What is the shy bladder protocol?

The U.S. Department of Transportation (DOT) has specific procedures for urine specimen collection and urine testing. The shy bladder protocol is a subset of guidelines that come under their urine collection procedures. It refers to the procedure that occurs when a person is unable to provide a sufficient quantity of urine specimen (45 ml). This can occur if the person providing the urine sample says that they "can't go."

During the DOT urine specimen collection, a person who says they "can't go" is required to try anyway. If they are unable to produce a sufficient urine specimen, the "shy bladder" protocol starts from this point.

The process must be documented, and the employee needs to be informed when the three hour shy bladder time frame starts and ends. Note that specimens cannot be combined from different times. The specimen needs to come from one collection.

Procedures for "shy bladder"

1. Discard the insufficient specimen unless another problem exists (e.g. the specimen is outside the temperature range or appears to have been tampered with/is an adulterated specimen)
2. Ask the employee to drink up to 40 ounces of water. This can occur up to a three hour time frame, or until the employee provides a sufficient specimen (whichever comes first).
3. If the employee refuses to provide a specimen or leaves the testing site or collection site within the three hour time frame before a specimen is obtained, this is recorded as "refusal to test." Note that refusal to drink fluids is not a refusal to test.
4. If the employee has not provided a sufficient urine specimen by the end of the allotted three hour time frame, this marks the end of the shy bladder procedure. It must be recorded and the Designated Employer Representative (DER) must be notified.
5. From that point, the employee is asked to obtain a medical evaluation within five days, from a licensed physician. The aim is for the physician to evaluate any medical reasons that may be the cause of the employee's inability to provided a sufficient urine specimen.

Full details of DOT's urine specimen collection guidelines and the Shy Bladder Protocol were updated in January 2018.