[MCOH-EH] FW: Color blindness screening

[Grubbs, Scott]

Hi, Melanie-
I appreciate your contributions to MCOH-EH discussions.  We are in the process of improving our about color -blindness testing processes.  Your discussion below is about as enlightening as anything I have run across in the literature (and I have been looking).

Have you seen any literature that would support a specific time interval for repeat color-blindness testing in health-care related employees? You mentioned annual testing.  Is there evidence that testing that frequently is necessary.  (It would fit in with other annual surveillance activities.)

Are you aware of any concrete examples that you can share where institutions are doing "good competency testing" including the positive and negative controls, etc.

Thank you in advance,

D. Scott Grubbs, MD
WorkWell Occupational Health
Bon Secours St. Francis Hospital
Greenville, SC
Tel.  864-675-4632
Fax. 864-675-4604


From: MCOH-EH [mailto:mcoh-eh-bounces at mylist.net] On Behalf Of Swift, Melanie, M.D.
Sent: Tuesday, June 06, 2017 9:23 AM
To: mcoh-eh at mylist.net
Subject: #ExtMail# 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>

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