Temperature out of range

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mctaylor

Temperature out of range

Post by mctaylor » Wed Jun 16, 2010 1:23 pm

Employee in for pre-employment physical, had urine drug screen (non-DOT). Temperature out of range at 108.0 F.

2nd specimen collected under direct observation, temp normal, both specimens sent to lab.

Result of specimen #1 was "NA ... specimen not suitable". This is of course due to the temperature issue.

Result of specimen #2 (observed) was "negative."

We sent both "results" to employer. I cancelled specimen #1 and made comment "Test cancelled, temp out of range, see also result for spec #2 with ID# XXXX."

How should these be handled as far as sending results (particularly in DOT situations) to the employer?.

Section 40.162 appears unclear, at least to me. I understand if both are tested and both are negative, you report the negative. Also, if one is negative and the other is non-negative, you report the non-negative. (The example given in section 40.162 is "substituted.") This was not an "invalid" test so I did not interview. I did not report "refusal" because she agreed to direct observed specimen, which turned out to be negative. Since my situation was non-DOT I realize that it may be up to the employer, but what about DOT situations?

Thank you for any input.

M. Taylor



DrSteve

Re: Temperature out of range

Post by DrSteve » Wed Jun 16, 2010 1:46 pm

I am unclear about the report of the first specimen. Please clarify these results. Did the lab actually test the first specimen? What does NA mean? Not suitable for what reason? Did the lab test the first "hot" specimen, and did it come out negative? The result that you seem to be posting does not make a lot of sense to me. Please clarify. Thanks.

Normally the lab will do validity testing and will test all specimens regardless as to whether or not you tell them it is a temperature-out-of-range specimen. And you would get a real result..... i.e. Negative, Temperature out of Range. If the specimen falls out in the validity testing, you should be told why, and the specimen is reported out as "invalid", "substituted", "adulterated", etc.

Also you have the ability of informing the employer in the non-DOT test as to what happened, as the temperature of the first specimen was 108 F, and they can choose whether or not to proceed with the hiring of this individual. Did the collector confront the donor about this specimen, and what happened at the collection site, and comments from the collector can also help.

Steven Herbets, M.D.

mctaylor

Re: Temperature out of range

Post by mctaylor » Wed Jun 16, 2010 2:10 pm

I spoke with a certifying scientist at the lab and also with the collector. The donor made no comments as to why the temperature was 108. She hesitantly agreed to the observed specimen.

The certifying scientist that I spoke with stated that they tested the "out of temp" specimen and performed validity testing but don't report the results in non-federal because temp was out of range. They reviewed their results with me on the phone and everything was indeed negative on the "hot" specimen also. The results I received had a "NA" next to each drug tested, creatinine 55.3, and neg nitrites/neg chromium. Their comments were, "specimen not suitable, specimen temp not within reference range at time of collection."

It therefore appears that both specimens are "negative." I have not yet sent the results but was planning to cancel the out of temp specimen with a comment re: out of temp and reference the other collection under observation (which was negative). I would then report the observed as negative.

In my few years of performing MRO work, I'm not sure I've actually had anyone stick around if their specimen was out of temperature range.

Sorry for the confusion re: my initial comments. Hope this helps. Any input would be appreciated. It appears if this had been DOT, and both are indeed negative, then you simply report a negative. But do you report two results or just one (the observed collection)?

Mark Taylor

DrSteve

Re: Temperature out of range

Post by DrSteve » Wed Jun 16, 2010 5:59 pm

I guess the labs I use all will report out the results as negative or non-negative after the validity testing, with a note that the specimen was temperature-out-of-range. In this case all you can do is to report out both results to the employer, and I suggest a telephone call from you would also help.

Report out both results, and let the employer decide what to do, based on your recommendations. I would not cancel either test. I would report out both tests.

gwoccmed

Re: Temperature out of range

Post by gwoccmed » Wed Jun 16, 2010 11:53 pm

For the DOT portion of your question, assuming both specimens were collected at the same visit (as DOT would dictate for the situation described), this would be simply reported as a single negative (again, if DOT). For DOT, a truly observed specimen with a lab result is considered solid and final in the absence of another positive specimen at the same collection. If done on separate days (a faulty DOT collection sequence), even if DOT, I would report as two results, etc. (just as Dr Steve and I both might advise for non-DOT on same day). That said, I believe most employers would then still feel obligated to just reluctantly accept it as negative, DOT or not.

One plausible speculation (of many possible) could be attempted substitution to avoid a positive for "X" drug when "x" isn't being tested for . . .
Also, It is desirable to have collectors quickly pour to another cup for abnormal temperatures as a double check for a faulty temperature strip or, if temperature is high, to at least check if the cup felt "hot".

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