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How we marketed drug abuse testing.

Careful laboratory planning, a commitment to quality, and extensive documentation are ingredients of a successful drug testing program.

The author is aboratory director at Union Hospital in Dover, Ohio.

Our 220-bed hospital has a psychiatric unit, and the pathologists also handle the forensic workload for five counties. Thus the laboratory has long done toxicology testing, which made drug abuse screening a logical extension of our services two years ago.

Such screening met a need in our community-where the most abused substances seem to be alcohol, marijuana, and benzodiazepines-and proved profitable for our laboratory . In fact, drug screening will meet a need in any community since the problem of drug abuse pervades the entire nation.

Where does a laboratory start, however, if it is interested in tapping this market? How does a lab provide quasity drug testing service? What are the pitfalls to avoid, what are the risks, and what are the benefits'? The following answers to these questions are based on our own experience.

*Preparation. The first steps in marketing are to determine whether there is a need for a particular product or service, and if so, whether it is financially feasible to satisfy that need, Once an organization decides to provide a product, marketing includes public relations, customer relations, and development of goodwill.

Our laboratory started outside testing a decade ago with a reference service and courier system for physicians' offices. Three years ago, we began publishing a monthly newsletter that features anatomical and clinical articles written by the pathologists. Some 150 copies are distributed to nursing stations and local physicians' offices, giving the lab both internal and external exposure.

Periodic market surveys to monitor changing client needs and assess our performance led us to establish a consultation service for physicians' office laboratories. This brought in even more referrals.

Next, the laboratory blitzed the local media, sending out press releases about the latest technological advances and new services available to the community. We performed cholesterol screening at area malls and fairs, and participated in local business expositions. At times, we had to fight for approval of our plans, but the community response persuaded hospital administration that we were on the right track (the laboratory's first cholesterol screening drew 1,800 participants).

All this exposure paid big dividends: In 1986, we posted increases of 9.7 per cent in overall test volume and 11.6 per cent in laboratory revenue. The trend continued in 1987, with increases of 18.5 per cent in volume and 14. 1 percent in revenue.

Thus were we encouraged to add and market drug testing.

* The market. News reports and publicity about the widespread drug problem have marshaled support throughout much of our society for screening. As a result, extensive market research isn't necessary because what the customer needs is already known in general terms, and the marketable product or service has already been identified as drug testing.

The laboratory should, however, perform an internal audit to assess its strengths and weaknesses and determine whether it is willing and able to enter this highly technical area of service. This wasn't a pressing need in our case: We knew we could handle the work because we had the instrumentation and personnel in place for our toxicology program.

We decided to aim our marketing efforts at two local targets-area high schools and local business and industry. Acting as an information source and technical consultant, we sent fact sheets on drug abuse and testing to the schools and to about 60 firms listed with the Chamber of Commerce. This was followed by phone calls and invitations to attend a detailed presentation. Our laboratory also sponsored roundtables for companies in one or another particular field. Whenever a contact expressed interest in drug testing, we offered to help set up the program.

As consultants, we emphasize to clients that they should be clear on what they expect out of a drug screening program. Most, we have found, are not prepared to deal with the very real possibility that one of their employees will test positive. When a positive result is reported, they panic and want to fire the person on the spot, which may lead to legal problems. That's why we urge prospective clients to seek guidance from their legal counsel and to write concise procedures and policies that do not conflict with existing personnel policies.

While management can generally set whatever terms it wishes for preemployment drug screens, testing of current staff members is another matter. To get a program started often requires union negotiations. It is important to educate employees about the new policies, to receive their input, and to maintain strict confidentiality. In addition, if a large company plans to conduct drug screens, we strongly recommend setting up a drug counseling program in advance.

We give our clients a course in chain of custody, preemployment versus for-cause testing, and important technical considerations. One such consideration is that a negative result does not always eliminate cause for concern-clients must understand the limitations of atest's sensitivity. Another consideration is that a positive result does not absolutely prove that an employee is impaired or unable to perform as required on the job.

During the education sessions, we stress the need for quality, and we promote the quality of our program. We also discuss common concerns that underscore the need for counsel-for example, what can and cannot be done to guard against tampering during collection of a urine specimen.

*The laboratory. How does the laboratory fit into this marketing activity? First of all, no lab should contemplate such a program unless it is committed to providing a high-quality service amid strong constraints. Thorough quality control, quality assurance, proficiency testing, and the capability to confirm all positive results are but a few of the musts.

Other recommended components of a drug testing program include technical training (with documentation); a separate refrigerator for drug testing specimens that can be locked to restrict access; special protocols for specimen collection and chain of custody; and limitations on access to the test area, including instrumentation, performance logs, and patient files.

We do all of these things. For example, certain chemistry technologists handle the drug testing. The section supervisor has overseen their training, and we consult with a clinical chemist at a large hospital in Akron. Only three individuals have keys to the refrigerator/freezer that is used solely for drug specimens; if a specimen comes in late at night, lab personnel must call security to unlock it.

Everything should be documented. Records to be maintained in the laboratory include accreditations by such agencies as the College of American Pathologists and (if sought and obtained) the National Institute on Drug Abuse; personnel qualifications and certifications; and specialized training on specific instruments and procedures.

It is also important to keep on file instrument calibration and maintenance records; reagent calibration and verification records; current procedures; quality control and proficiency survey results; reports of any quality assurance incidents that arise; chain of custody records; and copies of test results. Think twice before discarding any piece of paper that may even remotely be connected with your drug testing service.

Specimen collection and integrity, chain of custody, and confidentiality of reports are three key areas where care must be taken to insure the integrity of the program. These are also the hardest to control, because they involve a number of persons at multiple sites.

We ask clients to have their employees sign a medical release form before specimen collection. The client keeps the originals and forwards copies for the laboratory's file. This form explains the drug testing program and provides the basis for releasing private information (test results) to a designated individual.

Most specimens, however, are collected outside the laboratory, away from our direct supervision. We have received two-day-old specimens for testing and seen others suspiciously watered down. It is essential to keep working closely with clients and teach their personnel how to obtain an adequate specimen and maintain its integrity.

Everyone who comes in contact with a specimen or the test resu Its-from the time of collection until the report goes to client-must sign and date the chain of custody form shown in Figure 1. The laboratory sends a copy of this form to the client.

If a laboratory lands in court over its drug testing program, it will appreciate the importance of this piece of paper. The opposing attorney's job is to prove or imply that someone tampered with the process somewhere along the line. Documentation is the only way the laboratory can establish this could not have happened.

There are two fundamental ways to protect a test subject's privacy and confidentiality of information. First, never release laboratory results over the telephone. You would be surprised at how many clients want you to do just that, particularly in preemployment screening. Second, keep all logs, reports, and files locked up at all times, and limit who has access to them.

Of course, lab control over access ends once the reports go out. It's a good idea to make sure test results are delivered directly to the designated recipient-generally the company physician or nurse or the head of personnel, all of whom should know how to handle patient records. We entrust delivery to a courier and provide explicit instructions on who is permitted to sign for the reports.

* The risks. Without the proper planning, commitment to quality, and documentation, entering the market can be very risky because of the legal nature of drug testing and the implications of a positive result. Even with the best planning and quality, you can expect to spend some time in court (we have been lucky-no court appearances yet).

The subject of drug testing is hotly debated, and as a client's intentions are questioned, your laboratory will be asked to testify about its involvement in the drug testing program. The client's witness in court is likely to take the position that his or her firm was only following the laboratory's recommendations.

Your laboratory's product is information-the contents of a report. If that information is about drug levels in employee specimens, the burden of proof is on the client to link it with some degree of work impairment. Make the lab's role clear during the initial consultation when you discuss what the client wants versus what the testing program can provide.

Some employers, looking for a dishonest laboratory, request advice on how to beat the test or a guarantee that there will be no positive results. Many employers seek overnight turnaround, particularly on preemployment screens so they can make a prompt hiring decision. That's understandable, but it takes 48 to 72 hours to get negative results back to the client, and as much as five to seven days, depending on the confirmatory procedure used, to get positive results back.

Positive screening results are presumptive and must be confirmed by a different method of equal sensitivity. Be sure to document use of an acceptable confirmatory method on your screening report form (Figure 11). If you do not and a positive result is challenged in court, the opposing attorney will make your tab look foolish. Word of such a setback will quickly reach other clients and cause your drug testing program irreparable harm.

*The benefits. Our program opened with two corporate clients and one hospital client. It now serves 11 local businesses, three hospitals, two drug counseling programs; and a regional hotel chain. Drug screening volume climbed from 400 tests in 1986 to 1,600 tests in 1988, and revenue in the same period grew from $6,000 to $48,000. In addition, some of our clients have asked us to provide wellness profiling.

With proper planning, a commitment to quality and integrity, and extensive documentation, any laboratory can enjoy a long and profitable relationship with its drug screening clients.
COPYRIGHT 1989 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1989 Gale, Cengage Learning. All rights reserved.

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Author:Bennett, W. David
Publication:Medical Laboratory Observer
Date:Feb 1, 1989
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