April FY 21

[clawry]

This month's journal article has been submitted by Jessica Switzman. The article is titled Substance Abuse and Misuse Identification and Prevention: An Evidence-Based Protocol for CRNAs in the workplace. Substance abuse is the principal cause of anesthesia personnel professional impairment. Approximately, 1 out of 10 CRNAs experience addiction to drugs or alcohol. The purpose of this evidence-based protocol is to provide a standardized approach for the prevention and early identification of substance abuse and misuse in the practicing nurse anesthetist.

1. Do you feel this evidence-based protocol to identify substance misuse would be valuable at Hopkins?

2. Are there tools/approaches we can use to abate substance misuse in the anesthesia community?

Here is a link to the article.

[Jennifer Hannon]

1) I feel the EB protocol would be helpful at Hopkins, but having worked here for 10 years+ as well I know Hopkins has it's own system they follow. Many of the same ideas on the protocol are done at Hopkins already.

2) There are tools and approaches to abate the response to substance misuse, however I personally feel it comes down more to one's external factors, one's chemical/genetic make-up and also the ease of access that anesthesia providers have and sadly this will always be around a ~10% problem among all providers.

[Anne McNulty]

the Samip -C protocol could be beneficial at JHU. This protocol is top-heavy with high level personnel, committee meetings, and supervisory personnel. It needs substance abuse counselors and rehab specialists. Still, after all the years, a culture of care is missing. I have never seen any one involved with substance abuse return to work at JHU. Whatever the state of Maryland does to help a CRNA still has very few CRNAS returning to work after rehabilitation. Tools and approaches to abate substance misuse are frequently ineffective. Waste documentation, cameras and anesthetic records will still not end this endless workplace problem. Now that we are a feel good society and fentanyl is a known household word, the stats are higher than in the past 25 yearsl.

[Monica Douglas]

1. Do you feel this evidence-based protocol to identify substance misuse would be valuable at Hopkins?

I feel that the evidence-based protocol to identify substance misuse would be valuable at Hopkins, but I have conflicting views on the definition of "substance misuse." In our society, certain "substances" are more socially
acceptable than others. Would the substance misuse protocol include alcohol use or prescription narcotic use? Having been a drug and alcohol counselor in my previous life (lol), I know that alcohol is identifiable in the system for 24 hours. Therefore, I am not sure how alcohol misuse could be identified with a simple drug screening. Would someone be identified as having substance misuse if they had a glass of wine the evening prior to being screened for substance misuse? Another example is prescribed narcotic use. If someone is prescribed narcotics for chronic pain and they take it as prescribed, would they be identified as having substance misuse because it was detected in their system.

2. Are there tools/approaches we can use to abate substance misuse in the anesthesia community?
I feel that an anesthesia provider's performance should be the primary tool for identifying possible substance misuse. If someone is truly engaged in addictive behaviors, eventually, their substance misuse will interfere with their ability to perform optimally. Because of the reasons that I identified in the previous question, I feel that there is truly no way to accurately identify substance misuse until one's behavior/performance gives administration reasons to question and suspect alcohol misuse in an employee.

[Dahlia Rouchon]

I feel the evidence based protocol could also be useful to a degree we have adequate staffing/resources/desire to utilize these resources to do so in a culture of empathy, support, and without stigma. Implementing it in the manner outlined in the article however, seems a challenge given limited anesthesia providers overall, cameras needed to the multitude of clinical sites that use narcotics at East. Baltimore campus, etc. as listed.
Tools to support substance misuse in the community would be an individual effort or acceptance of the disorder, desire to make personal/lifestyle changes to make it happen and this cannot be forced. Ultimately the safety of the patient and provider is the 1st priority so when the impaired provider is recognized, the individual must be removed from the work environment.

[kels]

Yes I do feel this evidence-based protocol to identify substance misuse would be valuable at Hopkins. Unfortunately I am not very confident that substance misuse in the anesthesia community will be decreased unless we cultivate a work " community ". A community were one feels accepted to discuss struggles going on in ones life before making that first move to abuse drugs. A lot of the time I think people think work is work and nothing more. It would be awesome if work felt like a safe haven when it came to the struggles of life outside of work ( and at work ) , a place where one could get support for these struggles without thinkink the job is in jeopardy . 10 % is a lot, how cool would it be for a wellness coach to check on each one of us a least once a year.

[kelseyleonard]

1. Do you feel this evidence-based protocol to identify substance misuse would be valuable at Hopkins?
I agree with others that this protocol could be used at Hopkins however there are limitations. Culture is something that can be very difficult to change, especially at an institution like JHU. Identifying a risk assessment and creating an environment in which CRNAs feel comfortable talking about these struggles sounds great but I feel would be challenging. We have such a large number of CRNAs, plus anesthesiologists, plus others brought in to help form the initial committee such as administrators and pharmacists, it may be too broad for someone to feel comfortable sharing struggles before/after substance misuse occurs.

2. Are there tools/approaches we can use to abate substance misuse in the anesthesia community?
Without the willingness of an individual to be forthcoming about the potential for misuse or the once it has begun, I think it is difficult to identify tools to abate this problem. Once the individual's impairment becomes evident in the workplace then patient safety becomes the first priority.

[aileenm4]

1. A protocol that is transparent and communicated and shared with many would be helpful. I believe the community of caring and sharing where people can go for help if needed or just to talk needs to be communicated on a more often basis especially during this ultra stressful time of COVID. Confidentiality is essential as well for all those involved for success
2. Tools that can be used are continued education on avenues for help, education,leadership check ins, pharmacy discrepency followups, community of helping those who need help how to find it easily

[Ben Waldbaum]

1.) I think parts of it would be very helpful, especially random drug screening. I've been here 10+ years and there have been multiple CRNAs/MDs found to be diverting narcotics. I think random testing would find more offenders in the short term and in the long term prevent some CRNAs from diverting.

2. There's no "one size fits all" approach.

[Soo-Ok Kim]

1.Do you feel this evidence-based protocol to identify substance misuse would be valuable at Hopkins?
It sounds wonderful if the protocol works at Hopkins. However, I am not sure the limitations such as cost, time and personnel resources in instituting protocol can be overcome. The 10% incidence in this issue is pretty high, which means about 10 people in more than 100 CRNAs in Hopkins may have experienced this. The magnitude of related issue to our work place will be even higher. I have not seen the affected CRNAs in Hopkins back at our work place.
Stigma and punitive behavior tends to be more prevalent than supportive and productive treatment option offer.

2. Are there tools/approaches we can use to abate substance misuse in the anesthesia community?
Work place support and amicable work culture change will help affected providers to seek for necessary assistance.

[Christine Velarde]

I think the protocol would be welcomed at Hopkins. However a talk by the legal department and the Maryland nurses association made it clear diversion is a crime and that the nursing board is here to protect the consumer not the person that may need the help.
I think people may not seek the help they need to get the appropriate treatment.
2. What tools or approaches can be used? I think we should try a non-punitive approach to help someone who has a substance abuse problem. As someone mentioned, one accused is assumed guilty until proven innocent. We do need to let our supervisors know about suspected misuse/ abuse so that we can help our colleagues seek the help/counselling they need.

[Lu Lin]

1. Do you feel this evidence-based protocol to identify substance misuse would be valuable at Hopkins?

I feel that the evidence-based protocol to identify substance misuse would be valuable at Hopkins. In our society, certain "substances" are more socially
acceptable than others. Would the substance misuse protocol include alcohol use or prescription narcotic use?  If someone be identified as having substance misuse if they had a glass of wine the evening prior to being screened for substance misuse. If someone is prescribed narcotics for chronic pain and they take it as prescribed, would they be identified as having substance misuse, only because it was detected in their system.

2. Are there tools/approaches we can use to abate substance misuse in the anesthesia community?

I think anesthesia provider's performance should be the primary tool for identifying possible substance misuse. If someone is truly engaged in addictive behaviors, eventually, their substance misuse will interfere with their ability to perform optimally. 

[nanci]

1. Do you feel this evidence-based protocol to identify substance misuse would be valuable at Hopkins?
I think it would be valuable at Hopkins but not sure how they would implement it as appears it would cost more and take a lot of time away from clinical practice (with already short staffing how to rotate people through to allow screenings on work time). Hopkins does promote evidence-based practice so an evidence-based protocol seems to fit as being useful if they found a way to implement it.

2. Are there tools/approaches we can use to abate substance misuse in the anesthesia community?
Would be nice if staff had a safe way to approach getting assistance with substance misuse and felt that their careers would not be put in jeopardy for coming forth asking for assistance. Supportive measures and feeling valued in the workspace can help.

[Wai-Ling Lo]

1. Do you feel this evidence-based protocol to identify substance misuse would be valuable at Hopkins?
Yes I too think it would be valuable at Hopkins. But the sustainability of the protocol is challenging because maintaining it can be costly and labor intensive. Like Anne and Kels said, other than implementing an evidence based protocol, nurturing a culture of care and work community to support struggling coworkers are also important.


2. Are there tools/approaches we can use to abate substance misuse in the anesthesia community?
In clinical setting, patient safety is the first priority. Therefore, 'see something say something' is everyone's responsibility.
Everyone put effort to cultivate colleague relationships and be supportive to each other.

[Amy Swank]

1. An interesting idea to implement here at Hopkins... Perhaps not the entire protocol, but at least some aspects. I thought it startling that I haven't seen random drug testing here or at least after an "event". In other professions, that is the standard. Care and support for the struggling provider is admirable, but so is keeping patients safe. I always found myself so struck that I didn't know so many of impaired providers were working alongside me! An unbiased random evidence-based system would be beneficial.

2. I remember the first day of anesthesia school having the required lecture about substance abuse within the anesthesia community. Always perplexed me - is the individual who has addictive tendencies drawn to this profession? Or does the access to the narcotics tempt a provider to start down the path? I admire the resources available within AANA and I'm sure here at Hopkins. Support so crucial.