A 63-year-old man is screened during booking. The intake nurse notes a blood pressure of 180/98. The man reports he is prescribed Lisinopril 40mg daily, though he hasn’t taken it that day. After verifying the prescription with his community pharmacy, the nurse obtains a continuation order and administers a dose from stock. He begins daily administration during pill line.

Several days later, the patient is brought to sick call complaining of lightheadedness and feeling unsteady. His blood pressure has now dropped to 90/50.

What happened?

This is a classic example of the “Compliance Trap,” a term coined by correctional physician Dr. Jeff Keller. In this scenario, the community-based dosage was accurate, but the patient had not been consistently taking the medication prior to incarceration. Now that he is receiving the medication daily as prescribed, his body is reacting as though he is overmedicated.

According to research, roughly 50% of patients with chronic illnesses do not take medications as prescribed. In some populations, adherence is even lower. Correctional facilities often see patients with complex histories of medical neglect, misuse, or misunderstanding of their prescribed regimens. These factors complicate care when providers and nurses assume adherence that did not exist.

As correctional nurses, we must remember that medication verified in the community does not always mean the patient was taking the medication as prescribed, and we must be vigilant when administering medication to watch for signs that the dose is not appropriate, especially in the first days and weeks of incarceration when compliance with medication becomes easier for the patients.

Key Considerations for Intake and Early Observation

• Ask how consistently the patient was taking the medication in the community—not just what was prescribed.
• Monitor vital signs daily for the first few days after initiating or resuming critical medications like antihypertensives, antidiabetics, and psychotropics.
• Communicate with the provider if symptoms of overmedication (e.g., dizziness, hypotension, lethargy) develop.
• Advocate for temporary dose adjustments or re-titration based on observed tolerance and stability.

This case underscores the vital role correctional nurses play in bridging the gap between community health care and incarceration. In Corrections, medication compliance is supported by nurses administering medication. And that changes everything.