
Treatment is effective
People Recover
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Drug Free work place programs
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American Nurses Association
Code of ethics for nurses: “incompetent, unethical, illegal, or impaired practice”
A nurse who is aware of such a practice has an ethical
obligation to report
“Concerns should be expressed to the person carrying out the questionable practice” before reporting to a higher authority, such as a supervisor (ANA, 2001).
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Essential Elements
Build a team
Assess your workplace
Develop a policy
Plan and implement program
Evaluate program
Provide support
https://www.samhsa.gov/workplace
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When impairment is suspected
• No action
– Denial
– Fear of litigation and lack of established policies
– Change jobs when they perceive that their behavior is
scrutinized
• Enabling
– Covering up/ making excuses for impaired coworker to
protect their job
• Reporting
– Factual reporting to chain of command
– Confidential reporting
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Occupational Health Professionals
role in developing a program
Developing a Culture of Transparency and Support
Minimizing horizontal violence and stress at workplace
Supportive work place environment
Education in the workplace about the issue
Prevention actions for diversion
Proactive policies and procedures
Regular monitoring as prevention
Internal investigations
Identifying worker with substance use disorder
Managing worker with substance use disorder
Action plan
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SBIRT
• Screening
➢ Health care professional including EHS clinician
➢ Supervisor
➢ Self-administered questionnaires
• Brief Intervention
➢ Motivational interviewing
➢ Asking, assessing, advising and monitoring
• Referral to Treatment
Multiple tools are available online
➢ Use your EAP resources
➢ Follow-up and maintain support upon reentry to workforce.
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References American Nurses Association: Substance Use Disorders and the American Nurses Association Code of Ethics for Nurses.
https://connect.springerpub.com/content/sgrcn/24/3/163.full.pdf
Carter, T., McMullan, S. P. & Patrician, P. A (2019) Barriers to Reentry Into Nurse Anesthesia Practice Following Substance Use Disorder Treatment: A Concept Analysis. Workplace Health and safety, Apr;67(4):189-199. doi: 10.1177/2165079918813378.
Lambrechts, M. C., Ketterer, F., Symons, L., Mairiaux, P…et al (2015). The Approach Taken to Substance Abuse by Occupational Physicians: A Qualitative Study on Influencing Factors. The Journal of Occupational and Environmental Medicine, Nov;57(11):1228-35. doi: 10.1097/JOM.0000000000000549.
Monroe, T., Vandoren, M., Smith, L., Cole, J. & Kenaya, H. (2011) Nurses recovering from substance use disorders: a review of policies and position statements. The Journal Of Nursing administration, Oct;41(10):415-21. doi: 10.1097/NNA.0b013e31822edd5f
Mumba, M. N. (2018). Employment implications of nurses going through peer assistance programs for substance use disorders. Archives of Psychiatric Nursing, 32(4):561-567. doi: 10.1016/j.apnu.2018.03.001
Mumba, M. W., Baxley, S. M, Snow, D. E. & Cipher, D. J. (2019). A Retrospective Descriptive Study of Nurses With Substance Use Disorders in Texas. The journal of addictions Nursing, Apr/Jun;30(2):78-86. doi: 10.1097/JAN.0000000000000273.
NCSBN: A nurse mangers guide to substance use disorder in nursing https://www.ncsbn.org/Mgr_SUDiN_Brochure_2014.pdf
Phillips, J. A., Holland, M. G., Baldwin, D. D….et al (2015) Marijuana in the workplace: guidance for occupational health professiona ls and employers: Joint Guidance Statement of the American Association of Occupational Health Nurses and the American College of Occupational and Environmental Medicine. The Journal of Occupational and environmental Medicine, Apr;57(4):459-75. doi: 10.1097/JOM.0000000000000441
Riboldi, L., Bordini, L. & Ferrario, M. M. (2012). Fitness for work in health care workers: state of the art and possible operational recommendations for its formulation and management in relationship to alcohol and drug addiction. May-Jun;103(3):203-11
Substance Abuse and Mental Health services administration: https://www.samhsa.gov/ebp-resource-center
Warsley, M., Satterfield, J. M., Curtis, A., Lundgren, L. & Stare, D. D. (2018) Alcohol and Drug Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training and Implementation: Perspectives from 4 Health Professions. Journal of Addictions Medicine, Jul/Aug;12(4):262-272. doi: 10.1097/ADM.0000000000000410
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