TITLE: Health Services Medication Control
To establish process and procedure for the handling and administrating of prescription medications to offenders in Community Based Corrections (CBC) facilities.
Trained staff will secure, control and audit scheduled controlled substance medications. Over the counter medications and prescribed medications deemed to not be a scheduled controlled substance will be possessed by offenders, unless there is reason to believe the offender may abuse the medication. This policy applies to all CBC staff and will be maintained current by the Residential Manager or designee.
- Over-the-Counter Medication - Any medication purchased without a prescription from a doctor.
- Prescription Medication - Medication dispensed only when prescribed by a doctor and filled by a pharmacy or provided by a nurse practitioner or medical doctor.
- Scheduled Controlled Substance - Medication prescribed by a doctor and filled by a pharmacy, but these medications possess an increased risk of abuse or addiction and is DEA identified as a schedule I II III IV or V.
- Offenders will have over-the-counter medication in their possession unless there is reason to believe the offender may abuse the medication. In this case, staff may deny possession of the over-the-counter medication and instead will store it in a secured location. Any Medication containing alcohol is prohibited unless prescribed by a doctor.
- Offenders will have control of their own prescription drug if it is not a scheduled controlled substance. If it is deemed that the offender is not allowed to keep these prescriptions in their possession then staff will store it in a secured location- once this medication is secured it will be allotted and recorded the same as the controlled drugs. Offenders will possess any medication that is not traditionally to be known as an abused medication in their rooms in their original container, in their locked box, with child safety caps on.
- Staff shall secure scheduled controlled substances and injectable medication. Scheduled controlled substances will be hand counted by staff and recorded upon entering the facility and are to be locked and secured at all times. If the medication comes in a sealed container then the seal will be broken and the contents of the bottle will be counted and recorded.
- A medication form shall be completed for each secured medication. Written directions shall be recorded on the form identical to what is typed on the label on the bottle. A hand count of the medication will occur prior to any drugs being allotted to the offender. Non-secured medication will be recorded on the “In Room” inventory form for each offender which is recorded in the shared folder on the computer. The non-secured medication can be audited at anytime but is not required.
- The Medication Form for scheduled controlled substances shall contain the following information:
- Offender's name
- Offender’s ICON number
- Date on Prescription label
- Pharmacy name as typed on the label
- Prescription number (if applicable)
- Name of medication and instruction as typed on the label
- Date the medication was brought into the facility
- Quantity as typed on the label
- Actual amount brought into the facility (as amount counted and recorded by med allotter)
- Staff and offender signature and date
- The following information is documented on the form each time staff allot medications to the offender: date, time, amount taken, amount remaining, staff initials, offender initials and any staff member comments such as packaged for furlough, broken/defective syringe destroyed etc. quantity left in bottle and when audit was conducted, i.e.
- When the medication page is full and no further entries can be made on that sheet the completed sheet will be filed in the dead med file located at each control desk.
- All medication refills will require a new medication page. If the refill is not ready to be used as there is medication remaining in the current prescription, the med allotter should label the bottle with a note stating not to use until previous prescription is completed. However the refill will be included in medication audits as part of the weekly routine.
- The following criteria shall govern the security and audits of medication:
- All medications brought into the facility by offenders (including over-the-counter and all prescription medications) must be shown to staff for proper authorization and to make a determination if the medication needs to be stored in the medication cart. Staff will determine if the medication is a controlled substance or not. If the medication is not an identified DEA I,II, III, IV or V, controlled medication then a decision can be made to allow the offender to keep the medication in his room secured in a locked box.
- All prescription medication and scheduled controlled substances shall be kept in the bottle as dispensed by the pharmacy
- All medication bottles will have child safety caps.
- Only authorized and trained staff shall have access to controlled medications.
- Scheduled controlled substance medication as outlined in Iowa Code Chapter 124 shall be secure while stored in the Facility.
- Controlled substance medication normally can be identified by a white or yellow auxiliary (additional) label on the prescription container. The auxiliary label will state the following warning, "Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed."
- If staff cannot confirm the contents of a prescription to be a controlled substance by the container label, staff shall confirm same through the dispensing pharmacy or physician or by:
- Contacting the Iowa Board of Pharmacy Examiners, 1209 E. Court Avenue, Des Moines, Iowa, 50319, phone number (5l5) 28l-5944
- Contacting the Poison Control Center at 1-800-222-1222 or http://www.iowapoison.org
- Reviewing the U.S. Drug Enforcement Administration's website at http://www.usdoj.gov/dea/pubs/scheduling.html
- Assigned med allotter shall conduct audits (completed count of each pill, each syringe and liquid medication), preferably daily, but required once per week, of all staff-secured medications with the results noted in the audit section on the appropriate medication form. Verifying the count of the medication against the recording in the medication book to verify a match between the hand count and the last recording. The Residential Manager or designee shall be notified of the results of the audit whenever there is a variance. All shortages unaccounted for shall be reviewed by the Residential Manager or designee.
- Monitoring Secured Medications
- It is the offender's responsibility to ensure that the secured medication is taken as directed. Staff shall complete the Medication Refusal form for all offenders refusing to follow the secured medication requirements. And the offender’s counselor should be notified of offender’s refusal.
- All secured medications shall be taken in the presence of a staff member if taken at the facility. Upon an offender's request, staff will provide the offender with the medication, ensuring the correct container is given. Offenders shall self-administer all medications. Staff will hand the offender the medication bottle and the offender will administer his or her own pills. Staff will have the offender open his or her mouth to ensure the medication has been swallowed. Staff shall document on the Medication Form that the medication was released, and both the offender and staff shall initial the form. (6 Rights- Right offender, right medication, right dose, right route, right recording and the right time)
- When staff observes an offender taking medication inappropriately, behaving irrationally or having possible side effects, they shall contact the appropriate authority.
- Offenders are required to obtain a duplicate medication bottle, also known as a travel bottle, if they wish to take their medication out of the facility for any reason. These bottles are obtained from the pharmacy that filled the original prescription. They will take the duplicate bottle with them to work or on furlough with the exact dose needed while out of the facility. Staff shall audit the medication when the offender leaves the facility and returns to the facility.
- Under no circumstances shall staff provide an offender with another offender's medication.
- Monitoring Injectable Medications
- It is the offender's responsibility to ensure that injectable medication is taken as directed.
- Injectable medication and sharps will be secured by staff even though most injectable medication is not a controlled medication.
- Medications are the personal property of the offender and shall be released to the offender upon discharge.
- If the offender is placed in jail, staff shall provide jail staff with the offender's medication as soon as possible or per the jails policy on incoming medication.
- When an offender leaves any type of medication at the facility, whether through discharge, escape or transfer, it will be disposed of by staff, within thirty (30) days, in an environmentally safe method. The disposal of the medication will be witnessed by two staff members and documented on the offender's Medication Form. The medication will not be given to a person who picks up an escapee's property. (Code of Iowa Section 124.506)
- If disposal of medication(s) are requested by the offender (i.e., medication dropped or spilled on the floor), the amount of medication disposed of shall be documented in the "comments" section of the form with both the staff person and the offender signing the section.
- Needles, scalpel blades and other sharp instruments shall be considered as potentially infectious and shall be handled with extraordinary care to prevent accidental injuries.
- All disposable syringes and needles and other sharp items found or obtained in the course of employment shall be disposed of in puncture resistant containers located as close as practical to the area in which they were used. To prevent injuries by needle stick, needles shall not be recapped, purposely bent, broken, removed from disposable syringes or otherwise manipulated by hands. Offenders should dispose of their own sharp in containers provided.
- Training Requirements for Staff
- All staff who may be assigned to allot medication will be provided Community Based Corrections Medication Allotter Training. Recertification training will occur every three (3) years.
- Assignment of Staff Medication Allotter
- The Residential Manager or designee will assign a trained staff person to allot medication on each shift daily. The assigned medication allotter is responsible for the intake of new medication, the audit of medication and the allotment of medication on their shift.