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VA Nebraska-Western Iowa Health Care System

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Identification and Reporting of Impared Licensed Independent Practitioners

The Joint Commission on the Accreditation of Health Care Organizations (JCAHO) states in Standard MS.4.80 that the “medical staff implements a process to identify and manage matters of individual health for licensed independent practitioners (LIPs).”  The purpose of the process is to facilitate rehabilitation, rather than discipline, by assisting a practitioner to retain and to regain optimal professional functioning.  The Elements of Performance for this standard require the “education of LIPs and other organization staff about illness and impairment recognition issues specific to LIPs .”

The purpose of this training document is to provide LIPs and other organization staff with this information.  Please read this document, sign and date it, and return it to Employee Education (03E) at your Division for entry of education credit (15 minutes) in TEMPO by 1/31/07.  You may also post a copy in your work area for future reference.  While this document was prepared to educate staff specific to substance abuse in LIPs, the information provided here can also be used by staff to identify and report impairment in any employee.

Health professionals, like anyone else, are susceptible to substance abuse and psychiatric illness.  Left untreated, these problems can put them and their patients at risk.  The American Medical Association uses the term “impaired physician” to identify those members of the medical profession whose performance may be adversely affected by reason of mental or physical illness, including alcoholism and drug dependence.  In these conditions, impaired judgment prevents an accurate self-assessment.

In the general working adult population, it is estimated that 6.2% of adults working full time are heavy alcohol users and that an estimated 6.5% of full time and 8.6% of part time workers are current illicit drug users.  Amongst practicing physicians, the current estimated rate of illicit drug use is 8-14% and the rate of abuse of prescription medicines, including opioids and benzodiazepines, is up to five times higher than the general population.

In the past, it was hypothesized that long working hours, stressful work conditions, and easy access to drugs were the main factors that pre-disposed healthcare workers to substance abuse.  However, data does not support this.  Many healthcare employees work under these conditions and do not develop substance abuse or dependence.  A healthcare worker’s reaction to the work environment (i.e., coping skills) and personality characteristics including underlying psychopathology such as depression and anxiety are much stronger risk factors for substance abuse.  Family history of substance abuse is also a risk factor.

Identifying Substance Abuse – the following signs raise suspicion but do not necessarily mean that a substance abuse problem exists:

  • Social or professional isolation
  • Friction with colleagues (labile mood, unexplained anger)
  • Disorganized schedule
  • Inaccessibility to patients and staff
  • Frequent absences
  • Rounding on patients at odd hours
  • Decreased work and chart performance
  • Large quantities of drugs ordered for “stock”
  • Inappropriate orders
  • Forgotten verbal orders (given during a black out)
  • Slurred speech during off-hour phone call for orders
  • Heavy drinking at hospital functions
  • Pre-employment indicators (vague letters of reference, numerous job changes, unexplained gaps in employment, acceptance of jobs for which clearly overqualified)
  • Pharmacist notices prescription being written for family member
  • Changing personal appearance
  • Overdose
  • Suicide attempts

Reporting Impairment in LIPs and Other Employees:

Healthcare workers have an ethical responsibility to report a peer who may be endangering the lives of others through impairment.  Legal requirements for reporting vary by state and by profession (example: MD versus RN).  Professionals should familiarize themselves with these legal requirements and follow them.

To report impairment in LIPs at VA Nebraska – Western Iowa Health Care System, reference HCS Policy COS-001 Medical Staff Health Policy.  The key points in this reporting process are:

  • Any employee can file a report.  Medical staff with personal issues may also enter the process by self-referral.
  • To report concern about an impaired provider, contact the Chief of Staff or the Chair, Physical Standards Board.
  • The Physical Standards Board will arrange assessment, treatment, support, and monitoring to facilitate recovery and appropriate return to work.

To report impairment in other employees at VA Nebraska – Western Iowa Health Care System, report the situation to an appropriate Supervisor.

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