How do surveyed Substance Abuse Policies for Anaesthesia in New Zealand District Health Board hospitals compare with international expert guidelines?

Abstract

Diversion of drugs from clinical practice with subsequent impairment, plus or minus addictive disease has a history that parallels medicine itself. For decades the association between addictive disease and clinical practice has been acknowledged by medicine and nursing alike, with significant morbidity and mortality reported for over a century. The incidence of abuse of drugs diverted from clinical anaesthesia is approximately 2% and there has been little significant reduction demonstrated over the preceding forty years. This research provides a description of New Zealand District Health Board staff substance abuse management and policy documents for benchmarking against selected international recommendations.

The aim of this study was to examine how substance abuse policy, education programme curriculum and practice in all twenty of New Zealand District Health Board hospital departments of anaesthesia compare with selected international recommendations. Existing international substance abuse policy documents developed for application in anaesthesia departments acknowledge addiction to drugs diverted from clinical practice as an inherent and serious risk experienced by those who work in anaesthesia. These guideline documents outline strategies to support the prevention, identification, and intervention of individuals impaired by abuse of diverted drugs. A quantitative approach was utilised, this approach included the development of two non validated survey tools and a survey instrument pilot exercise. Eighteen of the twenty departments of anaesthesia clinical directors invited to participate did so with the return of the questionnaire survey; and all twenty District Health Boards participated with information about substance abuse policy documents. The key findings from this study identify that while all participants acknowledged substance abuse as an inherent risk associated with the practice of anaesthesia, very few organisations were prepared by way of a robust, evidence based policy document. Twelve of the twenty District Health Boards in New Zealand were found to have no substance abuse policy document and of the eight District Health Boards that did have a substance abuse policy only two of these documents had been specifically written for the department of anaesthesia. The risks associated with abuse and addiction to drugs diverted from anaesthesia continues to be of significant concern in New Zealand. This study concludes that New Zealand District Health Board departments of anaesthesia are infrequently supported by robust policy documents despite the acknowledgement of substance abuse as an inherent risk and the presence of a sound document recently published by the Australasian Continuing Education Coordinating Committee [ACECC] which is comprehensive and represent co-operative engagement from key stake holders (ACECC, 2011).