Risky Business: Pre-Pour Meds in Jails and Prisons
The prison is on lock-down due to a suspicious inmate death. Cell searches are underway. The lock-down is expected to last several days and inmate movement is extremely limited. Medications need to be delivered cell-side. This might have been manageable, if not time consuming, if the prison was new enough to have elevators to the upper levels. However, in this case, only narrow stairwells are available and medication carts cannot be pushed up stairs. What’s a responsible nurse to do?
Medication administration is one of the riskiest nursing tasks in any clinical situation due to the many opportunities for error. Medication administration in a jail or prison has added layers of risk. Correctional nurses must daily administer thousands of doses of medication to inmate-patients in general population, segregated units, and specialty housing areas. Even medication that don’t require a prescription may need administered by healthcare staff to reduce opportunity for abuse in the prison black market.
The three main ways medications are administered in correctional settings are: Med Line (Watch Take), Keep on Person (KOP), and Pre-Pour. This post focuses on key elements for safe pre-pour administration.
Administering medication prepared in advance is risky and should only take place in unavoidable situations where medication cannot be administered directly from the labeled supply. Medications prepared prior to administration are usually placed in small labeled and sealed envelopes for direct transport by the nurse who will administer them. During a pre-pour situation, the following safeguards should be in place:
- Medications are prepared immediately before they are transported to the patient.
- The same nurse prepares, transports and administer the medication.
- Medication envelops have at least 2 patient identifiers (name and ID#) and include the date and time of the doses.
- All medication rights are checked at the time of medication preparation.
- Patient identification processes happen again at the time of administration. For example, confirming the patient’s name and ID#.
- When possible, the patient confirms that these are the medications they were expecting to take. Although inmates may not be aware of their specific medications based on how they look, nurses should double check any medication an inmate questions.
- Documentation of administration should take place at the time of administration or directly after returning to the unit – not before administration. Medication may be refused or delayed for a variety of reasons. Documenting administration at the time of preparation is inappropriate.
What other safeguards do correctional nurses use when pre-pouring medications? Provide your additional tips in the comments section of this post.
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Comments
All the issues you have mentioned also happen in all our jail facilities. The majority of meds are pre poured in our largest facility housing close to 1300 inmates. Our medications are in “binders” with plastic (zippered) pouches; prepoured meds are placed in paper medicine cups inside the pouches or in the areas that are locked down placed in trays that the nurse carries up and down the stairs. Per policy Custody staff are to help monitor ingestion which of course is questionable because custody have other tasks like passing mail, laundry or what have you while trying to monitor med pass. I would like to hear from other jail systems if there’s a better way of accomplishing this process of medication pass with less risks.
We elimated pre-pouring medications in our facility about 4 years ago. The key safety issue I have come across with other facilities that still do this as a major function of medication pass is to make sure that the Nurse whom sets up the medications is the one who passes them.
Good advice, Lorry. During my correctional nurse career, I found that the State Board of Nursing had very firm opinions about this procedure and were quire restrictive about its use.