In the 2008 Standards for Health Services, the standard on Medication Services (D-02) contains a new compliance indicator: Inmates entering the facility on prescription medication continue to receive the medication in a timely fashion as prescribed, or acceptable alternate medications are provided as clinically indicated.
Newly admitted inmates who report taking medications currently or who bring medications with them are to continue their medication unless there is a clinical reason to alter or discontinue the medication. Note that the E-02 Receiving Screening standard states in Compliance Indicator 9 that “prescribed medications are reviewed and appropriately maintained according to the medication schedule the inmate was following before admission.” Protocols should be in place so that the drugs are administered in a timely fashion as dictated by clinical need. Clinical need is the key factor; therefore, medications should be prescribed only when they are clinically indicated.
There are different options to ensure that inmates who are admitted on prescribed medication continue to receive necessary drugs. Perhaps the physician or on-call physician is contacted by health staff for a verbal order once they have verified the medication through the community prescribing clinician or pharmacy. Another option is authorizing nurses to give medications based on the community clinician’s valid order until the facility physician is able to see the inmate. Some facilities do allow the use of medication that is brought in if it is contained in the original pharmacy packaging, labeled as required and staff have verified the order with the community prescriber or pharmacist.
A physician, dentist or other legally authorized individual may determine that a prescribed treatment is no longer clinically indicated or that there is an alternative to a medication that the patient was taking before incarceration. It is good practice to explain to patients the clinical justification behind discontinuing or prescribing alternate medication so that they understand that health care decisions are made based on their health needs and not for any punitive reason.
Importance of Continuity
Continuity of care is an important concept in this standard as it intends to help prevent adverse patient outcomes. For instance, it may not be possible to maintain a therapeutic dose of medication unless medications are taken as prescribed. Inordinate delays in receiving clinically indicated prescription medication may result in significant morbidity or mortality. Adverse patient outcomes can also occur when there are frequent changes in medication orders, medication histories are not reviewed by the clinician or treating clinicians are unaware of each other’s prescribing practices.
We all understand the importance of patients continuing to take medication as prescribed for health conditions such as high blood pressure or diabetes. There are also many other prescription medications that could have adverse health consequences if abruptly discontinued or not taken in a timely manner; steroids, antidepressants, antibiotics, and others require strict regimens in order to remain effective or prevent side effects. The facility provider will evaluate the medical necessity of prescriptions for newly admitted inmates to ensure that there is continuity of care and that health needs are met.
Medication services should, of course, be clinically appropriate and provided in a timely, safe and sufficient manner commensurate with current community practice. Therefore, the responsible physician should establish the policies regarding all prescription medications administered or delivered in the facility.
[This article first appeared in the Spring 2009 issue of CorrectCare.]
D-02 Medication Services (essential)
Medication services are clinically appropriate and provided in a timely, safe, and sufficient manner.
—2008 Standards for Health Services for jails and prisons