Nursing sick call has been described as the signature practice defining the specialty of correctional nursing. There is no experience quite like sick call in any other area of nursing practice. Nursing sick call is considered the backbone of health care delivery in correctional settings because it is the primary way inmates can access health care during incarceration. In a recent interview Jessica Lee, Vice President for Nursing Support at Corizon commented that sick call is a barometer of the quality of the entire health care program in a correctional facility.
The manner in which inmates make requests for health care attention is the first step in the sick call cycle and the focus of this post. The ability to request health care attention is a fundamental right of persons who are incarcerated. The American Correctional Association (ACA) and the National Commission on Correctional Health Care (NCCHC) both have established standards which require that:
- requests are received by health care personnel every day,
- each request is evaluated within 24 hours of receipt and
- there are no impediments to making requests for health care attention.
Seems pretty simple but compliance requires that correctional officers and nursing staff act in ways that are consistent with these standards in hundreds of encounters and interactions with inmates every day. So access to health care is a high volume, high risk activity in correctional health care. Correctional facilities can protect themselves from adverse patient events and litigation by developing policies, procedures, job descriptions and assignments that meet these standards. In addition it is important to verify that actual practices are consistent with the facilities policies and procedures through supervision and audit of staff performance. The following is a breakdown of the areas that need to be considered to ensure that your facility meets accepted standards for access to care.
Communication: The facility should have one or more ways established for inmates to make requests for health care attention. Inmates must be informed of this process at the time of admission to the facility. Common methods used to request health care attention are by filling out a request slip that is given to a health care provider, signing up on a list, showing up at a particular time, or calling to request an appointment. The next consideration is whether the selected methods are working. Pitfalls to an effective request process include not giving inmates this information at admission, inmates not understanding the process, not having a secure place to put written requests, not picking up written requests every day, forms that are too complicated to fill out, not having sufficient forms, not having access to the sign up list or use of the telephone, lock down or scheduling conflicts, and intimidation of inmates requesting care by other inmates or staff. Nurses should be assigned daily to review and assure that the method(s) used to request care are working. There should be documentation that provides evidence that requests for access to care may be made daily and that there are no impediments. Having the date on each request received, each list of inmate requests, or each walk-in encounter is the kind of documentation that provides this evidence.
Triage: Every request for health care attention must be evaluated within 24 hours of receipt. This evaluation is a form of triage used to determine when and how each request will be handled. Triage is a clinical decision made by licensed health care personnel. Triage requires use of the nursing process to assess the patient, diagnosis the problem, identify the desired outcome, plan and implement intervention(s) to achieve the identified patient outcomes. Simply reading a written sick call slip is not sufficient triage of a request that involves any description of a symptom based complaint. Any inmate submitting a written request for health care attention for a complaint that is symptom based must be evaluated in a face to face encounter within 24 hours of receipt of their request. With other methods for making requests (sign- up, telephone or walk- in) as long as nursing personnel evaluate each request within 24 hours the standards are met. Documentation includes the nurse’s evaluation as well as the date and time the patient was seen. Problems with nursing triage of inmate requests for health care attention include not performing triage seven days a week, not triaging every request received on a daily basis, using inappropriate personnel to perform triage, clinically inadequate triage, trying to talk patients out of needing to be seen, minimizing patient complaints or blaming the patient.
Disposition: The outcome of triage is the disposition or decisions made in response to the patient’s request. Dispositions include treatment, referral, patient education, and advice about self- care. Many times a single request will have more than one disposition decision. In addition to the decision about what is to be done the nurse also decides who will do it and by when. Each of these decisions, including by whom and when, are documented and dated. The nurse should explain the disposition to the patient so that they know what to expect and by when. Every nursing encounter should be considered an opportunity to education that promotes the patient’s engagement in their health care. Pitfalls in the disposition of requests for health care attention include poor clinical decisions, inadequate follow through or handoffs to responsible others, silos between programs and departments that result in disruption of care, and lack of patient understanding or agreement with the plan of care.
Monitoring: When requests for health acre attention are not received and acted upon in a timely, responsive and clinically appropriate manner the efficient operation of the health care program will be in serious jeopardy. Effects of insufficient access are increases in the number of inmate grievances, increases in requests for emergent health care attention and inmates will submit multiple requests for the same problem. Health care programs should track the timeliness, completeness and appropriateness of communication, triage and disposition of health care requests. Other aspects of access to care that should be monitored are the types of requests being made as well as the subject and frequency of multiple requests. This data helps to answer two questions: Is the system to access care working and are the responses clinically appropriate, responsive and timely?
Do the practices in place at your facility meet the standards for access to health care? How does the facility monitor access to health care? What is your role in ensuring that inmates have unimpeded access to health care during incarceration?
For more on nursing sick call and access to care read Chapter 15 in the 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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