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 for 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

 

If major signs:

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

 

If minor signs:

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

 

Intervention meeting:

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