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Chemical Dependence - Alfred Campus Policy
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CHEMICAL DEPENDENCE
THE ALFRED GROUP OF HOSPITALS
ALFRED CAMPUS
DEPARTMENT OF ANAESTHESIA
Chemical dependence is probably the major single
occupational health risk associated with the practice of
anaesthesia. It is therefore essential to have a policy
understood by all staff so that when realistic concerns or
reasonable evidence of drug or alcohol abuse surface,
appropriate and safe action can be taken. There is usually a
long prodrome of this illness before signs appear at work.
It is therefore appropriate that carefully planned rather
than hasty actions are taken where the problem of chemical
dependence is suspected.This policy is written to address the problem of chemical dependence within the specialty of anaesthesia. It is recognised that this is a difficult problem to deal with and this policy requires acceptance by members of staff as a group for its effective implementation. Its aim is to provide an avenue for appropriate treatment of anaesthetists who develop chemical dependence to aid their recovery. It is also designed to protect the safety of patients anaesthetised in this hospital and to ensure the hospitals responsibility to those patients are met.
POLICY ON CHEMICAL DEPENDENCE
1. All members of the Department of Anaesthesia have a responsibility to share concerns about chemical dependence, either in themselves or other members of the department, in confidence with a designated resource person.
2. The Director of Anaesthesia or his designate must act as a confidential resource on chemical dependence.
3. The Director of Anaesthesia, in consultation with an appropriate medical specialist, will judge whether any member of the department is suffering from untreated or relapsing chemical dependence.
4. Should the Director of Anaesthesia after consultation mentioned above, believe that a member of staff is suffering from chemical dependence he/she will seek advice from the appropriate specialist with regard to the timing and nature of the confrontation with the staff member, and the advice to be given to that staff member until the staff member sees the specialist.
5. All members of the Department of Anaesthesia, recognising the serious nature of the condition and the dangers to both themselves and the hospital, must agree to accept the Director of Anaesthesia's decision that referral to an appropriate specialist is required.
6. Should it be determined by the specialist that the department member is not suffering from chemical dependence they will return to work with no further action or comment. Confidentiality must be maintained to allow this option without the individuals reputation being smeared by allegations of chemical dependence. It is also essential that members of staff permit this sequence to occur so that should the problem of chemical dependence exist, it can be treated as a medical disorder rather than as a disciplinary problem within the hospital.
7. Return to practice should remain an option for the staff member after recovering from chemical dependence. Return to work must be supervised by the treating doctor who must be given clearance by the treated staff member to have free communication with the Director of Anaesthesia.
8. Should the Director of Anaesthesia, in consultation with the treating specialist in chemical dependence, determine that the performance of clinical anaesthesia is incompatible with recovery, the department member should agree to resign from the department.
9. If it is agreed that the staff member may return to work after recovering from chemical dependence, a re-entry contract must be arranged between the staff member, the treating physician and the Director of Anaesthesia.
10. the re-entry contract should be drafted on an individual basis. The following points should be considered.
(a) The staff member provides the department with the name of the treating physician for the disease of chemical dependence. The physician must be one acceptable to the department and the staff member must give the physician permission to share all information concerning recovery with the Director of Anaesthesia on a confidential basis.This policy is based on recommendations of the American Society of Anaesthesiologists. It was prepared after considerable discussion with interested specialists.
(b) Staff member must agree to follow recommendations of the physician including involvement in follow-up programs and abstinence from substances of abuse.
(c) He/she must agree to random blood and to urine screens. Supervision and drug screening to be done by a physician outside the department of Anaesthesia. The outside physician must agree to perform random screens and provide results to the Director of Anaesthesia.
(d) Violation of this contract by evidence of self medication of any type or a positive drug screening must result in termination of staff privileges. Option of re-instatement after further treatment should remain open. It is recommended that all drug therapy including both prescription and over the counter drugs be individually approved prospectively by the treating physician. This is important to maintain strict control of drug use and of false positive tests on random urine screening.
Medical staff are reminded of the Doctors Health Advisory Service and may see advice from that organisation to obtain appropriate confidential referral. Where professional help is sought directly, the treatment of chemical dependence is between the patient and the treating specialist and may involve notifying the Medical Board, but does not necessarily involve the hospital. In that situation it is for the treating doctor or the patient to advise the hospital as appropriate.
Director of Anaesthesia and Operating Theatre Services
Alfred Hospital
PO Box 315
PRAHRAN VIC 3181 AUSTRALIA
(REPRODUCED WITH PERMISSION)
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