What factors contributed to the misconduct of health practitioners? An analysis of Australian cases involving the diversion and supply of pharmaceutical drugs for non‐medical use between 2010 and 2016

Abstract

Introduction and Aims. Increasing quantities of pharmaceutical drugs are used non-medically around the world, including in Australia, resulting in rising harms. This study examines the role of health practitioners (HP) in diversion and the circumstances surrounding their misconduct in Australia. Design and Methods. Tribunal decisions were obtained from the Australasian Legal Information Institute for 117 complaints against HPs for inappropriately prescribing/supplying or misappropriating drugs, representing a comprehensive search of cases from 2010 to 2016. Bivariate and multivariate logistic regressions were used to examine patterns of misconduct by demographics, drug type, scale and contributors. Results. Cases involving inappropriate prescribing/supply (73%) had greater odds of involving doctors (adjusted odds ratio [AOR] 48.18, 95% confidence interval [CI] 3.63-640.11) and pharmacists (AOR 85.59, 95% CI 5.08-1443.05) and HPs over 50 years (AOR 16.54, 95% CI 2.80-97.60) and lower odds of being attributed to individual circumstances (AOR 0.06, 95% CI 0.01-0.57). Cases involving misappropriation (31%) had greater odds of involving nurses (AOR 19.86, 95% CI 2.50-157.93), HPs under 40 years (AOR 5.08, 95% CI 1.24-20.90) and being attributed to individual circumstances (AOR 7.96, 95% CI 1. 52-41.75). Subgroup analyses indicated that doctors were more likely to inappropriately prescribe pharmaceutical opioids, sedatives and Schedule 8 drugs, and their misconduct was attributed to lacking the skills and temperament to manage complex patient groups, while pharmacists were more often involved in pseudoephedrine supply for financial reasons. Discussion and Conclusions. Strategies to reduce diversion should be multifaceted and may include better supporting HPs to manage complex patient groups and removing barriers to substance use treatment for HPs. [Hulme S, Hughes CE, Nielsen S. What factors contributed to the misconduct of health practitioners? An analysis of Australian cases involving the diversion and supply of pharmaceutical drugs for non-medical use between 2010 and 2016. Drug Alcohol Rev 2019;38:366-376]

Unprofessional conduct by nurses: A document analysis of disciplinary decisions

“…69 We found that more than half of the registered nurses who were disciplined were over the age of 45 years. Healthcare professionals may have a higher risk of mental health problems and substance use disorders 11 with associated personal problems. 8 Substance abuse may also affect a nurse's ability to work, and it needs to be seen as a disease that needs to be treated.…”

“…11,25,39 In addition, health problems can also lead to substance abuse. 11 Despite this, there has been very little research on how nurses' professional, individual or contextual circumstances lead to unprofessional conduct at work.…”

“…It has been recognised that nurses face increased risk for substance abuse problems because their work is stressful and they have easy access to medication in their workplace and knowledge about how it can be used based on their profession. Stealing medicines often indicates substance abuse problems, 11 which can be key markers for unprofessional conduct. Developing procedures to identify key signs of substance abuse could reduce the prevalence of this form of unprofessional conduct in the future.…”

“…1,2 However, most nurses have observed unprofessional conduct at some point during their working career. [3][4][5][6][7][8][9] Unprofessional conduct 8,10,11 refers to a nurse's failure to meet the expected professional and ethical standards and legislation. 8,9,[12][13][14][15] It includes poor ethical competence and neglect of professional guidelines, 16,17 not respecting patients' rights and dignity and threatening patient safety.…”

“…However, previous studies have reported challenges when it comes to being aware of unprofessional conduct as a phenomenon and recognising it in clinical practice. 8,9,11 In future, more attention need to be paid to the types of work communities where nurses' unprofessional conduct has been identified. It needs to be clear what role nursing managers play in monitoring professional standards in clinical practice, together with the self-regulation role of the nursing profession.…”