Presentation on theme: "Medical Qualification"— Presentation transcript:
1Medical Qualification Fitness for DutyPrescription/Over-the-Counter Medication UseandMedical QualificationRobbie L. SarlesRLS & Associates, Inc.May 31, 2012NTSB challenged FTA to address Rx/OTC medication use as a safety concern for transitStatus of the industry, not necessarily “best practices.”1
2History2002: 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.
3History NTSB Satisfied by Responses, but: Further research needed to establish nature of relationship between Rx/OTC medications and transit accidents.
4History 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.
5History 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.
6History 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.
7History2011: 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.
8History 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 policiesHIPAAADALabor Unions
9Actions to Date Rx/OTC Toolkit issued April 2011 To download the FTA Rx/OTC Medication Toolkit,go to:Click on Drug and Alcohol Program.
10Actions to DateAdvisory Group reviewed Draft Rx/OTC Medication Study and Recommendations April 2011Final Study and Recommendations completed October 2011Follow-up Post Accident Questionnaire initiated December 2011
11General 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
122011-2012 Post Accident Questionnaire 277 Total Systems Contacted for Initial Online Questionnaire: 4,196 AccidentsThese numbers were the total reported to NTD for 2010Of the 277 systems initially contacted:79 Systems responded – 1,820 AccidentsOf the 79 Respondents:67 Systems collect Rx/OTC information – 1,692 AccidentsOf the 67 Systems that collect Rx/OTC information:50 Systems provided follow-up data on selected accidents-1,202 AccidentsThis Survey: 79 RespondentsLast Year’s Survey: 128 RespondentsThis Survey: 343 accidents with reported data from systemsLast Year’s Survey: 243 accidents with reported data from systemsThis Survey, as of Jan 26, 2012: Even with 40% less respondents in the pool, we were able to get data on 30% more accidents than last year’s survey; with a better spread across the various states.
13Summary Of Responses Of the 1,202 possible accidents: Data for 376 (~31%) out the total 1,202 accidents reported to NTD has been provided.Large Urban64%This Survey: 79 RespondentsLast Year’s Survey: 128 RespondentsThis Survey: 343 accidents with reported data from systemsLast Year’s Survey: 243 accidents with reported data from systemsThis Survey, as of Jan 26, 2012: Even with 40% less respondents in the pool, we were able to get data on 30% more accidents than last year’s survey; with a better spread across the various states.Small Urban32%Rural – 4%
15Summary Of ResponsesIs it a standard practice for your system to ask about Rx/OTC information as a part of all Post-Accident investigations?
16Summary Of ResponsesWere 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.
17Reported Rx/OTC Summary Of 376 accidents studied146 instances of medication use reported96 unique medications54 Medications (56%) with potential side effects that may impair drivingDizziness/lightheadedness (30)Drowsiness/fatigue (19)Impair Judgment (3)Cause anxiety/insomnia (2)
18Reported Rx/OTC Summary 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
19Trends & 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).
20Trends & 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.
21List of Reported Medications Bold = Name of Medication as Reported by the Transit SystemMedications ReportedTrade NameGeneric nameMedication TypeRx or OTCCommon IndicationsCommon Side Effects Which May Impair Driving1Accupril – (1)quinaprilantihypertensiveRxhypertension (high blood pressure)dizziness, lightheadedness2Advair – (1)fluticasone/salmeterolbronchodilator/steroidasthma; COPDdizziness3Advil – (2)ibuprofenpain relieverOTCn/a4Aleve – (2)naprosyn pain reliever5ZyloprimAllopurinol - (2)treatment of goutgout6Ambien – (1)zolpidemsedative/hypnoticInsomniadrowsiness, fatigue7NorvascAmilodipine – (3)hypertension (high blood pressure), control angina8Lotrelamlodipine/benazepril – (1)hypertension9Amoxil – (1)amoxicillinantibiotic10ASA - (3)aspirin11TenorminAtenolol – (1)hypertension (high blood pressure); control anginadizziness; lightheadedness12Avandamet – (1)rosiglitazone/metforminantidiabetic hyperglycemialightheadedness; hypoglycemia
30OverviewIn 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 PolicyPhysical and Cognitive medical assessments for all safety sensitive employeesRx/OTC Medication Policy
31Indiana 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
32Indiana Medical Qualification Program, cont’d Each Section 5311 system has entered into a contract with the selected vendorMedical Assessments are underway
33Indiana Medical Qualification Program, cont’d Assessments Completed September 1, 2011 through January 20, 2012New HiresAnnualReturn to Active StatusSupervisor Observation Concern 1Post AccidentActual Pre employment test performed were 95 – information entered for only 93Annual physicals performed through January 20th is 562 but information has only been entered for 404Total all tests performed through January 20th is 659Total tests for Indiana Safety Sensitive positions is expected to exceed 1000 with over 936 of these tests annual assessments of existing employees.95 pre-employment562 annual1 return to active status1 Supervisor Observation Concern0 Post Accident
34Indiana Medical Qualification Program, cont’d New Hire Results89 granted one year qualification2 were temporarily disqualified and referred for additional testing that resulted in qualifying status2 were deemed unqualified
35Indiana Medical Qualification Program, cont’d Annual Assessment Results337 granted one year qualification19 granted three month qualification1 granted six month qualification114 were referred for additional testing44 of the 114 were temporarily disqualified, however 35 of the 44 now meet MQ requirements3 were deemed unqualified
36Indiana Medical Qualification Program, cont’d Referral ReasonsBlood PressureVisionHearingDiabetesSleep ApneaPhysical AbilitiesCardiovascular
37Indiana Medical Qualification Program, cont’d Other AssessmentsThe Return to Active Status employee was granted qualificationThe Supervisor Observation Concern employee was deemed unqualified
38Indiana Medical Qualification Program, cont’d Average number of prescription and over the counter medications reportedNew Hires average number of medications = 1.78Qualified for one year employees average number of medications =4.48Qualified for six months employees average number of medications = 5.69Qualified for three months employees average number of medications = 6.08
39Indiana Medical Qualification Program, cont’d 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.
40Indiana Medical Qualification Program, cont’d The following slides contain a summary of the self reported Health Risk Assessment results from November 1, 2011 through January 20, 2011.
56Medical 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 ApneaCardiovascular DiseaseDiabetes
57Medical Determination Officer Comments, cont’d Cerebrovascular DiseaseHypertensionMusculoskeletal DisorderCognitive DeclinePhysical Agility ConcernsMedication IssuesPhysician/Patient RelationshipWellness and Self Care Issues
58Indiana Medical Qualification Before and After Survey Results Indiana’s 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.
59Before and After DataThe 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.
60Survey ParticipantsIndiana 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.