Facility Profile

Pinellas County Sheriff’s Office

Health services staffers look forward to their new digs. L-R: clinical supervisor Lori McGill, RN; Robin Carlson, LPN; Merry Caldwell, LPN; Sharilyn Woods, RN; and Wendy Freeland, pharmacy technician

Facility: Built in 1979, this large county jail complex occupies 48 acres in Clearwater, FL, a densely populated metropolitan area. Correctional Population: The average daily census is 3,240, about 70% pretrial detainees and 30% sentenced. Average length of stay is 22 days. Annual intake in 2004 was 52,225. The jail also houses DOC inmates returning to the county for appeals and a small number of juveniles adjudicated as adults. A boot camp houses up to 60 juvenile males. Health Care Staffing: Operated in-house, the jail’s health depart-ment has 152 authorized positions, of which 132 are licensed. Included are numerous physicians, mental health professionals, nurses and ancillary and support staff. The nursing roster also has 5 advanced RN practitioners, a nurse educator, an infection control nurse, a case manager and a “health monitor” who serves as a patient advocate. The plan for the new building calls for 7 new medication nurse positions. Unfortunately, of the 102 RN/LPN positions, about one-third are vacant. Health Care Services: Operating 24 hours a day, the department already aims to provide all health services on site, but the new, 432-bed facility will expand on many of these. Features include separate rooms for medical and mental health exams, a three-chair dental operatory, a dialysis room, a physical therapy suite, a 116-bed infirmary with 20 negative pressure isolation cells, a 216-bed special needs housing unit, a 100-bed psych unit, plus laboratory, radiology, pharmacy and more. The only function that will remain decentralized is medication administration. Accreditation: The Pinellas County jail was initially accredited in March 1990, and was last surveyed in September 2003. Quoteworthy: “Accreditation provides a mechanism for ensuring appropriate quality care through compliance with standards.” — Victoria Scotti, RN, BSN, CCHP

Rebuilding Health Services 
From the Ground Up

By Jaime Shimkus

No more squeezing clinical and diagnostic services into retrofitted jail cells. No more shuttling equipment room to room. No more physical therapy sessions in the hall.

When the Pinellas County jail opens its new building in fall 2006, this $30 million facility will be dedicated solely to the health services mission. From the ground up, it has been designed with extraordinary attention to the real needs, present and future, of the large and complex department. Importantly, the health services staff has “been very involved from the start,” says Victoria Scotti, RN, BSN, CCHP, program administrator for inmate health care.

No stone was left unturned in the planning. In a process that took nearly a year, an architectural “programmer” held weekly meetings with various staff members to map out tasks, processes and work flow. The architects then pieced together the essential features of the building.

Armed with this information, a second architectural firm created the final design. Even then, health services provided feedback at every step. For example, Scotti says, “We’d say, ‘Wait, we need more handwashing stations.’”

Scotti was a perfect fit for such an enormous role, says Janice Hill, RN, MPH, health services administrator for the Pinellas County Sheriff’s Office. Scotti oversaw an equally daunting task in 1999, when the jail brought health care back in-house after years of contract management. “We were all scared to death,” says Hill, “but we maintained the program’s integrity and focused on the goal of achieving excellence.”

State of the Art
Since the health care “ideal” and the budgetary “real” do not always mesh, a nurse is assigned full-time to the transition team to represent the department’s interests.

Such thorough guidance will be appreciated by those now working in cramped quarters scattered across the campus. Nearly all health services will be consolidated in the four-story facility, which is designed with plenty of space for not only clinical services but also special needs housing, administration, medical records and much more (see box for details).

It also will have state-of-the-art systems for electronic medical records, medication management, nurse call (probably wireless) and, through a vendor, automated medication packaging. That’s no surprise, given the jail administrators’ positive view of high-tech solutions.

In fact, the EMR system has been in place since December. “It was a natural move,” Scotti says. “For me, it was a safety issue: How can you deliver care when your patients are in one building and their charts are in another?” Since patient records are sometimes needed by different people at the same time, an EMR also ends disputes about whose needs take priority.

Next up: medication administration records. As with the EMR, the MAR will tie into the electronic jail management system now being implemented. In a large jail like Pinellas County this is important because whenever an inmate is moved to a new location, the MAR will ensure that the correct medications follow. For even greater flexibility and accuracy, the med carts will be outfitted with wireless laptop computers.

The policies and procedures manual also is in electronic format. This makes the manual readily accessible at every computer terminal, and ensures that everyone is using the same version whenever it is updated.

Progressive Thinking
The health department demonstrates progressive thinking in many other ways, as well. For example, an RN serves full-time as a patient advocate, fielding inmate complaints and frequent calls from family members, and trying to resolve concerns before they escalate into grievances. Another RN works full-time on case management of hospitalized inmates. Scotti is certain that these efforts prevent countless problems and save money in the long run.

[This article first appeared in the Summer 2005 issue of CorrectCare.]