Controlling risks of HCW drug diversion
It’s happening much more than it used to’
Hospitals increasingly are teaching managers to look for signs of drug abuse among employees, focusing on subtle clues like talk of financial problems or more blatant signs, such as arriving to work late or failing to show up as scheduled.
Once there is suspicion of a problem, managers can refer the employee for a drug and alcohol screening test.
The biggest trigger for screening a health care worker for substance abuse is suspicion of drug diversion, says Jay D. Harper, MD, MBA, MPH, employee health services medical director at the University of Pittsburgh Medical Center.
"Drug diversion is the trigger that gets a lot of attention and is happening much more than it used to," Harper says.
Hospitals increasingly are having employees drug-tested when there are problems of miscounted medications, not following procedures, and not being able to say what happened to missing medications, Harper says.
Here are a few suggestions for how to screen for drug diversion and handle the problem:
Require a blood-borne pathogen test: "When we do fitness for duty testing, we do blood-borne pathogen testing, checking for HIV, hepatitis B and C, because with diversion there have been cases where health care workers have been taking syringes and injecting themselves, and then giving them to a patient," Harper explains. This practice may result in patients becoming infected, especially with hepatitis C, he adds.
If the employee who is suspected of drug diversion tests positive for hepatitis C that matches the infected patient, then hospital officials have confirmation of drug diversion.
Involve other departments when diversion is suspected: Ask a human resources representative and the employee’s manager to be present as witnesses. The decision about requiring a blood-borne pathogen test should be made by HR and the manager — not employee health, Harper notes.
"The person suspected of diversion should always be accompanied by another person to employee health," he explains. "We’ll do the testing and make sure the employee has transportation to return home."
Results can be given over the telephone by the employee health director.
Keep employee assistance in the loop: Whenever there’s a fitness for duty test, it’s a mandatory referral to the hospital’s employee assistance program (EAP), Harper says.
Employees with substance use problems sometimes need medical and other help.
"EAP reports whether the person is complying or not with their recommendations," he says. "I get involved if the employee’s drug test comes back negative, but the person still has behavior problems at work — maybe there’s a medical reason."
The hospital’s EAP also can take care of making arrangements for narcotics anonymous or alcoholics anonymous.
"I’ll talk to the employee, and EAP will talk to them, so if there’s an issue other than drugs where they need help, we’ll figure it out," Harper says.
Offer last-chance agreements: "We give last-chance agreements where the employee is subject to random drug testing for three years," Harper says. "The person is tested frequently for six months and then less frequently, and it’s totally random."