How is Drug Testing like Halloween? Both can be scary at times; especially
when problems arise. In many cases, the drug testing process is straightforward and stress-free. The individual goes to a collection site (or a collector comes onsite to your location), the specimen is collected, the paperwork is completed correctly, the sample is sent to the lab for testing, then results are reviewed by a certified MRO, and you get the
results. But what happens when something does not go as expected, or a problem arises? Knowing what may go wrong, and how to handle it when it does, is essential for any company or drug testing provider.
What Could Possibly Go Wrong?
There are three main areas where something may go wrong in the drug testing process or pose a challenge to an employer. These are the collection process, the laboratory testing and MRO review, and employer/employee test issues.
Collection Process Issues
Collectors should be trained to accurately complete the collection process. For Federal or DOT collections, they must meet specific qualifications including training and completion of proficiency demonstrations. Issues can arise even with trained collectors. Unfortunately, some collectors are not properly trained and make easily avoidable mistakes. Most problems in drug testing arise from errors in the collection process. Some of the most common errors include A) failing to properly complete the custom control form, B) not packaging the specimen up properly or insufficient amount of specimen packaged up, C) not knowing how to handle situations that arise during the collection process such as temperature out of range or a shy bladder, D) not providing proper documentation, E) not sending custody and control forms to the employer or medical review officer.
Both employers and drug testing providers can help minimize the chances of these errors by using properly trained collectors, reviewing custody & control forms (CCF) once collections are completed, auditing their collection sites, and when errors do occur, making sure proper error correction training is provided. You can find more information on these errors and how to avoid them in articles and videos found on the NDS Blog.
Laboratory & MRO Review Process Issues
Laboratory errors are not very common but there are issues that arise related to the testing process. These include the specimen not making it to the laboratory for testing or something happening to the specimen while in transit resulting in an insufficient quantity of specimen to complete the testing. Other issues that may arise at the laboratory include:
A. the lab being unable to determine an accurate and legally defensible result from the specimen provided resulting in a test result of “invalid”
B. an insufficient amount of specimen to complete required confirmation testing (typically happens with expanded panels and alternative specimen types such as hair).
When the laboratory receives a specimen and custody & control form, they review it for completeness and accuracy before moving the specimen into testing. If there is something materially missing from the form, then that will halt the testing process until it is resolved or if it cannot be resolved, it may result in a correctable flaw or fatal flaw / cancelled test.
Examples of issues may include:
A. The temperature box on the form not being marked or a collector signature or name missing
B. required remarks missing.
C. during the testing process, if the initial screen is non-negative, then confirmation testing will be required. This may only take 1 to 2 business days, but in some instances may take 4-6 business days to determine an accurate result. This delay, although completely legitimate, may result in challenges for the individual being tested, the employer, or TPA.
Once the laboratory has a valid result, it is reported out to the employer, TPA or the Medical Review Officer depending on the test result and how the account is set up. All Federal testing, including DOT test results, must always go to a Certified Medical Review Officer prior to being released. For employment related testing (with a few exceptions), all lab confirmed positive tests should go through a Medical Review Officer to evaluate and determine if there is a legitimate medical explanation for a positive test result. Challenges that may arise during this process may include:
A. not being able to reach the employee to verify information necessary to release the result,
B. not receiving the MRO copy of the CCF,
C. determinations that additional testing is needed; such as D&L Isomer Testing or testing of a split specimen requested by the employee.
Any problems during the collection process, lab testing, or MRO review process affect the employee being tested and may create challenges for the employer.
Employer/Employee Test Issues
A frequently asked question from employers is “I received a positive test result. What do I do now?” Employers should have a policy in place to answer this question. But even with a policy, other considerations may come into play such as unions, state laws, or federal laws. What is usually scarier is determining how to properly handle situations such as when the donor left the collection prior to providing a specimen: this could be due to a shy bladder, the person just leaving, or other reasons. The Designated Employer Representative (DER) of the company NOW must make the determination as to whether it was a refusal to test, which can have serious consequences, especially for Federal/DOT testing.
Other challenges may involve, receiving a notice of a safety concern from the MRO, employee claims of a false positive or that the collection site “messed up” the collection, need for a Shy Bladder evaluation, or collector error that resulted in a canceled test. These are just some issues you should be prepared to handle. Make sure to visit our other articles and videos that go more in-depth on drug testing issues and offer solutions and suggestions to best handle them.
Be Aware So that You Can Beware
Dr. Robert Rohm once stated, “You cannot beware of something until you are first aware of it”. Now that you are more aware of things that may go wrong or lead to problems, you can proactively take steps to prevent these from occurring and implement processes to best handle things outside your control when they do happen. Being aware of issues that may arise during the drug testing process is the first step. Now it is time to take action so that issues do not become challenges or even worse, scary problems!