Evaluation of nurses' attitudes and behaviors regarding narcotic drug safety and addiction: a descriptive cross-sectional study

BACKGROUND

By evaluating nurses' attitudes and behaviors regarding narcotic drug safety and addiction, effective strategies need to be developed for combating addiction in healthcare institutions. This study, aimed at providing an insight into patient and staff safety issues through the formulation of health policies, aimed to evaluate nurses' attitudes and behaviors regarding narcotic drug safety and addiction.

METHODS

The study was conducted in a descriptive cross-sectional design. It was carried out with 191 nurses in a public hospital between March 2023 and August 2023. Data were collected through face-to-face interviews, gathering socio-demographic information and utilizing the Addictive Substance Attitude Scale. The data were analyzed using independent sample t-tests, one-way ANOVA tests, and regression analysis (P < .001 and p < .05).

RESULTS

The average age of the participants was determined to be 36.58 ± 8.40. It was reported by 85.3% of nurses that narcotic drug follow-ups in their units were conducted according to procedures. In the study, it was found that 63.9% of nurses did not know the procedure to be followed towards a healthcare professional identified as a narcotic substance addict. The total mean score of the Addictive Substance Attitude Scale of nurses participating in the study was 74.27 ± 14.70. A significant difference was found between the total scores of the scale and the level of education of nurses, the follow-up status of the drugs in the unit where they work, their status of receiving narcotic drug addiction training, and their routine use of the half-dose drug disposal form (p < .05).

CONCLUSIONS

The findings of this study underscore the importance of evaluating nurses' attitudes and behaviors regarding narcotic drug safety and addiction. These results indicate the need for nursing administrators, particularly in terms of patient and staff safety, to adopt more effective policies and strategies.

Refocusing on work-based hazards for the anaesthesiologist in a post-pandemic era

The coronavirus pandemic has raised public awareness of one of the many hazards that healthcare workers face daily: exposure to harmful pathogens. The anaesthesia workplace encompasses the operating room, interventional radiology suite, and other sites that contain many other potential occupational and environmental hazards. This review article highlights the work-based hazards that anaesthesiologists and other clinicians may encounter in the anaesthesia workplace: ergonomic design, physical, chemical, fire, biological, or psychological hazards. As the anaesthesia work environment enters a post-COVID-19 pandemic phase, anaesthesiologists will do well to review and consider these hazards. The current review includes proposed solutions to some hazards and identifies opportunities for future research.

Preventing controlled substance diversion in perioperative settings: a narrative review

PURPOSE

Diversion of controlled substances in the perioperative setting is an ongoing challenge, with consequences for patients, anesthesiologists, perioperative staff, and health care facilities alike. Perioperative environments are at high risk for diversion, since controlled substances are frequently handled in these settings, with varying levels of oversight. In this narrative review, we summarize strategies for preventing diversion of controlled substances in perioperative settings (i.e., operating rooms, endoscopy suites, and postanesthesia recovery units).

SOURCE

We performed a targeted literature search in PubMed MEDLINE, Embase, Scopus, Web of Science, the Cochrane Register of Controlled trials, and the Cochrane Database of Systematic Reviews, as well as a manual search for additional references. We used terminology related to drug diversion, drug abuse, anesthesiologists, pharmacists, physicians, operating room personnel, and controlled substances.

PRINCIPAL FINDINGS

Many strategies have been described for preventing diversion in perioperative settings, and these are broadly categorized into: education, distribution, auditing, or provider screening. Some of these approaches may be time- and resource-intensive. There is limited evidence to inform anesthesia departments' choice of which strategies to adopt.

CONCLUSION

Although awareness of perioperative controlled substance diversion has been improving, there are too few data to suggest an optimal approach. Anesthesia departments will need to work collaboratively with hospital pharmacies and actively select strategies that are reasonable given local resources.

Signs and Behaviors to Identify Impairment and Drug Diversion

Substance use disorder in health care professionals may adversely affect patient care. To reduce the risks of harm, raising awareness among all staff for early identification and response is a primary goal. Knowledgeable co-workers play an essential role to identify signs and behaviors indicating at-risk substance use by observed impairment or suspicion of drug diversion and report to a supervisor. Response protocol for a timely, confidential, safe and non-punitive intervention can help connect the clinician to needed assessment and treatment help and potentially save a life and provide a hopeful outcome to retain their license and career.

How to Conduct a Safe Intervention for Substance Use Disorder and What to Avoid

An intervention is sometimes needed in situations where those struggling with a substance use disorder (SUD) require outside assistance, motivation, support, or predetermined consequences to help curb the behaviors associated with the SUD. A multidisciplinary team approach which incorporates safety, compliance, and access to care is ideal. The intervention is often the final step in an investigative process that also includes surveillance, interviews, drug testing, and chart audits. Additionally, the culture of the institution helps to formulate policies that are in line with the mission, vision, and values of the company. A punitive system-wide culture, for example, can expect a far different intervention outcome than one that is support and treatment-centric.

[The operating room, at the center of the danger]

Cardiac anesthesiologists face a demanding and stressful practice that requires a sense of well-being at work that is essential to patient safety and quality of care. Like all cardiac caregivers, they are exposed to the death of the people they care for and must nevertheless overcome the difficulties associated with the management of heavy patients.

Propofol misuse in medical professions: a scoping review

PURPOSE

We aimed to describe the current literature concerning propofol misuse in medical professionals, specifically relating to the individual demographics of those misusing propofol and the outcomes of propofol misuse.

METHODS

We conducted a retrospective scoping review of the literature using a modified PRISMA approach. We used MEDLINE, EMBASE, and PsycINFO databases to identify relevant studies based on search terms. Studies describing individual medical professionals misusing propofol were included.

RESULTS

Twenty-four articles describing 88 individual cases of propofol misuse were included for data charting and analysis. Anesthesiologists and certified registered nurse anesthetists were most commonly identified. Death was a common method of identification of misuse, while rehabilitation and death were common final outcomes associated with propofol misuse.

CONCLUSIONS

Despite knowledge of the pharmacokinetic and pharmacodynamic properties of propofol by those misusing this medication, death was a common outcome reported in the literature. Data related to long-term outcomes including re-entry to clinical practice or success of rehabilitation were limited.

Psychiatric Issues Among Health Professionals

COVID-19 has increased the interest in the wellbeing of health professionals (HPs) as they have experienced stress, loss, and fatigue-related symptoms. Research evidence from previous epidemics points to an increase in the prevalence of affective, anxiety, and addictive disorders among them. HPs are trained to care for others and to recover from severe stressors. However, they tend to neglect self-care and have difficulties in seeking appropriate help when need it. This new scenario becomes an opportunity to promote a new culture of professionalism whereby caring for the caregivers becomes a priority both at a personal and institutional level.

Propofol misuse in Ireland - Two case reports and a review of the literature

Propofol is a rapidly acting sedative drug, which is usually administered intravenously. It is widely used in procedural sedation due to its rapid onset and easy reversibility. It has a good safety profile when used in combination with ventilation and monitoring. However, propofol can bring on feelings of euphoria, sexual disinhibition, tension relief and hallucinations, creating a potential for abuse. At an international level, recreational propofol use among medical staff is a growing, yet under reported problem. In order to highlight this issue in an Irish context, the case reports described are among the first recorded deaths in Ireland due to unmonitored self-administration of propofol. The difficulties facing forensic pathologists in detecting propofol and its metabolites in these cases are outlined. The potential for propofol abuse should influence healthcare facilities to make their staff aware of the risks associated with it. This in turn would promote vigilance and encourage those affected to seek treatment.

Propofol but not dexmedetomidine produce locomotor sensitization via nitric oxide in rats

RATIONALE

The abused potential of some anesthetics has been debated. Measurement of locomotor sensitization is a better way to detect the neurobehavioral plasticity of addiction.

OBJECTIVES

The present study aims to explore whether propofol and dexmedetomidine are capable of inducing locomotor sensitization.

METHODS

Male Wistar rats (250-300 g) were the subjects (n = 8 for each group). Propofol (20 and 40 mg/kg) and dexmedetomidine (2.5-20 μg/kg) or saline were injected to rats intraperitoneally (IP), and their locomotor activities were recorded for 15 min. Consequently, L-NAME (30 and 60 mg/kg)-a nitric oxide (NO) inhibitory agent-was injected to rats 30 min before propofol (40 mg/kg) or saline injections, and the locomotor activity was recorded. The process was carried out for 13 days, with 7 sessions applied every other day.

RESULTS

Dexmedetomidine did not produce any significant locomotor sensitization. While propofol (20 mg/kg) produced a significant locomotor sensitization in the last treatment session (day 13), at the higher dose, it prompted a significant locomotor sensitization from the 3rd treatment session. L-NAME blocked propofol-induced locomotor hyperactivity and sensitization significantly without producing any noteworthy changes on the locomotor activity during the testing period of 13 days when administered alone.

CONCLUSIONS

Our results suggest that propofol but not dexmedetomidine produced a significant locomotor sensitization via central nitrergic system. Dexmedetomidine may have a lesser psychostimulant type addictive potential than propofol. Sensitization development by propofol implies that this drug might be effective on the neuroadaptive processes associated with a stimulant type of dependence.

Substance use disorder in anaesthetists: A personal perspective

In this article, I present a firsthand account as an anaesthetist with substance use disorder who has been through rehabilitation and returned to clinical anaesthesia, followed by an overview of substance use disorder in anaesthesia. Substance use disorder is prevalent within the anaesthesia community and can result in tragic consequences, including death in many cases. The incidence is around one to two per 1000 anaesthetist years and this appears to be rising, perhaps mirroring the population-wide increase in substance use disorder as a result of the opioid epidemic. Recognising substance use disorder in a colleague and intervening to try and help them and protect patients can be immensely challenging. Carrying out a successful intervention requires careful planning and coordination in order to protect the affected individual, their colleagues and patients. Returning to clinical anaesthesia following a diagnosis of substance use disorder is also contentious, with the high abstinence rate (relative to the wider substance use disorder population) having to be balanced against the risk of death following relapse. Any return to practice must be well planned and supported, and include appropriate toxicology screening. With such measures, rehabilitation and a return to clinical anaesthesia is possible in certain cases. For the affected individual regaining, then maintaining, their professional identity can be a powerful motivator to remain abstinent. Drug diversion and substance use disorder in anaesthesia is unlikely ever to be fully preventable, but strategies such as biometric dispensing, analysis of unused drugs, random toxicology and ongoing education may help to keep it to a minimum.

Male and Female Physician Suicidality: A Systematic Review and Meta-analysis

IMPORTANCE

Population-based findings on physician suicide are of great relevance because this is an important and understudied topic.

OBJECTIVE

To evaluate male and female physician suicide risks compared with the general population from 1980 to date and test whether there is a reduction of SMR in cohorts after 1980 compared with before 1980 via a meta-analysis, modeling studies, and a systematic review emphasizing physician suicide risk factors.

DATA SOURCES

This study uses studies retrieved from PubMed, Scielo, PsycINFO, and Lilacs for human studies published by October 3, 2019, using the search term "(((suicide) OR (self-harm) OR (suicidality)) AND ((physicians) OR (doctors)))." Databases were also searched from countries listed in articles selected for review. Data were also extracted from an existing article by other authors to facilitate comparisons of the pre-1980 suicide rate with the post-1980 changes.

STUDY SELECTION

Original articles assessing male and/or female physician suicide were included; for the meta-analysis, only cohorts from 1980 to the present were included.

DATA EXTRACTION AND SYNTHESIS

The preregistered systematic review and meta-analysis followed Cochrane, PRISMA, and MOOSE guidelines. Data were extracted into standardized tables per a prespecified structured checklist, and quality scores were added. Heterogeneity was tested via Q test, I2, and τ2. For pooled effect estimates, we used random-effects models. The Begg and Egger tests, sensitivity analyses, and meta-regression were performed. Proportional mortality ratios were presented when SMR data could not be extracted.

MAIN OUTCOMES AND MEASURES

Suicide SMRs for male and female physicians from 1980 to the present and changes over time (before and after 1980).

RESULTS

Of 7877 search results, 32 articles were included in the systematic review and 9 articles and data sets in the meta-analysis. Meta-analysis showed a significantly higher suicide SMR in female physicians compared with women in general (1.46 [95% CI, 1.02-1.91]) and a significantly lower suicide SMR in male physicians compared with men in general (0.67 [95% CI, 0.55-0.79]). Male and female physician SMRs significantly decreased after 1980 vs before 1980 (male physicians: SMR, -0.84 [95% CI, -1.26 to -0.42]; P < .001; female physicians: SMR, -1.96 [95% CI, -3.09 to -0.84]; P = .002). No evidence of publication bias was found.

CONCLUSIONS AND RELEVANCE

In this study, suicide SMR was found to be high in female physicians and low in male physicians since 1980 but also to have decreased over time in both groups. Physician suicides are multifactorial, and further research into these factors is critical.

Health, risk behaviour and consumption of addictive substances among physicians - results of an online survey

Background

Previous studies were able to show that hazardous alcohol and substance abuse among physicians is not rare. Currently no recent data to detect risk groups are available either on the prevalence of hazardous drinking disorders and risky health behaviour among physicians or on influencing factors (age, gender, role, institution, specialization, working hours).

Methods

A 42-item online questionnaire was distributed to 38 university hospitals, 296 teaching hospitals and 1290 physicians in private practice. The questionnaire addressed health behaviour and alcohol/substance consumption as well as demographic and work-related properties.

Results

Out of 1338 a total of 920 questionnaires could be evaluated. 90% of physicians estimate their health status as satisfying. 23% of doctors consume hazard quantities of ethanol, 5% are nicotine addicted, and 8% suffer from obesity. Childlessness (p = 0,004; OR = 1,67; KI = 1,17-2,37) for both genders and the role of a resident for females (p = 0,046, OR = 3,10, KI = 1,02-9,40) poses a risk factor for hazardous alcohol consumption. Weekly working hours of more than 50 h (p = 0,009; OR = 1,56; KI = 1,12-2,18) and a surgical profession (p < 0,001; OR = 2,03; KI = 1,47-2,81) may also be a risk factor towards hazardous and risky health behaviour.

Conclusion

A more structured and frequently repeated education on help offerings and specific institutions for addicted and risk groups seems essential.