A receiving screening should take place for all inmates as soon as possible by qualified health care professionals or health-trained correctional officers. As we know from the E-02 standard, this is a two-step process.
The first step is medical clearance. This should happen as soon as the individual is admitted into the facility (it is often done in the sally port). A correctional officer can quickly inspect individuals to determine who may be too ill to wait for routine screening or be admitted; those identified to get immediate medical clearance are pulled from the group before admission. The medical clearance may come from on-site health staff or may require sending the individual to the hospital emergency room.
Medical clearance is conducted to ensure that emergent health needs are met. Particular attention should be paid to signs of trauma. Those arriving with signs of recent trauma should be referred immediately for observation and treatment. In addition, staff have a responsibility to report suspected abuse to the appropriate authorities. Remember, the medical clearance should be documented in writing.
Structured Screening ASAP
The second step is the actual screening. The receiving screening is a process of structured inquiry and observation designed to prevent newly arrived inmates who pose a threat to their own or others’ health or safety from being admitted to the facility’s general population. It is intended to identify potential emergency situations among new arrivals and to ensure that patients with known illnesses and currently on medications are identified for further assessment and continued treatment. It is conducted using a form and language fully understood by the inmate, who may not speak English or may have a physical (e.g., speech, hearing, sight) or mental disability.
What does “as soon as possible” mean? If a group of 80 detainees comes in, obviously they cannot all be screened simultaneously. Standard E-02 does not define a concrete time frame. However, the screening should be conducted promptly without delay. This means that It is not acceptable to wait to start the screening until correctional staff complete the admission process.
Ideally, the receiving screening is conducted within minutes of an inmate’s arrival; however, a good rule of thumb is that it should take place no more than two to four hours after admission. An individual may be medically cleared, but health staff still need to get an idea of inmates’ urgent health needs, identify and meet any known or easily identifiable needs that require medical intervention prior to the health assessment (see E-04 Initial Health Assessment), and identify and isolate inmates who may be contagious. For example, we do not want a person in need of insulin sitting in a holding cell for hours on end.
Prescribed medications are also reviewed and appropriately maintained according to the medication schedule that the inmate was following before admission (see Compliance Indicator 9 of standard E-02 and also see D-02 Medication Services).
An important concept here is that all inmates are to be screened. This means that all inmates are to receive all elements of the screening as described in the standard. This includes every inquiry and observation as outlined in Compliance Indicators 5a-k and 6a-f. It is not acceptable to conduct an abridged version as soon as possible with the remaining questions being asked several hours later or the next day. Another process that would not meet the intent of the standard is where inmates are asked some of the questions and only a “yes” to certain questions triggers a complete receiving screening. It is certainly acceptable to conduct more in-depth screening later, as long as the screen as described in the standard is being completed promptly.
The receiving screening inquiries include current and past illnesses, health conditions or special health requirements (e.g., dietary needs); history of or current suicidal ideation; past or current mental illness, including hospitalizations; allergies; legal and illegal drug use (including type, amount and time of last use); dental problems; drug withdrawal symptoms; current or recent pregnancy; past serious infectious disease; and recent communicable illness symptoms (e.g., chronic cough, coughing up blood, lethargy, weakness, weight loss, loss of appetite, fever, night sweats). Other health problems on the screening form should be designated by the responsible physician.
Observations include that of appearance (e.g., sweating, tremors, anxious, disheveled), behavior (e.g., disorderly, inappropriate, insensible), state of consciousness (e.g., alert, responsive, lethargic), ease of movement (e.g., body deformities, gait), breathing (e.g., persistent cough, hyperventilation) and skin (including lesions, jaundice, rashes, infestations, bruises, scars, tattoos and needle marks or other indications of drug abuse). It is good practice to train screeners not only to observe but also to ask additional questions. An example is when an individual does not have a rash visible to the screener. Asking questions will elicit the best possible screening.
Screeners should make adequate efforts to explore the potential for suicide. This includes both reviewing with an inmate any history of suicidal behavior and visually observing the inmate’s behavior (delusions, hallucinations, communication difficulties, speech and posture, impaired level of consciousness, disorganization, memory defects, depression or evidence of self-mutilation). Screeners should also investigate the potential for individuals to be exhibiting symptoms of withdrawal from alcohol and other drugs. These approaches, coupled with training in aspects of mental health and chemical dependency, enable staff to intervene early to treat withdrawal and to prevent most suicides (see G-05 Suicide Prevention Program and G-06 Intoxication and Withdrawal).
The training given to correctional officers who conduct the receiving screening depends on the role they are expected to play in the process. At a minimum, they should receive instruction on how to take a medical history, how to make the required observations, how to determine the appropriate disposition of an inmate based on responses to questions and observations and how to document their findings on the receiving screening form. When health-trained correctional personnel perform the receiving screening, they are to call health staff for disposition of the inmate if problems are identified (Compliance Indicator 4). Because newly arrived inmates may need urgent medical assistance, correctional officers in the reception area should have current training in first aid and CPR.
Finally, it is important to train all of your screeners to record the disposition of the inmate (e.g., immediate referral to an appropriate health care service, place in general population) and the date and time of the screening with their signature and title (Compliance Indicators 7 and 8) on the receiving screening form. Timeliness of the receiving screening makes a great CQI process study.
[This article first appeared in the Winter 2011 issue of CorrectCare.]
E-02 Receiving Screening (essential)
Receiving screening is performed on all inmates on arrival at the intake facility to ensure that emergent and urgent health needs are met.
—2008 Standards for Health Services for jails and prisons