B.06.09 Management of Unit-Dose Packaged Prescription Medication administered by Unit staff

Managing Unit Dose- Packaged Prescription Medication

 The purpose of this procedure is to ensure:

• In the event that Health Services staff are not able to issue unit-dose packaged prescription medication to a prisoner directly this alternative procedure is to be followed;
• Unit-dose packaged prescription medication is issued to the correct prisoner by unit staff in a manner which complies with general legal requirements;
• All issuing of Unit-dose packaged prescription medication is documented to meet requirements and assist with follow-up health care by Health Services; and
• Unit staff issue unit-dose packaged prescription medication according to clear procedures when Health Services staff are unable to issue to the prisoner directly.

Performance Standards

1. In the event that Health Services staff are not able to issue unit-dose packaged prescription medication to a prisoner directly this alternative procedure is to be followed.
2. All prisoners have access to their prescription medications within the limitations of a custodial environment.
3. All medications administered by unit staff are provided in unit- dose packaging, other than for inhaler exchanges.
4. Prescription medications are stored within custodial units in a securely locked drawer or cabinet, accessible by the senior officer on duty in charge of the unit.
5. Prescription medications are to be administered in accordance with written instructions provided by Health Services staff, or in accordance with the instructions on the medication wrapper.
6. Oral prescription medications are to be taken in front of unit staff, with a drink, unless Health Services staff provide alternative written instructions.
7. The administering of prescription medication is documented by unit staff and signed for by the prisoner.
8. If incorrect prescription medication is given it must be reported immediately to the unit manager or senior officer, and to Health Services staff, and an incident report be completed.
9. The administering of Controlled Drugs is done by Health Services staff, not by unit staff.

Procedures

1. Prisoners who have prescription medications administered by unit staff must have the process explained to them by Health Services staff and be advised of the process by which their medication may be accessed. This discussion should be documented on the prisoner’s electronic clinical file.
2. A Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) will be completed daily for each guardroom/wing office, including the prisoner’s name, medication details, and what action to take if a prisoner refuses medication.
3. Unit-dose packaged medication will be checked against the medication chart and each Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) by Health Services staff and placed in appropriate containers for delivery to units.
4. Unit-dose packaged prescription medication will be delivered to the unit by Health Services staff and received and signed for by the senior officer on duty in charge of the unit on the Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1).
5. Prescription medications will be stored in a securely locked drawer or cabinet accessed by the senior officer on duty in charge of the unit.
6. Prisoners will present themselves at the guardroom/wing office, with a drink, for medication administration at the required time.
7. Unit staff will issue unit-dose packaged prescription medication to prisoners, who will sign for the prescription medication on the Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1), (prior to the medication being provided) and swallow the medication in front of the unit staff (unless written Health Services instructions state an alternative route for taking the medication).

Health Services staff roles and responsibilities

1. Health Services staff ensure that unit-dose packaged prescription medication has been checked, and that:
   • The correct medication is contained in the pack;
   • It is labelled with the correct (legible) prisoner name; and
   • It is labelled with the correct time to issue (am, lunch, or pm)
2. Discuss with the prisoners who have prescription medication in the guardroom/wing office what the process for access to medication is (note discussion on the prisoner’s electronic clinical  files).
3. Complete daily the Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) identifying the prisoners that will have prescription medication left in the guardroom/wing office. The Log Sheet is to accompany the unit-dose packaged prescription medication and be placed in the guardroom/wing office.
4. The Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) will identify:
   • The prisoner’s name;
   • Time of prescription medication administering (if required);
   • Whether the prisoner takes the prescription medication at the guardroom/wing office in front of unit staff (with a drink) or takes the prescription medication with them to take later (if this is noted as permissible in the Health Services instructions); and
   • What to do if the prisoner does not take their prescription medication.
5. The Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) will also provide for:
   • The prisoner will sign the log sheet after their correct identity has been established and prior to receiving their medication. The prisoner to sign as acknowledgment of receiving their prescription medication;
   • The unit officer to sign following issue of prescription medication; and
   • The unit officer to sign if a prisoner has not taken their prescription medication.
   • The unit officer to note any other action taken in the Action Taken column on the Unit-Dose Packaged Prescription Medication Log Sheet.
6. Collect, on a daily basis, the completed Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) and any prescription medication not issued. Unit-dose packaged prescription medication is not to be left in the guardroom/wing office if the prisoner is unable or unwilling to take their prescription medication.
7. Discuss with prisoners not willing to take prescription medication the reasons for this and decide on the best management for these prisoners. For example:
   • Refusal of treatment being documented on prisoner's electronic clinical file
   • Change of Residential Unit given to enable Health Services staff to administer medication if necessary
   • Referral to Medical Officer to review treatment.

Unit staff roles and responsibilities

1. The senior officer on duty signs for receipt of prescription medication and secures the unit dose-packaged medication in designated securely locked storage area.
2. Prior to issuing the unit-dose packaged prescription medication, unit staff should identify the correct prisoner using the face-to-name-muster board.
3. Unit staff follow the instructions provided by Health Services staff on the Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) or on the prescription medication package.
4. Unit staff ensure the prisoner signs for medication after the prisoner’s correct identity has been established and prior to the medication being given.
5. Unit staff instruct prisoners to take medication in front of them, with a drink, unless instructed otherwise by Health Services.
6. Unit staff observe the prisoner consuming prescription medication if it is to be taken at the guardroom/wing office. Prisoners will be instructed to bring a drink with which to take their prescription medication.
7. Unit staff sign the Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) following the issuing of prescription medication.
8. Unit staff secure any prescription medication not taken by prisoners, for Health Services staff to retrieve.
9. When a prisoner refuses to take prescription medication, the unit officer notes this on the Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) signs it and records that Health Services instructions were followed by staff. The unit officer to note any other action taken in the Action Taken column on the Unit-Dose Packaged Prescription Medication Log Sheet.
10. If the unit staff member is concerned (for example prisoner states incorrect dosage the unit staff member can phone the on call nurse.
11. If the incorrect prescription medication is given to a prisoner, the unit officer needs to report this immediately to the unit manager or senior officer, who immediately informs Health Services. An incident report must be completed.

Prisoner responsibilities

1. Prisoners take responsibility for attending the guardroom/wing office to be issued their medication at the required time.
2. Prisoners sign the Unit-Dose Packaged Prescription Medication Log Sheet (B.06.09.F1) to acknowledge receipt of the prescription medication.
3. Prisoners take the prescription medication, if instructed, at the guardroom/wing office, with a drink (the prisoner brings the drink with them).

Necessary Forms

• Unit Dose-Packaged Medication Log Sheet (B.06.09.F1)
• Health Services Standing Orders (managed by Health Services staff)
• Advice of Prisoner Health Status (B.06.03.F2)
• Medication Chart (Health Services form)
• Medication Administration Record (Health Services form)