Dr Peter Cook
Aboriginal Health
ICU
Procedures
Clinical Articles
Chemical Dependence - Alfred Campus Policy
Management of the dying patient in ICU
Substance Abuse / Chemical Dependence
Substance Abuse Protocol - Auckland Hospital
Disaster & Emergency Medicine Project
|
Current Legislation & Future
Options Prevention of Drug Misappropriation Management of Drug Dependence The Alfred Campus Policy on Chemical Dependence The Auckland Hospital Substance Abuse Protocol |
CURRENT LEGISLATION
AND FUTURE OPTIONS
Drug abuse by anaesthetists can be divided into:(1) chronic substance abuse
(2) suicide utilizing pharmacological knowledge.
Neither category of drug abuse will be totally prevented by clerical methods of drug handling.
PREVENTION
OF DRUG MISAPPROPRIATION
In NSW Public Hospitals drug handling should comply with
NSW Health Department Circular 95/37. Failure to comply with
the mandatory requirements of this document may not be
noticed until a drug related critical incident occurs. At
that time causation may be suggested between the failure of
compliance and personal harm. This may or may not have some
basis in reality.Broadly speaking only two rules significantly impact on anaesthetic care. Firstly, all unused opioids should be disposed of and these discards must be recorded (on the anaesthetic sheet is acceptable). Secondly, opioids should only be drawn up for the imminent use on one patient.
Labelling the anaesthetic drug trolley as an emergency or resuscitation trolley may obviate the need to implement more restrictive drug handling measures. Placing separate opioid safes in individual theatres may also make compliance with regulations easier.
MANAGEMENT OF DRUG DEPENDENCE
The management of chemical dependence in the anaesthesia department requires awareness and planning. Protocols exist and these are largely local modifications of the 1991 American Society of Anaesthesiology Chemical Dependence Guidelines.
These state that substance abuse is a medical disease incompatible with safe anaesthetic practice. The Chief of Anaesthesia, after expert consultation, decides if any staff member is suffering from chemical dependence. The affected member must accept this judgement. This person is immediately placed on leave and assessment and treatment begins. If there is an error in diagnosis all references are expunged from the staff members employment records. Return to work is governed by Chemical Dependence Re-entry Policy.
A modification of this approach, reflecting different departmental structures and work practices in this country, is under consideration by the Australian and New Zealand College of Anaesthetists.
(Copies of NSW Health Department Circular 95/38 are available by phoning (02) 93919010)
Intensivist/Anaesthetist
LISMORE NSW 2480
PHONE (02) 66 221285
FAX (02) 66 22 0740
EMAIL: cookcare@nor.com.au
|
Return to top of page This page was last built on 5/6/99; 10:54:35 AM. It was originally posted on 6/5/98; 6:54:49 PM. Webmaster:  lemlink@medicineau.net.au |
 |
Index |  |
Substance Abuse Protocol - Auckland Hospital |
MedicineAu