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Monitoring Medical Staff Members
CPPPH Workshop San Diego, California September 20, 2014 Robin Seaberg MD Chair, University of California, San Diego Physician Well-Being Committee
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Monitoring In special circumstances in lieu of formal evaluation
Most often part of aftercare program Commonly used with Substance Use Disorders Mental Health Disorders, Boundaries Violations Other behavioral contracts Can be individualized
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Goals of rehabilitation
Optimize physical and mental health Motivation to achieve and maintain abstinence Participation in counseling to build a substance-free life Adoption of relapse prevention techniques.
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Aftercare 12 step meetings (AA, NA) Diversion meetings Counseling
Drug screening Recovery is a life-long process.
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Planning for return Must occur while still in treatment
PWBC must have coordination and communication with PHP and treatment center Get an outline of projected discharge recommendations Department defines role on return Determine practice parameters
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Planning for return Coordination between PWBC and practice representative Determine who will be making schedule or overseeing hours Identify potential work site monitor Prepare re-entry agreement Determine who will be doing tox testing and formal monitoring.
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Re-entry process Gradual, staged Continue meeting attendance
Restrict access to drug of choice No night call in early phases Worksite monitor
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Contracts and monitoring
Responsibilities Consequences Monitoring Worksite Drug screening
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Participation agreement
Specific requirements to maintain active medical staff privileges based on initial problem and treatment recommendations
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Participation Agreement
5 year monitoring period Abstain from all mood-altering substances Attendance at 12 step and diversion meetings Worksite monitoring Random, monitored urine drug screens Primary care MD prescribes all medications +/- Naltrexone, Disulfiram administration Clear consequences
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Elements of agreement may also include
Therapy, counseling etc Prescribing restrictions Names of treating professionals + ROI Travel restrictions
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Worksite monitor Has regular contact with the participant
Is aware of the situation Should be a neutral peer/supervisor Motivated by a desire to be a support, not a disciplinarian Be willing to be on the lookout for, and be willing to report signs of relapse Makes quarterly reports to PWBC/PHP
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Return to work is not immediate
Participant must establish support system and structure of recovery program at home Establishing home group, recovery meetings, setting up random tox testing, Sign contract with Monitoring entity Sign monitoring agreement with PWBC also Establishing care with mental health professionals as appropriate
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HPP and PWBC work together to
Monitor continued compliance Report non-compliance to supervisor and MEC Provide ongoing support of physician and source for physician questions and concerns Keep documents attesting to ongoing compliance (tox testing WSM reports, therapy compliance reports)
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Monitoring is not recovery
Monitoring documents compliance with various components of recovery program.
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