Tennessee Professional Tennessee Professional Assistance ProgramAssistance Program

Mike Harkreader, MS, RNMike Harkreader, MS, RN

Executive DirectorExecutive Director

Substance Use in AmericaSubstance 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.

AddictionAddiction

• A multi-factorial (bio-psycho-social) chronic brain based disease, with a predictable clinical course, symptoms that are recognizable, and without treatment will result in a progressive physical, emotional, financial and mental decline which frequently ends in premature death.

The Disease Concept of The Disease Concept of AddictionAddiction

• Chronic• Progressive• Incurable, but treatable• Neuro-chemical disease• Characterized by

Increased tolerance Compulsive using regardless of consequences Relapse Health problems and even premature death

Continued Compulsive Use Despite Continued Compulsive Use Despite Negative ConsequencesNegative Consequences

• Occupational and career problems

• Health issues

• Legal problems

• Marital problems including divorce

• Losing custodial rights to children

• Losing social stature

• Financial ruin

Examples of Medical Complications Examples of Medical Complications Secondary to AddictionSecondary to Addiction

• Hypertension & Cardiac abnormalities

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

Examples of Emotional and Examples of Emotional and Psychiatric Problems that Psychiatric Problems that

frequently co-occur with Addictionfrequently co-occur with Addiction

• Major Depression or Dysthymic Disorders

• Bi-Polar Disorders

• Anxiety Disorders

• Panic Attacks

• Post- Traumatic Stress Disorder

• Dementias

• Various Personality Disorders

Incidence of Substance Incidence of Substance DependencyDependency

• General Population = 1 in 10 (10%)

• Health Care Professionals = 1 in 7 (14%)

• Anesthesia Providers = 1 in 5 (20%)

Risk Factors Inherent in the Risk Factors Inherent in the Health ProfessionsHealth 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 belief that “it can’t happen to me.”

Just what is anJust what is an“Impaired Professional” or a “Impaired Professional” or a

“Chemically Dependant” person?“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

How do you recognize the Impaired How do you recognize the Impaired Professional?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

Attendance…Attendance…

• Alcohol dependence– Often absent on day

following time off

• Stealing/diverting drugs– Volunteer to work

overtime or return early from time off

• Both:– Tardiness– Unscheduled absences– Last minute requests

PerformancePerformance

• Inconsistent• Substandard• Declining competence• Difficulty completing

complex assignments• Sloppy, illegible

documentation

BehaviorBehavior

• More talkative or more withdrawn

• More calm or more agitated

• Conflicts with co-workers increases

• Emotionally labile

Physical SignsPhysical Signs

• Shakiness/tremors• Unkempt Appearance• Diaphoresis• Bloodshot eyes or

dilated or constricted pupils

• Drowsiness/fatigue• Unsteady gait• Sensitivity to heat

and/or cold

So, why would a professional So, why would a professional need “Peer Assistance?”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)

Caring Support for Impaired Caring Support for Impaired ProfessionalsProfessionals

• Voluntary, confidential alternative to disciplinary action

• Professionals in violations of their Practice Act due to abuse of alcohol or other drugs.

What is TNPAP all about?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

Steps in the TNPAP processSteps in the TNPAP process

• Evaluation • Treatment, if applicable -

recommendations to professional and TNPAP Case Manager

• Must comply with evaluation and treatment recommendations to participate in TNPAP

Steps…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

Motivation to Enter/Sustain Motivation to Enter/Sustain TreatmentTreatment

• 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

Committee on Physician Committee on Physician Assistants: Two Avenues to ReportAssistants: 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 Committee on Physician Assistants

– Evaluation– Contract if treatment

required– Avoids sanctions

Investigative ProceduresInvestigative Procedures

• Report to board• Investigator contacts

all involved, including accused

• Collection of data and facts to Committee on Physician Assistants

Board ActionsBoard Actions

• Committee on Physician Assistants has the authority to:– Deny– Revoke– Suspend– Place on Probation– Refer to TNPAP– Assess civil penalties

and hearing costs

Other ServicesOther Services

• Pre-licensure evaluation

• Referral database

• Educational services

Other Important Information Other Important Information About TNPAP About TNPAP

• Funding provided by grants from Tennessee Department of Health

• A program of the Tennessee Nurses Foundation, a non-profit corporation

That’s all FolksThat’s all Folks