Random drug screening saves costs and time

Drug screening rarely comes out positive in new hires, but the screening itself may dissuade drug users from applying for jobs. The University Health Systems of Eastern Carolina in Greenville, NC, was able to make the process more cost-effective by implementing random drug screening.

"You put them on notice that all applicants are subject to the drug screen," says Pat Dalton, RN, COHN-S, occupational health administrator. But only 20% of the randomly selected new hires actually undergo the drug screening, she says.

Instead, the hospital system focuses on for-cause drug screening of employees. "We do have some pre-placements that come up positive, but it’s a very, very low percentage," she says. "We figured, Let’s put more emphasis on managers picking up on people who are having problems once they get on board.’"

In fact, out of 188 pre-placement drug screens in 2002, only four were positive. The system conducted 982 pre-placement health screenings, for a savings of about $12,000. By contrast, out of 10 for-cause drug screens, six were positive.

There’s an exception to the rule: If a community is perceived as having a higher incidence of illegal drug use, the pre-placement drug screening should be routine, Dalton adds. For example, at the hospital that serves the Outer Banks coastal area of North Carolina, all new hires are subject to the drug screen, she says.

Intranet helps streamline exams

At Baystate Health System in Springfield, MA, pre-placement health screening is tailored to the potential hazards the new employee will encounter. Managers complete a form on the health system’s intranet.

"It lists the hazards in terms of the kind of lifting, pushing, and pulling; chemical exposures; if they have direct patient contact; if they have TB exposure; [or] if they drive corporate vehicles," explains James Garb, MD, director of occupational health and safety.

"When someone comes in for a physical, we type in the cost center and the job code; and the form will come up with all the required testing for that job," he says.

That process helps streamline the pre-placement testing and exams, which are conducted by employee health nurse practitioners. For example, employees may be assessed for carpal tunnel syndrome, counseled about hepatitis C testing, or screened for color vision. Latex allergy questionnaires have detected 80 people with latex allergy.

The physical does not include tests for general wellness, such as urinalysis, complete blood count, or cholesterol screening. "We have a disclaimer that says this physical does not replace the physical you would get from a private physician," he says.

Garb concedes that the pre-placement screening is time-consuming. But he says it establishes a good first impression of the employee health department. "We talk to them about reporting injuries and if they have a needlestick, what they should do," he says. "I think most employees leave feeling that they got a good examination. It helps establish our credibility."

Targeting exams on high-risk job categories

If you rely on questionnaires, rather than physical exams to determine whether new hires can perform their job duties, you are counting on full disclosure of prior injuries or restrictions. Unfortunately, that doesn’t always happen, says Geoff Kelafant, MD, MSPH, FACOEM, medical director for occupational health and employee health at McLeod Regional Medical Center in Florence, SC.

The hospital had some significant workers’ compensation claims resulting from injuries of nonclinical employees who hadn’t revealed their history of prior injuries, Kelafant says. "They represented themselves as being fully able to do the job."

McLeod Regional Medical Center now is identifying the three nonclinical job classifications at highest risk of workplace injury. New hires in those areas will receive a physical exam from a physician and a physical abilities screening from a physical therapist as well as the questionnaire.

Kelafant will evaluate the effectiveness of the new screening. "If we find one or two [cases of restricted capabilities] a year that we catch in that process, it will probably more than pay for itself," he says.

Sometimes, more means less. That is the case for Vanderbilt Occupational Health Clinic in Nashville, TN, which serves about 20,000 employees at the university and medical center. Providing pre-placement health exams for every new hire would require tremendous resources.

Instead, employee health professionals attend the bimonthly new staff orientation sessions to provide TB skin tests and necessary immunizations, says medical director Melanie Swift, MD. Only police and security personnel receive a physical exam; they undergo a cardiovascular screening before they begin the vigorous training program.

With most employees, Vanderbilt does not even use a medical history questionnaire asking about prior injuries and probing for possible limitations. Instead, it deals with individual issues as they arise.

"It does conserve our resources, make us efficient, and help us have the first interaction be positive," Swift says.

"When [employees] do need our help, they see us as a resource not as a medical resource police," she adds.