RD20 (2016) Substance abuse

If direct evidence:

Now

· Make sure patient ok

· Make sure colleague ok

· Relieve colleague of clinical duties

Today

· High risk of suicide

· Do not leave him/her alone

· Arrange psych admission

· Notify head of department

Later

· Rehabilitation

· Assess suitability of RTW

· RTW programme with regular drug testing

· Consider career change

Signs

· Injection marks

· Carrying paraphernalia outside OT

· Taking out large amounts of drug

· Poor record keeping

· Drug book inconsistencies

· Patients consistently in severe pain in PACU

· Change in behaviour

· Withdrawal signs

Actions

· Notify senior colleague

Signs	· Change in behaviour, mood, personality, appearance · Deterioration in performance · Away too much (away sick, late to work, in bathroom) · Present too much (taking on shifts, staying late, refusing breaks)
Problems	· Patients could be at risk · Anaesthetist could be at risk · Department cohesion could be at risk · Difficulty maintaining confidentiality
Notification	· Notify senior colleague · Written statement better than verbal statement
Investigation	· Retrospective and/or prospective audit of drug prescription · Discrete observation by trusted person · Findings must be documented · Process may take some time
If not upheld	· Keep a record of the investigation · Do not attempt intervention if evidence is insufficient

Before

· Notify the anaesthetist early in the day when he/she is on duty

· Allow anaesthetist to appoint an advocate

· Anaesthetist must be accompanied at all times because of suicide risk

During

· Explain reason for meeting

· State evidence

· Allow response

· Explain what happens now

After

· Arrange admission to detoxification unit

· Anaesthetist must be accompanied at all times because of suicide risk