I agree with you 100% Melanie, and made such an argument to a client of mine, a multi-site FQHC. However, they were “dinged” from the Joint Commission for not conducting color vision screening pre-employment.
I argued the point, for many of the reasons you mention below, and per the health center, they would not budge on this opinion. So, we perform a 6-plate Ishihara through our Titmus for their employees, with the caveat that they still must complete all competency
training requiring color interpretation – as you point out, many can still perform the tests accurately.
Linda
Linda L. Clark, MD, MS
Occupational and Preventive Medicine
(585) 227-0072
P
(585) 227-9585
F
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net]
On Behalf Of Swift, Melanie, M.D.
Sent: Tuesday, June 6, 2017 9:23 AM
To: mcoh-eh@mylist.net
Subject: Re: [MCOH-EH] Color blindness screening
Darn, I loved “screening mythology” – I might use that. Particularly apt for color vision screening.
A couple of things to bear in mind:
·
Color vision testing in a clinical setting is a
medical test under the ADA.
·
Competency demonstration in the workplace is not a medical test.
Chew on that a minute. Now a few more background things to note:
·
Color vision deficiency can occur in different spectra – red-green, blue-yellow are the main types. Ishihara and most commercially available color vision screening tests are focused on red-green which
is most common congenital deficiency. Point of care tests often use the yellow-blue spectrum more.
·
Even if the colors you test do match those the person uses in their job (and the ADA expects you
not to be doing a medical test unless it relates directly to the job function) that does not mean that they can correctly perform and interpret the test. For patient safety you still have to do a competency test.
·
People with color vision deficiency can often compensate. If the test includes a key or legend, they may still be able to accurately match the key, even if what they are seeing looks olive to them instead
of pink. Therefore someone who fails a color vision test still needs a competency test to determine if they can do this job function safely.
·
While some color vision deficiencies are genetic, others are acquired, most often through a chronic disease process like diabetes. So if you are going to rely on color perception testing, you would
need to do it periodically, not just at hire.
·
Lighting is a huge factor in color vision perception. Someone with a partial deficit could perform well in a well-lit exam room where you are going screening, but be completely unable to discriminate
those same colors in a poorly lit area.
In short, for color vision screening to make sense and be ADA compliant, you’d need to perform the testing in a setting that mimics their work environment, using the same colors that they would be using in the
tests they perform and not just what is in the Ishihara plates, and you’d need to repeat testing periodically. And they would still need to do competency testing periodically to demonstrate that they can accurately perform and interpret the test.
I’d urge you to resist the temptation to do standard color vision screening test, and to consider doing good competency testing annually. That’s another rock to look under – what does the competency testing entail.
There should be positive and negative controls, and everyone should have adequate lighting to do the task, both in the competency test area and in the clinical area where the test is performed, which are ideally the same place.
Melanie
Melanie Swift, MD
Senior Associate Consultant
Division of Preventive, Occupational, and Aerospace Medicine
Phone 507.284.2560
_______________________________
Mayo Clinic
200 First Street SW
Rochester, MN 55905
www.mayoclinic.org
From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net]
On Behalf Of Holley, Stephanie A
Sent: Monday, June 05, 2017 6:24 PM
To: mcoh-eh@mylist.net
Subject: Re: [MCOH-EH] Color blindness screening
Ok-screening is not a mythJ How about sharing your
methodology, please. Thanks! Steph
From: Holley, Stephanie A
Sent: Monday, June 05, 2017 5:59 PM
To: 'mcoh-eh@mylist.net'
Subject: Color blindness screening
Good Evening,
We are interested in knowing if your facility screens health care providers for color deciphering (i.e. Ishihara or Farnsworth). If so, would you please share what screening
mythology you use and if you have a product that works well (vendor for purchases).
Thanks much!
Stephanie Holley MBA, BSN, RN, CIC, FAPIC
Nurse Manager, University Employee Health Clinic
University of Iowa Hospitals and Clinics
319.384.9584
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