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Monitoring Contract Part II

General Requirments

PARTICIPANT MANUAL

West Virginia Restore P.O. Box 11626 Charleston, WV

25339 304-932-7675

Fax (606) 832-0077 Website: www.wvrestore.org

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MISSION STATEMENT

The mission of West Virginia Restore is:

to protect the public by providing a monitoring and recovery program for Registered Professional Nurses

with a substance use disorder or a qualifying mental health condition.

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TABLE OF CONTENTS

MISSION STATEMENT Page 3 INTRODUCTION Page 5 HISTORY AND PURPOSE OF WVR Page 6 WVR OBJECTIVES Page 6 ADMISSION TO WVR Page 7 ADMISSION TO WVR BY BOARD ORDER Page 7 CONFIDENTIALITY Page 8 COST OF PARTICIPATION Page 9 EVALUATION AND MONITORING Page 9 PARTICIPANT RIGHTS Page 9 EXPECTATIONS FOR PARTICIPANTS Page 10 FAMILY RECOVERY Page 10 EMPLOYMENT Page 10 REGISTERED PROFESSIONAL NURSE ANESTHETISTS PROTOCOL Page 11 CONTROLLED SUBSTANCE ACCESS Page 12 REQUIRED MEETINGS AND MONITORING REPORTS Page 12 USE OF MOOD-ALTERING CHEMICALS Page 14 NALTREXONE AND VIVITROL Page 15 COMMUNICATION WITH WVR Page 15 RELOCATION OUT OF WEST VIRGINIA Page 16 RANDOM DRUG TESTING Page 16 MISSED CHECK-IN Page 17 DILUTE AND ABNORMAL URINE Page 17 MONITORING INTERRUPTIONS Page 17 MEDICAL CARE Page 18 RELAPSE BEHAVIORS Page 18 RELAPSE PREVENTION PROGRAM Page 19 SATISFACTORY PROGRESS Page 19 FAILURE TO PROGRESS Page 19 NON-COMPLIANCE Page 20 MONITORING CONTRACT TERMINATION Page 20 TRANSITIONAL MONITORING Page 21 COMPLETION OF ACTIVE MONITORING Page 21 ANNUAL WVR CONFERENCE Page 22 A FINAL WORD Page 22 FAQ Page 23 APPENDIX 1 Page 25 ADDITIONAL REFERENCE INFORMATION Page 25

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INTRODUCTION

Your WVR Monitoring Contract is comprised of II (two) parts. Part I is your Monitoring Contract and this Participant Manual is Part II. PLEASE BE ADVISED THAT BY SIGNING YOUR MONITORING CONTRACT YOU ARE AGREEING TO ADHERE TO THE CONTENT OF THIS MANUAL.

The purpose of this manual is to provide you with information that will assist you during your WVR participation. Please retain this manual as a reference for future use. If you have questions about any of the information provided, please do not hesitate to call the WVR office.

Please review carefully the information provided in this manual. As a WVR participant you are responsible for adhering to all conditions outlined in this manual and your individualized WVR Monitoring Contract, Part I.

Your WVR Monitoring Contract has been individualized to your identified needs. This participant manual addresses WVR participation in general terms, and outlines requirements and expectations. Any exceptions to these general expectations will be stated in your individualized WVR Monitoring Contract.

Your WVR Monitoring Contract will not be executed until all areas are completed and signed by you and returned within 14 days. Upon receipt of your executed WVR Monitoring Contract, and activation of your Affinity account with an initial monitoring fee of $84.00, you become an active WVR participant and will be held accountable for adhering to the terms of your WVR Monitoring Contract, which includes this Participant Manual.

Until your WVR Monitoring Contract is signed, and the initial fee is in your Affinity account, your participation in WVR is “pending”. Please address any concerns or Monitoring Contract related questions to the WVR Intake Staff. When this Monitoring Contract is signed and received in the WVR Office, your case becomes “active”. Your WVR Case Manager’s name is on the front cover of the Monitoring Contract. Please refer future communication to your Case Manager.

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HISTORY AND PURPOSE OF WVR

The West Virginia Board of Examiners for Registered Professional Nurses (WVBOERPN) is mandated by state legislation to protect the public (§30-7-11). This responsibility is implemented through the licensing and regulation of designated professions by individual boards. During the 2012 Legislative Session, a law was passed permitting the WVBOERPN to establish a non-disciplinary program for the Registered Professional Nurse who has a substance use disorder and/or qualifying mental health condition that may affect the ability to practice nursing (§30-7-11a). To move this important work forward, the WVBOERPN established West Virginia Restore (WVR), a monitoring and recovery program for Registered Professional Nurses, in order to assure patient safety while the Registered Professional Nurse is healing. As the name expresses, the goal is to help restore a Registered Professional Nurse to a state of wellness. WVR provides an alternative to disciplinary action for Registered Professional Nurses who are unsafe to practice due to the use of drugs including alcohol, or psychological conditions (§30-7-1 et seq., and §30-15-1 et seq.). Based on the law as outlined in the Nurse Practice Act and associated Legislative Rules, it is mandatory for any Registered Professional Nurse, including employers who are Registered Professional Nurses, to report any Registered Professional Nurse who is in violation of the Nurse Practice Act (§30-7-1 et seq., §30-15-1 et seq., and §19-3-14 et seq.). Registered Professional Nurses may be referred to WVR instead of being reported to the WVBOERPN if the violation is associated with impairment due to drugs, alcohol, or psychological conditions. The most common referrals to WVR are due to impairment in the workplace, forgery, diversion (theft) of drugs, or the use of illegal substances. WVR offers an alternative to the disciplinary process. Due to increased education of nursing professionals and employers, Registered Professional Nurses experiencing difficulties are more promptly and more effectively identified and a referral to appropriate treatment is made. Most Registered Professional Nurses participating in WVR do so voluntarily instead of being reported to WVBOERPN. Registered Professional Nurses who participate are required to withdraw/refrain from the practice of nursing immediately and until such time that WVR is assured that the Registered Professional Nurse is able to practice nursing safely, thereby protecting the public from unsafe practitioners.

WVR OBJECTIVES

WVR has adopted the following objectives:

1. Ensure public health and safety through a program that provides education, early intervention, and close monitoring of Registered Professional Nurses who may be unsafe to practice due to the use of drugs including alcohol and/or a psychiatric or psychological condition. (§30-7-11a)

2. Protect consumers from impaired practice; WVR requires that the Registered Professional Nurse withdraw from nursing practice immediately and refrain from working until WVR is assured that the Registered Professional Nurse is fit for practice and can safely return.

3. Facilitate early intervention, thereby decreasing the time between the referral of the Registered Professional Nurse to WVR, and entry into an effective treatment and recovery process.

4. Coordinate rehabilitation and provide monitoring for Registered Professional Nurses in a therapeutic, non-punitive and confidential process.

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5. Provide a cost-effective alternative to the traditional disciplinary process. 6. Develop and maintain a statewide resource network of appropriate services for WVR

participants including approved treatment providers and programs, nurse support groups, etc.

ADMISSION TO WVR

WVR participation is limited to:

a. Any Registered Professional Nurse or student of a Registered Professional Nursing Program currently licensed in the State of West Virginia or has a pending completed application for licensure in the State of West Virginia

b. Any Registered Professional Nurse with a temporary work permit residing in the State of West Virginia

c. Any graduate of a Registered Professional Nursing Program, who is eligible for licensure d. Any Registered Professional Nurse requesting licensure and relocation to West Virginia who

is currently in good standing in an alternative to discipline or peer assistance program in another state

e. Any Registered Professional Nurse or student in a Registered Professional Nursing Program in West Virginia who is willing to voluntarily participate

f. Any Registered Professional Nurse or student in a Registered Professional Nursing Program who is evaluated to be appropriate for WVR participation

The following conditions are appropriate for WVR entry:

a. Impairment concerns due to the use of alcohol and/other drugs or due to any psychiatric or psychological condition which potentially impairs nursing practice

b. Nurse Practice Act violation(s) related to any impairment and/or the use of alcohol and/or other drugs

c. Unprofessional behaviors that could potentially harm the health care consumer d. Referral by the WVBOERPN e. The potential WVR participant must be willing to agree to terms of WVR participation in

writing by executing the WVR Monitoring Contract and appropriate releases. f. The applicant, if previously terminated from WVR, will be readmitted to WVR by the terms

of the current readmission policy/and or approval by the WVBOERPN. g. The Registered Professional Nurse must reside in West Virginia or a state with a similar

monitoring program in which the Registered Professional Nurse can successfully enter and participate

ADMISSION TO WVR BY ORDER OF THE WV BOARD OF EXAMINERS FOR REGISTERED PROFESSIONAL NURSES (WVBOERPN)

WVBOERPN ordered participants are held accountable to the same requirements as other WVR participants, in addition to any requirements as outlined in formal WVBOERPN order(s).

There may be instances when WVBOERPN requests that WVR contact a Registered Professional Nurse to offer WVR services. WVR will assist the WVBOERPN whenever possible.

Board mandated WVR participation that is a “stayed suspension” of the nursing license is considered discipline. This means the license has been suspended; however, the suspension will be lifted (stayed)

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when the Board office is notified of active status by WVR. The suspension will remain “stayed” as long as the WVR participant is compliant with all terms and conditions required by WVR. This allows a disciplined (suspended) Registered Professional Nurse who is complying with WVR and who has been approved by WVR, to return to nursing practice. Failure to comply with the terms of WVR participation will place the Registered Professional Nurse in violation of the Board Order, with subsequent termination from WVR and a report made to the WVBOERPN.

The fact that discipline occurred by the WVBOERPN will be part of the Registered Professional Nurse’s permanent record at the WVBOERPN and will be available to future nursing employers.

If the Board of Nursing assesses an administrative fine, the terms of payment are outlined in the Final Board Order and paid directly to the WVBOERPN office.

WVBOERPN referred WVR participants are instructed to consult directly with the WVBOERPN office (for phone number see Appendix 1) for information on any issue impacting the ability to be licensed…i.e. applications, license renewal, CE, specific mandatory educational requirements, refresher courses, fees, administrative fines, and name or address changes. The Nurse Practice Act requires all nurses to keep the WVBOERPN informed of current address, all convictions, and to practice under the name printed on the license. Since WVR is a separate entity from the WVBOERPN, participants are also required to inform WVR of this same information.

CONFIDENTIALITY OF WVR PARTICIPATION

WVR seeks to protect and keep confidential the identity and personal information about participants in the program. WVR will only release information in a participant’s file if certain criteria are met. WVR will evaluate each request for participant records in consultation with WVR Legal Counsel. If WVR receives a subpoena or court order for a participant’s records, the subpoena will be reviewed by the WVR legal counsel prior to releasing any information. Subpoenas should be served by the appropriate officials through the local sheriff’s office and signed for only by named person or by the WVR Program Consultant or her designee.

1. A “Participant’s Consent to Release Confidential Information” should be signed as soon as WVR has contact with a participant. Even if the participant has not entered into a Monitoring Contract, but is being processed through Intake, this form will be signed.

2. “Participant’s Consent to Release Confidential Information to Third Party” will be signed by the participant when they want WVR to send their information to a third party.

3. “Notice of Confidentiality of Alcohol and Drug Abuse Participant Records” is required by 42CFR and states that the participant acknowledges that they have been told of their rights. This will be included in all release forms and be executed in the Intake process.

4. A “Participant’s Consent to WV Restore’s Release of Confidential Information to the Impaired Practitioners Program(s) of Other State(s)” will be signed by the participant when he/she requests information be sent to another state(s) Impaired Practitioners Program(s). The only information released will be a copy of the WVR Monitoring Contract, Transfer into or Out of WVR packet, and or compliance/stability reports to the other state(s) program(s).

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CONFIDENTIALITY OF WVR PARTICIPATION AFTER SUCCESSFUL COMPLETION

When a participant successfully completes WVR, all information about prior participation is held confidential within the WVR system. WVR will neither confirm nor deny previous participation due to the confidentiality of the WVR program.

Previous WVR participation is disclosed only at the discretion of the completed participant. However, when participants successfully complete while under a WVBOERPN order or by direction of the WVBOERPN, the Board will be notified of successful completion.

COST OF WVR PARTICIPATION

A small urine drug screen administrative fee is collected as part of the drug screen total cost. Additionally, there is a monthly fee for WVR participation. Please refer to your Monitoring Contract, Part 1, “WV Restore Monitoring Fee”, for specific details. You are responsible for all fees related to WVR participation including, but not limited to evaluation(s), treatment and continuing care (e.g., nurse support group fees, aftercare, therapy, etc.) as required by your WVR Monitoring Contract.

EVALUATION AND MONITORING

The first step in your WVR entry process was completion of a thorough evaluation to determine treatment need(s) and monitoring specifics. WVR assisted you in obtaining an evaluation with a WVR approved evaluator. Once your evaluation was completed, WVR assisted you in accessing treatment as recommended. Upon completion of appropriate treatment your individualized monitoring program was determined. This is outlined in your WVR Monitoring Contract. Ongoing monitoring generally includes attendance at support groups and nurse support group, random drug screening, and completion of quarterly monitoring reports. WVR is responsible for monitoring both fitness to practice and progress in recovery. Each of the monitoring tools will be discussed in more detail later in this text.

PARTICIPANT RIGHTS

As a WVR participant you are entitled to certain rights. You have the right:

1. To be treated with dignity and respect 2. To refuse participation in any or all components of WVR; however, to do so may result in a

formal report to the WVBOERPN 3. To know the name and title of any WVR staff member involved in your case at any time 4. To know results of any assessments you undergo, drug testing results, and treatment

recommendations 5. To file a grievance if you feel your rights have been violated

Any grievance must be filed in writing with the WVR Program Consultant, who will review the file and information provided by the concerned party with the appropriate Case Manager. You will be notified of the results of this review within thirty (30) days of receipt of complaint by the WVR Program Consultant, when possible. See Appendix 1 for name and mailing address of the WVR Program Consultant. If you do not feel the grievance was appropriately resolved, a grievance may be filed with the WVBOERPN.

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EXPECTATIONS FOR PARTICIPANTS

As a participant in WVR, you also have certain requirements and responsibilities.

1. You must agree to WVR participation in writing by executing the WVR Monitoring Contract 2. Due to the individualization of identified needs, some participants may have additional or

alternative requirements depending on the treatment/monitoring recommendations received by WVR. Each participant has an individualized WVR Monitoring Contract, which clearly describes what is required.

3. You are to adhere to and will be held responsible for all aspects of this WVR Monitoring Contract, which includes the Participant Manual.

4. Your WVR Monitoring Contract is subject to change based on failure to progress, relapse behaviors that may or may not include chemical use, monitoring noncompliance, treatment provider recommendations, or other necessary revisions required to ensure public health and safety.

5. If, during the course of WVR monitoring, additional mental health, physical, and/or substance abuse problems are identified, evaluation and treatment for those identified problems will be required as well as additions or changes to your WVR Monitoring Contract.

6. Monitoring Contract noncompliance will jeopardize your WVR participation and may delay your WVR completion. Monitoring Contract noncompliance may result in a report to the WVBOERPN. Failure to return your executed Monitoring Contract as instructed will result in a report to WVBOERPN.

7. Failure to progress, noncompliance, relapse behaviors that may or may not include chemical use, and/or Monitoring Contract noncompliance will result in withdrawal from nursing practice and/or initiating a Voluntary Withdrawal.

8. In addition, the participant will obtain a WVR facilitated evaluation, and treatment at a higher level of care than received in the past, including residential and/or healthcare practitioner specific treatment. A readiness to complete evaluation may be required prior to WVR completion.

FAMILY RECOVERY

Substance Use disorders and mental health disorders impact family members. The advantages of having family members and/or significant others involved in the recovery process are well documented. Please check in your local area and/or with your Nurse Support Group Facilitator for resources for family recovery groups. Some examples of these include ALANON, NARANON, and National Alliance for the Mentally ILL (NAMI), treatment facility facilitated family groups, etc.

EMPLOYMENT

1. The general WVR requirements for employment are: a. Approval from WVR for you to return/enter nursing practice is required before you accept a

new position or return to previous employment. If you need clarification or have questions related to appropriate employment, please contact your WVR Case Manager.

b. You are to inform your prospective employer of your WVR participation prior to accepting any position and refer the employer to your WVR Case Manager to verify your participation and any work-related restrictions. You are required to provide your employer with a copy of your WVR Monitoring Contract.

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c. Your nursing position must include direct supervision by another licensed healthcare professional (LPN cannot supervise Registered Professional Nurse) who is:

1) Aware of your WVR participation 2) Working on the premises or same unit 3) Readily available to provide assistance

d. You are required to work in nursing a minimum of 96 hours per quarter while employed, to meet completion criteria.

e. You must submit in writing to WVR the name, address, and phone number of the current place of employment and the name of your immediate supervisor, with his/her email address. Notify and obtain approval from WVR prior to starting employment or making any changes in any healthcare related position.

f. You must inform WVR of any changes in employment immediately by phone/email and submitting a Change of Employment (COE) form to WVR.

2. Generally, upon return to nursing practice: a. You may not be self-employed in the healthcare field or work for multiple

employers b. You may not work more than forty (40) hours per week and/or more than eighty-

four (84) hours bi-weekly, if working 12-hour shifts. c. You may not work for a staffing agency, in SUD treatment, home health settings or

float to areas not supervised by your manager. 3. WVR participants may not work in a nursing or direct patient care position until approved to do

so by WVR. THIS APPROVAL DOES NOT TAKE EFFECT UNTIL WVR RECEIVES A CHANGE OF EMPLOYMENT (COE) FORM AND WVR TALKS TO THE NEW SUPERVISOR. Failure to adhere to this requirement will result in termination from WVR and a report will be made to the WVBOERPN.

4. WVR receives recommendations based on WVR “Return to Work” criteria used by treatment providers when assessing the return to work/ability to practice issue with WVR participants. These areas for assessment are:

a. Stability in Recovery b. Support Systems c. Problem-solving ability d. Cognitive functioning e. Judgment f. Ability to psychologically cope with stressful situations g. Decision making ability in a crisis

WVR will consider treatment recommendations when determining if the Registered Professional Nurse or student in a Registered Professional Nursing Program may resume practice.

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REGISTERED PROFESSIONAL NURSE ANESTHETISTS PROTOCOL

Registered Professional Nurse Anesthetists will be managed in the usual manner regarding their entry into WVR. Registered Professional Nurse Anesthetists are often at higher risk for relapse because of their access to controlled substances, variable work schedules and their practice autonomy. For this reason, criteria have been established that will enable the CRNA to more effectively transition to clinical practice with the greatest degree of long-term support through accountability and documentation. Specific CRNA re-entry conditions will be required when approved to return to CRNA practice.

CONTROLLED SUBSTANCE/NARCOTIC ACCESS

In order to facilitate the recovery process and as a safety measure within the clinical setting, WVR may require that participants refrain from dispensing controlled substances until approval is given by WVR. Please see your individualized WVR Monitoring Contract, Part 1.

1. Generally, WVR participants may not have access to or administer any controlled substances for a minimum of twelve (12) months. A WVR participant who does not adhere to this requirement is subject to termination from WVR and a report will be made to WVBOERPN.

2. Specifically, if it is stated in your WVR Monitoring Contract that your controlled substance access is restricted, you may not have access to, administer, witness, waste, to include titrating, any controlled/locked (Schedules I-V) medication that is mood/mind-altering, for a period of one (1) year after you return to clinical nursing. You may not have access to any controlled/locked drug that is mood/mind-altering via any automated delivery system (PYXIS or Sure-Med, etc.), hold the controlled substance keys or count controlled substances during this time. You must adhere to proper procedure to regain your controlled substance access privilege.

3. WVR participants who refrain from clinical practice during the first twelve (12) months of WVR participation will have a controlled substance restriction for a twelve (12) month period when returned to clinical practice.

4. After working for 1 year (12 months) in clinical practice and submitting four (4) favorable Work Performance Evaluations, the participant will be eligible for review for reinstatement of controlled substance access. a. If eligible, the participant will receive an instruction letter. b. The written recommendation to lift controlled substance restriction must be received in the

WVR office from the nursing employer, Registered Professional Nurse, Support Group Facilitator, and other treatment providers as requested by WVR.

c. The participant will be informed in writing by WVR when this restriction is lifted. Written approval by WVR is necessary prior to the participant assuming the responsibility of gaining access or administering controlled drugs.

5. Some participants choose to postpone resuming the responsibility of controlled substance access for longer than the twelve (12) months. Participants will be expected to fulfill this requirement prior to program completion and demonstrate a minimum of six (6) months of ability to administer controlled substances without incident.

6. WVR participants employed in non-clinical areas, whose goals reflect continued employment in a non-clinical setting, may be eligible for completion of WVR without demonstrating safe administration of controlled substances if certain criteria are met. A “Readiness to Complete” evaluation may be required.

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Please contact your WVR Case Manager if you choose to remain in non-clinical nursing and do not wish to return to clinical nursing.

REQUIRED MEETINGS AND MONITORING REPORTS

The Work Performance Evaluation and the Progress Evaluation provide WVR with ongoing evidence of your compliance and progress. It is your responsibility to inform your evaluators (work supervisor, Registered Professional Nurse or student Support Group Facilitator and treatment providers) of the date your reports are due in the WVR office. These evaluations are due every three (3) months (January, April, July and October) by the due date on the front of your WVR Monitoring Contract.

It is strongly recommended that you retain a copy of all submitted paperwork for personal records and mail all required paperwork electronically. Failure to attend required meetings and submit reports when due will result in noncompliance, possible refrainment from practice and may result in your termination from WVR. Third party reports (CAC, individual therapy, med reports, Facilitator reports) that are not submitted within two weeks of the quarterly reporting month ending will now be a mandatory material non-compliance. It is the participant’s responsibility to verify all their reports are submitted from 3rd. parties. We notify participants of late reports via Affinity message so in addition…check your messages.

1. If required, attendance at Mutual Support Group meetings is specified in your WVR Monitoring Contract. WVR encourages you to develop a mutual support system within a group that is knowledgeable about substance use disorders or the issues that have caused problems in your life. This support system must: a. Be readily available/accessible b. Meet the times per week you are required to attend c. Have a structured meeting format with a leader d. Promote personal growth

Historically, twelve-step meetings fulfill these needs for the majority of WVR participants. In the event you would like to discuss alternative meetings, please contact your Case Manager.

2. Attendance at Weekly Nurse Support Group meetings is effective immediately unless otherwise directed by your WVR Monitoring Contract. Please give your Facilitator a copy of your Monitoring Contract. This meeting is required and may not be changed without the approval of WVR and the present Facilitator. You are required to participate in the structured monthly Relapse Prevention for Nurses (RPN) continuing education program provided to you by your Nurse Support Group Facilitator and WVR. Please note that these modules relate to problems of everyday living and can be utilized by anyone, not just those affected by substance use disorders.

Attendance is required at aftercare therapy and/or other requirements as individualized per your Monitoring Contract, Part 1.

3. Employer Report is used in the assessment of your work performance by your employer. a. This report is to be completed by your immediate supervisor, online whenever possible.

4. Facilitated Support Group Report provides an assessment of your general behavior, appearance, and progress in recovery.

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a. Your Nurse Support Group Facilitator will utilize an online tool and make a recommendation as to your progress in recovery.

5. Quarterly Evaluation form may also be completed by any treatment provider of the nurse at the request of WVR.

6. Meeting Attendance Log of all 12-step and/or mutual support meeting(s) is done electronically through the AOS system.

7. Self-Report is required quarterly on all participants and must be done electronically via the AOS system.

USE OF MOOD-ALTERING CHEMICALS

1. WVR participants in abstinence Monitoring Contracts are expected to remain free of all mood-altering, controlled, or addictive substances to include alcohol, over-the-counter drugs and prescription drugs.

2. WVR does not determine if you can take a mood-altering and/or over-the-counter medication. This is a decision you and your prescribing professional (who is aware of your WVR participation) must make. WVR will determine your safety to practice, with recommendations from evaluators and or treatment providers. WVR encourages you and your prescribing professional to explore non-mood-altering alternative methods of pain control to minimize risk to your recovery.

3. If there is a medical need for the use of any mood-altering chemical, you are required to inform your WVR Case Manger as soon as possible, either when prescribed or the next business day. You must submit a fully completed Medication Report form to WVR.

4. In the event a random drug screen is positive and you have not informed WVR of your medication use as required, your use of the medication will likely result in an evaluation.

5. You are to refrain from providing patient care when using any prescribed mood-altering medication until authorized to return to practice by WVR. A negative urine drug screen will be required prior to return to patient care.

6. Medically necessary, frequent, or extended use of any mood-altering medications will require that a WVR approved addictionist be involved in your case to monitor your medication management. A performance assessment and/or neuropsychological testing to determine your practice ability may be required

THE LONG-TERM USE OR CHRONIC USE OF MOOD-ALTERING MEDICATIONS

FOR PSYCHIATRIC CONDITIONS

In rare cases a participant may require a mood-altering medication and/or controlled substance for the treatment of an ongoing chronic psychiatric condition. WVR encourages the participant who does not have a substance abuse and/or dependency diagnosis and who has been prescribed a mood-altering medication on a long-term basis for a psychiatric disorder, to look for non-addictive alternative medications if possible. If the continuing use of the mood-altering medication is required as determined

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by their treating physician, WVR strives to ensure that the practitioner can practice with reasonable skill and safety with no harm to the public while taking the medication.

Given the disease concept of addiction as defined by the American Medical Association and the numerous non-addictive medication options, WVR does not support the use of mood-altering substances for the treatment of psychiatric conditions in WVR participants who also have a substance abuse and/or dependency diagnosis.

LONG TERM OR CHRONIC USE OF MOOD-ALTERING MEDICATIONS

FOR MEDICAL CONDITIONS

In rare cases a WVR participant may require a mood-altering medication and/or a controlled substance for the treatment of an ongoing chronic medical condition. However, it should be noted that WVR does not support the use of mood-altering substances for the treatment of chronic medical conditions in WVR participants who also have a substance abuse and/or dependency diagnosis.

In those cases it is felt, if possible, that Suboxone or Methadone is a more appropriate long-term choice than the participant’s drug of choice or a shorter half-life medication.

In all cases where long-term or chronic mood-altering medications for a medical condition have been prescribed, the goal of treatment should be ultimate abstinence or to take as little as required for the medical condition in order to help ensure that the practitioner can practice with reasonable skill and safety with no harm to the public.

At no time can you begin the long-term use of mood-altering chemicals without permission from WVR. Please contact your Case Manager for the proper procedures.

NALTREXONE AND VIVITROL

Research has shown that Registered Professional Nurse Anesthetists and other healthcare professionals who actively give, dispense, or are closely involved with the giving or dispensing of controlled substances have a lower relapse rate upon return to practice if they are taking monitored Naltrexone or Vivitrol. WVR participants who are identified at high risk for relapse and/or potential overdose of controlled substances will be required to take monitored Naltrexone or Vivitrol for a period of one to two years and be re-evaluated.

COMMUNICATION WITH WVR

1. It is imperative that WVR be able to communicate by phone, email, and via written correspondence with you. It is your responsibility to inform WVR of your current address and phone number as well as those of your nursing supervisor and any subsequent changes. Failure to do so will negatively affect your compliance.

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2. Please use your WVR case number located on the first page of your WVR Monitoring Contract when communicating with WVR. Using this on all written or verbal communication via voice mail will help facilitate timely response to your concerns by WVR staff.

3. You are known to WVR by the name on your nursing license, regardless of what name you may be using. Please ensure that the name on all written correspondence by you or anyone submitting a report or evaluation on your behalf is the name on your nursing license. Otherwise, pertinent information may not be credited to you. Any name change must be done formally with the WVBOERPN. Please inform your WVR case manager that your name has been formally changed on your nursing license. This may result in a change in your case manager. Be aware that Registered Professional Nurses in West Virginia are required to practice under the name that is printed on their license. Please refer any questions to the WVBOERPN.

4. If you do not provide updated contact information to WVR, allowing WVR to communicate with you on a regular basis, you will be subject to WVR termination.

RELOCATION OUT OF WEST VIRGINIA

Any relocation out of West Virginia must be authorized by WVR prior to the move. In order to facilitate a transfer for WVR participants who wish to relocate to another state, WVR has established the following procedure:

1. In the event you wish to relocate to a state that has a structured alternative to discipline program similar to that of West Virginia, WVR will assist you in transferring to the new program. Please contact your Case Manager for details. To be eligible for transfer, you must be compliant with all aspects of your WVR Monitoring Contract and gain acceptance for entry into the program you wish to transfer.

2. In the event you wish to relocate to a state where there is not a structured program similar to that of West Virginia and/or the state where you wish to transfer will not allow your entry into that program, contact your WVR Case Manager.

3. In the event you relocate without WVR approval, you will be terminated from WVR and reported to WVBOERPN.

4. If you return to West Virginia, your case will be reviewed individually regarding WVR participation.

RANDOM ALCOHOL AND OTHER DRUG TESTING

You are to participate in the WVR random alcohol and other drug testing program effective immediately upon receipt of this Monitoring Contract unless otherwise directed by WVR or your WVR Monitoring Contract.

It is important that you understand that any urine drug screen that is considered dilute/abnormal cannot be treated as a negative drug screen, and cannot substantiate recovery. Continued dilute/abnormal screens may result in WVR requesting additional urine drug screens and referral for further evaluation.

NOTE: The ingestion of poppy seeds and the use of alcohol based products including hand sanitizer, mouthwash, breath spray, over the counter medication, foods prepared with or containing alcohol, etc., puts you at risk for having a positive urine drug screen. It is the policy of WVR that these

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products are not to be used while under a Monitoring Contract. Any positive urine drug screen requires action by WVR, regardless of the etiology of the substance or how it happened.

Information on safe medications may be found at: http://talbottcampus.com under the programs section, select medication guide to download a copy.

Please see your Affinity eHealth Activation Guide for Instructions:

1. It is your responsibility to submit the specimen(s) for alcohol and/or other drug testing as required. You must be aware of the hours of the lab operation.

2. Failure to submit specimen for alcohol and other drug screening may be managed as a relapse, and you may be required to be evaluated by a WVR approved evaluator.

3. All lab results will be forwarded directly to WVR. You, your employer, Registered Professional Nurse or student Support Group Facilitator and any treatment provider will be informed of any confirmed positive alcohol and/or other drug test.

4. It is your responsibility to inform your WVR Case Manager in the event you are unable to provide a specimen due to hospitalization, or any other reason, etc.

5. WVR requires that all alcohol and other drug testing have chain of custody maintained. You are responsible for insuring that chain of custody for your specimen is maintained until sealed per required procedure.

6. If you are not required to participate in the WVR random alcohol and other drug testing program, you may be subject to random screens in the event of Monitoring Contract noncompliance, behaviors indicative of chemical use, or Nurse Support Group Facilitator, employer or treatment provider recommendation. Participation in the WVR alcohol and other drug testing program may be required if concerns persist.

MISSED CHECK-IN

Checking in to the AOS system daily is required both as a way to determine if you are selected for testing in addition to a daily accountability behavior supportive of your on-going compliance and progress. Failing to check-in daily as required is a concern as it places one’s participation at risk. It is ideal to establish a habit early by making “checking-in” a regular part of your morning. This simple act is a way to begin the day thinking about the “next right thing” to do both for your WVR participation and overall health and well-being.

DILUTE AND ABNORMAL URINES

Urine drug screens are increasingly being used by licensing boards as a tool demonstrating sobriety and compliance with a recovery program. It is difficult to adequately monitor participants who consistently have multiple dilute and/or abnormal urines (Creatinine <20mg/dL and/or specific gravity <1.003). It is recognized that a normal urine creatinine for most individuals is in the range of 100 to 150 mg/dL and that to make dilute urine it takes a fairly large amount of water. Therefore, multiple dilute urines are of concern and must be addressed.

1. The participant will be provided the dilute and abnormal policy. 2. After the first dilute or abnormal screen, the participant will be notified by the WVR UDS

Specialist and required to submit another screen.

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3. After the second dilute or abnormal screen within a 12-month time frame, your case will be reviewed by the WVR Clinical Director and additional testing will be required.

4. After the third dilute and/or abnormal screen within 12 months, the participant’s case will be reviewed by WVR’s Medical Director/Consultant for appropriate disposition and probable fitness to practice evaluation and/or nephrology evaluation.

5. Multiple dilute and/or abnormal urine screens without resolution will impact a participant’s ability to be monitored effectively, and may result in program termination.

MONITORING INTERRUPTIONS IN THE U.S.

Participants are required to check-in to the Affinity Online System daily when traveling in the United States. Participants must notify WVR 5 days prior to travel by requesting a monitoring interruption online and providing the appropriate ZIP Code to the travel destination. The request for a monitoring interruption will be reviewed and approved by WVR. The participant will be notified on the online system if the travel is approved by WVR. If the participant is selected for testing during travel, participant must provide a specimen, as indicated by the Affinity Online System.

MONITORING INTERRUPTIONS OUT OF THE U.S.

Participants traveling out of the country, or on a cruise, must request a monitoring interruption 5 days prior to traveling. The request must be submitted on the Affinity Online System. Participants are also required to submit documentation of their travel plans to the WVR office, 5 days in advance of travel. If the monitoring interruption is approved, the participant will not be required to check-in to the Affinity Online System.

MEDICAL CARE

1. You are required to inform all treating professionals (e.g., doctors, dentists) of your participation in WVR and have your treating professional provide written documentation to WVR when non-mood-altering options have failed and you require mood-altering medications. To prevent the use of prescribed mood-altering medications from being considered relapse by WVR, it is imperative that you inform your WVR Case Manager of your need to take such medication, preferably prior to taking the medication. However, should an emergency arise outside WVR office hours, you are to obtain appropriate medical care, informing the provider of your recovery status and inform your WVR Case Manager the next business day.

2. Generally, WVR participants are not allowed to provide direct patient care or make clinical decisions if taking mood-altering medications.

3. Please establish a primary physician who will coordinate all medications, treatments, and procedures with other healthcare providers and WVR.

RELAPSE BEHAVIORS

Relapse behaviors include:

1. Failure to submit to requested toxicology testing 2. Non-approved use of mood-altering chemicals 3. Psychiatric or physical impairment

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The use of mood-altering chemicals (such as Ultram, Benadryl, alcohol, etc.), use of previously prescribed mood-altering drugs (known as self-medicating), or the use of any newly prescribed medications without informing WVR will be considered relapse.

It is your responsibility to avoid the ingestion of poppy seeds or health food products such as herbs, and avoid situations in which you may be exposed to passive inhalation of substances that may result in a positive drug screen. Positive alcohol and other drug screens due to these substances will be managed as relapse.

When relapse has occurred, the WVR participant, facilitator, and employer will be informed that the Registered Professional Nurse or student in a Registered Professional Nursing Program must refrain from work (either through voluntary refraining or Voluntary Withdrawal) until a WVR facilitated evaluation is completed.

Recommendations will be made by the evaluator about treatment needs and ability to practice safely. WVR’s Medical Director/Consultant and clinical team will determine further participant requirements.

Successful WVR completion requires that abstinence be documented for the duration of the WVR Monitoring Contract, therefore, if relapse occurs, WVR participation dates will be recalculated. A new WVR Monitoring Contract outlining all requirements of continued WVR participation must be executed by the Registered Professional Nurse or student in a Registered Professional Nursing Program..

Registered Professional Nurses or students in a Registered Professional Nursing Program who refuse to comply with reevaluation and subsequent WVR requirements, and/or display multiple noncompliance/relapse behaviors will be terminated from WVR and reported to WVBOERPN.

RELAPSE PREVENTION PROGRAM

WVR participants, depending on diagnoses, may be required to participate in a structured relapse prevention program which includes a Recovery Maintenance Workbook of modules. Modules will be completed in Registered Professional Nurse student Support Group. CE information can be accessed at www.recoverymaintenance.org .

SATISFACTORY PROGRESS

Progress in the area of concern that precipitated your referral to WVR must be demonstrated while being monitored by WVR. Progress is demonstrated by:

1. Adherence with all aspects of your individualized WVR Monitoring Contract 2. Consistent positive reports from Nurse Support Group Facilitators and treatment provider(s)

indicating stability, progress, and consistent attendance at required appointments and meetings 3. Consistent positive reports from employer indicating ability to practice with reasonable skill and

safety to patients 4. Negative toxicology screening substantiating continued abstinence if required by WVR

Monitoring Contract 5. Consistent attendance and verification of required meetings

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FAILURE TO PROGRESS

The statutes and rules that govern WVR mandate that WVR participants must demonstrate progress while being monitored by WVR. By law, any WVR participant is to be reported to WVBOERPN if failure to progress occurs.

Failure to progress includes:

1. Failure to progress satisfactorily in an approved treatment program 2. In the event the participant fails to satisfactorily progress or fails to complete treatment, or

should the participant’s impairment constitute an immediate, serious danger to the health, safety, or welfare of the general public.

3. Being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, chemicals or any other material, or as a result of any mental health condition (§ 30-7-11a)

4. Three incidences of Material Non-Compliance are grounds for WVR Termination (see Non-Compliance Section of this Manual for details).

NON-COMPLIANCE

Per WVR policy, material non-compliance or inability to progress shall include, but shall not be limited to the followings acts or omissions:

1. Positive and confirmed drug screen not explained by a prescription or practitioner’s order acceptable to WVR

2. Unexcused missed drug screen 3. Tampered drug screen 4. Unexcused absences from required meetings, therapy, evaluations, or other occasions where

attendance is mandatory under the Contract 5. Diversion of drugs 6. Ingestion of drugs or alcohol in violation of the Contract 7. Illegal possession of drugs 8. Prescription forgery 9. Arrests involving use or possession of alcohol or drugs 10. Other arrests related to the ability to practice safely 11. Where medicine is prescribed to treat the illness or condition causing impairment, the failure to

take the medication as prescribed 12. Where the participant is restricted from access to controlled substances, violating that

restriction 13. Unexcused failure to respond to contact from WVR 14. Other admitted, confirmed, or diagnosed relapses, or conduct which WVR deems material non-

compliance 15. A participant’s inability to safely practice nursing care despite compliance with treatment,

response to treatment, and prognosis of condition.

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MONITORING CONTRACT TERMINATION

Specific circumstances which are considered grounds for Monitoring Contract termination include:

1. Material Non-compliance with the WVR Monitoring Contract as outlined in Non-Compliance section of this Manual

2. Failure to progress 3. Attempting to work or working as a Registered Professional Nurse without WVR

approval/knowledge 4. Relocation outside of the State of West Virginia without WVR approval 5. Request for Monitoring Contract termination by the WVR participant 6. Failure to pay program fee. 7. Failure to submit monitoring reports in a timely manner

At the time of Monitoring Contract termination, WVR will forward a written report to the WVBOERPN with information regarding any alleged violations of the Nurse Practice Act, reasons for termination, and any safety concerns the terminated Registered Professional Nurse or student In a Registered Professional Nursing Program may present. A report will be made to both the Registered Professional Nursing Program and WVBOERPN regarding students who are terminated from WVR.

TRANSITIONAL MONITORING

Participants who are in five (5) year Monitoring Contracts may be eligible for transitional monitoring in years 4-5.

All participants will be reviewed for transitional monitoring following three (3) years of active participation. Participants who meet the transitional monitoring criteria will have some of their Monitoring Contract restrictions lifted and/or modified to allow for more flexibility in their monitoring requirements.

COMPLETION OF ACTIVE MONITORING

1. In order to successfully complete active monitoring, the Registered Professional Nurse must meet the following criteria: a. Demonstrate progress and stability through monitoring reports, as well as documented abstinence, if required, from mood-altering chemicals for the indicated length of the WVR Monitoring Contract; b. Demonstrate the ability to provide safe nursing care for at least one year, and the ability to administer controlled substances, if applicable, for a minimum of six (6) months; c. Students in a Registered Professional Nursing Program working as patient care techs must meet all completion criteria, including employment as a licensed Registered Professional Nurse for a minimum of six (6) months; d. Demonstrate a minimum of 6 consecutive months of negative/normal toxicology screens.

e. If participant submitted an abnormal/dilute screen within the last 12 months, a negative 14-panel hair test and PEth will be required before completion.

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2. At the time of review for readiness to complete active monitoring, the following documentation must be submitted to WVR: a. The Registered Professional Nurse’s employer(s) recommendation indicating ability to practice nursing with reasonable skill and safety without restrictions or continued monitoring b. Nurse Support Group Facilitator and/or designated treatment provider recommendation(s) for completion of active monitoring indicating progress and stability. 3. A letter of instruction regarding WVR completion will be sent to the participant. Upon receipt of required documentation and review of the WVR file including progress, compliance, and work performance, WVR will determine if completion of WVR monitoring is appropriate. A formal readiness to complete evaluation may be required. 4. WVR will send a letter to the Registered Professional Nurse at the time of completion of active monitoring. A copy of this letter will be forwarded to the Nurse Support Group Facilitator. The status of the WVR participant will be changed to “completed”. 5. WVR may require a readiness to complete evaluation when an active participant is: a. Being considered for early completion b. In the event there are concerns about the WVR participant’s readiness to complete active monitoring c. If the WVR participant has demonstrated progress, but has not, for example, had the opportunity to demonstrate safe administration of controlled substances after return to nursing practice d. Has worked in a non-clinical practice and does not plan to return to a clinical practice. 6. Readiness to complete evaluations are required of all WVBOERPN referred WVR participants, if review for early completion is being considered. 7. The readiness to complete evaluation will include: a. WVR facilitated evaluation by WVR approved evaluator who specializes in the area of concern that precipitated WVR referral b. The evaluation must be current and completed within three months of expected WVR completion c. The written evaluation results must be received and accepted by WVR and support fitness to practice and WVR completion based on individual circumstances 8. Final readiness to complete determination will be made by WVR, following review of all monitoring reports, results of readiness to complete evaluation, and compliance with WVR completion criteria. 9. If you have not met completion criteria prior to the end of your WVR Monitoring Contract, you will be issued a new Monitoring Contract. This Monitoring Contract will be in effect until you have met all completion criteria.

ANNUAL WVR CONFERENCE

Each year WVR sponsors an annual conference. This is a special event that is attended by WVR staff, many Nurse Support Group Facilitators, WVR participants and interested others. This two-day event provides an opportunity for learning the latest information associated with substance use disorder and mental health issues as well as time for fellowship and fun. For more information please contact WVR.

WVR member’s participation in this conference is mandatory (it will be offered to participants at a greatly reduced fee). Every participant must attend at least one day of the two day event.

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A FINAL WORD

Our hope is that the information provided in this manual will better prepare you for your WVR participation. We have attempted to answer frequently asked questions of participants who have gone before you. Your feedback regarding the usefulness of this manual is greatly appreciated. All of the WVR staff wishes you the very best as you begin your participation!

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FREQUENTLY ASKED QUESTIONS

Q. How often do I need to check-in with the Affinity Notification System?

A. Participants are required to check-in every Monday through Friday, between the hours of 4:00 a.m. – 2:00 p.m. Eastern Standard time, including holidays.

Q. Do I need to call Affinity even when I am traveling?

A. If you are traveling within the State of West Virginia, you are required to continue checking-in with Affinity. If you are selected to be tested on a day that you are traveling within the state, call Affinity to identify a collection site in your area of travel.

If you are traveling outside the State of West Virginia, you are required to continue checking in with Affinity. See page 17 for the policy on Monitoring Interruptions. You may be required to submit a specimen at an Affinity/WVR arranged site.

If you are traveling outside of the country, you will not be required to call in. See page 17 for the policy on Monitoring Interruptions. You must provide proof of travel.

Q. What if I fail to check-in with Affinity on any given day?

A. If you fail to check-in with Affinity at any time Monday-Friday during the hours of 4:00 a.m. – 2:00 p.m. Eastern Standard Time, there are consequences. Please see the Toxicology Drug Testing section for more information about missed check-ins. We suggest, if possible, you submit a self-test the day of the missed check-in. Q. Are my conversations with Affinity confidential? A. Absolutely. All Affinity employees sign a confidentiality Contract; any discussions outside are prohibited. Q. What do I need to bring with me to the collection site? A. The collector is required to see your photo ID or driver’s license. The collection site would have a chain of custody form faxed to them by AOS. You should have a chain of custody form with you if using a third-party site. Q. What can I take if I am sick? A. Refer to the medication guide website link cited on page 16 for possible safe over- the-counter remedies. You should always read the label and it is wise to consult your primary care provider. You are responsible for what you take if you have a positive urine drug screen.

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Q. How does WVR get reports from my treatment providers?

A. It is your responsibility to make sure required reports get to WVR in a timely fashion. Reports can be submitted by fax, electronically or certified mail.

Q. How often do I have to attend the WVR support group?

A. Weekly

Q. What if I would like to use a drop site that is not on the Affinity list?

A. Call the Affinity staff and they will attempt to work with the site to get them approved as a third party drop site. There is an extra fee, however.

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APPENDIX 1 WVR P.O. Box 11626

Charleston, West Virginia 25339 (304) 932-7675 or (304)533-6844 Fax (606-832-0077)

Web Site: www.wvrestore.org

WVR STAFF Gary M Brown, Rph WVR Executive Director

Director, WV Pharmacists Recovery Network/WV Dental Recovery Network

James Bennett- CP,LPC,NCC,MAC,LSW WVR staff counselor, case management consultant, Facilitator/Evaluator educational Director

Ayla Accad-MSN, RN

Nursing educational programs consultant

Susan Jarvis Case Manager/Chief Financial Officer

Jan Gentry, RN Case Manager

Kathie Simpson, RN

Executive Director, SARPH/PNAP General Program Consultant

Additional Reference Information

Talbott Recovery Campus (for questions on what medications

participants should not take) www.talbottcampus.com/pdf/MedGuide.pdf

West Virginia Board of Examiners for Registered Professional Nurses

(304) 558-3596 www.wvrnboard.com

West Virginia Nurses Association (304) 342-1169

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www.wvnurses.org

International Nurses Society on Addictions www.IntNSA.org

American Society of Addiction Medicine

www.asam.org

WV Pharmacists Recovery Network www.wvprn.com

National Alliance on Mental Illness

www.nami.org