A well-informed patient can be a great assistance in reducing medication error. The more patients understand about the medications they are prescribed, the better they can assist with monitoring treatment practices and questioning when unfamiliar medication is offered. Here are four ways to engage your correctional patient in the medication process to avoid error.

Be Sure Your Patients Know the Important Stuff

Patients are best able to contribute to medication safety by having both general and specific knowledge of their medication regimen. Low general health literacy contributes to misunderstanding and gaps in patient medication. The level of understanding of the medical process, and specifically the medications ordered for treatment, affects medication adherence, whether provided by direct observation or through a self-administration process.

• Medication allergy. General knowledge includes an understanding of any medication allergies a patient has and the symptoms they experience when taking these medications. Indeed, understanding the difference between side effects and allergies are of particular importance for proper treatment. For example, a patient may state that they are allergic to aspirin when what they have experienced is stomach burning when they have taken aspirin on an empty stomach. Therefore, it is important to obtain descriptive information about medication allergies when documenting a health history.
• Medication effect and side effect. Even when patients come into the criminal justice system on long-term chronic medications, they may have misconceptions about why they are taking the medication, the expected effects of the medication on their condition, and what side effects for which they should be monitoring. There is even greater need for this information if new medications are added to the regimen.
• Self-administration practices. Self-administration practices such as dosing and timing of medication self-administration can be an added challenge for patients, especially those with low literacy skills. It may take more than mere labeling instructions to ensure patients are appropriately self-administering medications allowed in the Keep-On-Person program. Besides basic information about medication effect, side effect, dosing, and timing, patients should be able to identify potential interactions with food or other medications as well as any precautions that need to be taken such as avoiding direct sunlight or not stopping the medication abruptly. Because incarceration can restrict movement and meals, health care staff should also be sure self-administration practices are adapted to the particular situation of the patient.

Give Them a Way to Communicate Directly with You

A knowledgeable patient is particularly important in a correctional setting where security barriers can cause medication delay or omission. A direct communication process between the patient and the health care staff assists in empowering patients to speak up when they have concerns about medication administration schedules. Many inmates use the sick call slip process for communication with health care staff, although other systems may need to be initiated if this is burdensome to the sick call process. For example, some settings have electronic communication through a kiosk system and others have a phone message system for patient/health care communication.

Help Them Understand Their Role

Incarcerated patients may need to be directly told to speak up about their medical condition and to question medication administration that does not fit with their understanding of their medical treatment. Sometimes the system within a correctional setting does not encourage proactivity or self-efficacy in the patient population. Health care staff need to encourage and support patient participation in their care planning, including actively addressing unfamiliar medication administration.  Staff administering medications must be willing to explain any changes in the regimen. Here are a few common times when medications may be unfamiliar to a patient.

• New patients may have medications switched from non-formulary brands to generic equivalents on intake into the facility.
• Patients may not understand the information provided by a prescriber regarding a dosage change.
• A new medication formulation including a change in size or color of the pill may be used while patient-specific medication is shipped from the pharmacy.

Create a Solid Medication Self-Administration System

Involving the patient in administering their own medications can improve patient safety and assist with developing independent health habits. As identified earlier, patient education on drug and food interactions is important; so is information about medication effects and side effects. Confirm that the patient understands what situations require medical attention and the process for obtaining more medication when the supply needs replenishing. Here are some tips for a safe and effective keep-on-person (KOP) medication program.

• Establish a system for distributing and reordering KOP medications. Be sure patients understand the system and their responsibilities. Many medical units ask that patients show up at a treatment or pill line to reorder medications when there are about 10 doses left. This allows time for order filling.
• Incorporate KOP medication into the Medication Administration Record (MAR) process. All medications provided to the patient should be documented in a single place to assist in communication among care providers and decrease confusion in the treatment plan.
• Be sure every medication card has the patient’s name and ID, as well as medication and prescription information. During cell sweeps, medications will be confiscated if not in the possession of the person whose name is on the card.
• If providers give out medications during medical sick call, sometimes called ‘Provider Packs’, the medication cards should have the patient’s name and ID written on them by the provider along with date and signature.
• In like fashion, over-the-counter medication distributed by nurses during sick call should be labeled for the individual patient with date and nurse signature.
• Security staff should be able to confirm the rightful owner of any medication found in the general prison population.
• A regular spot-check process for patient compliance with KOP medications is helpful. Randomly check KOP cards in mid-cycle to determine proper use. For example, twice a week, a number of inmates with KOP medications could be called to report to the medical unit with all KOP cards. Nurses can use this time to validate proper use and reinforce patient teaching.

How do you involve your patients in monitoring their medications? Share your tips in the comments section of this post.