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The Latest Column
Questions are from the latest Standards Q&A column, posted in January 2019.
Hepatitis Screening on Admission
Our state performs hepatitis testing on admission into our prison system. Approximately 30% of our inmates are positive. Subsequently, our physicians have been ordering tests and treatment for these patients. Do the standards discuss hepatitis screening on admission?
In P-B-03 Clinical Preventive Services, compliance indicator #4 requires that the responsible physician determine the medical necessity and/or timing of screening for communicable diseases, to include laboratory confirmation, treatment and follow-up as clinically indicated. Similar language appeared in previous editions of the standards under the requirements for initial health assessments. The responsible physician decides which diseases to test for on admission.
Standard F-06 Response to Sexual Abuse does require that prophylactic treatment and follow-up care for sexually transmitted infections or other communicable diseases (e.g., HIV, hepatitis B) be offered to all victims of sexual abuse as appropriate.
The 2018 standards mention hepatitis in a few other areas, as well. A-04 suggests that infectious disease monitoring (e.g., hepatitis, HIV, TB) be included in monthly statistical reporting; B-01 recommends that educational programming include hepatitis A, B and C; and E-05 recommends further questioning regarding history of hepatitis and other health problems as a follow-up to the mental health screening.
Infirmary-Level Care Coverage
Does the infirmary standard require RN coverage of the facility’s infirmary 24 hours per day, seven days per week?
Standard F-02 Infirmary-Level Care was updated in the 2018 jail and prison manuals to focus on the level of care provided in a facility, not a physical location. Staffing levels for qualified health care professionals should be based on the number of infirmary-level patients, the severity of their illnesses and the level of care required for each. However, the standard does require that, on a daily basis, a supervising RN ensures that care is being provided as ordered.
One of the most important aspects in determining compliance is the facility’s definition of the scope of services it provides. The general rule is, the sicker the patients, the higher the skill level and hours of coverage for staff required to attend to them.
Discipline-Specific Health Records
In our facility, each of the major disciplines (medical, dental, mental health) keeps its own records separately. Is a unified health record required for accreditation?
In the 2018 manuals, standard A-08 Health Records does not require a unified health record for accreditation, but it is certainly recommended to facilitate continuity of care. Allowing each major discipline to maintain its own records is not only less efficient, but also less effective in that it allows more room for error.
If the facility chooses to maintain records separately by discipline, this is acceptable for accreditation purposes, provided that the following criteria are met:
• Pertinent basic information must exist in all three charts. For example, all three charts would have to list current problems, allergies and medications. We recommend establishing a mechanism to ensure that basic information with respect to treatment in progress is provided by each discipline to the other disciplines.
• Other aspects of health record management would apply to all three charts. For example, all would have to observe the standard with respect to confidentiality of health records, transfer of health records or summaries, reactivation of records and retention of records.