The Pill Drill

10/04/2017
Medication distribution can be one of the riskiest procedures in any correctional facility due to the high volume of inmate patients, possible black market selling scenarios and violent situations that could occur. Pharmacists, nurses and support staff administer thousands of doses of medication to inmate/patients in the general population, segregated units, and specialty housing areas on a daily basis. To make sure that things go smoothly, there are steps that must be followed to the letter. The three most common ways medications are administered are: Med Line (Watch Take), Keep on Person (KOP) and Pre-Pour meds.
 
Annual Training is a Key
Martha Ingram, RN, CCHP, CPHQ, director of Management & Performance Improvement at Wexford Health Sources, Inc., Pittsburgh, Pa., says their nurses are expected to annually train and refresh themselves on medication administration due to high volume and high risk of medication administration in corrections environments.
 
“There are several processes in place to ensure this happens. We have policies that spell out the expectations for a safe and accurate med pass which include ensuring the nurse uses two identifiers for patient ID to performing mouth checks to ensure meds are swallowed and not stashed for trafficking purposes.”
 
She points out that administration at each site determines if the site allows a KOP system. “If a KOP system is in place at the facility it is limited medications that the patient can keep in their cell.  Obviously medical staff has little control once the blister pack is given to the inmate.  A KOP system is usually limited to medications for chronic conditions and not psychotropic medications, to cut down on the potential for trafficking of these meds.”
 
EMR Technology Lacking
Ingram says that technology in corrections is far behind other health care industries (e.g., hospitals, long-term care facilities).  “While electronic medical records [EMRs] are being installed in more facilities, we are far behind those electronic systems in hospitals.  Nurses can rely on technology a great deal in hospitals but very little in corrections.  Many EMRs that are out there for corrections do not yet have a medication administration capability.  Correctional facilities are often physically old buildings with no ability to accommodate wireless technology and much of the care and meds are delivered on the units themselves.”
She says that Wexford Health prefers to use an electronic medication administration record (eMAR) system for their med administration to ensure efficient distribution. “Once this tool is in place and consistently used, we can use the data to monitor compliance.”
Ingram says they believe that the benefits of adding an eMAR to a facility will definitely help to increase the safe and efficient medication administration process. “In turn, by utilizing an eMAR, nurses are provided a failsafe method to ensure that medications are administered appropriately, safely, and efficiently.”
 
More Options
Todd Myers, director, IT Business Development at Corizon Health says with the increase in Correctional Healthcare Technology, facilities now have multiple options for increasing quality patient care while reducing medication administration errors. “While a fully integrated EHR would be the best option, some jail and prison systems have opted to start the transition to Healthcare Technology through the implementation of an eMAR.”
He explains that building on the 5R’s of medication administration, eMAR checks each barcode scanned RX number before administration to ensure Right patient, Right medication, Right dose, Right route, and Right time of day. “For certain diseases or patient diagnoses, the eMAR will prompt with alerts to ensure adequate measures are taken for specific medication administration.”
 
Myers adds through the use of barcode scanners, the fully integrated eMAR is synchronized with the pharmacy, ensuring patient profiles are up to date with active medications that have been checked for Drug to Drug and Drug to Allergy contraindications. “This close integration also grants the pharmacy added confidence the discontinued medications are immediately flagged and automatically removed from the patients’ profile prior to the next administration. Other functions such as Medication Hold, Refusals, and KOP workflows can be applied with eMAR technology.”
 
Blister Packaging Solutions
Gregg Puffenberger, Pharm. D. MBA, vice president of Pharmacy Management for MHM Services, Inc., reports that a unit dose/blister packaging drug distribution and control system is recommended and should focus on patient safety and result in a minimal incidence of medication errors and adverse drug reactions.  “Ongoing processes for the monitoring and reporting of adverse drug reactions and the detection and prevention of medication errors should exist. The system employed should foster drug-control and drug-use monitoring.”
He says that the system should also foster patient compliance, recovery of drugs because of expired orders, and ultimate destruction of all unusable and outdated medications.  “Inmates should not be used in the distribution process.  Patient confidentiality should be ensured in the distribution process. The facility should also ensure the proper security of medications stored in each location and that drug products are stored in accordance with manufacturer or USP requirements,” he explains.
 
Puffenberger adds that a process for minimizing and eliminating unauthorized use of medications by anyone other than the intended patient should exist.  “A process for minimizing and eliminating pilferage should be in place as well as a process for monitoring and preventing the dispensing of unusually large quantities of medications should exist as well.” 
He adds that a process for preventing the dispensing of sufficient doses of any medication to enable potential suicide should also exist.  “Individuals who are evaluated as high risks for suicide should be identified.  A process for the security and dispensing of controlled substances should be in place.”
 
He says that the facility’s medical staff and other responsible health authorities, should maintain policies and procedures for the routine review and renewal of medication orders and for any automatic discontinuance of orders.  “Access to patients’ medication records should be limited to authorized personnel only,” he points out.
 
Automated Dispensing an Emerging Trend
Puffenberger reports that automated dispensing devices are increasingly being used for centralized filling of individual patient prescriptions and unit-dose medication orders, decentralized dispensing, and other purposes.  “When such devices and the systems that support them are not used appropriately, their complexity, design and function variations, maintenance and education requirements, and other factors can compromise patient safety and have other harmful effects.”
 
He says the appropriate, accurate, and timely distribution of medications to patients is a well-established responsibility of the nursing and pharmacy staff.  “Automation has evolved to ease fulfillment of pharmacists’ distributive responsibilities, expand distribution system capabilities, and improve efficiency in distribution.
 
Automated dispensing devices are starting to become tailored for use in the correctional environment to increase accountability, security, decrease waste, and streamline the administration process for the healthcare staff,” he concludes.
 
Manual Blister Pack Solutions
While automation systems are beginning to be utilized, still the most efficient systems are in manual unit dose/blister packaging.
 
One of the biggest players in this area is Medi-Dose. Robert Braverman, president at Medi-Dose/EPS, Ivyland, Pa., points out that the Medi-Dose manual tamper-evident packaging system provides a solution for all types of correctional facilities.
 
“We provide any type of facility complete pharmacy solutions. Even if they have automated systems in place, they still will have medications that need to be manually packaged on a short run basis or if they need a back up to an existing system. That’s where we come in. We provide a manual tamper-evident system with complete labeling capabilities.”
 
Braverman points out while they are primarily a hospital-based pharmacy company; the beauty of their system is that it works great in a correctional setting.
 
He reports there are many medications that can’t be packaged via an automated machine. “With Medi-Dose, any time you pull a blister from our system it’s a clean sheet.  In just under one minute you can package 25 doses of medication with complete labeling capability. It’s a great way for any facility to package their medication either as a primary, back up or for meds that require special handling that can’t be packaged by a machine. Automated machines have their place and we co-exist with any of those systems,” he concludes.
If your facility is looking for additional products and services in the pharmacy area, here are some providers.
 
Pharmacy Services Provider
Diamond Pharmacy Services is the nation’s largest correctional pharmacy services provider, servicing over 500,000 inmates in over 900 facilities across 44 states, the company says. With over 30 years correctional experience, they promise to deliver the highest quality of healthcare service.
www.diamondpharmacy.com, 1.800.882.6337
 
Packaging System

Medi-Dose is a tamper-evident, solid oral unit dose packaging system.  Medi-Dose features 13 types of blisters, including new Mini Medi-Cup Blisters for small medications and Deep & Jumbo blisters for larger or multiple meds.  Medi-Dose features 1 year beyond use dating and tamper-evidence protection.  Their MILT software complements the Medi-Dose system and provides a variety of innovative features for all medication labeling needs…solids, liquids, IV’s, syringes, ampules, even equipment.  Facilities can design labels any way they want.  1-D and 2-D bar codes, graphics, numbering, special fonts; tall man lettering, shapes and logos and packaging logs are all included.
www.medidose.com, 1.800.523.8966
 
Dispensing System
Talyst’s InSite In-Facility Dispensing System was the first medication management system designed specifically for corrections. It enables secure, automated medication dispensing throughout a correctional facility 24/7/365, and is scalable to work across multiple facilities. The InSite pharmacy automation system is said to provide better inventory control and more efficient workflow to virtually eliminate expensive medication waste. Through effective medication management, the InSite System gives nurses more time to perform other important tasks, and improves overall patient and staff safety.
www.talyst.com, 1.425.289.5400
 
Electronic Medication Administration Record
In 2010 Corizon Health partnered with Health Care Systems’ (HCS) to implement their eMAR. Since then Corizon has deployed the product for three large DOC clients spanning 45 correctional facilities and 40,000 patients. Today, Corizon is actively working to deploy the latest eMAR release for its Philadelphia Department of Corrections partner. Corizon Health will be working closely with Philadelphia DOC to integrate the eMAR with the existing eClincial Works EHR.
www.corizonhealth.com, 1.800.729.0069
 
Correctional Services
MHM Correctional Services is a wholly owned subsidiary of MHM Services, Inc. MHM and its subsidiaries are under contract with correctional systems nationwide to provide a wide range of behavioral health, pharmacy, medical specialty and comprehensive medical services. In 2017, MHM provides services on site to over 350 facilities in 16 states nationwide.
www.mhm-services.com, 1.800.416.3649
 
Health Care Programs
NaphCare provides a proactive approach to health care programs for correctional facilities ranging from comprehensive health care, on-site dialysis, off-site management, in-house pharmacy and TechCare, their electronic health record (EHR) clinical operational tool.
www.naphcare.com, 1.800.834.8400
 
Health Care Solutions
Wexford Health Sources provides medical, mental health, pharmacy, rehabilitation, utilization management, claims processing, and technology services to state, regional, and local clients across the country. The company aids governments, correctional facilities, and other institutions control inmate health care costs while maintaining quality of care.
www.wexfordhealth.com, 1.888.633.6468