Receiving Screening

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Our state performs hepatitis testing on admission into our prison system. We are finding that 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 the 2018 standard 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 also makes the decision as to which diseases to test for on admission.

Also note that 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, tuberculosis) be included in monthly statistical reporting; B-01 recommends that hepatitis A, B and C be included in educational programming; and E-05 recommends further questioning regarding history of hepatitis and other health problems as a follow-up to the mental health screening.

— From CorrectCare Volume 32, Issue 4, Fall 2018

 
 

I have reviewed the 2014 NCCHC Standards but I cannot locate the time line for a tuberculosis test to be completed from the date of booking. Am I missing it, or is it the facility’s preference?

The answer varies depending on whether you are referring to a jail or a prison.

For jails, this is addressed in standard E-04 Initial Health Assessment. Whether you are using the full population assessment or individual assessment when clinically indicated, it is expected that TB testing is done at the time of the health assessment unless there is documentation from the health department that the prevalence rate does not warrant it (see compliance indicators #2e and #6e). The health assessments must be conducted within 14 calendar days after admission for facilities that conduct full population assessments, and within two days for facilities that choose the individual health assessment option.

For prisons, the Receiving Screening standard (E-02) states that a tuberculosis test must be completed during the screening (see compliance indicator #11).
— From CorrectCare Volume 31, Issue 1, Winter 2017

 
 

In our state, the law requires that the sheriff’s office house people who are intoxicated but not under arrest. We conduct a brief screening, but are we required to do a full receiving screening?

For jails, the Receiving Screening standard (E-02) requires a receiving screening as soon as possible. This includes anyone being detained, arrested or housed for any reason in the facility. If the brief screening mentioned does not include all of the inquiries required by this standard, then staff would need to conduct a receiving screening on these individuals, as well.
— From CorrectCare Volume 29, Issue 4, Fall 2015

 
 

In the 2014 editions of the Standards for Health Services, compliance indicator #4 of E-02 Receiving Screening says that “If a woman reports current opiate use, she is immediately offered a test for pregnancy to avoid opiate withdrawal risks to fetus.” How is “current” defined? And how is “opiate” defined? Is it used as a broad term to include opioids or is it specific to natural opiates only?

NCCHC does not have an official definition of “current,” but the intent is that if the woman has been using opiates recently, then the pregnancy test should be done. Your physician should help you define a time line.

Regarding the definition of “opiate,” the glossary of the 2014 Standards defines it as follows: “any preparation or derivative of opium, as well as opioid, a synthetic narcotic that resembles an opiate in action but is not derived from opium.”
— From CorrectCare Volume 29, Issue 1, Winter 2015

 
 

What is NCCHC’s position on using corrections officers or deputies for language assistance during the receiving screening process? We do a complete receiving screening of each inmate upon intake and determine acceptance to jail or need for medical clearance. We have deputies who speak other languages and work in our intake area. In lieu of calling an interpreter to come in, which could take several hours, can we use a deputy to be the interpreter between the new inmate and the nurse who is completing the receiving screening process with that inmate?

There are two standards to consider regarding the use of security personnel for language assistance during receiving screening. The first is J-E-02 Receiving Screening. This standard allows health-trained correctional officers to conduct the entire screening; however, in this case, the security officer is not doing the screening and so would not need to be health trained. The other standard is J-A-09 Privacy of Care, which requires that security staff and interpreters are given instruction in maintaining confidentiality when a health encounter is observed or overheard. The scenario you described would not violate either of these standards as long as the correctional officer is given instructions on maintaining confidentiality.
— From CorrectCare Volume 27, Issue 4, Fall 2013

 
 

Standard E-02 says that receiving screenings must take place “as soon as possible.” Can you be more specific about the time frame for these screenings?

In the 2008 Standards, “as soon as possible” is defined to mean that a receiving screening should be promptly conducted without delay. It is reasonable to expect that this could take time when there is a large group of new arrivals; however, it is not acceptable to wait to start the screenings until correctional staff completes the admission process. Individuals should not be released from the intake area until the receiving screening is completed.
— From CorrectCare Volume 27, Issue 2, Spring 2013

 
 

The nurses who do receiving screening at our county jail need guidance on “when is an inmate too intoxicated to screen?” We know that we need to get a set of vitals and ask if there is any significant medical history or allergies, but there are varying thoughts on doing the actual screen. When inmates are intoxicated you really don’t get an accurate screen because they just want to go to sleep.

You raise an interesting problem, but one that has a clear solution. The first step in the receiving screening (see J-E-02) is medical clearance, which assesses whether the person should immediately go to the hospital. If you decide to accept him or her into the jail, and since you really do not know what health conditions this person has, you should isolate the individual from the rest of the intake population, but be sure that he or she is closely monitored by custody and health staff. Many deaths of intoxicated individuals occur in jails. Of course, a good detoxification protocol should be implemented as clinically indicated.

If the person is medically cleared, there are two aspects to the receiving screening: asking questions and observation. If the inmate is too inebriated to reliably answer questions you might have to hold off until he or she becomes more responsive. You should duly note that. However, the observations section still should be completed. The receiving screening is performed to ensure that the individual is not contagious or has a larger medical or mental health problem, and thus determines the appropriate health services that need to be provided. Health staff should still collect the information, whether immediately or later when the person is more responsive, and make a professional judgment about the inmate. Health staff must care for their patients despite barriers to communication, whether intoxicated, mentally retarded or deaf and nonverbal.
— From CorrectCare Volume 26, Issue 1, Winter 2012

 
 

Does NCCHC have a policy or guideline about doing drug screens on intake for inmates suspected of substance abuse problems? Assessment is difficult without testing since drug intoxication and withdrawal often present with mental illness symptoms.

NCCHC standards require that you conduct your clinical practice as you would in any other setting, modifying nonclinical issues as required by the correctional setting but not compromising your clinical guidelines.

Health staff in facilities accredited by NCCHC are often cautious about substance abuse testing, being mindful of standard I-03 Forensic Information and the need to avoid getting into potential adversarial situations with inmates they are trying to treat.

However, your intent is a clinical one: to assess a substance-abusing inmate for diagnostic and treatment planning purposes. An important caution is that the results of such testing are not to be shared with corrections; results should be treated with the same confidentiality as any other blood or urine testing and recorded in the medical record.
— From CorrectCare Volume 20, Issue 2, Spring 2006