Levine M R, Rennie W P
Division of Emergency Medicine, Department of Medicine, Northwestern Memorial Hospital, Feinberg Medical School, Northwestern University, Chicago, Illinois, USA.
Occup Environ Med. 2004 Apr;61(4):318-24. doi: 10.1136/oem.2002.006163.
Patient safety and optimisation of worker performance are high current priorities. Arguments over employee drug testing have been debated over the past two decades.
To review prior information to reveal how current principles and practices regarding pre-employment drug testing of health care workers evolved, and to explore pressing current and future issues.
A literature search of Medline from 1980 to 1999 was performed. This yielded seven citations that reported results of pre-employment drug testing of health care workers, which we critically reviewed.
The process by which a rational testing process was developed for pre-employment urine drug screening in the health care field is illustrated. Also depicted are some important principles, inequities, and shortcomings of the system. The range of positive tests was wide, from 0.25% to 12%. Testing was not always applied uniformly to all health care workers. It became apparent that positive tests also require medical review to determine if they were truly due to illicit substance use.
Although pre-employment drug testing programmes in the health care industry have been firmly in place for many years, it is unclear whether such strategies have achieved their stated purposes. The next step is to study whether such programmes are effective at accomplishing specific goals, such as decreasing absenteeism, turnover, accidents, and medical errors, in order to justify continuing pre-employment testing versus changing to an alternative testing strategy.
患者安全和员工绩效优化是当前的首要任务。过去二十年来，关于员工药物检测的争论一直存在。
回顾先前的信息，以揭示当前医护人员入职前药物检测的原则和实践是如何演变的，并探讨当前和未来紧迫的问题。
对1980年至1999年的Medline进行文献检索。检索结果中有七篇文献报道了医护人员入职前药物检测的结果，我们对这些文献进行了严格审查。
阐述了在医疗保健领域为入职前尿液药物筛查制定合理检测流程的过程。还描述了该系统的一些重要原则、不公平现象和缺点。阳性检测结果的范围很广，从0.25%到12%。检测并非总是统一应用于所有医护人员。显然，阳性检测结果也需要医学审查，以确定是否真的是由于非法药物使用所致。
尽管医疗保健行业的入职前药物检测计划已经实施多年，但尚不清楚这些策略是否实现了其既定目标。下一步是研究这些计划在实现特定目标（如减少旷工、人员流动、事故和医疗差错）方面是否有效，以便为继续进行入职前检测还是改为采用替代检测策略提供依据。
