Tennessee Professional Assistance Program

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Tennessee Professional Assistance Program

• Mike Harkreader, MS, RN
• Executive Director

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Substance Use in America

• The use of drugs, including legal mood altering
  substances, has become a common occurrence in our
  society
• Consumers are constantly presented with
  marketing/advertisements for a variety of drugs
  for every ailment and dysfunction
• Social drinking is accepted and normalized
• Drinking to unwind and relax is considered
  acceptable
• Rite of passage for many teens and young
  adults.
• Most individuals grow up and inappropriate use
  or abuse of substances subsides by age 30.
• There are few long term consequences if survived.

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Addiction

• A primary, chronic, neurological disease, with
  genetic, psychological, and environmental factors
  influencing its development and manifestations.
• Impaired control over use
• Compulsive use
• Continued use despite harm
• Craving

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The Disease Concept of Addiction

• Chronic
• Progressive
• Incurable, but treatable
• Neuro-chemical disease
• Characterized by
• Increased tolerance
• Compulsive using regardless of consequences
• Relapse
• Health problems and even premature death

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Addiction

• Individuals suffering from addiction are
  restless, irritable and discontent unless they
  can experience the ease and comfort that comes at
  once by taking a few drinks or using a drug.

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Continued Compulsive Use Despite Negative
Consequences

• Occupational and career problems
• Health issues
• Legal problems
• Marital problems including divorce
• Losing custodial rights to children
• Losing social stature
• Financial ruin

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Examples of Medical Complications Secondary to
Addiction

• Hypertension Cardiac abnormalities
• Diabetes
• Cirrhosis of the Liver
• Hepatitis
• HIV/AIDS
• Dementia
• GERD
• Ulcers

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Examples of Emotional and Psychiatric Problems
that frequently co-occur with Addiction

• Major Depression or Dysthymic Disorders
• Bi-Polar Disorders
• Anxiety Disorders
• Panic Attacks
• Post- Traumatic Stress Disorder
• Dementias

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Incidence of Substance Dependency

• General Population 1 in 10 (10)
• Health Care Professionals 1 in 7 (14)
• Anesthesia Providers 1 in 5 (20)

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Risk Factors Inherent in the Health Professions

• Stress (life and death decisions)
• Suppression of feelings and emotions
• Emotional and physical exhaustion (odd shifts,
  double shifts and overtime expected)
• Awareness of the therapeutic effects of drugs
• Easy accessibility to drugs
• A grandiose belief that It cant happen to me.

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Just what is anImpaired Professional or a
Chemically Dependant person?

• One with a
• psychological and/or physical addiction to a
  chemical substance
• unable to provide safe and effective patient care
• unable to perform in a manner consistent with
  current standards of practice

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How do you recognize the Impaired Professional?

• Signs and symptoms often subtle in early stages
• May improve temporarily when others draw
  attention to behavior
• Look at
• Attendance
• Performance
• Behavior
• Physical Signs
• Narcotic Discrepancies

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Attendance

• Alcohol dependence
• Often absent on day following time off
• Stealing/diverting drugs
• Volunteer to work overtime or return early from
  scheduled time off
• Both
• Tardiness
• Unscheduled absences
• Last minute requests

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Performance

• Inconsistent
• Substandard
• Declining competence
• Difficulty completing complex assignments and
  meeting deadlines
• Sloppy or illogical documentation

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Behavior

• More talkative or more withdrawn
• More calm or more agitated
• Conflicts with co-workers increases
• Emotionally labile

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Physical Signs

• Shakiness/tremors
• Unkempt Appearance
• Diaphoresis
• Watery or bloodshot eyes, dilated or constricted
  pupils
• Drowsiness/fatigue
• Unsteady gait
• Sensitivity to heat and/or cold
• Slurred speech
• Weight loss or gain
• Runny Nose

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Narcotic Discrepancies

• Frequently incorrect narcotic count
• Apparent alteration of narcotic vials
• Increased number of patient reports of pain
  medication ineffectiveness
• Discrepancy between patient reports and hospital
  records of pain medication administration
• Large amount of narcotics wasted
• Numerous corrections on narcotic records
• Erratic patterns of narcotic discrepancies

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So, why would a professional need Peer
Assistance?

• Authorized channel for
• Early intervention
• Removal of impaired professional from practice to
  safeguard the public
• If compliant with the contract stipulations
  disciplinary action against the license may be
  avoided.
• Advocacy (Employer and Board)

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Caring Support for Impaired Professionals

• Voluntary, confidential alternative to
  disciplinary action
• Professionals in violations of their Practice Act
  due to abuse of alcohol or other drugs
• Professionals with mental health issues that
  impact their ability to practice safely

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What is TNPAP all about?

• A structured recovery and monitoring program for
  health care professionals, including
• Emergency Medical
• Personnel
• Medical Laboratory Personnel
• Nurses
• Occupational and Physical Therapists and
  Assistants
• Physician Assistants
• Respiratory Therapists

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Steps in the TNPAP process

• Comprehensive evaluation
• Treatment, if applicable - recommendations to
  professional and TNPAP Case Manager
• Must comply with evaluation and treatment
  recommendations to participate in TNPAP

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Steps

• Once treatment completed, sign TNPAP contract
• No practice until recovery documented
• Supervised practice
• REFRAIN from ALL mood-altering substances
• Narcotic Restriction
• Support Group Meetings
• Submit documentation of progress to TNPAP
• Random urine drug screens

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Motivation to Enter/Sustain Treatment

• Effective treatment need not be voluntary
• Treatment outcomes are similar for those who
  enter treatment under pressure vs. voluntary.
• Treatment reduces drug use by 40-60
• Treatment is less expensive than not treating or
  incarceration (Average of 18, 400 per year for
  imprisonment)
• Treatment can salvage an individuals career and
  personal life

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Mandatory Reporting

• RNs and LPNs are required by state laws and
  rules to report any health care provider who you
  believe to be impaired and/or in violation of the
  Nurse Practice Act
• You have no liability for reporting , if done in
  good faith

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Tennessee Board of Nursing Two Avenues to
Report

• Tennessee Department of Health, Bureau of
  Investigations
• Formal investigation occurs
• Findings reviewed by consultant
• Sanctions may occur

• Tennessee Professional Assistance Program
• Confidential reporting or referral by Board of
  Nursing
• Evaluation
• Contract if treatment required
• Avoids sanctions

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Board Actions

• Tennessee Board of Nursing has the authority to
• Deny
• Revoke
• Suspend
• Place on Probation
• Refer to TNPAP
• Assess civil penalties and hearing costs

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Other Services

• Pre-licensure evaluation
• Referral database
• Educational services

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Other Important Information About TNPAP

• Funding provided by grants from Tennessee
  Department of Health
• A program of the Tennessee Nurses Foundation, a
  non-profit corporation

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Thats all Folks