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| The pill problem |
| By Sarah Etter, News Reporter |
| Published: 04/02/2007 |
In 2006, the Institute of Medicine reported that annually1.5 million people are injured by taking the wrong dose of medication or the wrong prescription, adding an extra $3.5 billion in medical costs per year.
These estimates might be for the general population, but prescription errors in corrections are just as prevalent, and just as likely to land an agency on the receiving end of a large lawsuit. According to Dr. Bethany A. Weaver, an Armor Correctional Health Services medical consultant at Florida's Hillsborough County Jail, ensuring proper pill distribution in corrections is very complex. “First, there is a huge difference between prisons and jails,” Weaver says. “In jails, it is much more challenging to hand out meds because you are dealing with people who come in right off of the street. They might be suicidal, coming off of drugs, or unstable. In prisons, there is a bit more stability because the offenders have been sentenced and undergone evaluation for their medical needs.” Facilities must also consider security levels, number of inmates, and the number of medical staff on hand. There are quite a few different ways to handle medicine distribution. A pill line requires inmates to line up at the nurses' station, where medicine has already been sorted by offender name “When inmates receive medications by pill line, it's very important that nurses have the medication to deliver and that they can deliver it efficiently without it taking too long,” Weaver explains. “The longer it takes, the longer the inmates are in a line interacting with one another, and deputies have to keep close watch to make sure that it is a safe situation for everybody. With pill lines, the quicker and more efficient the line, the better the outcome for everyone.” Other options include providing weekly pill packets, which offenders then keep on themselves, also known as KOP, or using stock bottles so staff can count out doses and put them into a cup for offenders. Weekly KOP packets concern officials because of the potential bartering that might take place, especially when it comes to prescriptions like painkillers. “When you choose the KOP option, you really have to keep an eye on inmates trading pills,” sheadds. “You have to know what kind of meds you are giving them and whether or not they could be given to other inmates to use.” Pill count is usually a top concern when using the stock bottle option. “The downside to stock bottle is that you don't have as much control as far as who is receiving what and where the medications are going unless you count them at the end of every shift. If there were fifty pills in every bottle and now there are ten, that's a problem,” Weaver explains. “The nurse has to take the time to add up how many pills each patient gets; one inmate only needs one but another might need four. The nurse has to add how many pills are needed to create a certain dose, so that's also time consuming.” Bubble-wrap pill cards are another frequently used approach. These cards contain medication with the offender's name at the top. But staff must be careful when handling the packaging. “One thing you want to be careful of is re-packaging that pill in any way. If you remove the pill from the card, put it into your hand, and then transfer it to a cup, that is considered re-dispensing, and it is illegal,” says Weaver. Weaver says one great way to reduce errors is to control what comes into the facility. “In Florida, we do not distribute patient medications that don't come from our pharmacy. There is no way to know whether or not those pills are really what an inmate says and we don't want to take any chances. Their meds go to their property and they get them back when they are released.” Personal pills aside, the most important part of medicine distribution involves carefully monitoring the entire distribution process and remembering to follow proper procedure. This will help minimize the risk of lawsuits or the chance of a patient dying because of an error. “Anytime you are delivering medical care, it sets you up for liability,” Weaver says. If an error does occur, the best way to control its impact is to properly manage the situation. Being truthful with inmates about the incident, re-training staff to prevent the accident from happening again, and, above all, making sure that no one attempts to hide the medical error all are strategies that can help a facility limit its liability. No doubt, the right plan combined with well-trained staff and a careful eye can ensure that inmate ailments are properly addressed while medication errors, and potential legal hazards, are kept to a minimum. Related Resources: Recommendations to Reduce Medication Errors in a Non-Health Care Setting |
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