Transcript The First Few Minutes with an Impaired Colleague

The First Few Minutes with an
Impaired Colleague
1
MICHAEL W. NEFT, DNP, MHA, CRNA
LTC, US ARMY, RETIRED
APRIL 10, 2014
ASSOCIATION OF VA NURSE ANESTHETISTS
7/18/2015
Agenda
2
 SBIRT-InGAS Project: PITT’s Nurse Anesthesia
Program and the School of Dental Medicine
 Definitions of Substance Use Disorders (SUDs)
 Incidence of SUDs
 SBIRT definition
7/18/2015
SBIRT-InGAS Project
3
 Funded by HRSA
 3 year lifespan
 Objective(s)
 Brief SBIRT history:
 EtOH
 Illicit Drugs
 Colleagues
 Meaningfulness of this project
7/18/2015
SBIRT
4
 1990 IOM report
 Goal of SBIRT: Improve community health
 SBIRT concept: it is helpful because:
 Gives us something to act with when we suspect a problem
 Gives us a reference point
 Essentially it empowers us
7/18/2015
American Nurses Association
5
 Impaired Nursing Practice:

Dysfunction….judgment/safe care delivery issues

Remember: Impairment/impaired practice does not have to be
related to chemicals! It can be d/t organic dz of some sort
(physical or emotional)
7/18/2015
Substance Use Disorders
6
 Definition: DSM V

…10 classes of drugs

…brain’s reward pathways

…stimulation of reward pathways is of primary importance

…eventually, a primal urge
7/18/2015
Substance Use Disorders
7
 DSM V: 11 criteria
 Larger amounts…
 Wanting to cut back
 Time spent obtaining substance
 Cravings
 Not getting done what needs to be done
 Continuing to use
 Giving up important activities
 Use despite danger
 Use despite exacerbation of other problems
 Tolerance
 Withdrawal sx
7/18/2015
Current Rates of SUDs (general population)
8
 Per Substance Abuse and Mental Health Services
Administration (SAMHSA)





EtOH: 2.0-14.3%
Illicit Drugs: 0.1-7.8%
Greatest percentage of heavy EtOH use: 21-25 yo
¾ of illicit drug users are employed(may be dependent on
EtOH too)
Prescription drug abuse is a growing problem (4.5-25%)
7/18/2015
Current rates of SUDs (Anesthesia Professionals)
9
 Per AANA:

9.8-16.8% of all Anesthesia professionals

CRNAs: Males > Females, 6-10 years of practice
7/18/2015
Reasons for Substance Abuse
10
 Pain
 Stress/anxiety
 Easy access
 Family hx
 Personality Issues:
 Over achievers
 Sensation seekers
7/18/2015
S/S of SUDs in Healthcare Providers
11
 Call-offs
 Overtime
 Chaotic life
 Attire
 Frequent Breaks
 Work performance
 Mood swings
 Documentation
 Behavior with controlled substances in general
7/18/2015
SBIRT - Definition
12
 S = Screening
 BI = Brief Intervention
 RT = Referral to Treatment
 Per SAMHSA:
 Comprehensive, integrated approach
 For those with SUDs or those who are at risk
7/18/2015
SBIRT
13
 Screening (S): Assesses/identifies
 Brief Intervention(BI): Increasing insight/awareness
 Referral to Treatment (RT): Provides access to care
 Some employment settings may use SBIRT as a
means of screening employees in wellness programs
or something similar.


Decrease in drug and alcohol use 6 months after intervention
Decrease in risky behaviors
7/18/2015
Screening
14
 Many forms:
 One question
 Multi-page assessment
 **Can be tailored**
 Babor & Kadden (2005):
 Screening  process  determines if dz ids present or if
patient is likely to develop problems
7/18/2015
Screening (Pre-Screening)
15
 Pre-screening = carefully asked questions
 Example: “AUDIT-C”
 Alcohol Use Detection Identification Test-Consumption
 3 questions:
How often have you had a drink containing alcohol?
 How many drinks containing alcohol do you have on a typical day
when you are drinking?
 How often do you have 6 or more drinks on one occasion?


**Would I really ask these questions verbatim?**
7/18/2015
Screening (Pre-Screening)
16
 Single Question:
 "On any single occasion during the past 3 months, have you
ever had more than 5 drinks containing alcohol?"
 SRNA Questions to patients (brief and validated):
 "Have you ever taken a prescription medication for a purpose
other than what it was ordered for?“
 "Have you ever had more than 4 drinks in one sitting" (if a
male), or "…more than 3 drinks in one sitting" (if a female)(
some sources use 4 drinks for women and 5 drinks for men).
 Smith (2010) 100% sensitive/73.5% specific
7/18/2015
Brief Intervention (BI)
17
 Motivational Approach
 Discussion of positive & negative aspects
 Behavior oriented approach…reinforcement
 Goal of BI(SAMHSA):
 Educate
 Increase motivation
 Expresses concern
 BIs can be more effective when presented by person
with similar background
7/18/2015
Brief Intervention(BI)
18
 Four basic components:




Asking
Assessing
Advising
Monitoring
 Six basic elements of effective BI:






Feedback
Responsibility
Advice
Treatment/self-help
Empathy
Self efficacy/empowerment
 Patient example
7/18/2015
Brief Intervention (BI)
19
 Motivational Interviewing:
 Empathetic
 Nonjudgmental
 Assumes potential for change
 Conversation guided in 2 directions:
 1. Identifies motives for change
 Elaborates on motives
 2. Helps person overcome ambivalence
7/18/2015
Referral to Treatment
20
 Complex process
 Referral when person meets Dx criteria per DSM V
 Most HR offices/Employee Assistance Programs
(EAPs) have policies governing impaired employees,
interventions, rehab.
 Motivationally based BIs can increase patient
compliance with treatment.
7/18/2015
SBIRT Uses
21
 Primary care/inpatient settings
 SBIRT-InGAS: natural progression was to use it with




colleagues
Adapt questions/techniques
(See videos)
Avoid moralistic/punitive demeanor
Stress on helping the colleague
7/18/2015
Simulation feedback from students
22
 “Hard to confront a colleague”
 “I have some idea now of what to say”
 “I was never taught in school about how to deal with
this subject”
 Role in patient safety understood
7/18/2015
Patient Safety
23
 We must protect the patients (SBON must protect
the public)
 Set aside concerns about confronting peer (tough)
 Safety concerns


Patients of course
Impaired Colleague too:
Impaired
 Not thinking rationally
 Career coming to an end possibly
 Could very leave, hurt themselves or others
 Involve a supervisory person to help

7/18/2015
Questions?
or you may also call (215) 872-6821
24
7/18/2015