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Final Report

Proposal for Randomized Drug Screening

Submitted to: Robert Johnson, Terrace Communitys Manager

Submitted from: Sarah Cochran, LPN & Linda Blake, LPN

Vermont Technical College

April 23, 2008

Executive Summary
.

Need
This project shows the importance of the implementation of randomized drug
screening within the Terrace Communities. The impaired employee is a major risk
to patient care and safety within our facilities. The need of randomized drug
screening is essential for healthcare workers due to its high level of stress and easy
access to medications.

Background
The background explains why healthcare employees are at risks for substance abuse
and the major factors that may force and individual to become impaired. The
background also explains in detail the most common signs and symptoms that may
appear in an impaired employee.

Project Description
The project description explains in full detail the solution to the issue and the steps
and items necessary to allow this project to take place. The project description
provides a thorough timeline and the expectations of the evaluation phase.

Budget
The budget portion of this project provides a chart with the items that will be
required with the most recent cost efficient pricing. The total cost on the chart
includes the prices of shipping and handling.

Table of Contents

Section

Page

Statement of request..4
Discussion of need... 4
Patient Care...4
Productivity.. 4-5
Personal Well-Being....5
Workplace liability with legal or punitive proceedings...5
License suspension or revocation.....5
Background...6-7
Project Description..8-10
Time Table Plan..11
Budget.....12
Conclusion..13
Works Cited14
Resumes.....15-16

Statement of Request
This project is a proposal for the implementation of randomized drug screening within
the Terrace Communities. The initial setup time for this project will take approximately
two months with a review period annually. The approximate total cost of this project will
be $2167.00 per year. This project proposal for the implementation of randomized drug
screening will significantly increase patient safety and workplace productivity and will
allow us to identify the impaired employee or the potential new hire.

Discussion of Need
The discussion of need will further help you to understand the importance of workplace
randomized drug screening and how it will benefit the Terrace Communities. Patient
care, productivity, personal well-being, workplace liability with legal or punitive
proceedings, and license suspension or revocation can all be affected by the impaired
employee.
Patient care
The impaired employee has a direct impact on the care a patient receives by not making
reasonable judgment. The steps in providing proper care that is necessary to a person
may be omitted by the impaired employee due to lack of alertness. The sick residents
that are in pain may not be receiving their medications because individual administering
them is keeping the drug for their own personal use. Many times, an impaired nurse isn't
identified until patient safety has been compromised (MedSurg, 2006). According to the
Journal of PeriAnesthesia Nursing, June, 2003, it's believed that 10% of the nursing
population has an alcohol and/or drug abuse problem, and 6% of nurses have a problem
serious enough to interfere with their ability to practice.
Productivity
An impaired employee may have a negative impact on productivity for the following
reasons:
-Prolonged decision making capabilities.
-Might not be trusted to complete required tasks.
-Possibly with taking longer at medication administration because of trying to mask
addiction.
-May perhaps be consistently late or absent from work.
-May be consumed in their addiction such as obtaining substances that the overall
productivity level of that individual decreases.
There are significant intangible costs in terms of lower productivity such as greater use
of sick time and absenteeism. There is an increase in strain and tension among staff with
a concomitant decrease in staff morale along with lost productivity. The medical

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consequences of all drug abuse related health problems resulting in lost productivity
alone has been estimated to cost our society more than $33 billion each year (NIDA,
2008).
Personal well-being
The impaired employee may appear disheveled, complain of problems in their personal
relationships, and suffer from financial issues. The impaired employee may become
moody, irritable, tired and have difficulty concentrating on simple to complex tasks
(MedSurg, 2006). While outward appearances may show a nurse who's in control, often
they have a history of family problems, and be under financial strain (Journal of
PeriAnesthesia Nursing, 2003).
Workplace liability with legal or punitive proceedings
Failure to perform a task completely and competently by the impaired employee could
result in legal action against the employee and employer. The employer may be held
liable due to failure of recognizing the incapacitated employee with possible harm
resulting.
Drug use may give rise to litigation if an impaired healthcare provider injures a patient
while providing care. Because tort liability can arise for an employer out of injury to a
patient resulting from an act of negligence by a drug impaired employee, the healthcare
employer has a special interest in intervening quickly and efficiently when drug use or
impairment is suspected on the job (ANA, 2006).
License suspension or revocation
If the incapacitated employee happens to hold a license, it is possible that they would
face losing their license temporarily or permanently as well being required to complete a
treatment program.
As stated by the Vermont State Board of Nursing, disciplinary actions such as license
revocation and suspension may be a direct result from the inability to practice nursing
competently which includes performance of unsafe or unacceptable patient care.
Narcotic use and diversion among nurses is a growing problem. Substance abuse is the
number one reason named by state boards of nursing for disciplinary action (SBN,
2004).

Background
This portion of the project will discuss the impaired employee and the factors that may
influence an individual to abuse drugs.
Impaired Employee
Nurses, Licensed Medical Nursing Assistants, and Medical Technicians who work within
our healthcare facilities are at high risk for abusing drugs. It is not just the employees
working for the Terrace Community who are at risk but it is the people within the
healthcare career field in general. Factors that may force one in a position as mentioned
above to abuse drugs may include:
easy access to medications
high stress levels
long work schedules
A recent study from the MedSurg Nursing showed that 10% of nurses form some type of
drug dependency (2006). Substance abuse among nurses can have significant
ramifications for patient care, productivity, personal well-being, workplace liability with
legal or punitive proceedings, and license suspension or revocation as explained above.
The signs that an employee may be abusing drugs include but are not limited to:
Moods:
Depressed
anxious
Irritable
Suspicious
Complains about others
Emotional unsteadiness (e.g. outbursts of crying)
Mood changes after lunch or break
Actions:
Withdrawn or improperly talkative
Spends excessive amount of time on the telephone
Argumentative
Has exaggerated sense of self-importance
Displays violent behavior
Avoids talking with supervisor regarding work issues
Absenteeism:
Acceleration of absenteeism and tardiness, especially Mondays, Fridays, before
and after holidays
Frequent unreported absences, later explained as emergencies

Unusually high incidence of colds, flus, upset stomach, headaches,

Frequent use of unscheduled vacation time
Leaving work more than necessary (e.g. frequent trips to water fountain and
bathroom)
Unexplained disappearances from the job with difficulty in locating employee
Requesting to leave work early for various reasons

Accidents:
Taking of needless risks
Disregard for safety of others
Higher than average accident rate on and off the job
Work Patterns:
Inconsistency in quality of work
High and low periods of productivity
Poor judgment/more mistakes than usual and general carelessness
Lapses in concentration
Difficulty in recalling instructions
Difficulty in remembering own mistakes
Using more time to complete work/missing deadlines
Increased difficulty in handling complex situations
Relationship to Others on the Job:
Overreaction to real or imagined criticism (paranoid)
Avoiding and withdrawing from peers
Complaints from co-workers
Borrowing money from fellow employees
Persistent job transfer requests
Complaints of problems at home such as separation, divorce, child discipline
problems

Project Description
This project description report shows in complete detail a solution in preventing and
treating drug abuse among healthcare workers within the Terrace Communities. The best
step toward accomplishing this goal is to implement randomized drug screening within
our facilities.
The drug testing will be completely randomized unless it is a new hire or there is
suspicion of an employee abusing drugs. The drug testing process which includes
obtaining the tests results will be accomplished within our facilities. This will allow us
to identify any impaired employees and assist in seeking outside treatment.

Personnel needed
Implementation of this project will require the project coordinators and designated
observers.

Project Director
There will be at least one project director at each of the six Terrace Communities. The
selected persons for this position will be in charge of the randomized employee selection
process and maintaining a necessary amount of testing supplies within their facility. This
person will be responsible for teaching and explaining the drug testing policy all new
employees. The project coordinator will receive written consent from all newly hired
individuals agreeing to comply with the randomized drug screening policy. The project
director will be accountable in selecting qualified personnel to become designated
observers and assist in finding outside treatment for the impaired individual.

Designated Observers
The designated observers as mentioned above will be chosen by the project coordinator.
These people will be highly trusted and responsible individuals who will observe the
randomly selected employee provide the necessary urine specimen. There will be an
assigned male and female observer within each facility and they can only observe an
employee of the same sex. The project coordinator can act as an observer if assigned
person is unavailable. The designated observers will be present and observing while the
employee is leaving the sample to ensure the specimen is properly and honestly obtained.
The observer will know how to read and understand the results from the drug test and
will report results to necessary authorities.

Robert Johnson
Terrace Communitys Manager

Facility Administrator

Project Director (One per facility)

Designated Male Observer

(One per facility)

Designated Female Observer

(One per facility)

Organizational Chart

Equipment needed
In order to implement randomized drug screening within the Terrace Communities, we
will need a drug screening device. There are several types of drug screening kits
available but there was one in particular that would be the most beneficial to the Terrace
Communities and it is called the iCup A.D. drug screen. This device is a urine specimen
cup with a built-in validity test so that we would not have to spend the extra money or
time to have the specimen sent out and be tested. The iCup can test up to ten different
drugs as shown in figure 1 and has a 24-month shelf life. The cup has a two part result
form that is easy to read with results that are ready in five minutes (see figure 2). The
iCup is amazingly accurate and showed above a 95% accuracy rate for all drugs that are
tested by this device. Further information regarding the iCup can be found at the
following website. http://www.tryi.com/products/drugtesting/icup/index.php. Other
benefits of the iCup are listed below:

Reviewed and cleared by the FDA.

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Volume pricing available.

No reagents to add.
No technical training or certification required.
The iCup Drug Screen proprietary test strip is proven to correlate with results
Drug Name:

Abbr:

Cutoff:

Amphetamine

AMP

1000ng/mL

Barbiturates

BAR

300ng/mL

Benzodiazepines

BZO

300ng/mL

Cocaine

COC

300ng/mL

Ecstasy

MDMA

500ng/mL

Marijuana

THC

50ng/mL

Methadone

MTD

300ng/mL

mAMP

1000ng/mL

MOR

300ng/mL

Opiates

OPI

2000ng/mL

Oxycodone

OXY

100ng/mL

Phencyclidine

PCP

25ng/mL

Propoxyphene

PPX

300ng/mL

Tricyclic Antidepressants

TCA

1000ng/mL

Methamphetamine
Morphine

generated by the SYVA EMIT II standard laboratory drug screen.

Figure 1
Drugs tested by the iCup.

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Figure 2
iCup and Validity Chart

Timetable of Implementation
Date
Activity

Outcome

April 30, 2008

Project submittal reviewed by

Robert Johnson

Project Approved

Notify project directors and

nominate others at the other
facilities.

Project directors select one male

and one female designated
observer at each facility.

May 15, 2008

Submit purchase order for 25

iCup A.D. drug screening kits
for each of the six Terrace
facilities.

Supplies ordered and will be

delivered in approximately two
weeks.

May 29, 2008

Drug screening consent forms

are designed.

Drug screening consent forms

added to new employee
application packages.

June 8&9, 2008

Employee meeting regarding

new randomized drug screening

All employees understand new

policy and each sign the drug

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policy.

screening policy.

June 16, 2008

iCups arrive and are placed in

locked nursing closet.

Drug screening kits are now

available to begin testing new
hires and random staff members.

June 24, 2008

First employee randomly

selected to participate in a drug
screening by project director.

Male observer obtains specimen

from male employee and results
showed no evidence of drug use.

July 7, 2008

Potential new hire is screened

for drug use.

Female observer obtained

specimen from female applicant
and results tested positive for
opiates. Female was denied
position within the facility.

July 8, 2008

Drug screening Evaluation

Policy has been successful since

implementation as evidenced
above.

Impact on need: Evaluation Phase

Implementation of this project will:

Identify any impaired employee or potential new employee.

This will be evaluated at the yearly review by all of the facilitys project directors.
This will be assessed by looking at the amount of people tested, at the rate they
were tested and the results of the entire tests.

Increase productivity and improve patient care by identifying the impaired

employee.
This will be evaluated by each of the facilitys project directors in one year from
implementation of the drug screening policy. All project directors will meet to
review the years employee absence rate at each facility, and shows a decrease by
25%.

Show a decrease in drug errors by 25%.

This will be evaluated by showing a decrease in medication administration
errors, and will be evaluated by each of the facility's project directors six months

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from implementation of the drug screening policy.

Budget
The chart to follow shows in detail the costs that have been researched for this project.
The costs include tax and shipping expenses for items needed.
Item
iCup testing kits in bulk (25 kits in bulk) @
$227.00 x9 (225 individual tests) to split up
between all six facilities per year.
Shipping
Tax
Average cost per year

Cost
$2,043.00
$52.50
$72.00
$2167.00

The average cost per year for the implementation of randomized drug screening is
approximately $2167.00. This price is reasonable compared to the overall price that an
impaired employee could cause within a facility to include legal expenses and damage to
ones health. The iCup allows for quick result that can be read in house. If a specimen
was to be sent out for testing it would cost our facilities $37.00 per test and in comparison
with the figures above this would cost a grand total of $8,325.00. The iCup is just as
accurate as a lab test and it is significantly cheaper.

Conclusion
The Implementation of randomized drug testing within the Terrace Communities will
improve patient care, productivity, personal well-being, and will reduce the risks of
workplace liability including legal and punitive actions and license suspension and
revocation. The most optimal product chosen to accomplish this task is the iCup which is
inexpensive, accurate in testing for several drugs and easy to use. The implementation of
randomized drug screening will allow for the Terrace Communities to function at its
highest level with the most desired employees.

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Work Cited
American Nurses Association (ANA), (2006). Retrieved March 1, 2008 from the ANA
continuing education article The nursing risk management series.
http://nursingworld.org/mods/archive/mod310/cerm102.htm
Journal of PeriAnesthesia Nursing 162, (2003, June), pp 160-167.
MedSurg Nursing, August 2006-Volume 15/No. 4.
National Institute on Drug Abuse (NIDA). (2008). Retrieved March 1, 2008 from
National Institute of Health website:
http://www.nida.nih.gov/infofacts/workplace.html
State Board of Nursing (SBN) (2004, March 1). Retrieved February 24, 2008, from
Vermont Secretary of State Web site:
http://vtprofessionals.org/opr1/nurses/forms/nursingrules.pdf

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Sarah Cochran, LPN

255 Westfield Drive
West Hartford, VT 05084
802-295-2606
Scochran22@netzero.net

Work History
Valley Terrace, Norwich, VT
Licensed Practical Nurse, Per-Diem, 2007 - Present
Monitor and oversee the medication delivery system and
documentation of any and all medications or treatments given.
Responsible for resident assessments and provide direct care.
Assist with the ordering of medications, supplies and equipment
for the facility.
Monitor daily assignments for the Resident Assistants and assist
with making changes if needed.
Genesis Healthcare Center, Lebanon, NH

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Licensed Practical Nurse, Per Diem, 2007
Medication administration to all daily assigned patients.
Perform all necessary treatments and observations on assigned
patients.
Document and chart all necessary information in patient records.
Delegation of duties to the LNAs.
Dartmouth Hitchcock Medical Center, Lebanon, NH
Phlebotomist, 2006-2007
Successfully perform venous punctures and obtained needed blood
specimens.
Familiarization of all lab tests and lab based computer systems.

Education:
Vermont Technical College, ADN, anticipated graduation 5/17/08
Vermont Technical College, LPN with Honors 6/23/07
Hartford High School 1998-2001
Certification:
BLS (Basic Life Support) 2008
Basic IV Therapy Course 5/07
Linda S. Blake, LPN
538 Bridgewater Center Road
Bridgewater Corners, VT 05035
802-672-2161
blakeskie@yahoo.com
WORK HISTORY
Woodstock Terrace, Woodstock, VT
Licensed Practical Nurse, Per-Diem, 2007 - Present
Monitor and oversee the medication delivery system and
documentation of any and all medications or treatments given.
Responsible for resident assessments and provide direct care.
Assist with the ordering of medications, supplies and equipment
for the facility.
Monitor daily assignments for the Resident Assistants and assist
with making changes if needed.
Northern Ski Works, Bridgewater VT
Sales Clerk 2002 2007

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Assist Manager with receiving new product and distributing to

other two stores
Assist with ordering of supplies for the store
Provide direct customer care
Assisted with monthly scheduling and changes as needed
Responsible for daily receipts and balancing of cash drawers

Woodstock National Bank, Quechee, VT

Branch Supervisor, September 1999-2002
Responsible for daily operations and balancing of bank cash
drawers
Duties included were processing deposits, opening of new
accounts, ordering currency for daily operations of the branch,
training of new employees, ordering supplies as needed.
Attend required meetings
Maintained customer's confidentiality.
Education:
Vermont Technical College, ADN, anticipated graduation 5/17/08
Vermont Technical College, LPN with Honors 6/23/07
Woodstock Union High School 1984-1987
Certification:
BLS (Basic Life Support) 2009
Basic IV Therapy Course 5/07