Continuity, Coordination, and Quality of Care During Incarceration

E-09 Continuity, Coordination, and Quality of Care During Incarceration (essential)

Patient medical, dental, and mental health care is coordinated and monitored from
admission to discharge.

—2018 Standards for Health Services for jails and prisons

Coordinated care means integration of medical, mental health, dental and nursing services—along with specialty consultations as needed—to improve clinical outcomes. Because of the nature of providing health care in a correctional environment, care must be taken to ensure that all patient care, especially that ordered or provided by noncorrectional prescribers is adapted as needed to the patient and the circumstances. However, ensuring that a sound system is in place presents many challenges, which we will address throughout this article.

Examples of the Standard’s Requirements

Clinician orders must be evidence-based. It is important for the facility’s responsible physician to base their clinical guidelines on accepted medical practice. This helps guide facility providers toward evidence-based treatment orders. If deviations from evidence-based practices are indicated, clinical justification for the alternative treatment plan while in custody is documented.

Orders must be implemented in a timely manner. The responsible health authority should look at the process for order transcription. Are there any delays due to shortage of staff, knowledge of staff, pharmacy restrictions, transport availability, health record availability and so forth?

Documentation requirements are also specified in this standard. The health record should reflect the following occurrences:

  • Prescriber orders are implemented promptly
  • There are clinically justified deviations from the standard of practice, with the deviations documented
  • Diagnostic tests are reviewed by the treating provider promptly
  • Treatment plans are modified as clinically indicted by diagnostic tests and treatment results
  • Treatment plans, including test results, are shared with patients
  • For hospitalization, urgent care, emergency department or specialty visits:
    • Patients are seen by a qualified health care professional or health care liaison (if appropriate) upon return
    • Recommendations are reviewed for appropriateness in the correctional environment
    • A provider is contacted in a timely manner to ensure proper implementation of any orders and to arrange appropriate follow up

 Engaging patients in the development of their treatment plans allows a degree of ownership on the part of the patient and supports better compliance with treatment plans and better outcomes. Therefore, the health record must confirm that information is shared and discussed with the patient when treatment plans are developed or changed and when test results are received. The standard is clear that all treatment plans and test results must be shared and discussed with the patient; it does not matter if the testing was done for screening or diagnostic purposes. Sharing this information may be accomplished by scheduling follow-up appointments for the patient with the most appropriate qualified health care professional. Letters for screening tests indicating normal results can also be used as long as the letter does not indicate specific disease processes or contain positive results to maintain confidentiality.

Checking the System

This standard has many areas that could be studied in the continuous quality improvement program of the facility. Data collection could begin by conducting chart reviews and identifying areas of deficiency. The chart reviews should be completed by members of a multidisciplinary team as well as by clinicians during clinical encounters to ensure true integration of all aspects of care. Multidisciplinary team meetings are also of great value to discuss complex patients.

While other standards address elements of the patients’ total care, this standard focuses directly on the health staff’s ability to integrate all of these individual compliance standards while ensuring a continuum of care from admission to discharge.

A-07 Emergency Response Plan (essential)

Health staff are prepared to implement the health aspects of the facility’s emergency response plan.
—2014 Standards for Health Services for jails and prisons

A-07 Emergency Response Plan (essential)

Health staff are prepared to implement the health aspects of the facility’s emergency response plan.
—2014 Standards for Health Services for jails and prisons

A-07 Emergency Response Plan (essential)

Health staff are prepared to implement the health aspects of the facility’s emergency response plan.
—2014 Standards for Health Services for jails and prisons