Dr. Anno chaired the NCCHC task force that spearheaded the 2008 revision of the Standards for Health Services. A cofounder of NCCHC, she is now a senior partner in Consultants in Correctional Care, Santa Fe, NM.

Every five years or so, the National Commission on Correctional Health Care revises its standards for correctional health services. The 2008 versions for prison and jail settings are now available.

From now through Nov. 7, jails and prisons seeking continuing accreditation will be surveyed based on the 2003 editions of the standards, although they also must submit a plan for meeting the requirements in the 2008 edition. After Nov. 7, all surveys for continuing accreditation will use the 2008 version. Jails and prisons applying for accreditation for the first time must comply with the 2008 editions of the standards.

Users familiar with the 2003 versions will note several changes in the 2008 editions. While some of their concepts have been retained, five standards were deleted: Environmental Health and Safety, Kitchen Sanitation and Food Handlers, Ectoparasite Control, Exercise, and Personal Hygiene. These areas are generally under the control of correctional staff rather than health staff.

In other instances, two or more standards were combined. For example, informed consent and the right to refuse treatment are now addressed in a single standard, because they are two sides of the same coin. Similarly, there is now a single standard addressing the management of the heath record rather than three separate ones on availability, transfer and retention. Also, two new standards were added: one on patient safety and one on staff safety.

Exciting Changes
Some of the more exciting changes, though, were made to existing standards. The 2003 standard on continuous quality improvement was complicated and required numerous studies on a variety of topics. It was clear to the task force that revised the standards that the prior CQI standard promoted “paper pushing” rather than problem solving. In the 2008 editions, facilities housing more than 500 inmates must complete at least two process studies and two outcome studies that are specifically designed to address problems at their facilities. Facilities with fewer inmates must undertake at least one study of each type. NCCHC hopes this will make CQI more relevant for the correctional health care field.

Another significant change involves the receiving screening and initial health assessment standards. Jails and prisons now have two options. As previously, they must complete a receiving screening on all new admissions upon arrival and, as before, they may do an initial health assessment within seven (prisons) or 14 (jails) days on all inmates; this option is called full population assessment.

Alternatively, they can choose to do initial health assessments only when clinically indicated. To be eligible for the latter option, facilities must have 24-hour, seven days per week health staff coverage and must complete an expanded receiving screening, which includes further inquiry into past history and symptoms of chronic diseases, a finger stick on individuals with diabetes, vital signs including blood pressure, and further inquiry into medication history and dosages. Also, only licensed health care staff can complete the expanded receiving screening. If this option is selected, inmates identified with clinically significant findings as a result of the expanded receiving screening must receive an initial health assessment no later than two working days after admission.

NCCHC is particularly pleased with this change. Facilities can choose whether they want to put their diagnostic dollars into completing a full health assessment on all inmates, or whether they want to do an expanded receiving screening on everyone and a quicker health assessment only on those with clinically significant findings. When the new option was introduced at NCCHC’s Updates conference in San Antonio, Lynn Sander, MD, CCHP, past president of the Society of Correctional Physicians, stated it was the most significant change to NCCHC’s standards that she had seen in 20 years. We hope that is true for a lot of facilities. [See Spotlight on the Standards for more about the Initial Health Assessment standard.]

There were changes to other standards as well, both big and small, but they are too numerous to go into here. We tried to clarify the language and make the requirements for compliance more explicit based on users’ feedback on the 2003 edition. As always, NCCHC is interested in your feedback on the 2008 editions. It is our hope that through our continued dialogue, together we can continue to advance the quality of the correctional health care field.

To order a copy of the standards, see the Publications Catalog or call 773-880-1460. If you have questions about the standards, please send an e-mail to accreditation@ncchc.org.

[This article first appeared in the Spring 2008 issue of CorrectCare.]