Medication Administration in Correctional Medicine

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    hello all. i was wondering if you all could provide me some input on how you administer medications in a correctional setting - preferably a jail, rather than a prison. here is a scenario: we operate a pill team at our facilities, whose job it is to administer unit doses to inmates and document the administration on the mar. we receive blister packs of patient-specific meds from our off-site pharmacy with the appropriate pharmacy label (rx#, name, drug, strength, dose, instructions, etc.). it is common practice for the nurse (rn or lpn) to pre-set or pre-pull a unit dose of the medication to be administered - sometimes 24 hours ahead of time. for example, at one of our facilities, the nurses pre-pull the medications from the blister packs and put the unit dose of the medication in an envelope (like a coin envelope) and labels the envelope with the patient's name, drug, dose and instructions. this envelope is then taken to the housing unit/pod for distribution to the patient. is this routinely and customarily done in other facilities? i would sure appreciate your comments and input. thanks.
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    At our Violator's of Parole and our Work Release, most meds are given at a pill call, two big ones daily and one small one mid day. Very few of the Work Release inmates might have keep on person cards of meds. Work Release is prepoured and most of them observed taking them, sometimes an additional dose is given in an envelope if they have to go to work. The violators are observed swallowing everything. With the exception of narcs or a very few other things, everything is patient specific.

    Sounds like alot of work making all those envelopes everyday, and I suppose each drug would have to be in a differently labled envelope if they get several different meds? A couple pill calls might save a lot of work, even if you were walking through the facility and just got to reuse some of the envelopes for a couple days.
    Last edit by **nurse** on Oct 24, '06
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    when i first worked in the jail that is what we did. it is so many inmates and one nurse. i did it initially because i was new and i didn't want to tie up the limited deputy's that were there with my pill call. the administartor was aware and she was the one who trained me and so that's where i learned it. After about a month i was pretty oriented to the med cart on where to go if someone was out of there meds. i work evening shift and have to pass meds to over 300 inmates. my 4pm pill call is simple-just diabetics and HIV meds. my 8pm is the kicker because where not all 300+ inmates may beon ordered meds all of them come up for something-CTM, TUMS, TYLENOL, MOTRIN. Some of them need it and some of them just want it. I have a pretty good system so I don't have to prepour anymore.

    When we did the envelope thing we iddn't write their names on the envelope we just clipped them to that person's individual MAR.

    We had to start carrying a huge water pitcher on our cart so that the guys couldn't walk awy from the cart or "4get to get water" and also to keep them from spitting the pill back in their cup (which was dark) we had to give them clear plastic cups. On Fridays I would prepour so I could get out of there by just putting their meds in their cup that I labeled and that way they had their med and their cup and that's it.
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    We have a med cart for each pod along with a binder with all the MAR's in them. The med cart is stocked with all of the different meds in blister packs. We just take the med cart to each pod, inmates line up and we just go thru the MARs, popping out the pills from the blister packs into little pill cups. The inmates approach the cart one at a time, show us their wrist bands with names on it, we look up the MAR and give them what is needed.
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    Hi,
    About 3 months ago I took a correctional facility. My biggest concern is passing meds to about 500 male and female inmates. We also have the pre-pouring system and we also use little envelopes paper clipped to the individual mars. Maybe the daytime med pass is easier, but those sleeping aids and psych drugs are quite popular. It's not unusual for me to spend more than 1/2 hour on some pods. My question is -what is the average amount of people a nurse is responsible for? What do you do when the guard isn't nice and reprimands the nurse because a person's meds are not available, or maybe the paperwork hasn't caught up with that person yet?

    In this facility, all paperwork is transferred by the med nurse and is supposed to follow an inmate around the various floors and pods of the jail. Our jail has 8 floors of pod areas and right now our census is about 3,000. For general population, (those not housed in the infirmary, detox, or mental health) there are 3 med nurses for the entire jail. How's that for a poor ratio?

    What is the normal ratio for other correctional facilities? Any input would be appreciated. This jail ranges from low to maximum security. And if the inmates are locked in (detention housing) we go from cell to cell to give the meds. If the entire pod is locked in, that makes our job even harder.

    Are there any other nurses faced with this? I spend about 4 hours pouring my meds. We also hand write our mars to carry over into the new month. Needless to say, the mars are not completed for the month of November.

    What are some of the other nurses doing out there? Thanks in anticipation for some interesting responses.
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    You should check your state's pharmacy laws and check with the BON regarding the pre-pouring or re-packaging of prescription medications for administration to patient/inmate's. Putting pills in a small coin envelope and labeling it - is usually considered dispensing - and in violation of the law. It also creates more medication administration errors due the extra handling and labeling of the medications. However, many jails still use system - mostly to save time.

    The preferred legal and safe med. administration method is described by JamieB.
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    I pour according to the mar at the pod door checking id's and watching them swallow.This new jail though has KOP meds which floors me.I
    have never been allowed at the other facility to hand over a persons
    meds for them to keep in the pod.You are not sure if they are trading them etc.Its wierd and goes against what I have been taught.Also
    when I first worked at one facility we prepoured and used med cards
    and cups but the inmate had to take it at the gate as well.
    I wonder about this new method.I am not comfortable with it.
    I apprieciate any imput.
  11. 0
    Quote from sblackman
    hello all. i was wondering if you all could provide me some input on how you administer medications in a correctional setting - preferably a jail, rather than a prison. here is a scenario: we operate a pill team at our facilities, whose job it is to administer unit doses to inmates and document the administration on the mar. we receive blister packs of patient-specific meds from our off-site pharmacy with the appropriate pharmacy label (rx#, name, drug, strength, dose, instructions, etc.). it is common practice for the nurse (rn or lpn) to pre-set or pre-pull a unit dose of the medication to be administered - sometimes 24 hours ahead of time. for example, at one of our facilities, the nurses pre-pull the medications from the blister packs and put the unit dose of the medication in an envelope (like a coin envelope) and labels the envelope with the patient's name, drug, dose and instructions. this envelope is then taken to the housing unit/pod for distribution to the patient. is this routinely and customarily done in other facilities? i would sure appreciate your comments and input. thanks.
    you need to check the laws in your state. having the meds in the blister pack, takes the place of having to put them in envelopes. that is despensing as noted by a prior reply.
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    Most blister pack systems are patient specific and come directly from a licensed pharmacist - this is not dispensing. Some stock is allowed, but is usually documented accordingly.

    Pre-pouring and re-packaging is dangerous, whether it is coming from a blister pack or a bottle. In addition, there are new Pedigree laws being passed in many states and probably federally - this will outlaw any re-packaging.
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    i work in a california prison.
    we prepack for the night pass.
    what makes me mad is that we will often give meds that another person has prepared.
    many times the meds are wrong.
    sometimes the Inmate will notice and refuse, other times they don't pay attention, other times it may be a "better" drug then they should be getting so they take it.
    its not like I can memorize the meds for 500 guys, so how would i know if the med is wrong or not.
    If you want to work in the prison system, its common practice at the prisons i work at and management knows it.


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