medication administration

Orca, ADN, ASN, RN · Aug 27, 2013

The system you are using is on very shaky legal ground, IMO. You have unlicensed, non-medical personnel dispensing medication. I'm not naive enough to believe that this doesn't go on in a lot of places, but if you were audited by your state pharmacy board or health department it could be an issue. Pre-packing in and of itself is not illegal. We obtained an opinion from our state pharmacy board stating that pre-packing is not a problem as long as the medication is used the same day. With the volume of medications that jails and prisons dispense and the relatively low number of personnel they have to conduct pill call, it would take far longer than is practical if pre-packing did not occur. The worrisome thing about your system is that the person packing the medication is not the one passing it, and the people passing it are not licensed to issue medication. If there were a medication error, it could get really sticky. Dispensing multiple doses depends upon your facility policy. We have a policy that allows certain medications to be dispensed KOP (keep on person). Inmates can get up to a 30-day supply of KOP medication (depending upon the order) and they are responsible for proper administration of the medication, just as they would be at home.

The license question is a thorny issue. IMO the nurse would be ultimately responsible if a mistake occurred.

OfficerRNBSN · Aug 30, 2013

It depends on your state. If the inmates require meds then they require meds. In my state, jails aren't required to have around the clock medical coverage, and even my jail has only weekday coverage. For all other times, the jailers are it. Here, anybody can give meds, and you're more restricted as a licensed provider than you are as being some schmuck off the streets. At least they're uneducated and less accountable.

A jail or prison isn't a hospital. These are grown people, and if they're incompetent they're likely at some type of psych facility where the procedures will be obviously different. It's a legal thing really. Here, meds are taken on a cart to the inmate pods. If they don't take it then big deal. We document it and move on. If they don't show up to the door to get the med then again big deal. They're grown people and know what times meds come. It's a lot looser than my experience at a hospital. Whereas in a hospital I would've had to have woke a patient up, give them the med, coddled them, etc. in a jail I go to the door, if they're asleep I bang on the door and call their name. With no response I move on. They know what time they get meds.

We use direct observation therapy so they hetherns can't come up with some other use for the medication. Meds have been packaged in the dispensary and taken out into the jail to the inmates by a nurse or a jailer. The packaging is typically done by a nurse, however, it can be and is also done by some jailers (not specially trained just those willing to do extra work as most seem to be less than ambitious). However, if you gave someone a bag of tid meds, then just document that you educated them to take one now, one later, etc. They're grown, competent people. What they do is on them. You did your job. Qualified immunity.

Call your state board of nursing and pose these questions. I did, and I'm glad because I found some good answers to some things I was concerned about.