Education is an important facet of the drug testing program at Tampa (FL) General Hospital, says JoAnn Shea, CHON-S, MS, ARNP, director of employee health services.

"We want to identify it before, No. 1, the health care worker becomes so addicted that it's hard to recover," and also to ensure patient safety, she says.

Shea teaches a 1½-hour course about how to ensure a drug-free workplace. The course covers substances of abuse and symptoms of abuse. They include:

  • excessive use of sick time, especially following days off;
  • absence without notice or last-minute requests for time off;
  • long breaks or lunch hours;
  • frequent or unexplained disappearances from the department;
  • "job shrinkage": the employee increasingly does the minimum work necessary for the job;
  • increasing difficulty meeting schedules or deadlines;
  • sloppy or illogical charting;
  • smell of alcohol on breath;
  • an excessive number of mistakes (i.e., frequent medication errors or errors in judgment);
  • excessive use of breath mints, chewing gum, or mouthwash;
  • elaborate, implausible excuses for behavior;
  • emotional lability. The employee becomes quiet, irritable, or has frequent mood swings;
  • inappropriate verbal or emotional responses such as snapping at colleagues, uncontrolled anger, or crying;
  • diminished alertness, confusion, or frequent memory lapses;
  • the employee increasingly isolates himself/herself from co-workers;
  • requests transfer to the night shift;
  • increasing complaints from staff regarding employee not carrying his/her share of workload;
  • alcohol abusers may have bloodshot eyes, faces that are puffy and flushed, trembling hands, and spider veins around the nose;
  • pupils may be constricted (narcotics) or dilated (stimulants);
  • runny eyes or runny nose with clear mucous drainage;
  • unkempt. Hair lacks luster. Thin. Rarely physically fit or athletic;
  • avoids eye contact.

Nurses stay longer at the class to be educated on the signs and symptoms of diversion. [A copy of warnings signs for drug diversion is available here.]

Such education is necessary in today's surgical environment, Shea says. "I think that in every ambulatory care center, there is access," she says. "It depends on how the drugs are controlled, but they should have way to audit."

In addition to an audit program, many departments have included chart reviews of controlled drug usage in their departmental quality assurance programs, Shea says. "If you don't, you may end up having someone who is diverting and isn't identified."