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Chemical Dependence - Alfred Campus Policy |
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.
(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.
This policy is based on recommendations of the American
Society of Anaesthesiologists. It was prepared after
considerable discussion with interested specialists.
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.
A.M. WEEKS
Director of Anaesthesia and Operating Theatre
Services
Alfred Hospital
PO Box 315
PRAHRAN VIC 3181 AUSTRALIA
(Reproduced with permission)
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