Documentation
What case note is used to document that outcome of the sample collection?
Specimen Collection
What is considered a positive screen?
A result that identifies the presence of one or more substances or their metabolites at a concentration equal to or exceeding the designated cutoff level
How many hours does a patient have to provide a sample after notification of screen?
24 hours
What form needs to be completed for a drug screen confirmation and where in the chart is it located?
Drug Screen Confirmation Request form - document manager
Bob is selected for a random urine drug screen and provides a sample as requested. The screen is negative for all tested substances.
What should staff do next?
Continue routine treatment and monitoring
Who is entered as the service provided by?
The Medical Director
How does someone get added to special care fentanyl?
Induction: Enroll in Special Care if their intake urine drug screen is positive for fentanyl
Maintenance: If the patient admits to the intentional use of fentanyl or provides two positive screens
What is considered a refuse drug screen?
A sample that is not provided within 24 hours or a patient that denies to provide a sample within 24 hours
Who should sign the Drug screen confirmation request form and who should the form be emailed too?
Patient, counselor (or staff completing form), and prescriber
Regional Director with program director cc'd
**Provider needs to review positive screen and sign copy - document to be uploaded into chart**
Sam is asked to complete a random drug screen but states, "I don't want to do it today, can I do it tomorrow?"
How should this be handled?
Notify the Sam that he has 24 hour to provide the sample (provide him with the exact time). Enter an appointment status note (include the time shared with Sam at the state of the note). Update the event for the next day with an end time of the 24 hour.
Where do results post in the patient's chart?
Drug Screen Results
How often should a female be tested for pregnancy in New Hampshire?
Monthly
How should a "reschedule" UDS be documented in the patient's chart?
Appointment status note
What is the confirmation fee for confirmation and when does this need to be collected
$35.00 and prior to the request being submitted to the regional director
Judy's urine drug screen is positive for benzodiazepines. Judy reports they were recently prescribed a medication after medical procedure and can provide documentation.
What is the appropriate next steps?
Verify the prescription (PDMP and release of information) and document the information
What times should be entered into the Session start and end time?
Exact start and end time at point of service. The note will automatically calculate 7 minutes (update this time if it doesn't match the exact period of service)
How should we document drug screen result discussions?
Individual Counseling Note or patient engagement note (if done prior to an individual sessions)
How can a refusal effect a patient?
1. Treated as a positive drug screen
2. Lead to increased clinical concerns
3. Affect trust and accountability4. Trigger additional monitoring, testing, or counseling interventions.
4. Effect special take-home or phase status
What is the fee for oral swab collection and how does the oral swab collection get approved?
$10.00 and by the regional director with a prescriber order
Sally has been in treatment longer than 90 days. Sally has requested an increase in the number of drug screen because of court. Sally's counselor reviews in treatment team. Can an increase in random drug screens be ordered?
Yes, an increase in drug screens been ordered. Per policy, patient receive a sample at minimum 1x/monthly (except for the first 90 days). Any additional screens would result in a $10.00 fee.
When do we check that the patient "Attended?"
When the patient was able to provide a sample.
What should be reviewed/documented when discussing a positive screen?
Date of sample with the results, whether patient admits, denies, or would like to pay for a confirmation
Inquire and document: Triggers, behaviors when triggered, consequences for continued use, and how the illicit use will be addressed (meet with MD, add to tx plan)
If opiates, inquire about dose status + review for special care
How does a refusal drug screen get documented?
Specimen collection note - document the refusal
Drug screen results -- Select "new" and set "test date" to scheduled date, set "drug screen event" to refused, and document what happened in "other information"
**Information in "other information" should match corresponding case notes.
When is the patient eligible for reimbursement for a confirmatory test and who should be notified?
Negative results - notify program director for a patient reimbursement request to be completed
What is the most clinically appropriate response?
Address the relapse, assess safety and treatment needs, review treatment plan, and determine if a higher level of care or increase services are needed. Screen should be used as clinical information not punitive