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 meds. 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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Sue Smith, RN, MSN says
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.
Monina Viloria says
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.
Michael Brewer RN, Inmate Healthcare Supervisor, Ada County Sheriff Office says
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.
Ruth Wyatt says
Very good information. Thanks for sharing.
Ashley says
Very useful
concerned nurse says
We are told to prepour meds for upstairs max security patients since medication cart is not allowed to go up the stairs. So, many nurses prepour into envelopes.
Since nurses are rotated to different housing unit nearly every shift, pt medication envelopes are written out by each nurse at every shift.
The upstairs envelopes are then carried in a hand held tote upstairs.
Seems to be a disaster waiting to happen.
Shelly Davis says
While working for CFMG, all their meds were pre-poured and delivered by the nurse that poured them. Having enough staff on to allow for this may be the issue in other facilities. Currently,
I work in a facility where custody staff administers the meds from bubble packs. I never encountered any medication errors with medications while with CFMG, but daily I encounter them with custody staff administering. I would like to go to nursing staff delivering medications but there is not enough funding to warrant it.
Kate says
Where can one go to find their State’s ( Louisiana) rules related to pre pulling medications?
Lorry Schoenly says
Hi, Kate: You can read the various nurse regulations from the State Board of Nursing website. If you can’t find it there, call the BON office and request a consultation.
Michael says
I really need to know, is it against the Law for a CO jailer to pass meds in county jail? If so I need a code that states it… Many times I have had to pass meds not knowing what I am giving the inmate… I really don’t want to be held responsible for inmate having a reaction to the wrong meds that I gave them…. Please help.
Lorry Schoenly says
Hi, Michael. Thanks for getting in touch. Are you a CO? It depends on the state you are in and the nurse practice act for your state. In some states, COs ‘deliver’ medications that have been prepared by nurses. It is not a best practice but is not illegal. If you would like to discuss this further, you can send me an email with more details – lorry@correctionalnurse.net.
Sherry A. Pardy says
Should inmates be required to wear an I’d bracelet or badge when receiving their medication during med pass? I am encountering push back from corrections officers over the inmates not being compliant with keeping bracelets on. I have heard at some institutions if I’d bracelet is not shown nurse will refuse to give meds. What is best practice in the correctional setting?
Lori Roscoe says
Hi Sherry,
Thanks for your question. My experience reflects your comments – all patients who present for medication must bring their ID card/bracelet/etc before they are administered the medication. In fact, now most of the electronic medication administration records require that “scan” in order to even pull up someone’s medication list. I have found that setting the expectation and then adhering to the policy and procedure is most often the best and fastest way to make any procedure the standard. I don’t think the person coming to the cart should be refused their medication, but rather administration should be “deferred” until they return with the ID. It may be that correctional officers will have to assist with getting a replacement card/bracelet expeditiously so that the patient does not miss his/her medication. I would be interested to hear how others have handled this very important aspect of medication administration (patient identification).
Sherry Pardy, RN MSC says
Thank you for getting back to me. I am still working on figuring out the best protocol for my facility. in the past the inmates just refused to wear the bracelets and their were no real consequences such as meds being withheld until inmate produced his.her id band. We will be starting MAT soon and from what I understand it is an absolute must to have ID bracelets or ID bands before getting their medication. It is a safety net for them and for the Nurses administering the meds.
Lori Roscoe says
Hi Sherry,
Clearly this should be discussed with facility (Custody) administration, especially in light of the pending MAT program initiation. I would be very interested in hearing about your MAT program implementation, as many of our colleagues are also in various stages of implementation and we can definitely learn from each other! Good luck to you and your team!
Megan RN says
I just started working at a small county Juvenile Hall. There was just a major turnover, I started 2 weeks ago full time and the NP just retired, the full time day RN retired in March when COVID hit and the full time night RN is on medical leave until October. So right now it is me and temp nursing filling shifts. Our shifts are 0700-1500 and 1430-2230. I have a ER background and corrections nursing is brand new to me. I had a 2 week crash course and now on my own. This is a smaller facility and because of COVID they are keeping census as low as possible, we only have 15 youths at this time split between the jail unit and a group home type unit which is less secure and kids have more freedom. There are only a handful of kids on meds at this time but med pass still seems like it is dangerous, and the facility plans to expand the group home section with the potential of housing 50 youths’. As of now meds either come from a contracted pharmacy in bubble packs or brought in by parents in prescription vials. Meds are pre poured into cups labeled with youth name and DOB, then stacked on each other and brought to units with water jug. Youth is brought to nurse one at a time and armband confirmed before giving med. We have no med cart or med room. We have a nursing office/exam room and meds are locked in drawer of desk. My concern is as census goes up, med error seems more likely. I am also wondering if anyone is using eMARs as we only have paper MARs. Any advice is appreciated. Thanks