B.06.08 Over-the-Counter Medication

Providing access to over-the-counter medication

The purpose of this procedure is to ensure that:

Over-the-counter medications are issued to prisoners by unit staff in a manner that complies with general legal requirements and does not place any responsibility for clinical decisions on unit staff;
All issuing of over-the-counter medication is documented; and
There is national consistency of practice in PPS.

Performance standards

Over-the-counter medications are available in unit guardrooms/wing offices to manage unexpected discomfort (such as headaches, influenza symptoms, toothache) and comply with the requirement to provide safe, secure and humane access to simple over-the-counter medication.
The limited number of over-the-counter medications is correctly, safely and securely managed for and by prisoners.
Every site is to have the limited range of over-the-counter medication approved and documented in a Health Services Standing Order. This will include issuing instructions, dosage information, contra-indications and any required follow up by the prison Medical Officer, and is made available to all units by Health Services staff.
Over-the-counter medication is to be securely stored and the restricted supply will be managed and accounted for, with instructions and documentation.

Procedures

The limited range of over-the counter medication is approved in a Health Services Standing Order, by the Medical Officer.
Over-the-counter medication will be provided to unit guardrooms/wing offices by Health Services staff, in the original manufacturer’s foil, plastic, or cardboard packaging. The name of the product and dosage of medication must be easily identified on the packaging.
Medications will be stored separately (e.g. plastic container), from any prescription medication, in a designated securely locked place (drawer or cabinet) within the guardroom/wing office.
Providing access to over-the-counter medication will be undertaken by unit staff only, and not by, for example, social workers or programme providers.
When Health Services staff are not available, unit staff must:
1. Administer such medications in accordance with Health Services Standing Orders; and
2. Check for any Advice of Prisoner Health Status (B.06.03.F2) form, which indicates whether a specific prisoner should be provided with the over-the-counter medication for a designated clinical condition; or should not be provided with the over-the-counter medication.
Clinical diagnosis is not the responsibility of unit staff. The on-call nurse is to be contacted if the unit staff member believes this is necessary.
Prisoners are to be instructed to take medication, with a drink, in front of the unit staff member, unless instructed otherwise by Health Services staff. During the hours of lock-up every attempt is to be made by unit staff to view a prisoner swallowing the over-the-counter medication.
Unit staff will ensure that the Over-the-counter Medication Log Sheet (B.06.08.F1) is completed and signed. If it is difficult to obtain the prisoner’s signature during lock-up (to acknowledge receipt of the medication) the unit staff member is to document that obtaining a signature was not possible, noting the reason why.
Dosage of approved over-the-counter medication is to follow the Medical Officer’s Health Services Standing Order instructions noted on the Over-the-Counter Medication Log Sheet (B.06.08.F1), under the ‘Recommended Dose’ column.
At sites that provide a daily scheduled health service, the Health Services staff will be responsible for checking the Over-the-Counter Medication Log Sheet (B.06.08.F1) daily and following-up instances where prisoners are administered more than one dose of the over-the-counter medication within 24-hours. Sites not providing daily health service will follow-up on the days that Health Services staff are scheduled to work. If Health Services staff are not scheduled to be on-duty within 24-hours, the unit staff member is to refer to the Over-the-Counter Medication Log Sheet (B.06.08.F1) and Health Services Standing Order for further directions and any required follow-up. This may include contacting Health Services staff.
Follow-up health care will be documented on the Prisoner Health file.
Where necessary, an ‘Advice of Prisoner Health Status’ (B.06.03.F2) form will be provided to the Unit Manager for any subsequent follow-up.

Health Services staff roles and responsibilities

The Medical Officer approves limited over-the-counter medication. The product name, indications, recommended dosage, precautions, contra-indications and any required follow-up health care are entered as Health Services Standing Orders. This information will be entered on the Over-the-Counter Medication Log Sheet (B.06.08.F1). Variation between sites will depend on the Medical Officer’s preferred requirements, e.g. product availability where there is a high rate of allergies from grasses/pollens, or high risk of bee stings.
Health Services staff provide approved over-the-counter medication to unit guardrooms/wing offices in the original, clearly visible packaging, with the name and dosage of medication, as printed by the manufacturer, and accompanied by a copy of the relevant Health Services Standing Order.
A folder containing the Advice of Prisoners Health Status forms identifying prisoners not to be given medication is held in the guardroom/wing office and maintained by Health Services.
Health Services staff provide information on the Advice of Prisoner Health Status (B.06.03.F2) form to unit staff concerning unit prisoners who may be given specific over-the-counter medication. For example, a paracetamol product for influenza symptoms and sports injuries, a product for indigestion relief, or approved treatment for insect stings.
Where there is daily nursing coverage, Health Services staff are to visit the units daily to identify prisoners that may have received more than one dose in 24-hours of over-the-counter medication, and follow-up health care with these prisoners.
If Health Services staff are not scheduled to be on-site within 24-hours, but are on-call, the unit staff member is to refer to the Over-the-Counter Medication Log Sheet (B.06.08.F1) and Health Services Standing Order for further directions and any required follow-up. This may include contacting Health Services staff.
Health Services staff are to monitor anyone making repeated requests for over-the-counter medication, e.g. requests on three consecutive days or three times within any two-week period.
Health Services staff are to document in the Prisoner Health File that over-the-counter medication has been issued, follow-up health care has been provided and what action has been taken.
Health Services staff are responsible for the monitoring, usage and safe storage of limited stock. There is to be an agreed level of stock held during any given period. Stock use will need to tally with completed Over-the-Counter Medication Log Sheets (B.06.08.F1) to ensure correct and appropriate usage. Local arrangements should be in place for auditing and replacing stock.

Unit staff roles and responsibilities

Unit staff are required to provide controlled, safe and managed access to limited, specified ‘over-the-counter’ medication, and
- Ensure all details on the Over-the-Counter Medication Log Sheet (B.06.08.F1) are completed and signed;
- Pass on monitoring information to Health Services staff;
- Inform Health Services staff when a prisoner’s condition gives unit staff cause for concern. In this instance over-the-counter medication is not to be issued, and Health Services staff are to be contacted immediately.
Access by prisoners to over-the-counter medication is supervised by unit staff and will only be made at the request of the prisoner.
Prior to issuing over-the-counter medication, unit staff check that:
- The Medical Officer’s issuing instructions are documented in the Health Services Standing Order; and
- Any Advice of Prisoner Health Status (B.06.03.F2) form stating that the medication is not to be issued.
Unit staff must ensure the Over-the-Counter Medication Log Sheet (B.06.08.F1) is completed.
If a prisoner refuses to sign the Over-the-Counter Medication Log Sheet (B.06.08.F1) access to medication should not be allowed. If it is difficult to obtain a prisoner’s signature during the hours of lock-up (to acknowledge receipt of medication), the unit staff member is to document that obtaining the signature was not possible, noting the reasons why.
Unit staff must observe the prisoner swallowing the medication (with a drink), unless instructed otherwise by Health Services staff. During hours of lock-up every attempt is to be made by unit staff to view a prisoner swallowing over-the-counter medication issued to them.
There may be occasions when unit staff permit a prisoner to self-medicate over-the-counter medication following consultation with Health Services staff. For instance, when a prisoner has acute toothache, Health Services may direct a paracetamol-based product be taken with a further dose available to the prisoner to self-administer during the night.
If a prisoner’s condition gives cause for concern before issuing over-the-counter medication, then do not issue any. If the prisoner is identified as needing intervention for a previous known condition, such as requiring an inhaler for asthma or insulin for diabetes, over-the-counter medication should not be administered.
If at any time the condition of a prisoner gives cause for concern, either before or after the taking of medication, the ‘on-call’ Health Services staff member should be contacted immediately.
In emergencies unit staff will provide first aid and contact emergency services.

Prisoners roles and responsibilities

Prisoners should only request over-the-counter medication when it is required.
Prisoners must sign the Over-the-Counter Medication Log Sheet (B.06.08.F1) acknowledging receipt of over-the-counter medication and that they have no known allergies to the product.
Prisoners are not to store medication or pass it on to any other prisoner.
Prisoners are to swallow the medication or self-administer (if this action is noted by Health Services), in front of unit staff.

Unit Manager Roles and responsibilities

Ensures compliance in meeting the custodial responsibilities of the Health Services procedures, including the correct completion of documentation

Medical Officer Roles and responsibilities

Approves Health Service Standing Orders
Documents the indications, recommended dosage, precautions, contra-indications and any follow-up health care required on the Over-the-Counter Medication Log Sheet (B.06.08.F1).
Approves and documents the quantity of products to be held in the guardroom/wing office.

Regional Health Services Manager roles and responsibilities

Oversees the implementation of procedures and at all times is responsible for the monitoring and follow-up of prisoner health care.
Is responsible for the monitoring, usage and safe storage of limited stock.

Necessary Forms

Over-the-Counter Medication Log Sheet (B.06.08.F1)
Health Services Standing Orders (managed by Health Services staff)
Advice of Prisoner Health Status (B.06.03.F2)

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