An inmate arrives at the medication window one morning with an empty blister pack of Atripla. It is only 10 days since he received a month’s supply. He is sheepish about why they are already gone. After some questioning the nurse discovers that HIV medications bring 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. This process allows inmates 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 prison 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 inmates to carry with them based on the population characteristics 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 psyche medications can be abused. Vulnerable inmates with desirable medications on their person can become prey to stronger and more powerful inmates 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 inmates understand the system and their responsibilities. Many medical units ask that inmates 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 inmate’s name and ID written on them by the provider along with date and signature.
- In like fashion, OTC medication distributed by nurses during sick call should be labeled for the individual inmate 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.
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 information about medication effects and side effects. Confirm that the patient understand conditions with require medical attention and the process for obtaining more medication when the supply is dwindling.
How do you handle KOP medication at your facility? Share your tips in the comment section of this post.
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