Drug abuse can have lasting impact
By Matt Gunn
News Editor/Writer
Recent events such as the hepatitis C outbreak in Colorado highlight the dangers of employees who are abusing drugs or alcohol on the job. However it is often difficult to spot the signs of drug abuse in an employee or coworker until it’s too late.
Thousands of patients were at risk after an employee of Rose Medical Center in Denver – who later moved on to Audubon Surgery Center in Colorado Springs, Colo. – was accused of allegedly stealing liquid painkillers such as fentanyl and refilling the dirty syringes with saline. Not only did the patients fail to receive the painkillers , but the employee accused of stealing the drugs was infected with hepatitis C. Nearly 6,000 patients were offered a screening for the disease at the hospitals’ expense. The list of those infected grew throughout July and into August.
The accused employee – a surgical technologist – faces 21 counts of tampering and illegally obtaining a controlled substance. The situation in Colorado, where a technologist who should not have had access to drugs was able to obtain them in the operating room, shows how a system breakdown can contribute to widespread infection and a heavy financial burden upon the facilities in which it took place.
“Technologists don’t have access to meds like nurses do,” said Rebecca R. Heck, BSN, RN, MPH, Director of Nursing Peer Health Assistance and the Nurse Alternative to Discipline Program for Peer Assistance Services in Denver. “No way do they have access unless other providers leave it out.”
The accused technician is out of the profession and could face a long prison sentence. For nurses or other healthcare professionals, the effects of drug abuse can cause not only personal harm and the risk of infection, but also the loss of licensure. It’s also important to note that each state’s laws are different, and that other consequences can result from drug theft and drug and alcohol abuse in the workplace.
“Substance abuse prevalence in the general public mirrors that of substance abuse in healthcare professionals,” Heck said. “They say about 10% of the general population has a substance abuse disorder, and so do nurses, doctors, pharmacists – 10%. But healthcare professionals have a better rate of recovery because of programs like this that monitor and hold the healthcare professional accountable.”
One problem, however, can be that it’s not always easy to spot abuse until it’s too late. Employees who are abusing or stealing drugs could potentially be using a tactic called diversion; they may volunteer for overtime, arrive early or go the extra mile to help out. While most employees are honest workers, the traits of a drug abuser can include irritability or the sudden loss of irritability after they return from another location in the facility.
An alcoholic can be easier to identify – they might have the smell of alcohol on their breath, or the signs of a hangover at the start of each shift. It’s not so easy when an employee is abusing drugs only available in the facility, such as painkillers.
“With substances like fentanyl, Dilaudid or Percocet, what we have been seeing is that it’s the nurses who volunteer for all the overtime shifts because that’s where the drug is,” Heck explained. “If it’s alcohol you can get it anywhere anytime. If the nurse can only get the drug at work, he or she will be volunteering for a lot of overtime, leave the unit or the floor a lot to go use or steal the drugs, and you’ll also notice irritability. Sometimes you’ll notice poor charting or mistakes, but it’s usually not until the end of the disease or the process where they get sloppy with their charting and patient care.”
Read this issue’s Manager’s Q&A for more information from Heck regarding identification and treatment options for nurses who might be abusing drugs or alcohol in the workplace.
If more widespread problems are found, managers or human resources staff might need to begin investigating for issues beyond those of an individual employee.
“You have to find the failure point,” said Rod Hicks, PhD, RN, FNP-CS, patient safety chair at Texas Tech University-Health Sciences Center and mentor at the University Medical Center Health System in Lubbock, Texas. “These people are pretty intelligent in the area of deception. They are able to find the workaround.”
The burden is passed to the management, who might have to go back through medical records or examine mistakes in charts and medical records to see just how prevalent a problem might be.
“It comes down to professional accountability and responsibility,” Hicks said. “We have to supervise because those drugs are actually under the control of a licensed individual in that room. Finding a silver bullet for how to monitor that all the time? There is no one silver bullet.”
For nurses and other healthcare professionals, there are often services in place that can help aid recovery once a problem with drugs or alcohol is identified. At Peer Assistance, Heck said one of the first steps is to place an abuser on a one-to-five year plan. Though the use of a program like Peer Assistance is voluntary, it can be the only thing standing between recovery and the loss of a career.
“A nurse has his or her licensure at stake,” Heck said. “Once a problem is identified, and the nurse comes over to our program whether voluntarily or through the state board of nursing, we put them on a one to five year contract. It’s called a rehabilitation contract, and it holds them accountable for the treatment.”
Read more news in AORN Management Connections.