RECOGNITION, INTERVENTION, AND COMPASSIONATE RESPONSE TO SUBSTANCE USE DISORDER IN THE PERIOPERATIVE TEAM.

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SUBTITLE: Moving Beyond Stigma to Preserve Safety and Health

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PREPARED BY: YVONNE MAKOKHA

AAR HOSPITAL

Private & Confidential

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Substance Use Disorder is a medical disease, not a moral failing, and it poses a direct threat to patient safety and colleague well being.

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Private & Confidential

The Perioperative Environment is Unique:

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• High-stakes, intense stress, and emotional burden.
• Culture of self-reliance and perfectionism.
• Unique access to potent controlled substances.

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This creates a scenario of elevated risk for healthcare professionals.

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Introduction

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• To confront the issue of substance use head-on, moving beyond stigma.

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• To equip the perioperative team with knowledge for:

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-Proactive Identification of potential impairment.

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-Compassionate Intervention strategies.

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To preserve the twin pillars of our duty:

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• Patient Safety

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• Colleague Health

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OBJECTIVES

Why is the perioperative team at risk

Factors Creating a Perfect Storm:

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Work-Related Stress: Long hours,

life-or-death decisions, traumatic events.

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Easy Access: Direct handling of powerful

opioids and anesthetic agents.

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"Self-Medication": The temptation to use substances

to cope with physical or emotional pain.

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Culture of Silence: Fear of professional

repercussions and stigma.

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Recognizing the signs

Behavioral Changes:

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• Erratic Behavior: Mood swings, irritability, or sedation.

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• Social Withdrawal: Isolating from colleagues.

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• Performance Issues: Frequent errors, poor judgment,

missed deadlines.

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• Patterns: Volunteering for extra shifts, frequenting the

DDA/medication room, refusing breaks.

Recognizing the Signs: Physical & Other Indicators

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Physical Signs:

• Dilated or constricted pupils.
• Slurred speech, unsteady gait.
• Smell of alcohol or excessive use of mints/perfume.

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Workplace Signs:

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• Drug Discrepancies: Unexplained waste, incorrect counts, "spilled" medications.
• Frequent "Accidents" involving drug carts or syringes.

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The Ethical and Legal Imperative

1. Our Primary Ethical Duty is to Patient Safety.

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An impaired professional cannot provide safe care.

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2. Legal and Licensing Obligations:

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Mandatory reporting requirements for suspected impairment.

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Failure to report can have legal and professional consequences.

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Reporting is an act of compassion, not betrayal—it is the first step toward recovery.

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Shifting the Culture: From Punishment to Support

Old Culture:

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• Stigma, shame, and fear.

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• Punitive responses leading to job loss and license revocation.

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• Pushes the problem underground.

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New Culture (Our Goal):

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• Transparency, support, and compassion.

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• Non-punitive framework focused on rehabilitation.

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• Recognizes Substance use disorder as a

treatable disease.

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Institutional Policies & Reporting Pathways

• Clear, Written Policies are Essential.

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-Must define "impairment" and outline the steps for reporting.

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• Confidential Reporting Pathways:

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-Supervisor/Manager

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-Hospital Compliance/Quality Officer

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-Peer Assistance Program

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• Every team member must know these policies and feel safe using them.

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The Role of Peer Assistance Programs

What are they? Confidential, supportive programs designed to help colleagues with SUD and other mental health issues.

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Their Functions:

• Provide initial assessment and support.

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• Facilitate access to treatment resources.

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• Monitor recovery and facilitate successful return-to-work agreements.

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• They are a critical resource for both the individual and the institution.

How to Approach a Colleague: The Conversation

Strategy: Empathy and Clarity.

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Choose a private, safe place and time.

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Use "I" Statements:

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"I am concerned about you because I've noticed you seem stressed and unlike yourself lately."

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Be Specific & Non-Accusatory:

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"I was worried when I saw the medication discrepancy on our shift."

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Focus on Support:

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"We have resources to help. Your health and our patients' safety are the most important things."

The Goal: Rehabilitation and Recovery

The objective is always recovery and successful return to work.

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Treatment works, and people recover.

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With proper monitoring and support, many healthcare professionals with substance use disorder can return to safe, productive, and brilliant careers.

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Protecting a colleague’s career while protecting patients is a win-win.

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Conclusion: Our Collective Responsibility

• We must foster a culture of transparency and support over fear and shame.

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By being educated, vigilant, and compassionate, we can:

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• Safeguard our patients.

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• Support our peers.

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• Protect our profession.

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• Let's break the silence and build a stronger, healthier perioperative community.

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Take aways

• SUD is a treatable disease, not a moral failure.

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• Recognize the signs – behavioral, physical, and workplace.

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• Report concerns confidentially – it's an ethical and legal duty.

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• Approach with empathy – use clear, supportive language.

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• Advocate for rehabilitation – the goal is recovery and return to work.

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References

• National Council of State Boards of Nursing (NCSBN). (2020). Substance Use Disorder in Nursing.

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• American Nurses Association (ANA). (2022). Substance Use Among Nurses and Nursing Students.

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• American Society of PeriAnesthesia Nurses (ASPAN). (2019). Position Statement on Chemical Dependency.

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Private & Confidential