Health Professional
Monitoring Programs in
Kentucky
CAPTASA
Lexington, KY
January 26, 2013
Health Professional Monitoring
Programs in KY
KPHF
KYPRN
KARE for Nurses
There is a unique disconnect
between the scientific facts
and the public’s perception about
drug abuse and addiction
“The 12-step model of
recovery is the core
technology in the short and
long term treatment of
alcoholism and addiction…
the standard of care”
Garrett O’Connor, MD
CAPTASA 2005
Pamela Fleck MSN
Case Manger
Kentucky Alternative
Recovery Effort
KARE
KYPRN
Brian Fingerson, RPh, Inc.
KY Professionals Recovery Network
KYPRN
202 Bellemeade Road
Louisville, KY 40222
O/H: 502-749-8385, F: 502-749-8389
kyprn@att.net
Greg L Jones, MD
Kentucky Physicians Health
Foundation
9000 Wessex Place, Suite 305
Louisville, KY 40222
gregj@kyrecovery.org
(502)425-7761
Wow!
Fifteen Percent of U.S. Workers Report
Workplace Alcohol Use or Impairment in Past
Year February 15, 2006
An estimated 19.2 million U.S. workers (15.3%)
reported using or being impaired by alcohol at
work at least once in the past year, according to
recently released data from the National Survey
of Workplace Health and Safety.
Why are Nurses at RISK
1.
2.
3.
4.
5.
6.
7.
Long Hours
Extra Shifts
Staffing Shortage
Availability of medication
Need to CARE for others
Work Hard Party Hard
Knowledge of Drugs &
how they work
8. Knowledge It will never
happen to me
9. Stress
Profile of a Chemically
Dependent Nurse
Is demanding of self; denies stress,
depression, unhappiness
Expresses more guilt/shame about drug
usage
Usually graduated in upper portion of
nursing program
Have demanding and responsible jobs
Are highly respected for excellent work
Intervention and Assistance for
Nurses
Refer to Employee Assistance Program
Encourage nurse to contact KARE for
Nurses Program at time of meeting
Inform nurse that information will be
submitted to KBN as required by KRS
314.031
Warning Signs
1. Changes in personality and mood swings
2. Defensiveness when confronted about
chemical use – excuses, promises, lying,
denying, blaming
3. Changes in lifestyle to one more centered
on chemical use
4. Trouble at home, school and/or work
5. Withdrawal from family, friends, colleagues
and activities
Signs and Symptoms – Job
Performance
Too many medication errors
Too many controlled drugs spilled or
broken
Illogical or sloppy charting
Absence of charting
Frequently absent from unit
Frequent bathroom breaks
Comes to work early and stays late
Uses sick leave lavishly
Forms of Diversion
MD, pharmacist diversion
Doctor shoppers in ER
Stolen script pads and forged
prescriptions
Patient’s family
Unauthorized drug cabinet
access (ie,unit secretary)
Handlers of sharps containers
Common Methods of Diversion
For Health Professionals
Removal of duplicate dose
Removal of fentanyl patches
Removal too frequently (range order
issues)
Ordered q 4 hrs, removed q 2 hrs
Removal of medication without order
Medication override
Falsification of “verbal order”
Handlers of sharp containers
Mandatory Reporting

Kentucky is a Mandatory Reporting Jurisdiction
-- KRS 314.031(4)

Who?
-- Any nurse
-- Employer of nurses
-- Any person having knowledge of a violation
KARE for Nurses Program
…Identify and assist nurses whose
abilities to practice nursing are
compromised by dependency on drugs
or alcohol . Allow these nurses to get
treatment and recovery so they may
return to competent and safe nursing
practice.
Admission Requirements
Current license in KY or have applied for
licensure in KY
Request participation in KARE for Nurses
Program in writing
Submit to Chemical Dependency
Evaluation
Admit to misuse/abuse of ETOH or drugs
Agree not to practice until approved to do
so by KARE for Nurses Program staff
Drug abuse is a preventable behavior
Drug addiction is a treatable disease
Partnership for a Drug-Free America
http://www.drugfree.org/
What do we do with them then?
Assessment
Treatment
Monitoring
Contractual Relationship
5 Yrs of aftercare & monitoring
Help them get ready for return to “life”
Health issues Impairing Professionals
Substance Use Disorders
Mood Disorders
Personality Disorders
Sexual Acting Out Behaviors
Dementia & Medical Disabilities
Burnout-Anger & Fatigue
How can you tell if someone has this
Disease
Use of Alcohol or some other
Addictive substance (Opiates,
Sedatives, Amphetamines, Cocaine,
Marijuana)
Problems occurring while using
these or as a result of using
Continued Use of any Addictive
substance after problems begin
TREATMENT
Inpatient
Time enough and Gender
specific
Outpatient
Self-Help and 12-Step Groups
Therapy- Individual and Group
Abstinence Contract
PRN contracts typically include:
Specific number of AA/NA or other 12 step
meetings
Who is their primary care physician?
What medications are they taking?
No additional medications without notification to
the PRN (including OTC)
Urine drug screens
Notification of where they live and work to PRN
October 2003
February 2006
KBML Obligations
KBML Policy Regarding The Required
Reporting Of Impaired Physicians By Other
Physicians And Hospitals
Adopted:
March 27, 2003
Reporting impaired physicians directly to the
Kentucky Physicians Health Foundation’s
Impaired Physicians Program is not sufficient
to satisfy the statutory reporting
requirements.
Self-Reporting is still the best
bet
This policy revision makes no change
regarding the procedures followed in those
instances where an affected individual
voluntarily self-reports to the Foundation.
Response
House Bill 1
What is a relapse?
What does it “cost” you?
Aftercare
•What is done?
•How much and how long?
Drug and Alcohol testing
•What tests?
•How often?
•Random?
•For cause?
RESULTS
 80% Recovery Rate
at 5 Yrs with our
oversight for those
with a substance Dx
How can we help and
support?
•Let’s take care of each other
•Confidential reporting
•Recovering Professionals are hard
working
•They are monitored closely