Impaired Licensed Independent Practitioners

1. Impaired Licensed Independent Practitioners • The Joint Commission requires education of organization staff about illness and impairment issues specific to licensed independent practitioners (LIPs)—Physicians, PA, ARNP • Addiction • Mental/Behavioral • Physical Condition

2. Healthcare providers are not only advocates for the health of their patients, they are also important guardians of the health of their peers and themselves. • Due to the shame and stigma associated with medical conditions that may affect one’s ability to practice safely, healthcare providers are often hesitant to seek help for their fellow providers or themselves.

3. Physicians experience mood disorders, anxiety disorders, sleep disorders, and substance-related disorders—and yet these disorders are poorly recognized and often inadequately treated. Unfortunately, physicians are often the last to recognize these disorders in themselves or to recognize the degree of their impairment.

4. Types of Impairment • Addiction: providers struggling with addiction or substance abuse. Examples include alcohol dependence or addiction to an opioid or narcotic drug. • Mental/Behavioral: potentially impaired providers who may be suffering from mental illness, co-occurring or stress-induced disorders which manifest primarily as recurrent disruptive behavior in the workplace. • Physical Condition: providers who may be potentially impaired by a disabling physical or neurological condition. Examples include multiple sclerosis, stroke, or traumatic brain injury.

5. Impairment Signs and Symptoms • The impaired Healthcare Worker and LIP acts in an unusual manner and exhibits behaviors that can serve as warnings, if they are recognized and understood. • “They are just not the same person we used to know“ • Loss of enthusiasm, Negative attitudes • Cynical, fault-finding remarks ; Sarcastic, complaining, antagonistic behavior • Increased conflicts with colleagues/staff • Complaint’s of being overworked, misunderstood • Isolation, mistrust, abandonment of old friends, family problems and conflicts • Erratic work history/”job hopping”

6. Impairment Signs and Symptoms • “We can't trust his/her work anymore“ • Changes in work habits (disruption of consistent patterns); erratic productivity • Changes in handwriting; wrong dates, word reversals, dosage errors • Change in prescribing habits; change in number of consults • Procedural errors; errors of omission with alibis, cover-ups • Missed appointments, meetings, dropping of committees; complaints from staff, patients, families • Motor coordination changes • Changes in cognition

7. Impairment Signs and Symptoms • “She/he seems different somehow“ • Looks tired; admits to insomnia; Eyes don't look right • Personal hygiene changes; looks seedy; may smell of stale alcohol , mouthwash or strong cologne • Tremulous or sweaty; agitated or restless; depressed, anxious, mistrustful of others • Changes in speech (slurring, careful cadence, stammering or blocking, "tranquilizer lilt") • Periods of looking ill and then shortly thereafter looking well • Increased healthcare problems • Increased accidents

8. Chain of Command for Reporting Medical Staff/Attending Charge Nurse Department Manager or Designee Consult for guidance Consult for guidance COO, VP Operations or Designee Risk Management Section Chief and/or Medical Director SVP & Chief Medical Officer VP Quality & Associate CMO President of Medical Staff