The Latest Column
Questions are from the latest Standards Q&A column, posted in March 2020.
orientation for health Staff
My question is about the orientation packet that our company states is mandatory per NCCHC standards. We are told to sign all of the different spots on the packet stating that we have been oriented to these areas of the facility, but the orientation does not actually do this, and in fact it is conducted as quickly as possible without any structure. Is this the intent of the standard?
Orientation into a correctional health care setting is very important and should not be handled lightly or loosely. Standard C-09 Orientation for Health Staff states that health staff are properly acclimated to work in the correctional environment and understand their roles and responsibilities. A basic orientation should be conducted on or before the first day of on-site service. Within 90 days of employment, all health staff should complete an in-depth orientation. The orientation program should be documented and kept on file. If the orientation for your new health staff is not living up to this standard, you should consider reevaluating your orientation plan. Your staff deserves it.
privacy of Care
Our county jail is accredited by NCCHC. I work in the intake department, usually in an office where there is privacy when doing the medical history. When the jail is short-staffed and there is no deputy available to sit outside my office, I am expected to use an area that is not private at all. The inmate sits in a cubby and the nurse is behind a window. Behind the nurse sits office personnel and they can hear everything that I say and what the inmate says about their medical and mental health history. Does this comply with the standards?
This is a good question and a situation that we heard described before. Standard A-07 Privacy of Care states that health care encounters and exchanges of information are to remain in private. This includes discussions of protected patient health information and clinical encounters. Privacy should be afforded during physical exams, with special considerations for breast, rectal, pelvic or other genital exams. We understand that extenuating circumstances sometimes prevent this, but it should be the exception and not the norm.
initial health assessment
If an RN performs the initial health assessment after documented training, does the MD still need to sign off on the health assessment? I know this was a previous requirement, but I no longer find this in the 2018 standard.
This was one of the changes to the 2018 edition of the jail standards. Standard E-04 Initial Health Assessment says that a physical examination is to be performed by a qualified health care professional (defined as a physician, physician assistant, nurse practitioner or nurse). There is no compliance indicator that says a physician has to sign off on the assessment. The responsible physician does, however, need to determine the components of the initial health assessment.