What’s New in the 2014 Jail and Prison Standards

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by Dianne Rechtine, MD, CCHP-A, and Tracey Titus, RN, CCHP

The National Commission on Correctional Health Care has published the 2014 editions of its Standards for Health Services in Jails and Standards for Health Services in Prisons. The revised standards are the product of a task force of experts representing all disciplines within correctional health care.

The Standards lay the foundation for constitutionally acceptable health services systems and are the basis for NCCHC accreditation, which is a voluntary, ongoing process for continuing improvement. They address nine general areas: health care services and support, patient care and treatment, special needs and services, governance and administration, personnel and training, safety, health records, health promotion and medical-legal issues.

Each entry consists of the standard’s number and name, the standard itself, the compliance indicators, the definitions (if any) and the discussion. The “optional recommendations” from 2008 have either been eliminated or incorporated into the discussion section. The intent of the standard remains the first sentence of the discussion.

Each standard is designated as either essential (facilities must meet 100% of the applicable ones) or important (facilities must meet 85% of the applicable ones). Four standards that were classified as important in the 2008 manuals have been changed to essential in the 2014 editions:
• B-04 Federal Sexual Abuse Regulations
• D-05 Hospital and Specialty Care
• E-05 Mental Health Screening and Evaluation
  (jails only – already essential for prisons)
• G-06 Patients With Alcohol and Other Drug Problems

Nine standards were renamed or renumbered:
• B-01 Infection Prevention and Control Program
• B-04 Federal Sexual Abuse Regulations
• B-05 Response to Sexual Abuse
• C-01 Credentials
• E-12 Continuity and Coordination of Care During Incarceration
• G-06 Patients With Alcohol and Other Drug Problems
• G-07 Intoxication and Withdrawal
• H-03 Management of Health Records
• H-04 Access to Custody Information

Two standards were combined into one:
• G-09 Counseling and Care of the Pregnant Inmate
  contains elements previously found in G-07 Care of the
  Pregnant Inmate and G-09 Pregnancy Counseling.

One new standard was added:
• G-08 Contraception

Some changes to the standards were substantial, others were more subtle. These standards were extensively revised:
• A-06 Continuous Quality Improvement Program
• B-02 Patient Safety
• B-05 Response to Sexual Abuse
• C-02 Clinical Performance Enhancement
• C-08 Health Care Liaison
• D-02 Medication Services
• D-05 Hospital and Specialty Care
• E-04 Initial Health Assessment
• E-07 Nonemergency Health Care Requests and Services
• E-12 Continuity and Coordination of Care During Incarceration
• F-03 Use of Tobacco
• G-01 Chronic Disease Services
• G-07 Intoxication and Withdrawal (formerly G-06)
• G-09 Counseling and Care of the Pregnant Inmate (formerly G-07)
• G-11 Care for the Terminally Ill
• I-02 Emergency Psychotropic Medication

Snapshot of Notable Changes
The following are a few of the notable changes in the 2014 Standards. Future Spotlight columns will provide more detailed discussions of standards with important changes.

Many of the changes are designed to elaborate on the expectations for compliance. For example, Standard A-04 Administrative Meetings and Reports has added that health staff meetings must be documented in minutes or summaries and copies must be distributed. Standard A-08 Communication on Patients’ Health Needs now also includes suspected victims of physical or sexual abuse.

A-06 Continuous Quality Improvement Program has changed significantly. This standard no longer requires a basic or comprehensive CQI program based on average daily population in which facilities had to conduct one to two process studies and one to two outcome studies per year. Now, all facilities must establish a quality improvement committee. They must continue to study site-specific problems, but the type of study conducted is determined by the health care problem in question.

In the Personnel and Training section, C-02 Clinical Performance Enhancement was broadened to encompass all direct patient care clinicians, including RNs, LPNs and all qualified mental health professionals. C-06 Inmate Workers was changed to state that inmate workers may continue to assist with activities of daily living but not in the infirmary.

In D-05 Hospital and Specialty Care, a written agreement with the community hospital or off-site specialty services is no longer required, but it is recommended.

In Section E, Patient Care and Treatment, several standards have notable changes. E-04 Initial Health Assessment now requires that all positive findings are reviewed by a treating clinician no matter who conducts the health assessment, and for this standard, a treating clinician is defined as a nurse practitioner, physician assistant or physician. E-12 Continuity and Coordination of Care During Incarceration was almost entirely rewritten to be more patient-centered. Compliance indicator 2 states that deviations from standards of practice are to be clinically justified, documented and shared with the patient. E-13 Discharge Planning now requires a “reasonable supply” of medication, defined as sufficient for short-term continuity upon release.

In F-03 Use of Tobacco, compliance indicator 2 no longer requires that nicotine replacement products are available to all inmates.

G-01 Chronic Disease Services was changed to include monitoring disease control (poor, fair or good) and patient status (stable, improving or deteriorating), as well as taking appropriate action to improve outcome. G-05 Suicide Prevention Program redefined several terms; for example, “actively suicidal” was changed to “acutely suicidal.” New standard G-08 Contraception has a compliance indicator that requires that emergency contraception be available.

I-01 Restraint and Seclusion now specifies that health staff should order clinical restraints and seclusion only for patients exhibiting behavior dangerous to self or others as a result of medical or mental illness.

Complying With the New Standards
Accredited facilities may choose to follow either the 2008 or the 2014 edition of the standards until Oct. 1, when all programs must be in compliance with the 2014 edition. Facilities that are undergoing surveys before October and choose to be accredited under the 2008 standards must submit a transition plan to NCCHC by Oct. 1 outlining the changes that will be made to comply with 2014 standards.

Dianne Rechtine MD, CCHP-A, is a physician surveyor for NCCHC’s accreditation program and serves on the surveyor advisory committee. Tracey Titus, RN, CCHP, is the manager of accreditation services. For more information, write to accreditation@ncchc.org. To purchase the Standards, visit our catalog.

 [This article first appeared in the Spring 2014 issue of CorrectCare.]

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