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.
| Document type | Procedure |
| TRIM reference number | DD17/63381 |
| Date of endorsement | 6 February 2018 (effective from 4 June 2018) |
| Endorsed by | Medical Council NSW |
| Publication date | 11 April 2018 |
| Review date | 6 February 2023 |
Summary
This procedure explains to medical practitioners and students who have EtG screening conditions imposed on their registration how to participate in screening.
Applies to (scope)
• NSW medical practitioners and students required to undergo EtG screening
• Medical Council of NSW, its delegates and secretariat staff
| Document owner | Medical Director |
| Functional group/subgroup | Monitoring |
1. Purpose
If you have EtG 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.
2. Compliance context
You must comply with this procedure and:
• our Alcohol screening policy
• any alcohol screening conditions on your registration
If a condition on your registration is inconsistent with this procedure or the Alcohol screening policy, the condition prevails.
If you must attend other types of alcohol screening you must also comply with the relevant alcohol screening procedure.
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 EtG screening to monitor medical practitioners and students where there is a history of or concerns about alcohol misuse or dependence and whose conditions require them to be abstinent from alcohol. We do this to protect the public.
We understand that providing samples can be inconvenient, intrusive and expensive. However, negative EtG screening results are an effective way for us to know you are not affected by alcohol and can continue safely in practice or training.
4. Responsibilities
| Parties responsible (Positions/Groups/Bodies) | Key responsibilities |
|---|
| NSW medical practitioners and students | comply with processes for EtG 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 Alcohol screening policy and this procedure. |
5. Definitions and abbreviations
| Term | Explanation |
|---|
| Council / we / our | Medical Council of NSW |
| EtG | Ethyl-glucuronide – a test to monitor compliance for abstinence from alcohol, by detecting the presence of EtG (an alcohol breakdown product) in urine |
| participant / you / your | a medical practitioner or student participating in EtG 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
| Topic | Requirements |
|---|
| Start date | If you must attend EtG screening, you need to start within 7 days of the condition being placed on your registration. |
| Frequency | We will advise how often you must attend EtG screening both when the condition is placed on your registration and if your conditions change. The table below outlines the requirements for each frequency of screening. |
| Frequency | Requirements |
|---|
| 2 times a week | You must attend for screening every Monday and Thursday. |
| Random | You must call 1800 654 068 each weekday between midnight and 5 pm to find out whether you must attend for screening that day. You will be screened at least 15 times every 6 months on randomly selected dates. |
| Topic | Requirements |
|---|
| Public holidays | If you must attend 2 times a week EtG screening you do not need to attend for screening on public holidays (as defined in the Public Holidays Act 2010 (NSW)). But you must attend the next business day after the holiday. If you must attend random EtG screening you do not need to call the Council random screening phone number on a public holiday. |
| 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 alcohol screening conditions on your registration • believe you may have consumed alcohol. We will advise when you need to attend for extra screening. You may need to attend on a weekend. |
6.2 What to avoid
| Topic | Requirements |
|---|
| Alcohol | You must not consume alcohol. |
| 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. You must vigilantly check any prescription medicines and over-the-counter preparations you take, including supplements and complementary medicines. You must review the ingredient list for alcohol and 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 health and personal hygiene products, food and drink | Ingredients in health and personal hygiene products, foods and drinks can cause positive results. Before you use a health or personal hygiene product or eat or drink anything, carefully check that it does not include alcohol or any other ingredients that may cause a positive result. If you cannot find out its exact ingredients, you must avoid it. Do not drink too much water before you attend for EtG screening, as this can dilute your sample and cause an unsatisfactory result. |
7. Giving samples
7.1 Collection centres
| Topic | Requirements |
|---|
| 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
| Topic | Requirements |
|---|
| 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. |
| Collection | You must not handle your specimen at any time during the collection. |
7.3 Forms
| Topic | Requirements |
|---|
| EtG screening request form | We will provide you with EtG 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 and your Council-appointed practitioner • whether you want your results sent to you and any relevant group e.g. medical indemnity insurer. |
| 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. 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
| Topic | Requirements |
|---|
| Payment | You are responsible for all collection and screening costs. 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. |
| 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 and Council-appointed practitioners 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
| Topic | Requirements |
|---|
| Nominated parties | The pathology provider will send your results to the parties nominated on your EtG screening request form. You can also request a copy for: • yourself • any relevant group e.g. medical indemnity insurer. |
8.2 Positive or unsatisfactory results
| Topic | Requirements |
|---|
| Positive EtG result | Your EtG result is positive if the concentration detected is more than 500 ng/ml. |
| Dilute urine samples | A dilute urine sample has a creatinine level below 1.76 mmol/L. If your EtG 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 | Your EtG result is unsatisfactory if: • you provide more than one dilute urine sample • your urine sample was adulterated or substituted • your sample was otherwise 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
| Topic | Requirements |
|---|
| 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 • verify your absence from practice with Medicare. 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.
You must also 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 medical procedure | You must inform us of any planned medical 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 advised, prescribed or administered, 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. |
Unplanned absences
If you have an unplanned absence from EtG screening, you must meet the following requirements:
| Reason | Requirements |
|---|
| Missed screen | If you realise you have missed your screening, you must: • notify us immediately and explain why • 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
| Topic | Requirements |
|---|
| 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. Ending your screening
10.1 Decreases
| Topic | Requirements |
|---|
| Decreasing your screening | We will decide when you need less frequent screening or a different type of alcohol screening. |
| Screening type | Requirements |
|---|
| EtG (2 times a week) | You may be eligible to decrease to random EtG if you: • can show you have fully complied with your conditions, this procedure and the related policy • received negative results for 18 months. |
| EtG (random) | You may be eligible to stop your screening if you: • can show you have fully complied with your conditions, this procedure and the related policy • received negative results for a further 12 months. |
| Topic | Requirements |
|---|
| Reviews | You can request a review of your screening requirements by writing to us and providing evidence to support this request. |
| Considerations | We will decide whether to decrease your screening based on factors such as: • your request and the evidence you provide • your EtG screening results and other information from the pathology provider • any other alcohol screening results • reports from your Council-appointed practitioner, treating practitioner and any interview or hearing with us • your compliance with the conditions on your registration • your engagement with treatment • your health • any other information about your progress. |
11. Contacts and further information
| Drug screening contacts | Support services |
|---|
| Council random phone screening number Phone: 1800 654 068 | Doctors Health Advisory Service Phone: (02) 9437 6552 Visit: www.dhas.org.au |
| Queensland Medical Laboratory (QML) Phone: 07 3121 4945 (Commercial services) Visit: www.qml.com.au | Medical Benevolent Association of NSW Phone: (02) 9987 0504 Visit: www.mbansw.org.au |
| Council details | Beyond Blue Phone: 1300 22 4636 Visit: www.beyondblue.org.au |
| Phone: 02 9879 2200 Visit: www.mcnsw.org.au Mail: PO Box 104, Gladesville, NSW 1675 DX: 22808 Gladesville | Lifeline Phone: 13 11 14 Visit: www.lifeline.org.au |
| | Alcoholics Anonymous Australia Phone: 1300 222 222 Visit: www.aa.org.au |
| | Australian Doctors in Recovery Visit: https://www.idaa.org/sites/adr/ |
12. Legislation and references
| Category | Reference |
|---|
| Laws and standards | AS/NZS 4308:2008, Procedures for specimen collection and the detection and quantitation of drugs of abuse in urine |
| Handbooks | Our Health Program Handbook provides you with more information about the Health program |
| Fact sheets | We have a range of fact sheets providing information about alcohol screening. |
13. Related policies
Medical Council of NSW Alcohol screening policy
14. Revision history
| Version | Approved by | Amendment notes |
|---|
| N/A | N/A | N/A |
