|Medication Administration Training|
|Privacy of Care|
|Transgender Health Care|
|Use of Tobacco|
The Latest Column
Questions are from the latest Standards Q&A column, posted in March 2019.
Site-Specific Emergency Plans and Drills
Standard D-07 Emergency Services and Response Plan for jails and prisons requires that mass disaster drills are conducted so that each shift has participated over a three-year period. This is what our jail has been doing. However, a new jail has been constructed, and the old one no longer houses inmates. We rehearsed the new disaster plan in the old building about four months before moving into the new one. Can we count that rehearsal as a drill or must we have another drill in the new building?
The intent of this standard is to ensure that all staff are prepared to effectively respond during emergencies. Some considerations in a good mass disaster plan can be verified only by rehearsing the plan within the specific environment.
For example: Does everyone know where the emergency equipment and supplies are? Is the equipment operable? Are the needed supplies available? Where will triage be performed? Where will injured people be taken? If not on duty at the time of the disaster, which members of the health staff will be called? Will security measures, such as automatic doors, impede transport of casualties? The layout of the building and the security measures may be different, necessitating new procedures that differ from what was envisioned before the facility opened.
Although classroom exercises and staff discussions can be useful, they are not sufficient to meet this standard. Therefore, another drill should be held in the new facility.
CQI Program Development Tips
As the health service administrator of a large jail, I have been asked to develop a continuous quality improvement program as we prepare for NCCHC accreditation. Can you give me some guidelines on where to start?
It is good to hear that you are preparing for NCCHC accreditation. A continuous quality improvement program (standard A-06) is essential as you make changes in your system. However, you may already have some of the elements of a CQI program in place, but you may not be thinking of them as CQI
For example, does your facility have a grievance process for health care complaints? If someone is keeping track of the grievances, you may be noticing a pattern that could indicate an aspect of your services that needs improvement. Are you receiving environmental inspection reports? Do the same issues keep appearing in the reports? Are you noticing inmates from a particular housing area presenting at sick call with similar complaints? This could indicate that either a contagious condition is spreading in that unit or something in the environment is causing the problem.
Many of the ordinary, day-to-day activities of a facility, including monitoring compliance with NCCHC standards, fit nicely into a CQI program. Other areas that could be monitored are high-risk, high-volume, problem-prone aspects of the various services provided: medical, dental, mental health, pharmacy, food service, disaster readiness, etc. Just keep in mind that CQI is more than just monitoring. You are looking for areas to improve (i.e., areas that are falling below threshold levels). Those areas could be turned into the CQI process or outcome studies that are required in standard A-06.