[MCOH-EH] Suspected fentanyl use

[Shea, Joann]

We identify most of our diversions primarily from our controlled drug audit reports (variances in frequency of CS administration)  and not from impaired behavior.   Employees who are impaired at work are sent to EHS immediately.   If we have any concerns about patient safety or patients not receiving their pain medications, or work performance concerns,  we would intervene immediately.

Most healthcare facilities don't identify HCWs diverting on the first day they divert a controlled substance.  It has probably been going on for 2-3  months or longer.    Once we identify the person based on audits, we want to ensure that we have enough documentation to ensure we have "probable cause."   Once we feel we have enough documentation,   we schedule the intervention during or at the end of shift.   Most nurses who are diverting have never had workplace performance concerns and , in fact, many are the top performers.  They take extra doses of the drug or use the waste when they first start diverting.   The key is to identify as early in the process as possible.

  Because we have gotten better at identifying diversion using new in-house audit reports and have a dedicated diversion nurse,    we usually are able to intervene before the HCW has been using long enough to exhibit impaired behavior.     We  usually are able to identify diversions within 3 months now compared to up to six months or more previously.

  When we identify a variance in our audits, we meet with the manager to review performance and behavior and our diversion nurse does a chart review of MARS and pain scores and will even talk with patients about their pain if we notice the employee was medicating more frequently than co-workers on specific shifts.

The other reason we want to ensure we have a positive UDS and/or find drugs on their person is that, if the employee refuses to admit to the diversion and/or enter into our state mandated recovery program, we report them to the state and terminate.    Even with what we feel is solid documentation of probable cause,   with a negative UDS and no drugs, we have found that the state is more likely not to find "probable cause" and drop the case.   It is frustrating to hear that  a nurse we felt was diverting, who the state decided not to charge, is working at another healthcare facility.

This process has worked for our facility for many years and we have never had any patient safety issues related to scheduling an intervention during work time or end of shift as we ensure the employee is safe to practice.

Hope this explanation helps!  JoAnn






[TGH_employee health serv-color]
JoAnn Shea, ARNP, MS, COHN-S
Director, Employee Health & Wellness      "Caring for our Caregivers"
Work: 813-844-7692    Cell:  813-789-3441    FAX;  813-844-8144    Email: jshea at tgh.org<mailto:jshea at tgh.org>


From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Weaver, Meredith
Sent: Thursday, May 10, 2018 1:42 PM
To: 'mcoh-eh at mylist.net' <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Suspected fentanyl use

Hi JoAnn,

We had a recent situation with suspected fentanyl diversion and made a recommendation similar to the approach that your hospital takes where the intervention would be made during the middle or near the end of the shift.  The director of the unit was not comfortable with that approach from a patient safety perspective.  How do you address patient safety while the suspected diverter works his/her shift?

Thanks,
Meredith


From: MCOH-EH [mailto:mcoh-eh-bounces+weaverm=wvumedicine.org at mylist.net]On Behalf Of Joann via MCOH-EH Shea [*]
Sent: Wednesday, May 9, 2018 3:38 PM
To: MCOH/EH <mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>>
Cc: Shea, Joann <jshea at tgh.org<mailto:jshea at tgh.org>>
Subject: Re: [MCOH-EH] Suspected fentanyl use

We developed a healthcare professional panel with our lab that includes fentanyl and do a urine test when we have a suspected diversion.    If we suspect fentanyl diversion, we arrange for the intervention in the middle or near the end of the HCW's shift, as most will use it sometime during their shift and/or have drug in their possession when we search them and their belongings.    We get a positive urine drug screen results for fentanyl in most cases when we intervene in the middle or end of shift.

We contract with CRL and FedEX all urine specimens out for next day service.  We get results within 2-4 days, on average.

[TGH_employee health serv-color]
JoAnn Shea, ARNP, MS, COHN-S
Director, Employee Health & Wellness      "Caring for our Caregivers"
Work: 813-844-7692    Cell:  813-789-3441    FAX;  813-844-8144    Email: jshea at tgh.org<mailto:jshea at tgh.org>



From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net]On Behalf Of Yvonne Noel via MCOH-EH
Sent: Tuesday, May 01, 2018 11:29 AM
To: MCOH/EH
Cc: Yvonne Noel
Subject: [MCOH-EH] Suspected fentanyl use

CAUTION:This email originated from outside of the organization.  Do not click links or open attachments unless you recognize the sender and know the content is safe.


I would appreciate info on the following questions related to suspected  fentanyl use:

*        How would you proceed if an employee was suspected of fentanyl use?

*        Would you test urine, saliva or blood?

*        Can you provide the information on the screening panel used?

*        Where would the specimen be sent for testing?



Thank you,

Yvonne Noel





Yvonne Noel
Interim Manager
Occupational Health and Wellness
O: 214-456-1897
F: 214-456-2665
E:mary.noel at childrens.com



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