Participant procedure: Drug screening
Nursing and Midwifery
Published on 1 June 2018
Procedures provide practical step by step guidance to describe processes and actions required to enable the implementation of a policy or guideline. They can also be developed to ensure compliance with legislative or policy requirements by members, staff or delegates of the Council
| Date of endorsement | 1 June 2018 |
| Endorsed by | Nursing and Midwifery Council of NSW |
| Publication date | 1 June 2018 |
| Review date | 1 June 2019 |
| Summary | This procedure explains to practitioners and students who have drug screening conditions imposed on their registration how to participate in drug screening. |
| Applies to (scope) | • NSW practitioners and students required to undergo drug screening • The Nursing and Midwifery Council of NSW, its delegates and HPCA staff |
| Document owner | Assistant Director – Council Services |
| Functional group/subgroup | Council Services, HPCA |
Table of contents
| Clause | Page number |
|---|---|
| 1. Purpose | 3 |
| 2. Compliance context | 3 |
| 3. Key information | 3 |
| 4. Responsibilities | 4 |
| 5. Definitions and abbreviations | 4 |
| 6. Preparing for screening | 5 |
| 7. Giving samples | 7 |
| 8. Getting your results | 9 |
| 9. Managing absences and operational issues | 10 |
| 10. Screening group changes | 13 |
| 11. Contacts and further information | 14 |
| 12. Legislation and references | 14 |
| 13. Related policies | 14 |
| 14. Revision history | 14 |
| 15. Appendices | 16 |
1. Purpose
If you have drug screening conditions on your registration, this procedure explains how to:
- prepare for screening
- give samples at the required times
- get your results
- manage any absences you need to take
- apply to decrease your screening group.
2. Compliance context
You must comply with this procedure and:
- our Drug screening policy
- any drug screening conditions on your registration.
If a condition on your registration is inconsistent with this procedure or the Drug screening policy, the condition prevails.
We will decide all aspects of screening, including how often you need to attend. Our monitoring team will monitor your compliance.
3. Key information
We use urine drug screening and hair drug screening to monitor practitioners and students where there is a history of or concerns about substance misuse or dependence. We do this to protect the public.
We understand that providing samples can be inconvenient, intrusive and expensive. However, negative drug screening results are an effective way for us to know you are not affected by substances and can continue safely in practice or training.
4. Responsibilities
| Parties responsible (Positions/Groups/Bodies) | Key responsibilities |
|---|---|
| NSW nurses, midwives and students | comply with processes for drug screening outlined in this procedure. |
| Monitoring team | monitor compliance with this procedure on behalf of the Council. |
| the Council | make decisions about a participant’s progress and compliance with the Drug screening policy and this procedure. |
5. Definitions and abbreviations
| Term | Explanation |
|---|---|
| AHPRA | Australian Health Practitioner Regulation Agency |
| Council / we / our | Nursing and Midwifery Council of NSW |
| HCCC | Health Care Complaints Commission |
| participant / you / your | a practitioner or student participating in drug screening because a condition on their registration requires it |
| the Standard | AS/NZS 4308:2008, Procedures for specimen collection and the detection and quantitation of drugs of abuse in urine |
| substance | any: • substance listed in Schedule 1 of the Drug Misuse and Trafficking Act 1985 • pharmacist only, prescription only or controlled drug medication as contained in Schedule 3, 4 or 8 of the Poisons Standard (SUSMP). |
6. Preparing for screening
6.1 Timing
Starting
You need to start within 7 days of the condition being placed on your registration.
If you must attend hair drug screening, we will tell you the start date.
Screening Groups
The condition tells you what screening group you will commence on. We will advise you when the drug screening condition is placed on your registration.
| Screening Group | Urine Screens (on average) | Hair Analysis |
|---|---|---|
| Group 1 | 12 per month | Quarterly |
| Group 2 | 4 per month | Quarterly |
| Group 3 | 1 per month | Quarterly |
| Group 4 | 5 to 10 times per year | Quarterly |
| Group 5 | Nil | Annually |
Duration of screening groups
We may commence you on a higher screening group for a period of time and step you down to a lower screening group if you:
- show you have fully complied with your conditions, these procedures and the related policy
- received negative or nil detected results within the period of time specified.
If there are changes to your screening group, we will advise you in writing.
Groups 1 to 4
You are required to call the urine drug screening (UDS) telephone number 1800 027 624 every weekday after 6.00 am local time to find out if your screening group is required to provide a sample for UDS on that day.
Public holidays
You do not need to attend for screening on public holidays (as defined in the Public Holidays Act 2010 (NSW)).
Extra screening
We may require you to attend for extra screening if we are concerned you are not complying with this procedure, the related policy or any drug screening conditions on your registration.
We will advise when you need to attend for extra screening. You may need to attend on a weekend.
6.2 What to avoid
Substances
We have all urine and hair samples screened for the substances listed in Appendix A.
Prescribed substances and over-the counter preparations
Some prescription medicines and over-the-counter preparations may cause positive screening results. It is your responsibility to avoid these while you are attending for screening.
Do not self-administer any of the following unless advised or prescribed, and taken at the direction of a treating practitioner:
- prescribed substances
- narcotic derivatives
- non-prescription compound analgesics
- cold and flu medicines.
If you need to take any of these substances due to an illness, procedure or emergency, you must:
- notify us within 5 business days, or as soon as practicable in an emergency
- send us written confirmation from the treating practitioner of the event and any substances advised, prescribed or administered.
You must vigilantly check any over-the-counter preparations you take, including supplements and complementary medicines.
You must review the ingredient list for any substance that may cause a positive result. If the exact ingredients are not listed or you are unsure, you must avoid the preparation.
Some food and drink
Ingredients in foods and drinks can cause positive results.
Before you eat or drink anything, carefully check that it does not include ingredients that may cause a positive result. If you cannot find out its exact ingredients, you must avoid it.
Do not eat food that contains poppy seeds. You cannot use poppy seed consumption to explain a positive screening result.
Do not drink too much water before you attend for urine drug screening, as this can dilute your sample and cause an unsatisfactory result.
7. Giving samples
7.1 Collection centres
Council approved collection centres
You must attend a Council-approved collection centre for screening.
Contact your nominated collection centre to confirm their opening hours and the time you need to attend.
Alternative arrangements
We must approve any alternative arrangements, and will only do so in exceptional circumstances.
If you cannot attend a Council-approved collection centre, you must:
- write to us explaining why
- propose an alternative collection arrangement
- ensure that we receive this proposal as soon as possible, noting that for urine drug screening you must start screening within 7 days of the condition being placed on your registration.
These arrangements must meet all our collection and screening requirements, and can include collection by a local registered medical practitioner, nurse or pathology provider. You are responsible for any additional costs that may be incurred.
7.2 Sample collection and handling
Urine
If you are giving a urine sample it must be collected under direct supervision. The collector will stand in front of you and directly observe the urine passing from the urethra into the container.
Samples are otherwise collected and handled in line with the Standard.
Hair
If you are giving a hair sample, your hair must be:
- at least 3 cm long
- free from hair products.
The collector will cut a pencil-width section of hair from as close to your scalp as possible.
All samples
You must not handle your specimen at any time during the collection.
7.3 Forms
Drug screening request form
We will provide you with drug screening request forms. You must complete the participant section of this form at every collection.
You must complete this form correctly or the pathology provider may not screen your sample.
On the form, you must write down:
- any substances (prescribed or otherwise) you consumed since your last sample collection
- which parties need your results, including us, your treating practitioner.
Chain of custody
Every sample must have an accompanying chain of custody form, completed in line with the Standard.
For a urine sample, this must state:
- how the sample collection was supervised
- the sample temperature, recorded within 4 minutes of collection
- the urine creatinine result.
For a hair sample, this must state whether your hair is:
- chemically treated (permed, dyed or bleached)
- free from hair products.
You must ensure the collector completes this form, and you must sign it when the sample is collected.
We recommend you also keep your own sample collection records and ask the collector to sign them each time.
7.4 Costs, identification and privacy
Payment
You are responsible for all collection and screening costs, including any confirmatory testing.
You must pay the collection centre when you attend for screening. If you cannot pay when you attend, the centre cannot collect a sample. We will consider this a missed screen.
Screening is not eligible for a Medicare rebate.
If you are experiencing financial hardship you may contact us and discuss meeting these costs.
Proof of identity
You must show government-issued photo identification, such as a valid driver licence, identity card or passport, to the collector each time you give a sample.
Pseudonyms
If we approve, you can use a pseudonym for screening. You must write to us and provide your:
- proposed pseudonym
- real name and photo identification
- consent to provide the pseudonym to all treating practitioners, Council-appointed practitioners and pathology provider who may receive your screening results.
The collector must verify your real identity each time you give a sample.
8. Getting your results
8.1 Recipients
Nominated parties
The pathology provider will send your results to the parties nominated on your drug screening request form.
8.2 Positive or unsatisfactory results
Positive urine drug screening result
A urine drug screening result is positive if both of the following apply:
- it shows your sample contains a substance listed in Appendix A
- a treating practitioner has not confirmed they advised, prescribed or administered that substance.
In some cases your sample may be tested again to confirm the result. You are responsible for the cost of any confirmatory testing.
Positive hair drug screening result
An hair drug screening result is positive if both of the following apply:
- it shows your sample contains a substance listed in Appendix A.
- a treating practitioner has not confirmed they advised, prescribed or administered that substance.
Dilute urine samples
A dilute urine sample has a creatinine level below 1.76 mmol/L.
If your urine drug screening result shows you provided a dilute sample, we will notify you and ask you to take the necessary steps to avoid further dilute samples.
Unsatisfactory results
The following table lists unsatisfactory results for each type of screening.
| Screening type | Unsatisfactory result |
|---|---|
| Urine drug screening | • you provide more than one dilute urine sample • your urine sample was adulterated or substituted • your urine sample was otherwise inadequate or unsuitable. |
| Hair drug screening | • your hair sample was inadequate or unsuitable. |
If you receive an unsatisfactory result, we will:
- ask you for a written explanation
- use your explanation and information from the pathology provider to decide whether to take further action.
9. Managing absences and operational issues
9.1 Absences from screening
All absences
You must follow these procedures when taking leave from practice.
If you take leave, we may also require your employer or accreditor to confirm your leave period.
You must continue to screen during absences from practice, except in the circumstances specified below.
If you are absent and do not follow these procedures we may take further action, particularly if your absences follow a pattern.
Planned absences
If you intend to take a planned absence from practice, you must:
- complete our Leave from screening form
- ensure we receive this at least 5 business days before your planned absence.
If you are undergoing urine drug screening, you must meet the following requirements:
| Reason | Requirements |
|---|---|
| Travel within Australia | You must continue to attend for screening while you travel and attend the Council-approved collection centre you nominated on your Leave from screening form. If you are travelling to a remote location with no available approved centre, we may approve leave from screening. When you return, you must: • attend for screening no later than the next business day • send us evidence of your travel, such as boarding passes and receipts, within 5 business days. |
| Travel outside Australia | You do not need to attend for screening while you are outside Australia. When you return from leave, you must: • attend for screening no later than the next business day • send us evidence of your travel, such as boarding passes and receipts, within 5 business days. |
| Planned health procedure | You must inform us of any planned health procedure that may stop you from attending for screening. When you return from leave, you must: • attend for screening no later than the next business day • send us written confirmation of the procedure from the practitioner who performed it and any substance they administered, prescribed or advised, within 5 business days. |
| Any other planned leave | We will consider requests for planned leave for other reasons individually. You need to provide evidence to support your leave request for us to consider. |
If you are undergoing hair drug screening and plan to be absent on the date you must attend for screening, you must attend before you leave. We will use the date you attend to recalculate your next screening date.
Unplanned absences
If you have an unplanned absence from urine or hair drug screening, you must meet the following requirements:
| Reason | Requirements |
|---|---|
| Missed screen | If you realise you have missed your screening, you must: • notify us immediately • provide us with evidence to support your absence within 5 business days • attend for screening no later than the next business day. |
| Illness | If you are ill and cannot attend for screening, you must: • notify us within 24 hours of failing to attend • visit a medical practitioner who knows you are required to attend for screening and ask them to complete an Illness certificate form. When you return from leave, you must: • attend for screening no later than the next business day • ensure we receive your Illness certificate form within 5 business days. The certifying medical practitioner can only certify that you are ill for a maximum of 3 business days. If you are ill for more than 3 days you need to notify us and send us another completed Illness certificate form. We prefer the same medical practitioner completes the form each time. If you remain ill after that and are unable to screen you must contact us and provide supporting information from your treating practitioner about your illness, whether any substance has been advised, prescribed or administered, and when you will be able to return to screening. You must not practise during this time. |
9.2 Operational issues
Random screening phone number issues
If the random screening phone number is not working when you call, you must:
- note the time you called
- tell us immediately.
We will tell you whether you need to attend for screening that day.
The next day, call the random screening phone number as usual. If we don’t expect the issue to be fixed by the next day, we will tell you what to do.
Pathology provider issues
If the Council-approved collection centre cannot collect your sample, you must:
- tell us immediately
- attend for screening no later than the next business day
- send us the pathology provider’s written explanation for why they could not collect the sample, within 5 business days.
10. Screening group changes
10.1 ‘Step-ups’ or increases
Considerations
We will decide to step-up your screening frequency in circumstances where you have failed to comply with this procedure, our Drug screening policy and all drug screening conditions on your registration.
10.2 ‘Step-downs’ or decreases
Apply for step-down
You can request a review of your screening requirements by writing to us. Our step-down fact sheet tells you what you need to do.
Step-down requirements
We expect your screening requirements should decrease over time as your health improves.
We will consider stepping you down through the screening groups if you:
- show you have fully complied with your conditions, these procedures and the related policy; and
- received negative or nil detected results
Considerations
Unless there is a material change to your circumstances.
We will decide whether to step down your screening based on factors such as:
a) your request and the evidence you provide
b) your drug screening results and other information from the pathology provider
c) reports from your Council-appointed practitioner, treating practitioner or any interview or hearing with us
d) your compliance with the conditions on your registration
e) your engagement with treatment
f) the history of your health disorder and current health
g) any other information about your progress.
11. Contacts and further information
Drug screening contacts
Support services
| Service | Details |
|---|---|
| AHPRA Urine Drug Screening | Phone: 1800 027 624 |
| Queensland Medical Laboratory (QML) | Phone: 07 3121 4945 (Commercial services) Visit: www.qml.com.au |
| Council details | Phone: 1300 197 177 Visit: www.nursingandmidwiferycouncil.nsw.gov.au Mail: hpcanursingandmidwiferycouncil@health.nsw.gov.au |
| Nurse & Midwife Support | Phone: 1800 667 877 Visit: www.dhas.org.au |
| NSW Nurses and Midwives Association | Metro phone: (02) 8595 1234 Regional phone: 1300 367 962 Visit: www.nswnma.asn.au |
| Beyond Blue | Phone: 1300 22 4636 Visit: www.beyondblue.org.au |
| Lifeline | Phone: 13 11 14 Visit: www.lifeline.org.au |
12. Legislation and references
Laws and standards
- AS/NZS 4308:2008, Procedures for specimen collection and the detection and quantitation of drugs of abuse in urine
Fact sheets
We have a range of fact sheets providing information about drug screening.
13. Related policies
14. Revision history
| Version | Approved by | Amendment notes |
|---|---|---|
| 1st Version | N/A | N/A |
15. Appendices
Appendix A – Substances to be screened
| Substance to be tested+ | Detection limits |
|---|---|
| Amphetamine type substances • Amphetamine • Benzylpiperazine • Ephedrine • Methylamphetamine • MDA • MDMA • Phentermine • Pseudoephedrine | As per AS/NZS 4308:2008 |
| Benzodiazepines and their metabolites • Alprazolam • Clonazepam • Diazepam • Flunitrazepam • Nitrazepam • Oxazepam • Temazepam | As per AS/NZS 4308:2008 |
| Cannabis metabolites | As per AS/NZS 4308:2008 |
| Cannabinoids | As per AS/NZS 4308:2008 |
| Cocaine metabolites | As per AS/NZS 4308:2008 |
| Opiates • 6-acetylmorphine • Codeine • Morphine | As per AS/NZS 4308:2008 |
| Anaesthetic agents • Ketamine • Norketamine • Propofol | • 10 ng/ml • 5 ng/ml • 50 ng/ml for hydrolysed urine measuring total propofol or 20 ng/ml for propofol itself and one or more of its metabolites |
| Anxiolytic agents • Zolpidem • Midazolam | • 10 ng/ml • 10 ng/ml |
| Synthetic/semi-synthetic opioids • Fentanyl • Norfentanyl • Hydromorphone • Methadone • Oxycodone • Pethidine • Norpethidine • Tramadol | • 0.5 ng/ml • 0.5 ng/ml • 10 ng/ml • 10 ng/ml • 10 ng/ml • 20 ng/ml • 20 ng/ml • 20 ng/ml |
| Cathinone analogs (designer stimulants)* | Dependent on drug being used |
| Synthetic cannabinoids* | Dependent on drug being used |
| Hallucinogens • LSD • Nor-LSD | • 0.5 ng/ml screen kits and 0.2 ng/ml for confirmation or using MS techniques • 0.2 ng/ml |
| NBOMe derivatives* | This will depend on drug, but likely to be < 1 ng/ml |
Adapted from AHPRA – Drug and Alcohol Screening Protocol – Registrant Information (October 2017)
* Will require further expert advice in each case.
- QML routinely screen for a range of other substances in urine and hair in addition to the substances above. The full list is available on their website.
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