Presentation is loading. Please wait.

Presentation is loading. Please wait.

Fitness for Duty Prescription/Over-the-Counter Medication Use and Medical Qualification Robbie L. Sarles RLS & Associates, Inc. May 31, 2012.

Similar presentations


Presentation on theme: "Fitness for Duty Prescription/Over-the-Counter Medication Use and Medical Qualification Robbie L. Sarles RLS & Associates, Inc. May 31, 2012."— Presentation transcript:

1 Fitness for Duty Prescription/Over-the-Counter Medication Use and Medical Qualification Robbie L. Sarles RLS & Associates, Inc. May 31, 2012

2 2002: National Transportation Safety Board (NTSB) challenge to all FTA grant recipients: Review Rx/OTC Policies. Educate operators of potential risks associated with Rx/OTC use. 2003: FTA Released Rx/OTC Medication Toolkit: State-Of-The-Practice at that time. History

3 NTSB Satisfied by Responses, but: Further research needed to establish nature of relationship between Rx/OTC medications and transit accidents. History

4 2009: RLS & Associates, Inc. Conducted 2 Surveys: Gauge progress on Rx/OTC policies & procedures. Inquire about accident investigation practices. Update the FTA Rx/OTC Medication Toolkit. History

5 Survey Respondents indicated: Rx/OTC policies in place, but were limited in scope and rarely enforced. Most were not collecting Rx/OTC medication information. If Rx/OTC medication information was collected, little was done with it. No correlation between that information and accident investigations. History

6 2009 Rx/OTC Survey Recommendations: Standardize the collection and reporting of Rx/OTC medication use. Conduct fitness-for-duty assessments. Expand TSI post-accident procedures to address Rx/OTC. Educate transit systems. Educate physicians. History

7 2011: RLS & Associates Convened Expert Panel to Review 2009 Survey Results. Recommendations from Expert Panel: Focus on safety and ensuring that safety-sensitive employees are medically-qualified. Develop standard for retaining Rx/OTC medication information. Educate safety-sensitive employees on meaning of fitness-for-duty. Establish medical qualification standards for industry. History

8 Recommendations from Expert Panel: Collect information before and after implementation to enable cost/benefit evaluation. Study extent that Rx/OTC medication is a causal or contributing factor in transit accidents. Research legal/liability issues of Rx/OTC policies HIPAA ADA Labor Unions History

9 Actions to Date Rx/OTC Toolkit issued April 2011 To download the FTA Rx/OTC Medication Toolkit, go to: Click on Drug and Alcohol Program.

10 Actions to Date Advisory Group reviewed Draft Rx/OTC Medication Study and Recommendations April 2011 Final Study and Recommendations completed October 2011 Follow-up Post Accident Questionnaire initiated December 2011

11 General Guidance Recommendations Encourage transit systems to test for additional substances under their own authority following accidents. 10-panel or more. Expanded opiate testing. Expanded benzodiazepine testing. Methadone and other drugs should be considered. In addition to DOT 5-panel drug test. Incorporate Rx/OTC medications with common side effects that can impair driving into future Post Accident Testing Heuristics (PATH) studies

12 Post Accident Questionnaire 277 Total Systems Contacted for Initial Online Questionnaire: 4,196 Accidents These numbers were the total reported to NTD for 2010 Of the 277 systems initially contacted: 79 Systems responded – 1,820 Accidents Of the 79 Respondents: 67 Systems collect Rx/OTC information – 1,692 Accidents Of the 67 Systems that collect Rx/OTC information: 50 Systems provided follow-up data on selected accidents-1,202 Accidents

13 Summary Of Responses Of the 1,202 possible accidents: Data for 376 (~31%) out the total 1,202 accidents reported to NTD has been provided. Small Urban 32% Small Urban 32% Large Urban 64% Large Urban 64% Rural – 4%

14 Summary Of Responses

15 Is it a standard practice for your system to ask about Rx/OTC information as a part of all Post-Accident investigations? Summary Of Responses

16 Were any Rx/OTC medications discovered as part of the Post- Accident Investigation? Yes – 4 Accidents (~8%) No – 45 Accidents (~92%) Were any Rx/OTC medications pre-disclosed, prior to the accident? Yes – 17 Systems (34%) / 55 Accidents (~14%) No – 33 Systems (66%) / 321 Accidents (~86%) 98 Unique Rx/OTC medications discovered from the 55 Accidents. Summary Of Responses

17 Of 376 accidents studied 146 instances of medication use reported 96 unique medications 54 Medications (56%) with potential side effects that may impair driving Dizziness/lightheadedness (30) Drowsiness/fatigue (19) Impair Judgment (3) Cause anxiety/insomnia (2) Reported Rx/OTC Summary

18 20% (28) were antihypertensive medications (commonly prescribed for high blood pressure) 40% were Rx pain relievers (12) Sedative/hypnotics (2) Muscle relaxers (6) One report of Chantix for smoking cessation Reported Rx/OTC Summary

19 Trends & Other Information Most systems (85%) that responded to the questionnaire are collecting Rx/OTC medication information: Very few are integrating the Rx/OTC information with Post- Accident investigations. After collecting Rx/OTC information from the employee, nothing is done with that information. After an employee reports Rx/OTC medication use, systems do not track how long the employee is expected to take the medication(s).

20 Trends & Other Information The most common response from systems when asked why they do not inquire about Rx/OTC information as a part of Post- Accident investigations was fear/uncertainty of violating HIPAA. Many systems only ask employees about Rx/OTC medication use as a part of initial physicals, annual physicals, and bi-annual physicals.

21 List of Reported Medications Medications Reported Trade Name Medications Reported Generic name Medication TypeRx or OTC Common IndicationsCommon Side Effects Which May Impair Driving 1 Accupril – (1)quinaprilantihypertensiveRxhypertension (high blood pressure) dizziness, lightheadedness 2 Advair – (1)fluticasone/salmeterolbronchodilator/steroidRxasthma; COPDdizziness 3 Advil – (2)ibuprofenpain relieverOTCpain relievern/a 4 Aleve – (2)naprosynpain relieverOTC pain relievern/a 5 ZyloprimAllopurinol - (2)treatment of goutRxgoutn/a 6 Ambien – (1)zolpidemsedative/hypnoticRxInsomniadrowsiness, fatigue 7 NorvascAmilodipine – (3)antihypertensiveRxhypertension (high blood pressure), control angina dizziness, lightheadedness 8 Lotrelamlodipine/benazepril – (1)antihypertensiveRxhypertensiondizziness, lightheadedness 9 Amoxil – (1)amoxicillinantibioticRxantibioticn/a 10 ASA - (3)aspirinpain relieverOTC pain relievern/a 11 TenorminAtenolol – (1)antihypertensiveRx hypertension (high blood pressure); control angina dizziness; lightheadedness 12 Avandamet – (1)rosiglitazone/metforminantidiabeticRx hyperglycemialightheadedness; hypoglycemia Bold = Name of Medication as Reported by the Transit System

22 List of Reported Medications 13 Avapro – (1)irbrsartanantihypertensiveRxhypertension (high blood pressure) dizziness; lightheadedness 14 Benadryl – (1)diphenhydramineantihistamine; sedative/hypnotic OTCallergies; insomniadrowsiness; fatigue 15 Lotensinbenazepril – (1) antihypertensiveRxhypertension (high blood pressure) dizziness, lightheadedness 16 BuSparbuspirone – (1)antianxietyRxantianxietydrowsiness; dizziness 17 Celebrex – (2)celcoxibpain reliever, nonsteroidal anti-inflammatory Rxpain reliever, nonsteroidal anti-inflammatory n/a 18 Chantix – (1)vareniclinesmoking cessationRxsmoking cessationfatigue 19 Claritin – (1)loratadineantihistamineOTCantihistaminen/a 20 Klonopinclonazepam – (1)antianxietyRxantianxietydrowsiness 21 n/acolchicine – (2)treatment of goutRxgoutn/a 22 Coreg – (1)carvedilolantihypertensiveRx hypertension (high blood pressure) dizziness, fatigue 23 Coumadin – (1)warfarinanticoagulantRxprevent blood clots n/a 24 Crestor – (1)rosuvastatinantihyperlipidemicRx lowers cholesteroln/a 25 Detrol – (1)tolterodineanticholinergicRxincontinencedizziness 26 Lanoxindigoxin – (1)congestive heart failure Rx congestive heart failuren/a Medications Reported Trade Name Medications Reported Generic name Medication TypeRx or OTC Common IndicationsCommon Side Effects Which May Impair Driving

23 List of Reported Medications Medications Reported Trade Name Medications Reported Generic name Medication TypeRx or OTC Common IndicationsCommon Side Effects Which May Impair Driving 27 Diovan – (3)valsartanantihypertensiveRxhypertension (high blood pressure) dizziness, fatigue 28 Dispositron – (1)unable to identify 29 Sinequandoxepin – (1)antidepressant; antianxietyRxdepression, anxietydrowsiness 30 (drocode) dihydrocodeine – (1) pain reliever, moderate to severe Rxpain reliever, moderate to severe drowsiness 31 venlafaxineEffexor – (1)antidepressantRxdepressiondizziness 32 Vasotecenalapril – (1)antihypertensiveRxhypertension (high blood pressure) dizziness, fatigue 33 Plendilfelodipine – (1) antihypertensive Rx hypertension (high blood pressure) dizziness, fatigue 34 Propecia; Proscarfinasteride – (1)androgen hormone inhibitorRx enlarged prostate; male pattern hair loss dizziness; hypotension 35 Flexeril – (3)cyclobenzaprineskeletal muscle relaxantRx muscle spasmdrowsiness; fatigue 36 Flonase – (1)fluticasonesteroidRxintranasal steroidn/a 37 Flovent – (1)fluticasonesteroid Rxasthman/a 38 Glucotrolglipizide – (1)antidiabeticRx hyperglycemia (Diabetes)lightheadedness; hypoglycemia 39 n/aglucosamine – (1)OTC nutritional supplement OTCOTC nutritional supplementn/a

24 List of Reported Medications Medications Reported Trade Name Medications Reported Generic name Medication TypeRx or OTC Common IndicationsCommon Side Effects Which May Impair Driving 40 estradiolGynodiol – (1)estrogen Rx estrogen replacementn/a 41 Hydrodiurilhydrochlorothiazide – (5)antihypertensiveRxhypertension (high blood pressure) dizziness, lightheadedness 42 Vicodin; Lortab; Lorcethydrocodone with acetaminophen – (1) pain reliever, moderate to severe Rx pain reliever, moderate to severe drowsiness 43 Motrin; Aleveibuprofen – (3)pain relieverRx or OTC pain relievern/a 44 dutasteride/tamsulosinJalyn – (1)hormoneRxprostate enlargementn/a 45 Lasix – (1)furosemide diureticRxhypertension (high blood pressure) n/a 46 Levemir – (1)insulinantidiabeticRxhyperglycemialightheadedness; hypoglycemia 47 Synthroidlevothyroxine – (1)hypothyroidismRxhypothyroidismn/a 48 Lexapro – (1)escitalopramselective serotonin reuptake inhibitor (SSRI) Rxantidepressantimpair judgment, thinking, or motor skills 49 Lidex – (1)fluocinonidetopical steroidRxtopical steroid n/a 50 Lipitor – (1)AtorvastatinantihyperlipidemicRxlower cholesteroln/a 51 Prinivillisinopril – (7)antihypertensiveRxhypertension (high blood pressure) dizziness, lightheadedness 52 Claritinloratadine – (1)antihistamineOTC Allergy symptomsn/a

25 List of Reported Medications Medications Reported Trade Name Medications Reported Generic name Medication TypeRx or OTC Common IndicationsCommon Side Effects Which May Impair Driving 53 Lortab – (2)hydrocodone with acetaminophen pain reliever, moderate to severe Rxpain reliever, moderate to severe drowsiness 54 Lotrel – (2)amlodipine/benazeprilantihypertensiveRxhypertension (high blood pressure) dizziness, lightheadedness 55 Lyrica – (1)pregabalinanticonvulsantRxpain reliever, neuropathicdizziness 56 Medrol – (1)methylprednisolonesteroidRx inflammationn/a 57 Glucophagemetformin – (3)antidiabeticRxhyperglycemialightheadedness, hypoglycemia 58 Lopressormetoprolol – (1)antihypertensiveRxhypertension (high blood pressure) dizziness, lightheadedness 59 Motrin – (5)Ibuprofenpain reliever Rxpain relievern/a 60 Naprosyn – (2)Naproxen – (2)Pain reliever Rx pain relievern/a 61 Nifediac – (1)nifedipine antihypertensive Rx hypertension (high blood pressure) dizziness, lightheadedness 62 n/anitroglycerin – (1)vasodilator Rx treat anginadizziness 63 Norvasc – (1)amilodipineantihypertensiveRxhypertension (high blood pressure), control angina dizziness, lightheadedness 64 n/aomega-3 fatty acids – (1)nutritional supplementOTCnutritional supplement.n/a 65 Prilosec – (3)omeprazole – (2)gastroesophageal reflux disease (GERD) Rx or OTC gastroesophageal reflux disease (GERD) n/a

26 List of Reported Medications Medications Reported Trade Name Medications Reported Generic name Medication TypeRx or OTC Common IndicationsCommon Side Effects Which May Impair Driving 66 Paxil – (1)paroxetineselective serotonin reuptake inhibitor (SSRI) Rxantidepressantimpair judgment, thinking, or motor skills 67 n/apectin – (1)OTC nutritional supplement OTCOTC nutritional supplementn/a 68 Percocet – (2)oxycodone with acetaminophen pain reliever, moderate to severe Rxpain reliever, moderate to severe drowsiness 69 Plavix – (2)clopidogrelantiplateletRxstroke preventionn/a 70 Prevacid – (2)lansoprazolegastroesophageal reflux disease (GERD) Rx or OTC gastroesophageal reflux disease (GERD) n/a 71 Proventil – (1)albuterolbronchodilatorRxbronchodilatornervousness 72 Provigil – (1)modafinilstimulantRxnarcolepsyanxiety, insomnia 73 Accuprilquinapril – (1)antihypertensiveRxhypertension (high blood pressure) dizziness, lightheadedness 74 Zantacranitidine – (1)gastroesophageal reflux disease (GERD) Rxgastroesophageal reflux disease (GERD) n/a 75 Rhinocort – (1)budesonidesteroidsRxAllergy symptomsn/a 76 Zocorsimvastatin – (3)antihyperlipidemicRxLower cholesteroln/a 77 Januviasitagliptin – (1)antidiabeticRx hyperglycemialightheadedness; hypoglycemia 78 Soma – (1)carisoprodolmuscle relaxantRx muscle relaxantdrowsiness

27 List of Reported Medications Medications Reported Trade Name Medications Reported Generic name Medication TypeRx or OTC Common IndicationsCommon Side Effects Which May Impair Driving 79 Synthroid – (1)levothyroxinehypothyroidismRxhypothyroidismn/a 80 Restoriltemazepam – (1)sedative/hypnoticRxInsomniadrowsiness, fatigue 81 Synthroid(levo)thyroxine – (1)Thyroid HormoneRxHypothyroidismn/a 82 Zanaflextizanidine – (1)skeletal muscle relaxantRxmuscle spasmdizziness 83 Toprol – (1)metoprololantihypertensiveRx hypertension (high blood pressure); control angina drowsiness; dizziness; blurred vision 84 Ultramtramadol – (1)pain reliever, moderate to severe Rx pain reliever, moderate to severe drowsiness 85 Oeptrotrazodone – (3)AntidepressantRxdepressantdrowsiness 86 Tylenol with Codeine #3 – (2)acetaminophen with codeine #3 pain reliever, moderate to severe Rxpain reliever, moderate to severe drowsiness 87 Unidentified diabetic medication – (1) unable to identify 88 Unidentified high blood pressure medication – (1) unable to identify 89 Viagra – (1)sildenafilerectile dysfunctionRxerectile dysfunctionn/a 90 Vicodin – (3)hydrocodone with acetaminophen pain reliever, moderate to severe Rxpain reliever, moderate to severe drowsiness 91 Victoza – (1)liraglutideantidiabeticRx hyperglycemialightheadedness; hypoglycemia

28 List of Reported Medications Medications Reported Trade Name Medications Reported Generic name Medication TypeRx or OTC Common IndicationsCommon Side Effects Which May Impair Driving 92 Wellbutrin – (2)bupropionantidepressantRxantidepressantagitation, anxiety, insomnia 93 Xanax – (2)alprazolambenzodiazepineRxantianxietydrowsiness, dizziness 94 Zantac – (1)ranitidinegastroesophageal reflux disease (GERD) Rxgastroesophageal reflux disease (GERD) n/a 95 Zegerid – (1)omeprazolegastroesophageal reflux disease (GERD) Rxgastroesophageal reflux disease (GERD) n/a 96 Zoloft – (1)sertralineselective serotonin reuptake inhibitor (SSRI) Rxantidepressantimpair judgment, thinking, or motor skills

29 Indiana Medical Qualification Program

30 Overview In 2011, the Indiana DOT mandated a Medical Qualification (MQ) Program for all of its 45 Section 5311 Grantees. The MQ Program includes: A comprehensive MQ Policy Physical and Cognitive medical assessments for all safety sensitive employees Rx/OTC Medication Policy

31 Indiana Medical Qualification Program Indiana Council on Specialized Transportation (INCOST) conducted a procurement for a vendor to perform medical qualification assessments and other services under the oversight of a Medical Determination Officer

32 Indiana Medical Qualification Program, contd Each Section 5311 system has entered into a contract with the selected vendor Medical Assessments are underway

33 Indiana Medical Qualification Program, contd Assessments Completed September 1, 2011 through January 20, 2012 New Hires 93 Annual 404 Return to Active Status1 Supervisor Observation Concern1 Post Accident0

34 Indiana Medical Qualification Program, contd New Hire Results 89 granted one year qualification 2 were temporarily disqualified and referred for additional testing that resulted in qualifying status 2 were deemed unqualified

35 Indiana Medical Qualification Program, contd Annual Assessment Results 337 granted one year qualification 19 granted three month qualification 1 granted six month qualification 114 were referred for additional testing 44 of the 114 were temporarily disqualified, however 35 of the 44 now meet MQ requirements 3 were deemed unqualified

36 Indiana Medical Qualification Program, contd Referral Reasons Blood Pressure46 Vision23 Hearing19 Diabetes11 Sleep Apnea 9 Physical Abilities 4 Cardiovascular 2

37 Indiana Medical Qualification Program, contd Other Assessments The Return to Active Status employee was granted qualification The Supervisor Observation Concern employee was deemed unqualified

38 Indiana Medical Qualification Program, contd Average number of prescription and over the counter medications reported New Hires average number of medications = 1.78 Qualified for one year employees average number of medications =4.48 Qualified for six months employees average number of medications = 5.69 Qualified for three months employees average number of medications = 6.08

39 Indiana Medical Qualification Program, contd The Indiana Medical Qualification Program Medical Assessment requires individuals to complete a Health Risk Assessment questionnaire. The results of the questionnaire are used as a tool for the Medical Determination Officer to evaluate the overall health of the individual and to provide the individual will wellness information if desired.

40 Indiana Medical Qualification Program, contd The following slides contain a summary of the self reported Health Risk Assessment results from November 1, 2011 through January 20, 2011.

41 Assessment Participants

42 Average Age: Participant Age

43 Average # Risk Factors: 3.3 Self Identified Risks

44 Self Health Rating

45 Top 8 Medical Conditions Reported

46 Top 8 Controllable Risk Factors

47 Participants Readiness for Change

48 Participant Health Visit History

49 Physician Visits Past 12 Months

50 Participant Hospital Admissions Past 12 Months

51 Participant Tobacco Substance Abuse

52 Participant Substance Abuse Alcohol

53 Participant Medication Use as Relaxation Aid

54 Participant Satisfaction with Life and Work

55 Participant Stress Level

56 Medical Determination Officer Comments The Medical Determination Officer identified several conditions that are cause for concern for safety sensitive transit employees. The conditions causing concern in no particular order are: Sleep Apnea Cardiovascular Disease Diabetes

57 Medical Determination Officer Comments, contd Cerebrovascular Disease Hypertension Musculoskeletal Disorder Cognitive Decline Physical Agility Concerns Medication Issues Physician/Patient Relationship Wellness and Self Care Issues

58 Indiana Medical Qualification Before and After Survey Results Indianas 5311 transit systems were asked to complete a survey to determine the impact of implementing the Medical Qualification (MQ) Program. – The survey focused on safety-sensitive transit employees only. The financial impact of implementing the MQ Program. The impact implementing the MQ had on staffing and employee time off from safety-sensitive functions. Management perspective of safety-sensitive employee wellness and safety.

59 Before and After Data The survey captured data for the year prior to implementing the MQ Program (2010) and data the year the MQ Program was implemented (2011) to allow for implementation impact comparison.

60 Survey Participants Indiana has 48 designees required to participate in the Indiana Medical Qualification Program. 42 designees had established MQ Programs at the time of the survey. The designees safety-sensitive staff range in size from 3 employees to 150 employees. Survey participants staff ranged in size from 3 safety-sensitive employees to 150 safety-sensitive employees. 24 designees completed the survey representing 57% of designees with established MQ Programs.

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79


Download ppt "Fitness for Duty Prescription/Over-the-Counter Medication Use and Medical Qualification Robbie L. Sarles RLS & Associates, Inc. May 31, 2012."

Similar presentations


Ads by Google