Some patient safety standards from traditional healthcare settings are applicable in corrections; most notably patient identification, medication administration, and hand hygiene. Many, however, are of little effect in this setting. Several years ago, a panel of correctional health care experts was convened to propose patient safety standards for prisons. This group considered the standards currently in place for traditional settings, as well as the unique nature of correctional health care practice. Although dominated by physicians, the panel of 30 correctional healthcare professionals also included several nurses.
The outcome of this project was the creation of a list of 46 standards in seven categories. Conveners suggest that implementing these proposed standards will greatly improve patient safety in corrections. The following standards are of particular importance to correctional nursing practice:
- Medication References: Staff need up-to-date reference material to consult regarding unfamiliar medications or dosage ranges.
- Medication Labeling: Keep-on-Person medications should be fully labeled with patient name and number, prescriber, medication name, strength, dose, frequency, number of pills or time frame, lot number, date dispensed, expiration date.
- Topical Medication: should be stored separately from medications for internal use.
- Multi-dose Vials: should be clearly labeled with date opened and date for discarding (maximum of 30 days).
- Dangerous Abbreviations: Eliminate Do-Not-Use abbreviations from all documentation.
- Patient Involvement: Provide full information for active patient decision-making and informed consent. Share all test results with the patient.
- Pressure Ulcer Prevention: Have protocols in place to monitor for and treat pressure ulcers for all non-ambulatory patients.
The above standards are generally in place in traditional settings and this corrections-specific listing affirms their need. The following additional safety standards proposed by the panel are specific to the correctional health care delivery system:
- Nonmedication information (e.g., allergies, mobility limitations, language or communication limitations, and other disabilities) is reconciled whenever patient transitions from one primary provider or health care setting to another (e.g., infirmary to general population, prison to community, prison to hospital, prison to another prison).
- Patients admitted who are pregnant and opioid dependent, including those on methadone maintenance, will receive adequate opioid dosing to prevent withdrawal during pregnancy.
- The correctional environment is adjusted to special health needs of an inmate (e.g., adding air conditioning).
- Interpretation services are available for clinical encounters; interpreters should be qualified/certified; should not be custody staff or other prisoners except in emergencies.
- The following nationally accepted guidelines are followed for chronic disease management: (1) guidelines published by NCCHC; (2) correctional consensus psychiatric guidelines; (3) all patients receiving certain high-risk medications for ≥180 days receive appropriate lab test monitoring annually (or more often if clinically indicated).
Are you implementing patient safety standards in your correctional nursing practice? Share your tips in the comments section of this post.
Read more about Patient Safety in Chapter 4 from Essentials of Correctional Nursing. Order your copy directly from the publisher. Use promotional code AF1209 for $15 off and free shipping.
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