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

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

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” Notes: Once we have completed this process, you will be able to Articulate the expectations of the Drug – Free Workplace and Testing policy. You will also be able to describe the process to report suspected impairment due to drug, alcohol or substance abuse – or to report if you think someone is diverting which is stealing, patient medications. You will be able to list behaviors that may indicate impairment on the job. Discuss criteria for drug testing. And review the definition of “under the influence.”

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. Notes: CRMC is committed to providing quality health care service and acknowledges the importance of each employee to the effective functioning of a competent health care team. Our drug and alcohol free workplace policy is designed to ensure the positive reputation CRMC and its employees as worth of the responsibilities entrusted for providing quality patient care. Establish and maintain a productive, efficient, safe and healthy working environment, provide a program of education, testing, assistance toward rehabilitation, and/or discipline for employees aimed at prevention or elimination of substance abuse related problems in the workplace.

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.

Glossary Alcohol & Other Drug Abuse Use of mood-altering drugs, including all forms of alcohol, narcotics, depressants, stimulants, hallucinogens, marijuana or the use of prescription drugs when resulting behavior or appearance adversely affects work performance. Controlled Substances Includes those substances whose distribution is controlled by regulation or statute including but not limited to narcotics, depressants, stimulants, hallucinogens and cannabis. Dilute Specimen A urine drug collection in which results reveal insufficient concentration for determination of test results.

Drugs of Abuse/Mood Altering Drugs Drug Diversion The theft of controlled substances or other medications from the organization’s supply or from a patient’s supply, for purposes of self administration, selling or other use. Drugs of Abuse/Mood Altering Drugs Alcohol, narcotics, depressants, stimulants, hallucinogens, marijuana and any prescription drugs that interfere with the employee’s ability to safely and effectively perform job duties, or pose a threat to the safety of the employee or others, including patients. Health Professionals Services Program A state funded program recognized by multiple Minnesota regulated health professional boards that promotes early intervention, assists health professionals in obtaining care, provides monitoring and assists in preserving careers.

Impaired Behavior Behavior that MAY indicate impairment: When employee performance is inhibited Drowsiness and/or sleepiness Odor of alcohol on breath Slurred/incoherent speech Unusually aggressive or bizarre behavior Unexplained change in mood Lack of manual dexterity Lack of coordination in walking Unexplained work-related accident or injury

Reasonable Suspicion The basis for forming a belief based on specific facts and rational inferences drawn from those facts. Suspicion of Others CRMC employees are required to immediately notify their appropriate supervisor if they believe any employee or member of the healthcare team is not in appropriate mental and/or physical condition to safely perform his or her duties. Under the Influence Shall be determined to be present if the individual is perceptibly impaired; has impaired alertness, coordination, reactions, responses or effort; if the individual’s condition threatens the safety of employees, patients or visitors; or if the employee’s condition or behavior presents the appearance of unprofessional, irresponsible, or unsafe conduct detrimental to the public's perception of CRMC as determined by the supervisor, manager or department director.

Voluntary Disclosure Individuals are encouraged to voluntarily disclose the use of drugs and/or the misuse of alcohol before being confronted, tested or otherwise involved in drug and/or alcohol-related discipline or proceedings. An individual who does so will be granted time off for treatment, rehabilitation or counseling in accordance with the current labor agreements or CRMC’s non-contract policies. An employee who voluntarily discloses the use of drugs and/or the misuse of alcohol before being confronted, tested or otherwise involved in drug and/or alcohol related discipline or proceedings will not be discriminated against because of this disclosure. This information will not be used as the sole basis for corrective action, except where the employee has previously tested positive.

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.

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.

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. Notes: If you notice these behaviors, you need to report them immediately to your supervisor. Sometimes you may be reluctant to do so because you are concerned whether the behavior is impairment or another problem, the person is “nice” and you know they are going through a tough time, you don’t want to “get involved”, you may be afraid of angering the person or fear of retribution from another member of the healthcare team, or your colleague’s loss of professional practice. However, you need to get involved. It is an important decision that you will make for the well–being of your co – worker as well as your patients.

If you suspect impairment, do not allow them to perform ANY procedure! You waited to see what would happen. Your co-worker was assisting with an important patient care activity and was not able to complete the process successfully. Remember—If you suspect impairment, do not allow a physician or any other healthcare professional to perform a procedure on a patient such as, but not limited to: Giving Medications, Chest Tube Insertion, Thoracentesis, Paracentesis, IV Line placement, Cardioversion, or other procedures or treatments that would put that patient at risk for injury or less than optimal quality care.

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 All the behaviors listed above are situations that may indicate that an employee, volunteer, or member of the health care team is under the influence

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

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.

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.

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

Diversion Diversion Prevention and Reporting

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.

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

Uses the maximum PRN dosage when other nurses use less 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.

“The patient must have forgotten.” 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.

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

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

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

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.

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

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