Should all docs and nurses receive drug tests after adverse events?

Hospitals should conduct drug tests on all physicians and nurses, especially following an adverse event, and doctors and nurses should be ready to comply, according to an article by NYU Langone Medical Center's Director of Division of Medical Ethics.

Arthur L. Caplan, Ph.D., notes that while doctors and nurses should blow the whistle on colleagues they think are impaired by drugs and alcohol, healthcare workers are hesitant to report a suspected drug problem. So Caplan supports a policy that requires doctors and nurses pass a drug test prior to hospital employment.

The medical ethics director also encourages hospitals institute random drug tests. In anesthesiology, for example, drugs are easy to obtain and easy to abuse, he writes in MedPage Today.

Despite concerns about privacy invasion and disrespect, hospitals should have mandatory drug screenings following an adverse event. However, a positive test should warrant an investigation, not an immediate firing, according to Caplan.

"Despite some of the flaws with testing, it seems to me that if we are going to commit to patient safety and putting patients' interests first, we have to make sure that problems, safety difficulties, and adverse events are not linked to impaired physicians or nurses," Caplan writes.

The MedPage Today article echoes the sentiments of two Johns Hopkins physicians and patient safety experts who urged all hospitals to randomly test physicians for drug and alcohol use to enhance patient safety. The patient safety experts also recommend that with the prevalence of alcoholism among doctors, hospitals should implement mandatory physical examination, drug testing or both before appointment to the hospital medical staff, according to their commentary published in May in The Journal of the American Medical Association.

That could soon be the case for providers in New Hampshire, where a proposed bill would subject the state's healthcare workers to four random drug tests per year. Critics of the bill called it overly vague and expensive to providers.

For more:
- here's the Mescape piece