[MCOH-EH] MCOH-EH Digest, Vol 252, Issue 190

[Kari Cline]

​Melanie, I wholeheartedly agree with your approach, but I have
been advised by lab leadership at multiple healthcare organizations that
they have a CLIA (clinical lab improvement) requirement that mandates color
blindness screening for their lab personnel.  Of course, I can't find
anything in writing now that I look. Maybe this is a myth! Anybody else
know where I can find this in writing?
Thanks,
Kari

*Karilyn Cline, MPH RN COHN*

Team Member Health

Direct: 763-581-2187

Fax: 763-581-2181

Karilyn.Cline at NorthMemorial.com

*NorthMemorial.com*


On Tue, Jun 6, 2017 at 8:32 AM, <mcoh-eh-request at mylist.net> wrote:

> Send MCOH-EH mailing list submissions to
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> Today's Topics:
>
>    1. Re:  Color blindness screening (Swift, Melanie, M.D.)
>    2. Re:  [EXTERNAL] MCOH-EH Digest, Vol 252, Issue 189
>       (Mitchell, Peter)
>    3. Re:  Color blindness screening (Linda Clark, MD)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Tue, 06 Jun 2017 13:22:53 +0000
> From: "Swift, Melanie, M.D." <Swift.Melanie at mayo.edu>
> To: "mcoh-eh at mylist.net" <mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] Color blindness screening
> Message-ID: <9153c6$6t9o8p at ironport10.mayo.edu>
> Content-Type: text/plain; charset="us-ascii"
>
> 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<http://www.mayoclinic.org/>
>
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Holley,
> Stephanie A
> Sent: Monday, June 05, 2017 6:24 PM
> To: mcoh-eh at mylist.net
> Subject: Re: [MCOH-EH] Color blindness screening
>
> Ok-screening is not a myth:)  How about sharing your methodology, please.
> Thanks!  Steph
>
> From: Holley, Stephanie A
> Sent: Monday, June 05, 2017 5:59 PM
> To: 'mcoh-eh at 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
> stephanie-holley at uiowa.edu<mailto:stephanie-holley at uiowa.edu>
>
> [https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-
> signature-2016.jpg]
>
>
> ________________________________
> Notice: This UI Health Care e-mail (including attachments) is covered by
> the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is
> intended only for the use of the individual or entity to which it is
> addressed, and may contain information that is privileged, confidential,
> and exempt from disclosure under applicable law. If you are not the
> intended recipient, any dissemination, distribution or copying of this
> communication is strictly prohibited. If you have received this
> communication in error, please notify the sender immediately and delete or
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> ------------------------------
>
> Message: 2
> Date: Tue, 6 Jun 2017 13:28:37 +0000
> From: "Mitchell, Peter" <Peter.Mitchell at va.gov>
> To: "mcoh-eh at mylist.net" <mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] [EXTERNAL] MCOH-EH Digest, Vol 252, Issue 189
> Message-ID:
>         <8C605126729C3B42B3AED025267ED9BF2847C268 at VAPNSMSGD53S01.
> vha.med.va.gov>
>
> Content-Type: text/plain; charset="us-ascii"
>
> We use Ishihara as loaded in a TiTmus machine.
>
> Peter T. Mitchell, APRN, CNP, COHN-S
> Employee Occupational Health (111H)
> Veterans Affairs Health Care System
> Minneapolis, MN
> 612-467-2986 (direct)
> peter.mitchell at va.gov
>
> -----Original Message-----
> From: MCOH-EH [mailto:mcoh-eh-bounces+peter.mitchell=va.gov at mylist.net]
> On Behalf Of mcoh-eh-request at mylist.net
> Sent: Tuesday, June 06, 2017 7:29 AM
> To: mcoh-eh at mylist.net
> Subject: [EXTERNAL] MCOH-EH Digest, Vol 252, Issue 189
>
> Send MCOH-EH mailing list submissions to
>         mcoh-eh at mylist.net
>
> To subscribe or unsubscribe via the World Wide Web, visit
>         http://mylist.net/listinfo/mcoh-eh
> or, via email, send a message with subject or body 'help' to
>         mcoh-eh-request at mylist.net
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> You can reach the person managing the list at
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> When replying, please edit your Subject line so it is more specific than
> "Re: Contents of MCOH-EH digest..."
>
>
> Today's Topics:
>
>    1.  Color blindness screening (Holley, Stephanie A)
>    2. Re:  Color blindness screening (Holley, Stephanie A)
>    3. Re:  Color blindness screening
>       (SherriLynn.Davidson at hcahealthcare.com)
>    4. Re:  Color blindness screening (Senior, Cathy (Employee Health))
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Mon, 5 Jun 2017 22:58:43 +0000
> From: "Holley, Stephanie A" <stephanie-holley at uiowa.edu>
> To: "mcoh-eh at mylist.net" <mcoh-eh at mylist.net>
> Subject: [MCOH-EH] Color blindness screening
> Message-ID:
>         <1968FE2C56092444865BCBE94FEA64CD7F4CF77F at hc-mailboxc1-n2.
> healthcare.uiowa.edu>
>
> Content-Type: text/plain; charset="us-ascii"
>
> 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
> stephanie-holley at uiowa.edu<mailto:stephanie-holley at uiowa.edu>
>
> [https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-
> signature-2016.jpg]
>
>
>
> ________________________________
> Notice: This UI Health Care e-mail (including attachments) is covered by
> the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is
> intended only for the use of the individual or entity to which it is
> addressed, and may contain information that is privileged, confidential,
> and exempt from disclosure under applicable law. If you are not the
> intended recipient, any dissemination, distribution or copying of this
> communication is strictly prohibited. If you have received this
> communication in error, please notify the sender immediately and delete or
> destroy all copies of the original message and attachments thereto. Email
> sent to or from UI Health Care may be retained as required by law or
> regulation. Thank you.
> ________________________________
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>
> ------------------------------
>
> Message: 2
> Date: Mon, 5 Jun 2017 23:23:39 +0000
> From: "Holley, Stephanie A" <stephanie-holley at uiowa.edu>
> To: "mcoh-eh at mylist.net" <mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] Color blindness screening
> Message-ID:
>         <1968FE2C56092444865BCBE94FEA64CD7F4CFB11 at hc-mailboxc1-n2.
> healthcare.uiowa.edu>
>
> Content-Type: text/plain; charset="us-ascii"
>
> Ok-screening is not a myth:)  How about sharing your methodology, please.
> Thanks!  Steph
>
> From: Holley, Stephanie A
> Sent: Monday, June 05, 2017 5:59 PM
> To: 'mcoh-eh at 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
> stephanie-holley at uiowa.edu<mailto:stephanie-holley at uiowa.edu>
>
> [https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-
> signature-2016.jpg]
>
>
>
> ________________________________
> Notice: This UI Health Care e-mail (including attachments) is covered by
> the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is
> intended only for the use of the individual or entity to which it is
> addressed, and may contain information that is privileged, confidential,
> and exempt from disclosure under applicable law. If you are not the
> intended recipient, any dissemination, distribution or copying of this
> communication is strictly prohibited. If you have received this
> communication in error, please notify the sender immediately and delete or
> destroy all copies of the original message and attachments thereto. Email
> sent to or from UI Health Care may be retained as required by law or
> regulation. Thank you.
> ________________________________
> -------------- next part --------------
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>
> ------------------------------
>
> Message: 3
> Date: Tue, 6 Jun 2017 11:57:09 +0000
> From: <SherriLynn.Davidson at hcahealthcare.com>
> To: <mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] Color blindness screening
> Message-ID:
>         <3E6B29246184AD4290C8D65E6808AEDB22B2EC97 at XRDCWPMSGHCMD2C.
> hca.corpad.net>
>
> Content-Type: text/plain; charset="us-ascii"
>
> We use Ishihara in our facilities.
>
>
> Sherri Davidson, MSN, ARNP-BC, COHN-S
> Nationally Certified DOT Medical Examiner Clinic Mannager Company Care at
> Blake Medical Center
> 2010 59th Street West
> Suite 3600
> Bradenton, Fl 34209
>
> CONFIDENTIAL - Contains proprietary information.  Not intended for
> external distribution.
>
>
>
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Holley,
> Stephanie A
> Sent: Monday, June 05, 2017 7:24 PM
> To: mcoh-eh at mylist.net
> Subject: [EXTERNAL] Re: [MCOH-EH] Color blindness screening
>
> Ok-screening is not a myth:)  How about sharing your methodology, please.
> Thanks!  Steph
>
> From: Holley, Stephanie A
> Sent: Monday, June 05, 2017 5:59 PM
> To: 'mcoh-eh at 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
> stephanie-holley at uiowa.edu<mailto:stephanie-holley at uiowa.edu>
>
> [https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-
> signature-2016.jpg]
>
>
> ________________________________
> Notice: This UI Health Care e-mail (including attachments) is covered by
> the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is
> intended only for the use of the individual or entity to which it is
> addressed, and may contain information that is privileged, confidential,
> and exempt from disclosure under applicable law. If you are not the
> intended recipient, any dissemination, distribution or copying of this
> communication is strictly prohibited. If you have received this
> communication in error, please notify the sender immediately and delete or
> destroy all copies of the original message and attachments thereto. Email
> sent to or from UI Health Care may be retained as required by law or
> regulation. Thank you.
> ________________________________
> -------------- next part --------------
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>
> ------------------------------
>
> Message: 4
> Date: Tue, 6 Jun 2017 12:28:54 +0000
> From: "Senior, Cathy (Employee Health)" <CESenior at phhealthcare.org>
> To: 'MCOH/EH' <mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] Color blindness screening
> Message-ID:
>         <4d75c0442fd94e0498f4f71967c6ad40 at EX13DB01.phhealthcare.org>
> Content-Type: text/plain; charset="us-ascii"
>
> We use Quick Six Color Vision Test Pseudoisochromatic Plates.
>
>
> Cathy Senior RN BSN CDE
> Employee Health Director
> Penn Highlands DuBois
> 100 Hospital Avenue
> P.O. Box 447
> DuBois Pa 15801
> Phone 814-375-3392
> Fax 814-372-2610
> cesenior at phhealthcare.org
> www.phhealthcare.org
> [PHH ESig Logo 150dpi]
>
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of
> SherriLynn.Davidson at hcahealthcare.com
> Sent: Tuesday, June 06, 2017 7:57 AM
> To: mcoh-eh at mylist.net
> Subject: Re: [MCOH-EH] Color blindness screening
>
> We use Ishihara in our facilities.
>
>
> Sherri Davidson, MSN, ARNP-BC, COHN-S
> Nationally Certified DOT Medical Examiner Clinic Mannager Company Care at
> Blake Medical Center
> 2010 59th Street West
> Suite 3600
> Bradenton, Fl 34209
>
> CONFIDENTIAL - Contains proprietary information.  Not intended for
> external distribution.
>
>
>
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Holley,
> Stephanie A
> Sent: Monday, June 05, 2017 7:24 PM
> To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
> Subject: [EXTERNAL] Re: [MCOH-EH] Color blindness screening
>
> Ok-screening is not a myth:)  How about sharing your methodology, please.
> Thanks!  Steph
>
> From: Holley, Stephanie A
> Sent: Monday, June 05, 2017 5:59 PM
> To: 'mcoh-eh at 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
> stephanie-holley at uiowa.edu<mailto:stephanie-holley at uiowa.edu>
>
> [https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-
> signature-2016.jpg]
>
>
> ________________________________
> Notice: This UI Health Care e-mail (including attachments) is covered by
> the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is
> intended only for the use of the individual or entity to which it is
> addressed, and may contain information that is privileged, confidential,
> and exempt from disclosure under applicable law. If you are not the
> intended recipient, any dissemination, distribution or copying of this
> communication is strictly prohibited. If you have received this
> communication in error, please notify the sender immediately and delete or
> destroy all copies of the original message and attachments thereto. Email
> sent to or from UI Health Care may be retained as required by law or
> regulation. Thank you.
> ________________________________
>
> This email and any attached files are sensitive in nature and intended
> solely for the intended recipient(s). If you are not the named recipient
> you should not read, distribute, copy or alter this email. Any views or
> opinions expressed in this email are those of the author and do not
> represent those of Penn Highlands Healthcare or its affiliates.. Warning:
> Although precautions have been taken to make sure no viruses are present in
> this email, the company cannot accept responsibility for any loss or damage
> that arise from the use of this email or attachments.
>
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>
> ------------------------------
>
> Subject: Digest Footer
>
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>
> End of MCOH-EH Digest, Vol 252, Issue 189
> *****************************************
>
>
>
> ------------------------------
>
> Message: 3
> Date: Tue, 6 Jun 2017 13:32:09 +0000
> From: "Linda Clark, MD" <lclark at doctorclark.org>
> To: MCOH/EH <mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] Color blindness screening
> Message-ID:
>         <DM5PR19MB1035C8B0A750E3B68E43C739C3CB0 at DM5PR19MB1035.
> namprd19.prod.outlook.com>
>
> Content-Type: text/plain; charset="us-ascii"
>
> 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
> lclark at doctorclark.org<mailto:lclark at doctorclark.org>
>
> [065_clark_occ_logo_long_color]
>
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Swift,
> Melanie, M.D.
> Sent: Tuesday, June 6, 2017 9:23 AM
> To: mcoh-eh at 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<http://www.mayoclinic.org/>
>
> From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Holley,
> Stephanie A
> Sent: Monday, June 05, 2017 6:24 PM
> To: mcoh-eh at mylist.net<mailto:mcoh-eh at mylist.net>
> Subject: Re: [MCOH-EH] Color blindness screening
>
> Ok-screening is not a myth:)  How about sharing your methodology, please.
> Thanks!  Steph
>
> From: Holley, Stephanie A
> Sent: Monday, June 05, 2017 5:59 PM
> To: 'mcoh-eh at 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
> stephanie-holley at uiowa.edu<mailto:stephanie-holley at uiowa.edu>
>
> [https://medcom.uiowa.edu/theloop/wp-content/uploads/2015/04/Forbes-email-
> signature-2016.jpg]
>
>
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