Alleged Substance Use In Junior Medical Staff Flashcards
Initial Approach
The following are aspects that the candidate may choose to consider in the immediate situation:
How will the candidate manage the information they have received? Did the candidate try to obtain more information and get clarity on boundaries, responsibilities and roles from the police inspector: How will this information be managed? Will the police inspector release names? What will the police do next? Who else has been advised? Is there anything specific that the police inspector needs of the psychiatrist today? What should the psychiatrist not be doing?
The candidate should demonstrate capacity to develop an immediate plan of action that includes how they will manage the information they have. Are the staff concerned actually rostered on shift? Will the candidate come into the ward and directly assess the situation? Does the candidate consider whether nursing and medical staff may be intoxicated at work? Will they approach the individual clinicians about their concerns?
Does the candidate consider the immediate impact on the clinical duties to be undertaken today and assess the potential level of clinical risk to patients? Will the candidate liaise with the nurse in charge? Will the candidate assist in look at staffing mix, experience and numbers? How will the candidate manage their own work load?
When will they discuss with staff in charge of shifts today about escalation - e.g. Clinical Director/Head of Department, Nursing Manager/Director of Nursing? Who else needs to know today and who will make those disclosures/escalate concerns? What are the limits of what the candidate can put in their report when the matter is escalated?
Can the candidate describe where the threshold lies for acting on their concerns about a staff conduct, performance, competence or health; and how to raise concerns; and access the help and support available to them? Did the candidate articulate possible barriers or obstacles to acting on their concerns including fears that it may cause problems for colleagues, adversely affect working relationships, have a negative impact on their career or result in a complaint about them?
Clinical Governance
The wider clinical governance issues flow on from the immediate action.
From a clinical safety perspective patient safety is placed at risk if staff is coming to work potentially intoxicated, especially from cannabis, because of its long half life. What does the organisation’s code of conduct say with respect to drugs and alcohol? A surpassing candidate would outline the privacy issues for the staff involved - is this of any direct concern to the hospital if staff are not presenting to work intoxicated? A surpassing candidate will also understand the concept of natural justice and the need to safeguard individual’s reputations while any investigation is undertaken.
From a staff culture perspective a candidate may consider whether one should be differentiating between an episode of recreational drug use from a more systemic acceptance of drug use within the staff culture? Based on what is known it will be worth finding out if is this a real problem or not? Is it a situation that may indicate a potential broader problem amongst mental health staff?
As a clinical leader a psychiatrist would be expected to participate in the management of this kind of situation which would be led by the Clinical Director/Director of Medical Services/Executive Director. Some aspects the candidate may consider include plans on how to assess if there any known drug-related incidents involving staff members, or if there are complaints about staff that may be consistent with previously unidentified drug use? The candidate may suggest other areas of concern like any unauthorised medication use or missing mediations in the ward.
From the perspective of a supervisor the candidate may consider the need for discussion with specific registrar supervisors and escalation to the Director of Training. Information could be a pointer to examine specific workplace performance of junior doctors involved.
A surpassing candidate will identify, not only risk to patients and individual staff, but also organisational reputational risk, risk of media cover and risk of legal action should the incident become public knowledge or investigations to identify a broader organisational problem.
As potential interventions, the organisation’s drug and alcohol service would be able to provide context around the general drug use in the community and how to approach this issue with staff, many of whom would not be involved and might be totally unaware of concerns. Something like a Grand Round/Journal Club presentation on the subject might help to keep the issue visible in the wider organisation without giving away specific information.
Professional Issues
Medical and other clinical staff are at much higher risk of drug and alcohol misuse and addiction, however doctors have both a clinical and an ethical responsibility to protect patients from risk of harm posed by a colleague’s conduct, performance, competence or health, and patient safety should come first at all times.
There are also requirements for health professionals to consider reporting impaired colleagues. Candidates should demonstrate that they are aware of the requirements of health professionals to report to the registering authority concerns related to impairments or conduct by colleagues that places patients at significant risk. A better candidate will specifically identify that reasonable belief of practicing intoxicated is a situation that requires reporting.
