Cuyuna Regional Medical Center’s Drug/Alcohol Free Workplace and Testing Policy

1. Cuyuna Regional Medical Center’s Drug/Alcohol Free Workplace and Testing Policy Welcome…. Let’s learn about Cuyuna Regional Medical Center’s Drug-Free Workplace and Testing and Diversion Prevention Policies

2. Purpose - Inform all employees of the Drug /Alcohol Free Workplace and Testing Policy - Prevent and increase awareness of diversion - Increase awareness of addictions - Share expectations of employee responsibility in maintaining a drug/alcohol free workplace

3. Objectives Articulate the expectations of the Drug/Alcohol Free Workplace and Testing policy Describe the process to report suspected impairment due to drug, alcohol or substance abuse – or to report if you think someone is diverting (stealing) patient medication List behaviors that may indicate impairment on the job Discuss criteria for drug testing Review the definition of “under the influence”

4. CRMC Drug – Free Workplace Policy CRMC is committed to providing quality health care services and acknowledges the importance of each employee to the effective function of a competent health care team.

5. Policy Review Cuyuna Regional Medical Center and its Longville and Baxter clinics prohibit the use, possession, transfer, and sale of alcohol and illegal drugs while working, while on all premises owned or operated by the Medical Center, and while operating any medical center vehicle , machinery, or equipment. It also prohibits reporting for work and working anywhere on behalf of CRMC under the influence of alcohol or illegal drugs. This policy applies to all official or unofficial break and meal periods, and all other times during the working day in which an employee has reported for work, including unpaid meal breaks. The use and possession of properly prescribed drugs or medications is permitted provided that it does not interfere with the employee’s job performance or pose a direct threat to the health or safety of the employee and/or others. Please discuss with employee health.

6. Glossary

11. CRMC sees substance abuse as a very serious problem and threat to employees, volunteers, patients and visitors. During work hours, both on and off the medical center premises, no employee or volunteer shall manufacture, distribute, dispense, possess, sell, use, or be under the influence of any illegal drug or alcohol. Additionally, employees and volunteers shall not engage in these activities during rest and meal breaks or while taking off-premise calls.

12. Why do we have a Drug/Alcohol Free Workplace and testing policy? The ultimate goal of this policy is to balance our respect for individual privacy with our need to maintain a safe, productive, drug/alcohol free work environment. CRMC is committed to maintaining a work environment free from the influence of alcohol and/or drugs to protect the health, safety and well being of patients, employees, volunteers and visitors. CRMC complies with the requirements of the Drug – Free Workplace Act of 1988.

13. CRMC employees are required to immediately notify their appropriate supervisor if any employee, volunteer, or member of the health care team is not in appropriate mental and/or physical condition to safely perform their duties.

14. If you suspect impairment, do not allow them to perform ANY procedure!

15. Which of the following indicates an employee, volunteer, or member of the health care team is under the influence? • Smell of Alcohol • Motor skills issues • Performance/attendance issues • High/unusual patterns of access to controlled substances

16. A member of the health care team has displayed behaviors indicating she may be under the influence. What will occur first? The individual is subject to testing for reasonable suspicion. • When an individual is subject to testing due to reasonable suspicion he/she will be: • Relieved of his/her work responsibilities • Escorted to the CRMC Laboratory Department for specimen collection

17. c. An individual who refuses to be tested, or whose behavior prevents meaningful completion of the testing such as tampering with the sample or testing materials – behavior intended to provide a dilute sample, failure to provide specimen within a reasonable amount of time (3 hours from initiation of testing) or provide the required amount (30 cc), will be subject to termination, other disciplinary actions, or have the employment offer revoked. d. For the individual’s safety, arrangements may be made for: 1. Transportation: the individual will be sent home with a sober adult (family member, friend, or via a transport service – paid by CRMC). 2. If he/she insists on driving self home, city law enforcement will be notified. e. The individual will remain off work on paid administrative leave until all drug testing results are received and confirmed.

18. Can an individual refuse to undergo testing? Yes, an individual has a right to refuse testing. • The individual may refuse to undergo testing. However…All individuals requiring testing will: • Be offered/given a copy of the CRMC Drug Testing Policy. • Be given the opportunity to read and ask interpretive questions. • Sign the Consent form and Controlled Substance and/or Alcohol Test Notification form. • Be given the right to refuse testing but told the consequences of refusing which could include termination. • In the case of a diluted specimen, recollection will be required. If this second sample also tests diluted or there is a refusal to test, the job offer will be rescinded for applicants and the test considered positive for employees.

19. Cuyuna Regional Medical Center Commitment Cuyuna Regional Medical Center is committed to assisting employees who are suffering from substance abuse problems.

20. Diversion Diversion Prevention and Reporting

21. Diversion of Drugs Professionals suffering from addiction often exhibit similar unusual behaviors. Certain signs and symptoms may indicate a drug addiction problem in a health professional. When a health professional is suffering from addiction, the hospital drug supply is sometimes misused as a source for personal drug supply. This is called drug diversion and is grounds for immediate termination.

22. Diversion • Intentionally and without proper authorization, using or taking possession of a prescription medication or medical gas from CRMC supplies, CRMC patients, or through the use of CRMC prescription, ordering, or dispensing systems. Examples of drug diversion include, but are not limited to, the following: • Medication theft • Using or taking possession of a medication without a valid order or prescription • Forging or inappropriately modifying a prescription • Using or taking possession of medication waste, e.g., left over medication

23. Have you observed any of the following symptoms in any of your co-workers? • Uses the maximum PRN dosage when other nurses use less • Maximum PRN dosages are used by one nurse consistently but not by other staff • Insistence of personal administration of injected narcotics to patients • “If anybody needs help passing their pain meds today let me know.” Those are just some signs and symptoms of a drug impaired co-worker and should cue you to pay attention to what is going on with your co-worker. Leadership at CRMC would like you to use the above list to help you help your co-workers in their time of need.

24. Patients • Have you observed any of the following symptoms in any of your co-workers? • Patients state that pain medication was not given and documentation supports pain medication had been administered • Has responsibility for patients who complain pain medications given by one staff member are not as effective as those given by another staff member • “The patient must have forgotten.” • “He must have a low pain tolerance.” If the patient states that he or she received no pain medications for several hours but the documentation states that pain medication has been administered, this is the time to check with the co-worker. If your co-worker has the responsibility for a patient who is complaining that their pain medications are not effective when given by one staff member as opposed to another staff member, this is another time for you to be keyed up to check on your co-worker and perhaps talk with your leadership.

25. Documentation • Have you observed any of the following symptoms in any of your co-workers? • Frequent wastage of drugs for “spillage” • Sloppy record-keeping • Documentation of medication given does not match patient report • Uncharacteristic deterioration of handwriting or charting

26. Absenteeism • Have you observed any of the following symptoms in any of your co-workers? • Excessive absenteeism is common in end-stage addiction • Frequent disappearances from the work-site. • Frequent or long trips to the bathroom • Excessive amount of time spent near a drug supply • Appearing at work when not scheduled

27. Personality Changes • Have you observed any of the following symptoms in any of your co-workers? • Confusion, memory loss, difficulty concentrating • Interpersonal relationships with colleagues, staff and patients deteriorate • Rarely admits errors or accepts blame for mistakes or oversights • Personality change: mood swings, anxiety, depression, lack of impulse control • Patient and/or staff complaints about health care provider’s attitude and behavior

30. Committed to a Drug/Alcohol Free Workplace • What does this mean? • CRMC is committed to providing quality health care services and acknowledges the importance of each employee to the effective function of a competent health care team. • Cuyuna Regional Medical Center is also committed to providing the highest level of patient and employee safety.

31. Commitment- • I commit to a drug/alcohol free workplace at Cuyuna Regional Medical Center!

32. Thank you for viewing this course