A patient arrives at the medication window one morning with an empty blister pack of Truvada. It is only ten days since he received a month’s supply. He is evasive initially about why they are already gone. After some questioning, the nurse discovers that Truvada brings a high price on the prison black market as a ‘prevention’ for AIDs.

Keep on Person (KOP) medication administration is a common practice in many jails and prisons. Also called Self-Administered Medication (SAM), this process allows incarcerated individuals to keep a quantity of medications (usually 30 days) with them and self-administer according to the directions provided. Since most adults in the community self-administer prescription and over-the-counter medication, this seems a prudent practice. There are, however, several concerns that need to be addressed to successfully manage a KOP process.

Medications, like any material item, can be a commodity on the facility black market. Pills can be used for both intended and unintended purposes. In an environment of scarcity, community members will creatively use whatever is available to barter or gain status in the group.

Each facility determines which medications are safe for patients to carry with them based on the population characteristics , medication use, and past experience. The need for consistent administration may also be taken into account when determining self-administration medication classes. For example, tuberculosis medication administration is rarely left to the discretion of the patient, as consistent dosing over a long period of time is necessary for maximum effect. Another class of medications often eliminated from KOP lists is psychotropic medications. Patient adherence to daily psychotropic medication dosing can be a challenge even in the general community. In addition, many mental health medications can be abused. Vulnerable patients with desirable medications on their person can become prey to stronger and more powerful incarcerated individuals and gangs.

Here are some tips for a safe and effective 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 incarcerated individuals go to the treatment or pill line to reorder medications when there are seven to ten days worth of doses left. This allows time for order filling by the pharmacy.
• 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 healthcare staff and decrease confusion in the treatment plan.
• Be sure every medication card has the patient’s name and ID, as well as then name of the 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 Provider 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 the date and the provider’s signature.
• In addition, the Over the Counter (OTC) medication distributed by nurses during sick call should be labeled for the individual patient, and should include the date and the nurse’s signature.
• Custody staff should be able to confirm the rightful owner of any medication found in the general population.
• The initiation of a regular spot-check process to ensure patient compliance with KOP medications is very important. For example, a verification process could be initiated so that twice a week, a number of inmates with KOP medications are called to the medical unit with all their KOP cards. Nurses will then evaluate compliance and use this time to validate proper use, and reinforce patient teaching.

Involving the patient in administering their own medications can improve patient safety and assist with developing independent health habits. Patient education on drug and food interactions is important, as is sharing information about expected medication effects and potential adverse effects. Confirming that the patient understands the conditions that require immediate medical attention and the process for obtaining more medication when the supply is dwindling is also very important.

How do you handle KOP medication at your facility? Share your tips in the comment section of this post.