[MCOH-EH] Discrepancy screening

[Darlene Sims]

Thank you, Dr. Swift for response and I agree with what you are stating. Yes, we do have a MRO who reviews.
The request was for it to be done for discrepancy and reasonable suspicion screenings which I am not in support of. To clarify the "narcotic usage", I was referring to higher usage during patient care, not personal care.  Your response helps as I continue to stress the same to those who have asked. 

Thank you
Darlene Sims, FNP 

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Today's Topics:

   1.  EOHS staffing to employee ratio (Massey, Angela M)
   2.  Discrepancy screening (Darlene Sims)
   3. Re:  Discrepancy screening (Swift, Melanie D., M.D., M.P.H.)


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Message: 1
Date: Mon, 24 Feb 2025 18:14:27 +0000
From: "Massey, Angela M" <APugh2 at IUHealth.org>
To: "mcoh-eh at mylist.net" <mcoh-eh at mylist.net>
Subject: [MCOH-EH] EOHS staffing to employee ratio
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        <CH3PR11MB856491641AC8DDB768C03C4EF7C02 at CH3PR11MB8564.namprd11.prod.outlook.com>

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Hello,

I'm wondering if anyone is aware of a recent staffing ratio for Employee Health staff/#employees.  The most recent data I can find is from AOHP 2016, which is 1 Employee Health staff/1344 employees.

Thanks in advance for your input.



Angela Massey, RN, BSN
Director Employee Health and Safety
Indiana University Health
IU Health Medical Group
317.962.2563 (ofc) | 317.719.5064 (cell) | 317.962.8349 Apugh2 at iuhealth.org<mailto:Apugh2 at iuhealth.org>




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Message: 2
Date: Tue, 25 Feb 2025 05:24:00 +0000
From: Darlene Sims <Darlene.sims at infirmaryhealth.org>
To: "mcoh-eh at mylist.net" <mcoh-eh at mylist.net>
Subject: [MCOH-EH] Discrepancy screening
Message-ID: <742779EF-2147-43B6-B4E2-8326854E2CBB at infirmaryhealth.org>
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 Recently, one of our pharmacist made the request and pushing for our system to change to hair screening vs UDS.  I was just curious if anyone uses the hair method for discrepancies, particularly in situations where there are an employee's narcotic usage is higher than compared to others in the same department. We have not had an issue with our current process; however, he feels there may be missed cases.


Thank you,

Darlene Sims, FNP
Director, Infirmary Employee Health

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Message: 3
Date: Tue, 25 Feb 2025 15:58:27 +0000
From: "Swift, Melanie D., M.D., M.P.H." <Swift.Melanie at mayo.edu>
To: MCOH-EH <mcoh-eh at mylist.net>
Subject: Re: [MCOH-EH] Discrepancy screening
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        <SN6PR01MB5197A05F9C675B1B85C21CB08CC32 at SN6PR01MB5197.prod.exchangelabs.com>

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Darlene, can you please clarify what type of testing program you're asking about? Preemployment, for cause, random tests, follow-up/recovery support?

The pitfalls with occupational hair testing are myriad - primarily because it cannot be used to determine impairment. Employers are on safe footing to act on a test that indicates the person has the substance in their system at work at a level likely to be impairing. However employers need to be careful regarding medication or substance use that did not occur at work or cause impairment at work.

As for trying to evaluate "an employee's narcotic usage...compared to others in the same department" - this concept doesn't make sense to me. Drug testing of any sort will not tell you dosages, and individuals have different prescribed medications. If reviewed by an MRO (and I hope all your tests are MRO-reviewed) tests are either positive, negative, or cancelled (with some specifics in those categories of course - positive via refusal to test, negative dilute, cancelled for a list of reasons some of which have nothing to do with the donor.) It would not be appropriate for an employer to try and compare quantitative levels of drug metabolites between workers, for so many reasons it precludes enumerating here!

Probably the most valid reason to consider use of occupational hair testing would be for individuals getting follow-up testing as part of recovery support following treatment. Hair testing could identify interval unreported substance use that may constitute a violation of an abstinence agreement. But if you don't have an agreement that requires complete abstinence, you couldn't use this to identify whether the individual had the substance in their system or were impaired by it at work.

Melanie

Melanie Swift, MD, MPH, FACOEM
Vice Chair, Division of Public Health, Infectious Diseases and Occupational Medicine Medical Director, Mayo Clinic Physician Health Center Associate Medical Director, Occupational Health Service _______________________________ Mayo Clinic
200 First Street SW
Rochester, MN 55905

-----Original Message-----
From: MCOH-EH <mcoh-eh-bounces at mylist.net> On Behalf Of Darlene Sims
Sent: Monday, February 24, 2025 11:24 PM
To: mcoh-eh at mylist.net
Subject: [EXTERNAL] [MCOH-EH] Discrepancy screening

 Recently, one of our pharmacist made the request and pushing for our system to change to hair screening vs UDS.  I was just curious if anyone uses the hair method for discrepancies, particularly in situations where there are an employee's narcotic usage is higher than compared to others in the same department. We have not had an issue with our current process; however, he feels there may be missed cases.


Thank you,

Darlene Sims, FNP
Director, Infirmary Employee Health
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The MCOH-EH List has always been moderated by members of the ACOEM Medical Center Occupational Health Section. It is currently moderated by Joe Fanucchi MD FACOEM.
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End of MCOH-EH Digest, Vol 260, Issue 23
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