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HomeMy WebLinkAboutAgenda - 06-13-2006-5dORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: June 13, 2006 Action Agenda Item No. s-d SUBJECT: Orange County Jail Medical Plan and Hillsborough Medical Contract DEPARTMENT: Sheriff ATTACHMENT(S): Hillsborough Medical Contract -Health Care PUBLIC HEARING: (Y!N) No INFORMATION CONTACT: Sheriff Lindy Pendergrass 245-2923 Orange County Jail Medical Plan (under separate cover) PURPOSE: To adapt the Orange County Jail Medical Plan and approve the medical health care contract for inmate medical services at the jail facility for fiscal year July 1, 2005 thru June 30, 2006. BACKGROUND: The Orange County Jail Medical Plan is reviewed yearly per General Statute 153A-225, The Orange County Jail Medical Plan is responsible for providing 24-hour emergency medical care services for all inmates housed in our facility. To meet the medical plan approved by the Board of Commissioners, Dr. Philip Singer and his staff at Hillsborough Medical Group will assist the Orange County Sheriffs Office to provide on-site medical services as necessary and provide telephone consultation 24 hours per day seven days per week. FINANCIAL IMPACT: The Sheriffs Office will reimburse Hillsborough Medical Group at the rate of $4,728 per month for medical services, Hillsborough Medical Group agrees to maintain professional liability insurance. RECOMMENDATION(S): The Manager recommends that the Board adopt the jail medical plan and approved the medical services contract with Hillsborough Medical Group. Agreement between Hillsborough Medical Crroup, PA And Orange County, North Cazolina ,~ Whereas the Orange County Sheriff has need for provision of medical services to implement the Plan for Providing Medical Care for prisoners in the Orange County Jail; And whereas Hillsborough Medical Group, PA has the capacity, experience and interest in providing such services; Therefore the parties agree to the following: Hillsborough Medical Group, PA shall: Provide for medical supervision and routine medical care for prisoners, Develop and implement policies and procedures addressing each of the following areas: a. health screening of inmates upon admission; b. handling of routine medical care; c. handling of inmates with chronic illnesses or known communicable diseases and conditions; d. administration, dispensing, and control of prescription and non- prescription medications; e, handling emergency medical problems, including emergencies related to dental care, chemical dependency, pregnancy, and mental health; f. maintenance and confidentiality of medical records; and g, privacy during medical examinations and conferences with medical personnel, Provide onsite medical services as necessary and provide telephone consultation 24 hours per day seven days per week. Invoice monthly Orange County by delivering the invoice to the Orange County Sheriff s Office for service rendered in accordance with this agreement, Orange County shall: The Orange County Sheriff or designee shall ensure that tasks and duties assigned to Orange County Sheriff's staff are completed as directed by Hillsborough Medical Crroup, PA's health care providers or established protocols. Reimburse Hillsborough Medical Group, PA at the rate of $4728.00 per month for the above medical services Review invoice and make payment for service rendered in accordance with this agreement. This agreement shall be in effect from July 1, 2006 until June 30, 2007. Hillsborough Medical Group, PA agrees to maintain professional liability insurance of $1,000,000 each loss /$3,000,000 aggregate. It further agrees that it is operating as an independent contractor and is not eligible for any benefits available to employees, including worker's compensation coverage.. Hillsborough Medical Group, PA agrees to hold Orange County, the Orange County Sheriff and all deputy sheriffs and Orange County employees harmless from any and all accidental injury or personal loss as a result of implementing the elements of this Agreement. Hillsborough Medical Crroup, PA agrees to comply with all applicable federal and State laws related to the confidentiality of medical information. Hillsborough Medical Group, PA is a "Hybrid Entity" as defined by the Health Insurance Portability and Accountability Act of 1996 and its related regulations, as amended ("HIPAA") and Hillsborough Medical Group, PA shall, in compliance with HIPAA, "carve out" the services provided under this contract from the covered components of its Hybrid Entity. Either party may terminate this Agreement without cause with 30 days written notice. This Agreement may be terminated with cause at any time by either party upon at least 7 days prior written notice to the other party upon default of one or more of its obligations hereunder, unless such default is cured within 7 days of the notice of termination. Notice to Hillsborough Medical Group, PA should be mailed to: 101 East Corbin Street Hillsborough, NC 27278-2100 Notice to Orange County should be mailed to: Orange County c/o Orange County Sheriff 144 East Margaret Lane Hillsborough, N.C. 27278 In witness whereof, Hillsborough Medical Group, PA and Orange County have executed this Agreement in duplicateoriginals, one of which is retained by each of the parties. z, zoo6 Medical Crroup, PA ~~, © ~ L. Pendergrass, Sheriff c~)range County Pam Jones, Purchasing Director of Orange County Date John Link, Orange County Manager Date "This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act". Kenneth T. Chavious, Orange County Finance Director Date ORANGE, COUNTY JAIL, FACILITY MEDICAL PLAN: THE MEDICAL, PLAN REVIEWED AND APPROVED BY THE FOLLOWING ON THE SHOWN. ~~ ~ _ ATE ~~.~~ DA =~- DA SECTION IV: HEALTH, MENTAL HEALTH & RETARDATION AND SUBSTANCE ABUSE SERVICES TABLE OF CONTENTS Policv Number Policv Title 4.01 Facility Medical Plan 4.02 Qualified Medical Personnel 4.0.3 Medical Complaints and Referrals 4.04 Routine Medical Caze of Inmates (Non-Emergency) 4.05 Emergency Medical Plan 4.06 Dental Laze 4.07 Mental Health Caze Delivery Services 4.08 Substance Abuse Services for Inmates 4.09 Administration & Control of Medications 4.10 Suicidal Inmates 4.11 Acquired Immune Deficiency Syndrome (AIDS) 4.12 Communicable Diseases 4.1.3 Transportation of Inmates for Medical Care 4.14 Medical Records 4.15 Detention Officer -Med Passer Duties 4.16 Medical Cazt Procedures 5 G~ ORANGE COUNTY JAIL 144 East Mazgaret Lane Hillsborough, North Cazolina 27278 POLICY #: 4.01 PAGE 1 OF 2 TITLE: FACII.ITY MEDICAL, PLAN DATE: JULY 1, 2003 RELATED N.C. STANDARDS: .2801; 3203 POLICY STATEMENT: In order to provide for the health, well~~being and welfare of the inmates confined in the Orange County Jail, the Jail Administrator, as directed by the Sheriff; will be responsible for the development of a written facility medical plan that conforms with regulations and standards of North Carolina Minimum .Tail Standards.. The facility medical plan will be reviewed and updated, as necessary, on at least an annual basis by the Jail Administrator and must be approved by the Sheriff, The Sheriff and/or Jail Administrator will ensure that the plan is reviewed and approved by officials of the County Health Department and the medical officials contracted by Orange County to provide health caze for the inmates housed at the Orange County jail prior to implementation of the plan, SPECIFIC PROCEDURES: 1. As directed by the Sheriff, the Jail Administrator will be responsible for the development and annual review of the facility medical plan. The Jail Administrator will ensure that the plan is approved and signed by the Sheriff and reviewed and signed by officials of the County Health Department and Medical Officials contracted by Orange County to provide health care prior to implementation of the plan. 2, A copy of the facility's medical plan will be posted in the Control Room in a conspicuous azea so as to afford all detention officers access to the plan for review. 3. A brief summary of the plan, to include information as to the availability of health caze services at the facility, will be included in the Inmate Handbook so as to ensure that inrriates are aware of and familiar with the procedures necessary to be followed to access health care services. 4. At a minimum, the facility medical plan will include information that addresses the __ following areas: A. Health screening of inmates upon admission to the facility; B Procedures for handling routine medical care requests; POLICY 4.Q1, "FACILITY MEDICAL PLAN" PAGE 2 OF 2 C. Procedures for the handling of inmates with chronic illnesses or known communicable diseases or condition; D, Procedures for the administration, dispensing and control of prescription and non- prescription drugs; E. Procedures for handling emergency medical problems, including, but not limited to, emergencies involving dental care, chemical dependency, pregnancy and mental health; F. Procedures for the maintenance and confidentiality of medical records; G, Procedures for ensuring privacy during medical examinations and conferences with qualified medical personnel; -_. H. Procedures for handling of intoxicated inmates admitted to the facility; and; I. Procedures for the educating of officers as to AIDS and HIV disease and the transmission of AIDS/HIV; and; J. Procedures for transporting inmates to outside sources for medical care.. 5, Under no circumstances will the plan allow any inmate to perform any medical function at the facility. ~~~,1/' Reviewed and Approved: __ ~~_._- ~- (Sheriff) ~G~ Date: ~G, ~ (~~~ ORANGE COUNTY JAIL 144 E. Margaret Lane Hillsborough, North Carolina 27278 POLICY #: 4.02 POLICY TITLE: QUALIFIED MEDICAL PERSONNEL, DATE: JULY 1, 200.3 RELATED N.C. STANDARDS: ..2403 (a) (8); .3201 Page 1 OF 1 POLICY STATEMENT: The Sheriff or designee will ensure that qualified medical professionals are made available to provide for the evaluation of each inmate's health care needs. To this end, the facility will employ and contract with local health care providers who are licensed, registered, certified and/or approved to perform health care services/functions in accordance with applicable state and local laws. SPECIFIC PROCEDURES: The Sheriff or designee will ensure that the jail detention facility contracted local physician(s) or medical provider groups provide adequate health care services to inmates housed at the jail. 1. All health care professionals are to be licensed, registered, certified or approved, as required under applicable state and local laws.. 2. The names and phone numbers for all of our contracted medical professionals under contract for the Orange County Jail shall be cleaziy posted in the Control Room to ensure that all detention officers have access should need arise for the same. Detention Personnel who have been certified. as med passers shall only administer medication as instructed by contract Medical Professionals. Med gassers are NOT considered as medical professionals FOR MEDICAL needs. 3. Under no circumstances will any inmate housed at the facility be allowed to perform any health caze function in the jail, regazdless as to whether they may be licensed, registered, state approved or certified to perform any medical function. 4 It will be the responsibility of the Sheriff or designee to communicate to all detention officers who our health care professionals are and the hours/d they are ally scheduled to work or when they are to be available for caring for iru~ ~~"'~f Reviewed and Approved: `~ (/ (Sheriff) Date: ju-..y (, 2°y~ ~~ ORANGE COUNTY JAIL 144 E. Margaret Lane Hillsborough, North Carolina 27278 q POLICY #: 4,03 PAGE 1 OF 3 POLICY TITLE: MEDICAL COMPLAINTS AND REFERRALS DATE: TUL,Y 1, 200.3 RELATED N. C. STANDARDS: .2403 (a) (8); ..3201 POLICY STATEMENT: In order to provide inmates with an opportunity to communicate their medical complaints and needs to qualified medical personnel, the Jail Administrator will develop and implement a system whereby inmates can verbally express and /or document their medical complaints to ,jail detention officers. Jail detention officers shall be responsible for listening and cazefully documenting each inmate's medical complaindrequest and for ensuring as soon as possible that their complaints are referred to our contracted medical professionals for the facility. Inmates will be afforded the opportunity to communicate and /or document their health care complaints and needs to.jail detention officers any time a need arises or on a daily basis in the mornings when the designated detention officer checks each cell block ascertaining " if "any inmate has any medical needs. SPECIFIC PROCEDURES: 1. .Tail detention officers will ensure that daily rounds are conducted at the beginning of the _ morning shift and that inmates aze given the opportunity to voice any medical complaints/requests they may have to jail detention officers. 2. .Jail detention officers will record each inmate's medical complaint or request on a separate "Prisoner Medical Report Form: (see Attachment #1) on the space on the form where it requests information relative to the complaint. 3. Jail detention officers will be required to submit all "Prisoner Medical Report Forms" medical or medicines listed to the Shift Supervisor. The Shift Supervisor will record all "Prisoner Medical Report Forms" in the Prisoner Medical Farms Received Log, located in the Medical Room. The Shift Supervisor will initial at the right side of each entry they record in the Prisoner Medical Forms Received Log and give the form to the Med Passer on duty. The Med Passer on duty will initial at the right side of each entry of the forms they receive and place the form in a file for review by our contracted medical professional as soon as possible,. (NOTE: Should a,jail detention officer feel that an inmate's medical complaint may require emergency caze or attention, the procedure outlined in Orange County .fail Policy 4.05, "Emergency Medical Care" shall be followed). 4. The Jail detention officer completing the Prisoner Medical Report Form (see Attachment #1) with medical or medicine issues listed will give all completed farms to the Shift Supervisor to record all medical complaints and referrals received daily in the Prisoner Medical Report Form Log. The following information will be recorded: A. Inmate's name; B. Housing location; and, C. Date of the inmate's request. D. Officer's name E. Summarized Medical Complaint POLICY 4.03, "MEDICAL COMPLAINTS AND REFERRALS" ~~ PAGE 2 OF 3 5. Documentation: When an inmate is admitted to the Orange County .Tail, as stated the Detention Booking Officer shall complete a Medical Questionnaire. If the inmate on admittance requests or we find in our opinion on admittance that the inmate needs to see a medical professional, the booking officer shall complete a "Prisoner Medical Request Report", OR if during a shift an inmate request or if we fmd an inmate in need of medical caze, we in each situation shall file a "PRISONER MEDICAL REFERRAL /REQUEST REPORT". It shall be the duty of each day AND night detention shift supervisor on duty to collect and record on the prisoner medical report log in the Medical Room all new reguests or referrals for inmates, and "PRISONER MEDICAL REPORT FORMS", The log shall have the name of the inmate, date and time he/she was admitted OR REQUESTED MEDICAL TREATMENT, OFFICER COMPLETING THE FORM AND SUMMARY OF COMPLAINT OR FORM. The medical report shall have the date and time the inmate requested (asked) for medical treatment and detention officer who received the request.. The detention officer taking the medical request (complaint) shall summazize the complaint on the report, The Shift Supervisor, Med Passer, and Medical Professional receiving the form shall initial and mark the status of the medical request form in appropriate boxes. Upon completion, the on-duty Detention Supervisor shall present the forms to the on-duty med passer.. It is the duty and responsibility of the on duty med passer to wive the "PRISONER MEDICAL FORMS" to the contracted facility Medical Professional on duty for that day in the Orange County Detention Center, It is the duty and responsibility of the med passer to have the medical professional receiving the forms to initial or sign the medical log demonstratine that they have received all the forms from the detention med passer.. It shall then he the duty of the contracted medical professional to review each prisoner medical form, complaint and prioritize each inmate's medical complaint in terms of health caze needed. NOTE: ~• not fail it is the Shift Supervisor and Detention Officer's duty and responsibility to insure that collectinE and ~resentin2 of all recently admitted "Prisoner Medical Forms" to the med passer, whose duty it is to ensure they give the forms to the medical professional as prescribed with documentation.) The "PRISONER MEDICAL FORMS RECEIVED LOG" shall be signed by each of the following the Detention Supervisor, med passer and the contracted medical professional receiving the forms. If the medical professional is not on duty to receive the PRISONER MEDICAL FORMS, they shall be placed in the PRISONER MEDICAL FORM BOX in the medical room in the jail,(Remember we can not fail to have the medical professional to sign or initial receiving the forms) POLICY 4.03, "MEDICAL COMPLAINTS AND REFERRALS" " PAGE 3 OF 3 6. Once an inmate has been seen by our contracted medical professional staff, it will be the Medical Professional's duty to ensure that the Medical Report L,og is updated and that the following information is recorded in the Medical Report Log: A. Date and time inmate was seen by health care staff; B. Physician or health care professional that examined the inmate; and, C. Any medications required to be given to the inmate or special instruction that we are required to be observant for and monitor. 7. It shall be the duty and responsibility of the ,jail detention contracted medical care professional to RETURN THE INMATES completed "Prisoner Medical Report Form" to the Facility Medical Room and file the completed "Prisoner Medical Report Form" in the appropriate inmate's medical record file.. This is absolutely necessary to insure our records are complete and properly filed. Once a diagnosis has been made and recorded on the form, the "Prisoner Medical Report Form" becomes a confidential record.. 8, Orange County Detention contracted medical professional shall provide detention officers responsible for administering medications to inmates all information needed which pertain to any prescription or non-prescription medications that an inmate may need to take as a result of their diagnosis of the uunate (see, Orange County Jail Policy 4.09, "Administration and Control of Medications," for more detailed information). 9 All inmates will be informed of how they can request or make a medical request/complaint during the admission process. A summary of services available will be outlined in the Inmate Handbook provided to each inmate during thew admission to the facility. ~4'~ f i~~ ~G' " .C~^~ Reviewed and A roved: ~~ " PP (Sheriff) OJ Y Date: 7 -I'Z- is ORANGE COUNTY.JAIL SICK CALL REQUEST cc: Date: Time: .am/pm Oflicct Narnc __ Medical OCfsite Noti6cd: yes ~ no _ Uate/ i"ime Notified Inmate Transported to Hospital: yes _ no __ Subjective: Objective: T- P-_R-_B/P- Wt- Allergies AsscssrticnG 1. S. 2. _ C,. .3. ~^_ 7, 4. R. Plan: 1. 2. .3. 4. S. mcdicatinn ordered RTC for P/U _RTC prn -sent to ER -sent for Xray Provider Sivnahirc: Name: DOB: SS#: -return to jail area -jail medical supervision recommended -refer to dental _rc(cr to psych -outside referral: where: ATTACHMENT #1 Tlalr Tirnr ~m/nm ORANGE COUNTY JAIL 144 E. Margaret Lane Hillsborough, North Cazolina 27278 POLICY #: 4 04 13 PAGE 1 OF 4 POLICY TITLE: ROUTINE MEDICAL CARE OF INMATES (NON- EMERGENCY) DATE: JULY 1, 2003 RELATED N.C. STANDARDS: .2403 (a) (8); .3201 POLICY STATEMENT: In order to promote the health and well being of inmates confined to the Orange County Jail, detention officials will ensure that qualified health caze professionals are available to provide needed routine medical services and treatment to inmates on a regularly scheduled basis and as needed. Routine medical caze shall be provided to inmates daily as needed upon an inmate's request or when an emergency exists or upon the request of a .jail detention officer who has cause to believe an inmate needs medical assistance or care. SPECIFIC PROCEDURES: 1. The Orange County Tail shall ensure that qualified professional medical care providers are available on a 24 hr, basis. Our' contracted medical provider shall provide 24-hour service either by phone or in person. The contracted medical providers shall have a schedule for routine non-emergency needs for inmates. The medical providers shall schedule three (3) days, or more if needed.. If an emer~ency or need arises on days the medical provider is not scheduled to be in the fail The contracted medical provider shall be available for detention officers to call on call medical provider or call the medical providers office and obtain an appointment for transport of the inmate to the medical providers office. The medical providers schedule _will be given to the med passers and the Detention Lieutenant. The contracted medical professional shall remain in the Detention Center on these specified days until all inmates' medical needs are evaluated. Further after 1700 hours and nn weekends the contracted medical professional or qualified medical person shall be designated and available. L list of phone numbers FOR AFTER HOURS CONTACTS shall be posted in the control room for detention shift supervisors). 2 Should an emergency azise which cannot be attended to during the day by the contracted medical provider, Orange County EMS shall be called and requested to respond. Upon azrival should the EMS provider not be able to caze for the inmate's medical needs and after examination of the inmate advises or directs the Jail Detention Supervisor "that the inmate should be transported to UNGChapel Hill Hospital" we shall immediately do so either by ambulance or patrol vehicle. 14 POLICY 4.04, "ROUTINE MEDICAL CARE OF INMATES (NON-EMERGENCY) PAGE 2 OF 4 3. Procedures for Schedulins Inmate Visits by the contracted Medical Provider. A. Routine medical care may be obtained by inmates pursuant to the procedures outline in Orange County Jail Policy 4.0.3, "Medical Complaints and Referrals." Jail detention officers shall also be responsible for monitoring the condition of inmates during their security rounds and for referring any noted medical problems to our contracted medical care providers. B. Should a ,jail detention officer observe any inmate who appears to be in need of medical care, he/she should immediately document his/her observations on a "Prisoner Medical Referral Report Form," (see Attachment #1) and provide the on duty detention supervisor his/her findings. The on duty supervisor shall provide the contracted medical provider of the medical referral form once it is completed. If any emergency does not exist the form is to be given to the designated med passer who shall be responsible for giving the form to the contracted medical professional for evaluation. (Procedure to follow for Nan-Emergency Prisoner Medical Forms in located in Policy Manuel section 4.03 Page 2 of 2.) C. Copies of all "Prisoner Medical Report Forms" shall be given to the on duty shift supervisor, to give to the detention medical passer, who shall place the reports in the contracted medical professionals file to be reviewed and evaluated. The contracted medical professional will decide when the inmate will be seen or advise the on duty supervisor or detention med passer what is to be done to attend to the inmates medical needs.. The on duty supervisor shall be responsible for insuring all procedures are followed and that the following information is placed in the Inmates Medical Log: 1. Inmate's name; 2. Housing location; and, 3. Date of the inmate's request. 4 Officer's name 5. Summarized Medical Complaint D. Each morning after the breakfast meal is served, the Jail Detention Supervisor will designate a detention med passer to visit each detention cellblock and ascertain if any inmate has any medical needs. If any inmate states to the med passer that they have a medical need the med passer being told shall complete a "prisoner medical report form" ~s POLICY 4.04, "ROU'TINE MEDICAL CARE OF INMATES (NON-EMERGENCY) PAGE 3 OF 4 E, The med passer shall then report to the Shift Supervisor with the prisoner medical report forms. The Detention Shift Supervisor shall be responsible for reviewing all "Prisoner Medical Report Forms" that have been submitted by the med passer.. The Shift Supervisor shall at this time have the med passer deliver the Prisoner Medical Report Forms to the contracted Medical Professional (if on duty) and inform the medical professional of the requests, Contracted Facility Medical Professionals shall be responsible for prioritizing all "Prisoner Medical Report Forms" in terms of needed health care. F Once an examination has been completed in response to a "Prisoner Medical Report Form," request, the contracted medical professional conducting the examination shall be responsible for updating the information in the inmate's medical report. The inmate medical report shall contain the following information: 1. Date and time inmate was seen by health care professional; 2. Location of the examination; 3. Physician or health Gaze professional that examined the inmate; and, 4. Any medications required to be provided the inmate or any special instructions. G. The contracted medical professional will retain the "Prisoner Medical Report Form" for filing in the inmate's medical record. Under no circumstances will copies of any "Prisoner Medical Report Forms" containin_~~information as to the treatment or H. .Tail detention officers shall be held responsible for following all instructions given to them by health care professionals (e.g., administering medications to inmate's etc,). 4. Procedures for Accessing_Routine Medical Caze Services DurinQNnn-Scheduled Visiting Davs: A. Should an inmate have a medical need when our contracted Medical Professionals aze not on duty or when the call back medical professional is not available/ the jail detention supervisor shall first ask EMS to check the inmate? If EMS is unable to attend to the inmate's medical need or advises that we transport the inmate to UNC-Chapel Hill Hospital the Detention Supervisor shall immediately contact the Tail Administrator or Major or the Sheriff. (If an emergency exists common sense prevails -we da what is needed, we transport the inmate to the hospital and attend to the inmate's medical needs). B The jail detention officer contacting Medical Personnel must document the contact on a "Prisoner Medical Report Form". The same information contained in #2 (c), above, will also be required to be recorded in the Prisoner Medical Report Form Log. 1(v POLICY 4.04, "ROU'TINE MEDICAL CARE OF INMATES (NON-EMERGENCE" PAGE 4 OF 4 C. Inmates requiring transfer to IJNC-Chapel Hill Hospital shall be transported pursuant to the procedures outline in Orange County .Tail Policy 4.1.3, "Transportation of Inmates for Medical Care.." D. All inmates transferred outside the facility shall be accompanied by an Orange County Sheriff's Office Deputy. The Deputy will be required to hand-carry a copy of the completed "Prisoner Medical Report Form" to the medical professional, attending physician or health care provider. E. Once the inmate has been examined, treated and a diagnosis is completed of the inmate's condition, the medical professional attending the inmate will be responsible for recording the diagnosis and treatment on the "Prisoner" medical form. The transporting deputy sheriff shall return the "Prisoner" medical form" back to the Jail detention Supervisor who will ensure that the jail contracted medical professional places the form in the inmate's medical file. Under no circumstances shall the deputy return the inmate back to the fail without the "inmate's medical report form". (Remember this report has to be placed in the inmate's medical folder. F. Any information pertaining to any medication and/or treatment to be provided to the inmate by jail detention officers upon the inmates return to the facility shall be communicated to the transporting Deputy or called in to the Control Room officer by the health care provider, It is the duty and responsibility of the on duty Detention Supervisor to ensure that our1ail medical provider nets the information at the first available opportu, nits G. Once the inmate has been returned to the facility, the Jail detention Supervisor shall be responsible for informing our contracted medical provider who will he responsible for updating the Medical Report L,og and recording the following information pertaining to the inmate visit in the L,og: 1. Date and time the inmate was seen by the medical professional; 2. Location of the inmate's visit; 3 Physician or health care professional that examined the inmate; and, 4. Any medications required to be provided the inmate or any instructions required to be followed. ~' I~~`~~~,~ Reviewed and Approved: ~~ !/ (Sheriff) Date. fb~~ ~ ~ 20°`~ 17 ORANGE COUNTY JAIL SICK CALL REQUEST CC: Date: Time: .am/pm Officer Name __ Medical Offsftc Notified: yes ` no _ Dale/'t'ime Nvtificd Inmate Transported to Hospital: yes _ no __ Subjective: Objective: T- P-_R- B/P-_ Name: DOB: SS#: W t- Allergies AsscssrricnC 1. S. 2. _ (. 3. ~_ 7. 4. 8. Plan: 1. h 3. 4. S. medication ordered R`IC [or I:/U RTC pm !sent to ER -sent for Xtay -return tv jail area -jail medical supervision recommended ^rcfcrto dental -refer to psych _uutsielc referral: where' ATTACHMENT #1 ORANGE COUNTY JAIL 144 E. Margaret Lane Hillsborough, North Carolina 27278 POLICY #: 4.05 POLICY TITLE: EMERGENCY MEDICAL PLAN DATE: JULY 1, 200.3 RELATED N.C. STANDARDS: .2403 (a) (8); .3201 (G PAGE 1 OF 4 POLICY STATEMENT: In order to ensure that the health care needs of inmates housed at the Orange County Jail are met on a continuous basis, the facility will provide 24-hour emergency medical care services through our contracted medical professional, or Emergency Medical Services (EMS,). The facility will, at all times, ensure that medical services aze available on a 24-hour basis, First aid kits will also be available within the facility to allow officers to provide any needed services until such a time a medical professional (s) arrive at the facility. All jail detention officers will be trained in emergency first aid techniques and in the detection of the signs and symptoms that may suggest a medical emergency. SPECIFIC PROCEDURES: 1. Training: All jail detention officers employed by the Orange County .Jail will be instructed/trained in the following areas during their first year of employment: A. Emergency First Aid and CPR: All detention officers during their first yeaz of employment will be trained in the areas of emergency fust aid and CPR. techniques.. It will be the responsibility of the .Tail Administrator to coordinate and schedule this training, B. Detection of Medical Emergencies: All detention officers will be trained to detect the signs and symptoms of medical emergencies to include, but not be limited to, the following areas: 1, Signs of unconsciousness or semi-consciousness; 2. Signs of alcohol or drug intoxication; 3. Signs of severe bleeding; 4. Signs/symptoms of serious breathing difficulties; 5. Signs/symptoms of serious head injury; 6 Signs of severe bums; 7. Signs/symptoms of severe pain; 8. Signs of suicide risk; and, 9. Signs/symptoms of pregnancy or problems/complications. POLICY 4.OS,"EMERGENCY MEDICAL PLAN" PAGE 2 OF 4 I~ All training received by jail detention officers will be documented, maintained and filed as outlined in Orange County Jail Policy 1.04, "Employee Training." 2. Emergency Medical Care Procedures: A. In the event a jail detention officer should discover or be summoned to respond to a medical emergency, the jail detention officer will immediately contact the Control Room detention officer using the intercom system or radio and explain to him/her that a medical emergency exists.. B. The Control Room detention officer will be responsible for contacting the following individuals/groups in the following order. 1. EMS: 2 Senior Detention Officer 3. Lieutenant 4. Major or in his/her absence, the Sheriff. G A list of all emergency phone numbers will be posted in a conspicuous place in the Control Roam near the telephone for all detention officers to have access to, D. ANY jail detention officer responding to a medical emergency in a cellblock shall be responsible for observing all secruity precautions when entering the cellblock to provide care to an inmate. To this end, the detention officer will be responsible for ensuring that multiple detention officers are summoned to assist him/her in handling the medical emergency and to evacuate all other inmates from the cell block so that adequate medical care can be provided. (Detention staff shall ask an officer or the control room detention officer TO lock the cell door when they enter the cellblock if they have to enter the cellblock). If they have moved all other inmates from the cellblock this may not be necessary). E. The responding detention officer may employ emergency fust aid techniques and or CPR as needed until such a time that medical assistance arrives on the scene .Tail detention officers should use universal safety precautions when administering fast aid or CPR. to avoid contamination from any contagious or communicable diseases. F. Once EMS staff or medical professionals have azrived at the facility, jail detention officers will afford them access to the inmate requiring medical care and will allow the medical personnel to take over all medical care responsibilities. Jail detention officers are not to interfere with any medical care being provided an inmate by qualified EMS health care professionals. G. Should EMS or any medical professional responding to the emergency make the determination that the inmate requires transportation to an outside medical facility for treatment; officers shall follow the procedures outlined in Orange County Jail Policy 4.1.3, "Transportation of Inmates for Medical Caze," POLICY 4.05, "EMERGENCY MEDICAL PLAN" aC7 PAGE 3 OF 4 3. Documentation of Medical Emergency: The following documentation will need to be completed either by the responding .jail detention officer and/or other detention officers involved in the medical emergency situation: A An official "Incident Report" detailing the circumstances surrounding the event and any action taken by the detention officer and by the responding EMS or medical professional to treat the inmates mote: the fail supervisor on duty shall be responsible for obtaining a written report from EMS before they leave our facility or before the end of the shift. B. A "Prisoner Medical Report Farm" (see Attachment #1) to summazize the inmates medical problems and document any action taken by the detention officer to provide assistance; and, C. A record of the "Prisoners Medical Report Form" shall also be made on the Medical Log located in the Control Roam by the Control Room detention Officer. Copies of both forms will be provided to the .Jail Administrator and the Sheriff for review and an incident report will be filed in the inmate's confurement record, A copy of the prisoners medical report form will be filed in the inmates medical records in the medical room at the jail. 4 Maintenance of First Aid Kits: A. A first aid kit will be located in both Control Rooms and will be available for use by all jail detention officers at all times Replacement supplies for the kit will be maintained at the facility. B. Facility medical personnel will be responsible for periodically inspecting the contents of the first aid kit to ensure that all supplies are available.. Facility medical staff should advise the on duty detention supervisor any time that supplies need to be replaced. It will be the responsibility of the on duty supervisor to obtain any needed replacement supplies for the first aid kit from the stock of supplies located at the facility. C. Jail detention officers shall advise the detention on duty supervisor any time they utilize supplies from the first aid kit. The on duty detention supervisor shall be responsible for replacing any needed supplies in the first aid kit. ai POLICY 4.05, "EMERGENCY MEDICAL PLAN" PAGE 4 OF 4 D. The first aid kit should, at a minimum, contain the following items at all times: L Different size bandages; 2. Tape 3. Gloves 4. CPR Mask 5. Goggles 6. Alcohol wipes or swabs; 7. Cotton swabs; 8. Antiseptic lotion, cream or liquid; 9. ScissoTS; 10. Tourniquet(s); and, 11. Hot and/or cold packs for swelling G~~ifi1~^d Reviewed and Approved: (Sheriff) Date: "~~~~~ ~ , 2d o~ as ORANGE COUNTY JAIL SICK CALL REQUEST CC: Da[c: Timc: _am/pm O~cct Namc __ Medical Offsitc Notiticd: yes ~ no _ Uau:/'Timc Notified Inmate Transported to Hospital: yes _ no __ Subjective: Objective: T- P-_R-_B/P- Name: DOB: , SS#: Wt- Allergies Asscssrticnt: 1. 5. 1. _ C,. 3. ~ 7, 4. R• Plan: 1. 1. 3. 4, S. medication orrlercd -RTC Cvr P/IJ _R'TC pm -sent to ER -sent. for Xtay -return to jail area -jail mcdic:al supcrvisipn recommended _rcfcr to dental _rcfcr to psych outside referral: where: ATTACHMENT #i ORANGE COUNTY JAIL 144E Margaret Lane Hillsborough, North Carolina 27278 POLICY #: POLICY TITLE: DATE: RELATED N.C. STANDARDS: 4.06 DENTAL CARE JULY 1, 2003 .240.3 (a) (8); ..3201 a3 PAGE 1 OF 2 POLICY STATEMENT: In order to protect the general health and welfare of inmates confined to the Ckange County Jail, the facility will provide for the medical supervision of all inmates.. To this end, the Orange County Jail will arrange for dental care services to be provided by a licensed dentist when an inmate has a need for emergency dental care treatment/services. SPECIFIC PROCEDURES: 1. Dental care services shall be afforded inmates in need of emergency treatment/services -- by a licensed dentist contracted by Orange County to provide the same to inmates housed in the facility. 2. Dentat Gaze services will be limited to emergency fillings and dental extractions only. 3. Access to Dental Care Services: A. Should a detention officer detect or receive a dental complaint from an inmate that he/she is suffering from a dental ailment (e g., severe swelling of the facial azea or gums; broken or damaged teeth; severe pain, etc.), the detention officer will immediately contact the control room detention officer and notify him/her of the problem. B. The Control Room detention officer shall be responsible for contacting the on duty shift supervisor and/or Lieutenant. The shift supervisor and/or Lieutenant will be responsible for contacting the coritract dentist and explaining the inmates' symptoms so that a determination can be made as to whether the uunate will need to be transported to the dental office for treatment/caze. C Should a determination be made that the inmate requires transportation to the dentist's office or treatment, jail detention officers shall follow the procedures outlined in Orange County Jail Policy 4.13,"Transportation of Inmates for Medical Care," to carry out this process. POLICY 4.06, "DENTAL CARE" PAGE 2 OF 2 a ~- D. If, for any reason, the contract dentist is not available to provide care for the inmate, the on duty detention supervisor will contact the on duty or on call medical professional for directions to be taken to insure the inmate's dental need is cared for. 4, Documentation of Dental Care: A. The .jail detention officer responding to the inmate and/or the on duty supervisor and/or Lieutenant shall be responsible for completing an Incident report should an inmate need to be transported to either the contract dentist's office or another outside medical faciliiy for dental treatment. The Incident Report will contain, at a minimum, the following information: 1. The circumstances of the event; ?. Any action taken by the officer(s), to include any instructions made by the responding medical officials that may have been carried out by the detention officers. A copy of the Incident Report will be forwarded to the .Tail Administrator for review. The Jail Administrator will be responsible for filing and maintaining the Incident report. 13 All dental complaints or dental referrals will be recorded on a "Prisoner Medical Report Form" (see Attachment #1) by the responding .jail detention officer. The responding detention officer should indicate in the section marked "COMPLAINT" the dental problem the inmate was experiencing. C. The on duty supervisor will be responsible for logging the medical complaint/referral in the Medical I,og (see Attachment #2) located in the Control Room. D. A copy of the completed "Prisoner Medical Report Form" will be filed and maintained in the inmate's medical file. iJnder no circumstances will any "Prisoner Medical Report Form" containing any diagnosis or recommendations/referrals for treatment by any medical professional be placed in the inmate's confinement record or be made accessible to any jail detention officer. ;~~~y/k~;'~!/°~ i~ 9~" "`" j ~ sl, f"ct' Reviewed and Aprroved: (Sherif fl Date: J ~1.~-4 1 z°° as ORANGE COUNTY JAIL SICK CALL REQUEST CC P- R- B/P- Date: Time: -am/pm Officer Namc __ Medical OCfsitc Notifcd: yes _ no , Dale/'l'ime Noti6cd Inmate Transported to Hospital: yes _ nu __ Subjective: Objective: T-, Name: DOB: SS#: _Wt- Allergies Assessment: 1. ~. 2. C,, 3. T-_- 7. 4, R, Plan: 1. 2. 3. 4. S. -medication ordered _Rrc err p/u _R"I'C prn -sent to ER -sent for Xray ~rctum to jail area -jail medical supervision recommended _reter to dental -refer to psych outside referral: where: ATTACHMENT #1 Prnvirlrr Cirm ve nrr' rl....., '~'----- -- /-~- N C ~l ~F ~ a~ N o E m y ~ ~: : v w , r. ~: N m m ~ ~~i 3~ ~ n m A 4 V/ c N ~' 0 1 C O Z 4 - , n ~~ '' 0 ~ ° ~~r ~ m~- o -t Aw m ~ ~ ~ ' :~ ~ °- ~ n ~- * m ~ D r m _ Z 3 i, /~ ! ~~ .> m V m TT mF ~ :. Q N ~''D m r ~Z Z , ;,, _ o _ . _~ ,. ~ ~ ~ 0 . 1 y z = il: N r - n. ~ r m mL- ~~~ m ~ ~ i o~ = ~ 0 5 N _ T °~ N ~ 5~ , Z ,~ ~ Z pF~rZ pE` s~ =c zr . ~~~ ~ v.: 3 m 'm Fs.~ m;= ~ o ~ o _ t ~° o0 0 . n ~` e ` D ~ ~ ~ r m :~ ~Tr '^ ~ i @ ~ V_/ 6i O o - ^ 3YJ C7 ~ o `-J. ~ Yi m D ~ p ^ ~ ~" ~ D m~ r o ~ ~^ ': ~- r o a ~~r~. ~_ m O a ti-; m O p+; ~ ~.<r` +! C ~, v ~ ; i y_ a a n Z -i N a~ ORANGE COUNTY JAII. 144 E. Margaret Lane Hillsborough, North Carolina 27278 POLICY #: 4.07 PAGE 1 OF 3 POLICY TITLE: MENTAL HEALTH CARE DELIVERY SERVICES DATE: TULY 1, 200.3 RELATED N.C. STANDARDS: .2403 (a) (8); ,3201 (b (S) POLICY STATEMENT: In order to promote the mental well being and health of inmates confined to the facility, the Orange County Jail Administrator and the Sheriff will arrange for inmates in need of mental health care services to be referred to the facility contracted Psychiatrist for needed treatmendcaze All inmate referrals to Mental Health must be made by our contracted medical professional; however, ,jail detention officers shall report inmates who appear to be in dire need and are suffering from mental health problems to their supervisor for immediate referral possibly to UNC-Hospital as an involuntary commitment when our contracted medical professional is not available to make the referral. SPECIFIC PROCEDURES: 1. Routine Mental Health Care ServiceslTreaiment: A. Mental health care services will be provided inmates in the same manner outlined in Orange County .Tail Policy 4.03, "Medical Referrals and Complaints." Inmates will be allowed to communicate their mental health caze requests to jail detention officers who will be responsible for writing the inmate's complaint/request on a "Prisoner Medical Report Form," (see Attachment #1), B. All "Prisoner Medical Report Forms" will be required to be submitted to the on duty shift supervisor or the Jail Administrator for a record to be made of the same in the Medical Log (see Attachment #2) The contracted Medical professional shall ensure that the form is filed and maintained in the inmates medical record and for the contracted Psych Dr. to review. C. Upon examination of the inmate by the contracted medical professional a determination will be made as to whether the inmate is in need of the mental health care services provided by our contracted Psyche Doctor. D. Should the medical professional feel that an inmate is in need of mental health care services, he/she will refer the inmate to the contracted Psych Doctor or if any emergency exists contact the Jail Administrator and/or sheriff and request that the inmate be transported to UNC-Hospital for evaluation and or treatment.. ~8 POLICY 4.07, "MENTAL HEALTH CARE DELIVERY SERVICES" PAGE 2 OF 3 E. Transportation of any inmate to UNGChapel Hill Hospital will be done in accordance with the procedures outlined in Orange County .Tail Policy 4..13, "Transportation of Inmates for Medical Care." F. Emergency mental health needs for an inmate(s) may azise after hours or when the contracted medical professional and contracted Phys. Dr is not available.. The Supervisor on duty shall make a decision to contact the Lieutenant, Major or Sheriff and obtain an involuntary commitment order and transport the inmate for evaluation at UNC-Memorial Hospital. (Note: when the contracted Nurse Practitioner and or Contract Phys. Doctor are available they can make the decision.) G. A copy of the completed "Prisoner Medical Report Form" will be filed and maintained in the inmate's medical file. Under no circumstances will any "Prisoner Medical Report Form" containing any diagnosis or recommendations/referrals for treatment by any health caze worker be placed in the inmate's confinement record or be made accessible to any jail detention officer. 2. Emergency Mental Health Care Services: _ A. Jail detention officers will be instructed during Basic Jail Certification School of the signs and symptoms that may be the resuldcause of an emergency mental health problem, Should any officer detect any of the following signs/symptoms, he/she should immediately contact the Control Room officer who shall immediately contact the on duty supervisor: 1. Depression; 2, Disorientation; 3. Exaggerated mood swings; 4. Delusions and/or hallucinations; 5. Intense fear, panic or anxiety; 6. Wazning signs of suicide; and/or 7. Sleeping difficulties. B. The Control Room Officer shall be responsible for contacting the on duty supervisor and/or Lieutenant to provide assistance to the responding,jail detention officer. C. The on duty supervisor and/or Lieutenant after evaluating the irunates need shall contact the contract medical professional on-call and explain the situation/problem. (Should the contracted medical professional on call not be available and the situation is urgent the on duty supervisor may obtain a involuntary commitment and have the inmate transported to LJNC-Chapel Hill Hospital for evaluation; this certainly will not be done without the Jail Administrator, Major or Sheriff being notified. (This procedure can be complicated especially if the inmate is awaiting trial for a serious crime. The end result maybe that we have to obtain a safekeeping order and transport the inmate to Central Prison for safekeeping.. ) aq POLICY 4.07, "MENTAL HEALTH CARE DELIVERY SERVICES" PAGE 3 OF 3 D. The contract medical professional may make any of the following decisions: 1. The physician may travel to the facility to examine the inmate; 2. The physician may request that the inmate be transported to his/her office for examination, or, 3. The physician may recommend that our Contracted Psychiatrist see the inmate. 4. The contracted medical professional, contracted Psychiatrist, or EMS may direct you to transport the inmate to ZINC-Chapel Hill Hospital. E Any recommendation requiring an inmate to be transported outside the facility for treaimentlexamination shall be carried out in accordance with Orange County Jail Policy 4.1.3, "Transportation of Inmates for' Medical Care." F. Under no circumstances shall any Orange County Jail Detention official other than the contracted medical professional make any determination that any inmate is in need of Mental Health Caze. jnote: when an emerEency exists and when medical staff is not on duty the supervisor must contact the-Lieutenant Maior or Sheriff a decision will be made. G. Once a decision has been made by the physician as to the treatment of the inmate, the responding detention officers will be required to complete a "Prisoner Medical Report Form." The form should contain, at a muumum, the following information: 1. The problem(s) the inmate was having; 2. Any action taken by,jail detention officers; and, 3. Any instructions made by the physician that were carried-out by the detention officers.. H. All completed "Prisoner Medical Report Forms" shall be filed in the inmate's medical record. Documentation regarding the incident will be recorded on the Medical Log by the shift supervisor.. I. .Tail detention officers will also be required to complete an official Incident Report regarding the matter for submission to the .Tail A strator Sheriff by the next working day. ~ , ~~ Reviewed and Approved: ~~~ (Sheriff) Date: ?lll.~a l 2-°° y 3~ ORANGE COUNTY,jAIL Namc: SICK CALL REQUEST DOII: SS#: CC: = Date: Timc: am/pen DfCrccr Namc _ Medical OfCsite Notified: yes _ no ~ Date/Timc NutiGcd Inmate Transported to Hospital: yes _ no __ Subjective: Objective: T- P-iR- B/P- Wt- Allergies AsscssrricnC t. S. 1. __ ~• 3, 7. 4. R, Plan: 1. 2. 3. 4. 5. ~mcdication ordered -RTC Cor F/U -RTC prn -sent to ER ~scnt Cor Xray -return to jail area -jail medical supcrvisipn recommended _rcfcr (o dental _rcfcr to psych -outside referral: where: ...........__._. ATTACHMENT #1 Provider 5i~nature: Date Timc am/nm 31 ~, '~ a s:~ <h; 3 'O o "' ~ 2i - z ~w _:: o O rc ~- ~3~ w ° ~ '~ c O ,' J o Q .„ / 1 ~ ~ v~ ~.., v. A. ~ ~, v v, v. v. v. ~ v, w v v v. ~.. v, a V `ii r y a 4 Ac. w J_ C7 U n w _ ., O _€ _ U ~ U) J E rc J € ` ~(? ~Q ~ s a ~` ~ m t ~_ 0 W ~ i! w ,w !a W ~ • ~ v! 'r `O Z ~ 3LL IK Y J Q Z +~ h o , +2 Z ,g N m ~ ._ ~ ~ 5 ~ ~o 0 ~ U a /~ Lb W ~ry W U sa Q >~ ~ a ,~ W o _ J o z °- o w z Z w a w o Q _ :mo U W ~Z ~ ~ ': w ;J W ~ o Q U w ,V ~ ~ ~ w W N ~ S .~ ± Z O L /V W Li U '" y O Z ~ ~o w ;O '_ t~ LL /~ V/ =~ _ K va /~/ K ~ LaL ~ w _ - w N N ~' 1W W O U N O ~J IJ r..W is U h m ORANC,E COUNTY JAiL 144 E. Margaret Lane Hillsborough, North Carolina 27278 POLICY #: 4.08 POLICY TITLE: SUBSTANCE ABUSE SERVICES FOR INMATES DATE: TUL,Y 1, 200.3 RELATED N.C. STANDARDS. .240.3 (a) (8)~ .3201 (b (S) 3a PAGE 1 OF 1 POLICY STATEMENT: In order to protect the well-being of uunates confined to the facility, Orange County .Tail Detention officials shall provide routine and emergency medical services to inmates either suffering from severe drug OI' alGOh01 intoxication and to inmates suffering from the effects of severe drug or alcohol intoxication. SPECIFIC PROCEDURES: 1. Jail detention officers shall ensure inmates az'e provided routine and emergency medical services to inmates suffering from severe drug and/or alcohol intoxication or suffering from the effects of severe drug or alcohol intoxication, pursuant to the procedures stipulated in the following Orange County Jail Detention policies: A, Policy 4..04, "Routine Medical Care of Inmates; 'and, B Policy 4.OS, "Emergency Medical Plan." 2. Jail detention officers will be instructed in Basic .Jail Certification School to detect the signs, symptoms and effects of severe alcohol and drug intoxication. q~~e'~% `~~~ ' ,rte,-d Reviewed and Approved: (Sheriff) Date. j~~^a ~ ~-°~ ORANC>E COUNTY JAIL 144E Margazet Lane Hillsborough, North Carolina 27278 POLICY #: POLICY TITLE DATE. RELATED N.C. STANDARDS. 4 09 33 PAGE 1 OF 9 ADMINISTRATION AND CONTROL OF MEDICATIONS JULY 1, 2003 2403 (a) (8), 3201 (b (4) POLICY STATEMENT: Policies and procedures of the Orange County Jail are designed to promote and protect the health, safety and well-being of inmates All employees of the detention facility shall be cognizant of the fact that all medications; whether non-prescriptive or prescriptive shall be administered and stored at the facility in a manner that reflects these policies' and objectives Jail detention officers shall be aware that it is not within the scope of their job duties and responsibilities to recommend or prescribe any type of medication to inmates; (at no time shall a detention officer take it upon him/her self to do so If this is found to have occurred the detention officer faces severe disciplinary action including and up to dismissal) Rather, their role is to administer medications to inmates that have been prescribed or recommended under the attending contract medical professionals direct written orders. Further no detention officer shall ANYTIME at the request of any inmate, administer non-prescriptive medications. When any inmate makes such a request for ibuprofen or tylenol the on duty supervisor shall (tell the inmate as soon as we can get approval) contact our contracted medical professional or EMS for approval. If approved to be administered to the inmate it shall be recorded on the inmate's medical form for the medical professional to review and place in the inmate's medical record. This is required and shall done for each and every instance. UNDER NO CIRCUMSTANCES SHALL ANY INMATE HOUSED AT THE FACILITY BE ALLOWED TO POSSESS, ADMINISTER ANY MEDICATZONS FOR EITHER. THEMSELVES OR OTHERS. SPECIFIC PROCEDURES: 1. Non-Prescriptive Medications: A, Storage and Maintenance: 1 All non-prescriptive medications will be stored and maintained in a locked cabinet located within medical room and stored and maintained by the facility medical professional in the medical office. 2. The shift supervisor will bezesponsible for ensuring that non-prescriptive medications are maintained in the medical room and further it shall be the responsibility of the medical professionals to ensure adequate supply of medications is on hand for the jail facility. 3. The facility medical professional shall periodically inspect the supply of non prescription medications for expiration dates of non- prescriptive medications and replenish those medications needed. POIdCY 4.09, "ADMINIS'T'RATION AND CONTROL OF MEDICATIONS" 3Q- PAGE 2 OF 9 4. The on duty shift supervisor, the designated med passer and the contracted medical professionals shall be the only individuals authorized access to non prescriptive medications. Under no circumstances will any visitor or inmate he allowed access to non- prescriptive medications. (EXCEPTION: Jail Inspectors desiring to inventory non- prescriptive items or observe where they are being stored and maintained).. B. Type of Non-Prescriptive Medications: 1. The following basic items will be maintained within the facility to be provided to inmates at thew request: a, Tylenol; b Non-aspirin pain reliever; a Laxatives; and, d, Antacid tablets or liquid. e. Cough syrup f. Hydrocortisone Cream g. Anti-bacteria Ointment Other items may be added to this list as deemed necessary by the medical professionah. G Procedures for administering Non-Prescription Medications: 1. Only the shift supervisor, designated med passer and medical professional will be allowed access to and/or be allowed to administer non-prescriptive medications to inmates. (Note. only when approved by our contracted medical professional) 2. Non-prescriptive medications may be provided inmates in two (2) ways: (Both must be approved by contract medical professionals or EMS) a. Inmates may verbally request a non prescription medication; or, b, The facility medical professional may order med passers or detention personnel to administer the approved requested for the medication. 3, Each time anon-prescriptive medication is administered to an inmate, the med passer administering the medication must record this information in the Medical Administration Record in the medical office. At a minimum, the following information must be recorded in the Log: a, Date and time of the inmate's request for the medication.. Type of medication (e g., aspirin, laxative); requested. b. Time the medication was provided the inmate; c. Dosage of medication; and, d. Tail detention officer who provided the inmate medication. POLICY 4.09, "ADMINISTRATION AND CONTROL OF MEDICA'T'IONS" ~5 PAGE3OF9 4 Non-prescription med pass procedures 1 All non-prescription medication will only be given during one of the four regular med passes by certified med passers. 2. The procedures for non-prescription medication must be done in the following order: A. the inmate must request the non-prescription medication B. The officer is to ensure that the inmate has a request form to fill out for the non- prescription medication and the follow up visit with the doctor C The officer is to complete an inmate sick call request form, staple it to the inmate's request form, and hand it to the shift supervisor D, The shift supervisor is to; 1. Read the medical information on the form 2 Initial, time and date the form 3. Initial and log the form in the medical forms received log 4 Place the form in the inmate medical sick call request form holder in the medical office E. The following items aze to be done by the medical personnel on duty or the designated med passer if medical personnel are not on duty: 1. Write the order for the non-prescription medication to be administered on the sick call form according to the protocol 2. For inmates already on medication, attach the appropriate non- prescription medication label or transcribe the order to the mar, and complete according to the mar and protocol procedure guidelines, 3. For inmates not already on medication, take a blank mar and attach inmate photo id label, attach the appropriate non-prescription medication label or transcribe the order to the mar, ,and complete according to the mar and protocol procedure guidelines. 4. Place any new mar in the maz log book 5. Take the non-prescription medication card from the locked cabinet and complete the form verifying the amount of medication removed. 3~ POLICY 4.09, "ADMIlVIST'RATION AND CONTROL OF MEDICATIONS" PAGE 4 OF 9 6. Plane the non-prescription medication card in the cart according to the medical cart procedures. 7. Place the inmate medical sick call request form back into the medical sick call request form holder. (the next available medical personnel will paperclip the sick call request form to the inmate's chart and put both in the "to be seen in clinic" box.) 8. Administer the first dose of non-prescription medication immediately following the med pass if the request was made during the med pass. If the request was made after the med pass, administer the first dose at the next scheduled med pass. 9. The mar is to be initialed each time according to the mar procedure guidelines and the non-prescription medication protocol.. _ 7. When administering inmates with non-prescriptive medications, the shift supervisor, designated med passer or medical professional shall place the medication in a small medicine cup labeled with the inmate's name on the side of the cup far delivery to the inmate. Small medicine cups craze located in the medical office. Medications should be provided only in accordance with the schedule on the medicine package,. (We now have medicines prepazed which do not require the label to be placed on the cup) 8. The designated med passer administering the medicine should carefully watch atl irunates take their non-prescriptive medications to discourage hoazding of medication by inmates.. 2. Prescriptive Medications: A Storage and Maintenance. 1, All prescriptive medications, authorized to be taken by any inmate confined to the facility, will be stored and maintained in a locked cabinet or cart located in the facility Medical Room. 2. All prescriptive medications will be organized by the inmate's name to which the medication is prescribed. (in the following order: cell assignment, - alphabetical last name, and medication in M.A.R. order. ) 3. Note storage of prescription medicines is the TOTAL, RESPONSIBILITY OF THE CONTRACTED MEDICAL PROFESSIONAL. 3~ POLICY 4.09, "ADMINISTRATION AND CONTROL OF MEDICATIONS" PAGE 5 OF 9 4. Entry into the Jail facility medical office room is prohibited at all times. No detention staff shall enter the medical office room under any circumstances except by desitnated authority of the SHIFT SUPERVISOR OR CONTRACTED MEDICAL PROFESSIONALS. Each Detention shift shall have (I) or (2) designated MED PASSERS ADMINISTERING .MEDICATIONS TO INMATES. No one else shall enter the medical office except by invitation of the MED PASSERS, JAIL ADMINISTRATOR OR CONTRACTED MEDICAL PROFESSIONALS. 6. At no time shall the Jail administrator, Lieutenant, Shift Supervisor or any jail detention officer be authorized to enter the Facility Medical room to access prescriptive medications unless ordered or authorized by CONTRACTED MEDICAL PROFESSIONALS.. 7 NO ONE SHALL UNDER ANY CIRCUMSTANCE HAVE A KEY OR BE AUTHORIZED TO HAVE A KEY TO THE PRESCRIPTION DRUG CABINET, THE ONLY PERSONS ALLOWED IO HAVE A KEY TO THE, PRESCRII'TION DRiJG CABINET ARE THE CONTRACTED MEDICAL PROFESSIONALS, MEDICAL PERSONNEL AND MED PASSERS. (when locked by them it stays locked) The only time anyone shall be in the medical room would be to get the medicine cart previously prepazed by the med passers or contracted medical professional), 8 NO DETENTION STAFF MEMBERS SHALL UNDER. ANY CIRCUMSTANCE be authorized TO HAVE possession of any keys OTHER THAN the CONTRACTED FACILITY MEDICAL, PROFESSIONAL, MEDICAL PERSONNEL AND MED PASSERS. REMEMBER: ALSO Under no circumstance will any visitor or inmate be allowed access to prescriptive or non-prescriptive medications. 9. Only med passer detention officers will inspect prescription medications and or the expiration dates of such medications to ensure that all medications aze up-to- date. Med passers will inspect expiration dates during med pass times. (NOTE: .Tail Inspectors may request to inspect prescriptive medications to ensure they aze being properly stored and maintained). 3~ POLICY 4.09, "ADMINISTRATION AND CONTROL OF MEDICATIONS" PAGE 6 OF 9 B Individuals Authorized to Prescribe and Order Medication. 1. The following individuals will be the only persons authorized to prescribe medications to inmates confined to the facility: a. Prescribing physician b. Prescribing dentist; c. Attending physician at the local hospital to which an inmate may have been transported for care/treatment. d. Detention Med Passers when receiving drrect orders from a medical professional may (FAX-) the medical professionals written medication orders to our Pharmacy Supplier. (The med passer is only faxing an order prescribed by medical professionals) C Preparation and Distribution of Medications to Inmates Certified Med Passers (Detention Personnel who have attended and passed the State Medication Administration for Unlicensed Personnel course of instruction provided North Carolina Community College System.) shall be responsible for preparing medicines and for administering medicines to inmates. Monday through Friday the designated med passers assigned to work in the medical office shall administer all inmate medications. The hours of assigned duty shall begin at 0600 and end at 2200 hours On Saturday and Sunday each shift on duty shall have a designated med passer, who shall assume the duties of the off duty med.. Passers. (Certified Med Passers are Detention Personnel who have attended and passed the State Medication Administration for Unlicensed Personnel course of instruction provided North Carolina Community College System.) 1. It shall be the duty and responsibility of the shift supervisor to ensure only those authorized perform this duty. Only one (1) .jail officer, Facility Medical Personnel or shift supervisor per shift will be authorized to ADMINISTER prescriptive medications to inmates. 2. At the begimiing of each shift, designated medicine ADMINISTERING detention officers will be responsible for reviewing the Medical Drug Log to determine which inmates will require medications during their shift. 3- The designated medicine-administering officers will ensure that all inmates requiring medications receive the same at the prescribed tune and in the proper dosage. 3~ POLICY 4.09, "ADMINISTRATION AND CONTROL OF MEDICATIONS" PAGE 7 OF 9 a. Each inmate's medication will come from the contracted phazmacy on a card. The card shall include each unit dose and labeled with uunates name, medication strength, dispensing dose, route and time. Should a medication be in liquid, cream or powder form, small medicine cups will be used and the proper dosage poured into the cup; according to the medication label on the container. b. The inmate's name will be printed or labeled on the outside of each cup; each inmate's medication will be placed from the card(s) into the medication cup at medication administering time. PRN medications will only be placed in medication cups at the inmates request for the medication.. Powder, cream or liquid medications will be placed in medication cups at the cell where the medication is to be administered. a Once completed, all medications will be placed on a cart to be used for purposes of carrying the medications to each inmate. 4 Once the steps listed in 3 (a) tluough (c) have been completed all medications shall be returned to their proper medication cart drawer storage azea. Cards shall be filed by cell assignment, last name alphabetical order, and medication order according to the MAR. Extra medication cards will be stored in the bottom drawer of the medication cazt in cell assignment last name alphabetical order and medication order according to the MAR. At the completion of each medication pass, the Medicine Administering Officer will organize, as previously listed, the medicine cart and M.A.R. for the next med pass to begin. The ,jail detention medical administering officer shall obtain the Medication Administration Record L,og Book and begin distribution of medications to the appropriate inmates. The designated officer will, to the extent possible, ensure that another officer accompanies himlher when making medication rounds. 5. The designated officer will visit each inmate requiring medication at his/her housing unit to administer medication. The officer will be required in the presence of the inmate to double-check that the proper dosage is administered. After administering the inmate's medication; documentation shall be recorded on the MAR to confurn that medication was received or refused. 6 the designated officer will observe the inmate take his/her medication to discourage hoarding of medications by any particular inmate. 7 Once an inmate has been provided his/her medication, the designated med passer will record their initials in the box(es) at the date, medication and administering time on the page with the following information in the Medical Drug Log Book; indicating the same. a. Name of inmate; b. Type of medication edi c. Dosage amount; d. Time medication was taken; POLICY 4.09, "ADMINISTRATION AND CONTROL OF MEDICATIONS" PAGE 8 OF 9 The jail medicine administering officer shall initial or sign the Medical Drug Log to indicate his/her identity. The inmate will sign the Medicine Received Form (see Attachment #1) to verify their receiving of the medication. If the inmate refuses to sign the Medicine Received Form, the medicine administration officer will make notation of same and report the occurrence to the senior.jail detention officer. 8. Should an inmate refuse to take her/her medication, the officer accompanying the designated officer shall also indicate this information on the Medical Drug Log. (Note: this information is important if an irunate refuses his/her medicine by your initialing the form with initials and date and time we will be protected) a. It shall be the duty and responsibility of the medical administering officer to return the Medical Drug L,og to the Medical Office Room. Any medication not taken by an inmate -shall be packaged, sealed and initialed by both the medical administering oflcer and the witnessing detention officer.. All refused prescription medicines wiIl be placed in a secure locked drawer by the medical administration officer and the shift supervrsor. b. An incident report will be written stating what medicines were placed in the medical room. At an appropriate time the shift supervisor and the jail Lieutenant shall take the refused prescription drugs to the contracted medical professional. The medical professional shall sign a green evidence sheet verifying they have received the refused drugs. The green sheet and incident report will be turned over to the lower office records clerk and filed for future reference. c. Destruction or disposing of any prescription drugs will be done by the nurse practitioner and witnessed by the .Tail Lieutenant. Everything destroyed or disposed of will be recorded and a report written and filed by the Jail Lieutenant. This procedure shall not be violated.. 3 Handling of Medications Discovered During Admission: A. Should an admitting detention officer discover prescriptive medications being carried by a newly admitted inmate, the admitting detention officer will be required to confiscate the medication from the inmate until such a time that the medication can be verified... B. Any prescriptive medication found will be turned over to the shift supervisor for temporazy safekeeping.. ~-i POLICY 4.09, "ADMINISTRATION AND CONTROL OF MEDICATIONS" PAGE 9 OF 9 C. The shift supervisor and/or facility medical personnel will be responsible for contacting the contracted medical professional if on duty to request that he/she verify the medication. The medical provider may be contacted Monday thru Sunday 0800 hours until 2300 hours.. Between the hours of 2300 and 0800 EMS will be utilized for emergency situations.. All non emergency situations will be decided when the medical provider maybe contacted. D. Upon verification of the medication by the medical professional, the inmate's medication would be treated as other prescriptive medications maintained and stored within the facility medical room in the prescriptive drug cazt The inmate's name, medication, and administering directions on a MAR shall be added to the Medication Administration Record Log by the first available facility medical person so as to ensure that the inmate is provided his medication at the appropriate time. G~~ Reviewed and Approved: (Sheriff) Date: ~,'~ ` Z°,~ o- ~a ORANGE CAUNTY DETENTIAN CENTER MEDICATION RECEIVED FORM DATE TIME INMATE SIGNATURE OFFICER INIT. / / .. / f / / l I I l ~ / I ATTACHMENT #1 4~ ORANGE COUNTY JAIL 144 E. Margaret Lane Hillsborough, North Carolina 27278 POLICY #: 4,10 POLICY TIT'I,E: SUICIDAL INMATES DATE: JULY 1, 2003 RELATED N.C. STANDARDS: 2403 (a) (8); .2801; 3201 PAGE 1 OF 3 POLICY STATEMENT: Jail detention officers will make a reasonable effort to protect inmates who are believed or felt to be potential suicide risks. To this end, Orange County Jail officials will ensure that all ,jail detention officers receive training and instruction relative to the detection of inmates posing a potential suicide risk and that adequate prevention steps are taken by detention officers to provide for the safety of such inmates, SPECIFIC PROCEDURES: 1, Jail detention officers will have a short orientation within the first 30 days of employment for suicidal behavior, universal precautions and communicable diseases, Additional training will continue their fast year of employment to detect the signs, This training will be conducted during Basic Jail Certification School and will be documented pursuant to the guidelines outlined in Orange County Jail Policy 1,04, "Employee Training" 2, Procedures to be Followed Should an Inmate be Deemed a Suicide Risk: A. Upon admission to the facility, all inmates will be screened to assess their potential to commit suicide. This screening will be conducted during the admission process by the admitting officer and the booking officer and will be documented on an "Inmate Medical Screening Report," (see Attachment #1, questions #4). See also, Orange County Jail Policy 2.11, "Preliminary Health Screening"), Any inmate deemed to pose a suicide risk will be immediately brought to the attention of the Lieutenant and the Jail Administrator. B. Inmates confined to the facility will be observed during security rounds by .jail detention officers, Any inmate who exhibits any signs or symptoms suggesting that he/she may pose a threat of suicide will immediately be brought to the attention of the Lieutenant and the Jail Administrator. POLICY 4.10, "SiTICIDAL INMATES" PAGE20F3 C Any inmate deemed to present a suicide threat will be placed on suicide status and transferred to the Holding Cell adjacent to the Control Room so that he/she can be continuous observed by.jail staff. Jail detention officers will be required to directly observe inmates confined in the Holding Cell a minimum of every 15 minutes. All observations shall be documented on the "Holding Cell Security Monitoring Sheep' (see Attachment #2) to be located in the Control Room. D. Inmates placed on suicide status and temporazily housed in the Holding Cell will not be allowed to possess any items of personal property. The only items authorized such inmates will be a county-issued jumpsuit and lace-less shoes. E. The .Tail Administrator and/or Lieutenant will be responsible for advising all jail detention officers that an inmate has been placed on suicide status so as to ensure that all jail detention officers providing supervision for the inmate may watch for signs of any potential problems. F. The Jail Administrator will be responsible for contacting the Sheriff so that a determination can be made as to the continued confinement of the inmate at the Orange County Jail. The .Jail Admuristrator, as directed by the Sheriff, may: 1. Arrange for the inmate to be transferred to the North Carolina Department of Corrections, Central Prison, in "safe-keeper" status; 2. Arrange for the irunate to be involuntarily committed to a Mental Health Hospital or other mental health caze facility for treatment/care; 3. Continue to maintain the inmate on suicide status at the facility until such a time that a physician can examine the inmate and make a determinations to his/her condition and potential treatments or, 4. Arrange for the inmate (if a new admission) to be released from custody through the Court. G. An official Incident Report will be required to be completed anytime an inmate is deemed to pose a threat of suicide. Either the Lieutenant or shift supervisor will he responsible for completing this report and for providing a copy of the same to the Jail Admuristrator and/or the Sheriff. A copy of the Incident Report will be filed in the inmate's confinement record and the inmate's medical record.. POLICY 4.10, "SUICIDAL INMATES" ~ 5 PA(sE30F3 Procedures to be followed in the Event of an Actual Suicide.. A. Should a detention officer discover a deceased inmate who has apparently comaritted suicide, the procedures outlined in Change County Jail Policy 4,05, "Emergency Medical Plan," will be immediately enacted. (Officer discovering inmate an inmate (deceased) as stated means after EMS has pronounced the person to be deceased) B. In addition to the vazious reports required to be completed whenever a medical emergency exists (see Orange County Jail Policy 4.05, "Emergency Medical Plan), the following reports and actions will also be required: L If necessary, the Sheriff, will require an investigation 2, The Jail Administrator will submit Death of an Inmate Report to the Sheriff. The .Jail Administrator will ensure that a copy of this report is forwarded to the Jail and Detention Branch of the Department of Human Resources and to the Local Health Director within five (5) days of the inmate's suicide. C, The Sheriff will be responsible for notifying the inmate's next-of-kin regazding the inmate's death upon confirmation of the death by North Carolina Medical Examiner's Office. Reviewed and Approved: 9~%~ ~'~~~~~~lil ~~ ~,~j~'~ (Sheriff) l/ Date: 'j""t"`~ ~: Soaking r-: Date/Jilme: , $ookin6 Officer: _ ORANGE COUNTY SHERIItF'S OFFICE Inmate Medics! Screening Report Inmate: Race: Ses: DO$: Date/fhne 11/058002 SSN: Reviewed By (Nurse): Date: 17me: Q. # Question Answer Notes 1 Ts this a Federal Inmate (]`FS) State Inmate (NO) Y 2 Please type the Federal Inmate numbs USM# Y 3 Do you have any health problwrs including: diabetes, high blood prusure, Y heart disease, mental health, preg~aancy? 4 Have you ruently or in the past received mental health carol Have you tried N to harm yourself or kill youtse127 Where did you receive hratment7 5 Are you taking any medications, either prescription or over the counter? List Y 6 Do you have any injuries, cuts, bruises, open sores? N 7 Do you Gave any artifiral le&a, arms, eyes, glasses, contacts, hearing aids, or N dcntures7 8 Have you ever bad sew? What was the cause? 9 Havo you bem treated for drug or alwhol withdrawals? Had blackouts?. DTs7 ]0 Do you have tuberculosis, TB, or ever been treated or tested for TB, tuberculosis? Yes, Dates end Locations. I 1 Do you have or think you have any other contagious diseases? 12 Do yon have nay allergies to food or racdiciaes? 13 (Officer Observation} Does the booking officer observe any injuries? 14 (Omcer Observation)- Does the subject appear to be ill, oa Drugs, or Alcohoi7 IS (Officer Observation} Ta the subject able to speak english or understand directions? I6 The medical information I have just given is accurate to the best of my kaflwledge. I am respomrlrk for making nxdical problems known to the medical staff. To see a health care provider, I must sign up for sick call, which is avaIlabk weekdays. I will be-charged a fee fom my inmate account for non-~mergr»sncy side pIl visits. I will not be dartied health care because of a lack offunds, Limited death care is also on available. The Orange County Jail is not responsible for treating medical conditions requiring elective care or surgery, that were prrscat before admission to the jail. I give my consent for dre .Tail Healtir program to destroy nay medication I brought in 30 days after my releue from this facility. I have read or been read and understand ali of the above information. N N Y N N N N Y Y ATTACHMENT #I ~~ ORANGE COUNTY JAIL HOLDING CELL 6ECURITY MONITORING 6HEET DATE: Tim-' a of Condition of Jail Officer's Security Inmate Name Check ATTACHMENT #2 ~~ ORANGE COiTN'TY JAIL 144 E. Margaret Lane Iiillsborough, North Carolina 2727$ PAGE 1 OF 8 POLICY #: 4.11 POLICY TITLE: ACQUIRED INQvIUNE DEFICIENCY SYNDROME (AIDS) DATE: 7C1LY 1, 2003 RELATED N.C, STANDARDS: .2403 (a) ($); .32Q1; .3202 POLICY STATEMENT: In an effort to promote and protect the health, well-being, safety and welfare of inmates and staff of the Orange County Jail, jail detention officers will ensure, to the extent possible, that reasonable steps aze taken to prevent the spread of AIDS/HIV among inmates and staff To this ends, the facility will ensure that all detention officers receive training during their first year of employment relative to AIDS and the ways in which it can be transmitted. Jail detention officers will periodically receive information relative to AIDS and HIV infection during their course of employment, As a rule, all detention officers employed by the facility will be required to follow universal safety precautions in order to prevent the infection and spread of AIDS/HN disease. UNDER NO CIRCUMSTANCES WILL ANY INMATE BE SECsREGATED OR TRANSFERRED SOLELY BECAIJSE THEY ARE INFECTED WITH AIDS OR HIV. An detention officer found to have revealed that an inmate is HIV infected or has AIDS will be subiect to discinlinarv action. SPECIFIC PROCEDITRES: 1. Training: A. All jail detention officers will receive immediately upon employment, basic ' training concerning AIDS and HN infection; the transmission of these diseases; and, the universal safety precautions necessary to be followed to prated against possible transmission. This training will be conducted during the State Mandated Basic Jail Certification School. B. In addition to the above, all jail detention ofCcers will be required to read and become familiaz with the contents of this policy during their first week of employment, (~, The receipt of alt training will be documented pursuant to the procedures outlined in Orange County Jail Policy 1.04, "Employee Training." D, Tail detention officers will be provided with information relative to the AIDS and HIV infection periodically throughout the course of their employment. Jail detention officers will be required to sign for receipt of such material and for signing that they have read and understand all information pros~ided them (see Attachment #1). As required by state statute, the County Health Department or a representative should provide this training thereof ~~ POLICY 4.11, "ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)" PAGE 2 OF 8 - 2, Definitions: "ttie following definitions will be used throughout this policy: A, "AIDS": Aids is a fatal disease with no known cure.. Aids affect an individual's ability to fight off disease and, therefore, permits the contraction of other diseases and illnesses that can cause serious illness and death. B. "Asymptomatic": A person who is infected with HIV but show none of the signs or symptoms with the infection or with AIDS. C. "Human Immune Virus (HIV)": The virus that causes AIDS. D. "High Risk Behavior": Any behavior or activity that may involve the exchange of blood or body fluids. All sexual contact is considered high-risk behavior,. E. "HIV POSITIVE or HIV (+)": A person who is infected with the HIV infection. - Same as asymptomatic and as symptomatic. F. "Symptomatic": A person who is infected with HIV and has begun or has the physical symptoms associated with AIDS, to include, excessive weight loss, night sweats, diarrhea, recurrent fevers, and fatigue. G. "LJniversal Precautions": All actions required to be taken by ,jail officers to prevent transmitting infections, to include, wearing disposable rubber gloves when handling or coming in contact with blood or body fluids. 3. AIDS Policy Development: A. The Jail Administrator will be responsible for the annual review and revision, if necessary of this policy, Changes may be made to this policy at any time that new information concerning AIDS is received that may change the scope of the information contained in this policy. B. The initial AIDS policy and any changes made to the same will be required to be submitted to the contract health care physician for review and subsequent signanue Upon his/her review, the ,Tail Administrator will be responsible for forwarding this policy to the Health Department for approval. Signature blocks for the contract health care -- physician and Health Department official have been provided at the end of this policy for this purpose. ,o POLICY 4.11, "ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)" PAGE :3 OF 8 4. Screening of New Admissions: A. Pursuant to the procedures outlined in Orange County .Jail Policies Z.il, "Preliminary Health Screening," and 4.14, "Medical Records," the admitting detention officer will be responsible for making a visual inspection of each newly admitted inmate and for reporting any noted observations or any statements made by the inmate that may suggest or confirm that the inmate has HIV or AIDS. B. The procedures concerning confidentiality and filing of any information pertaining to an inmate either believed or admitting to being infected with AIDS or' HIV outlined in Orange County .Tail Policies 2,11 and 4.14, noted above, will be strictly adhered to by all jail officers. Information of this type is considered to be strictly confidential. Any officer who is found to be disclosing this information to another individual will be subject to disciplinary action. Under no circumstances will any information either suggesting or diagnosing an inmate to be HIV+) or AIDS infected be included in the inmate's confinement record. Rather, all such information will be placed in the inmate's confidential medical record ONLY. 5. Testing of Inmates for HIV/AIDS Infection: A, The routine testing of newly admitted inmates for HIV infection or AIDS will be strictly prohibited. B. The contract medical physician may request an immate to consent to receive a test for HIV or AIDS if he/she feels that the test is necessary for the appropriate treatment of the inmate. Testing will not be conducted, however, should the inmate refuse the test (NOTE:) The contract physician should have the inmate sign a refusal of treatment form for' filing in the inmate's medical record should the inmate refuse to be tested). C. The contract health care physician can require an inmate to submit to a test ro detect HIV or AIDS should an inmate, detention officer or other person be exposed to the inmate's blood or body fluid and it is felt that the exposure poses a threat/risk of transmitting HIV or AIDS,. Should an inmate refuse to be tested, the contract physician may obtain a court order to require the inmate to be tested or the physician may make all reasonable attempts to contact the inmate's previous physician to determine the status of the inmate. ~( POLICY 4.11, "ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)" PACE 4 OF 8 D. Should the inmate request that he/she be tested for HIV/AIDS, the contract physician will afrange for the test to be conducted. E. The laboratory results of any inmate tested for HIV/AIDS will be held strictly confidential and wilt be filed and maintained in the inmate's confidential medical record only. Any employee found to have revealed the medical status of any inmate housed at the facility will be subject to disciplinary action. The only exception to this will be in cases where another inmate or officer may have been exposed to an inmate's blood or body fluid and it is felt that the exposure poses a threatlrisk of transmitting HIV or' AIDS. In these cases, the inmate may be tested (see 5(c), above) and the contract physician will be responsible for revealing the results of the test to the exposed person. The exposed person will be instructed as to the confidentiality of the test result information and will be provided the opportunity to be tested him herself for the HIV/AIDS virus, 6. Housine of Inmates with HIV/AIDS: A. Inmates who are HIV (+) and asymptomatic will not be segregated or transferred from the facility solely because of their condition. However, the Jail Administrator, as directed by the Sheriff, may make the determination to segregate or transfer an inmate who is HIV(+) and asymptomatic for any of the following reasons: 1. To protect the inmate from other inmates (protective custody); 2. For engaging in violent, sexually assualtive, sexually active, or other high risk behaviors within the facility; 3. Pending transfer to another facility (the inmate may be placed in segregation); and/or, 4, Upon the recommendation of the contract physician, for the benefit of the inmate's treatment, B. Irunates who are symptomatic and have HIV or full blown AIDS may be placed on medical segregation status upon the direct recommendation of the contract physician. C. An inmate who is HIV (+) and has been recommended for transfer to another facility may be placed on medical segregation status pending transfer to this facility. ,~a POLICY 4.11, "ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)" PAGE 5 OF 8 D. Any inmate placed on medical segregation will be given the opportunity to participate, to fhe extent possible, in regular facility programs and services (e.g., visitation, recreation, etc.). E. Should any detention employee of the facility be found to be segregating an inmate within the facility solely because the inmate is HIV infected or has AIDS, he/she will be subject to disciplinary action. 7. Housins of Detained Defendants for Investieation and/or' HIV Testing: A. Pursuant to state statute, a judge may order a defendant to be detained for' up to 24 hours for investigation by public health officials or for a possible HIV test. Should an inmate be admitted to the facility for this purpose, the admitting officer will immediately notify the Lieutenant. B. The Lieutenant will be responsible for notifying the .Jail Administrator who will be responsible for contacting local public health authorities and advising them of the detainee. C. .Jail detention officers will afford public health officials reasonable access to the detainee. D. Should any individual contact the facility to find out the status of any test conducted on a detainee, jail officers will refer all such inquiries to local public health department authorities. &. Program Participation for HIV/AIDS Inmates: A. An inmate who is HIV infected or has AIDS will not be denied the same access to programs and services as other inmates housed in the general population at the facility. The only exception to this will be in cases where the contract physician has determined that an inmate should not participate in a certain program, activity or service due to medical reasons. 9. Safety Equ~ment and Universal Safety Precautions: A. The following safety equipment will be readily available for detention officer's use at the facility. POLICY 4.11, "ACQLTIl2ED IMMi7NE DEFICIENCY SYNDROME (AIDS)" ~~ PAGE 6 OF 8 1. Disposable latex or rubber gloves; 2. Pocket masks with one way valves for CPR; and, 3. Disposable paper towels and cleaning supplies. 4, Goggles B. Jail detention officers will be trained in the purpose and use of such equipment and in tmiversal safety precaution within .30 days of employment, additional training will continue at the State Mandated Basic Jail Certification School and during first aid training. C. Jail detention officers will not wear protective equipment while performing their normal job duties at the facility. D, The following universal safety precautions will be exercised by jail detention officers whenever an officer comes, or expects to come, in contract with blood or body fluids; 1. Jail detention officers will wear disposable or rubber gloves when handling objects; conducting cell searches; handling inmate laundry; handling disruptive, assaultive, or violent inmates; and/or, when physically required to handle inmates (e,g., during frisk searches); 2, Jail detention officers will ensure that any area on either their body, another individual's body, object or area exposed to blood or body fluids be thoroughly cleansed with warm water and soap; 3. Jail detention officers will ensure that any cut, sores or breaks in their skin be covered with water resistant bandages; 4. Jail detention officers should avoid situations where there is likelihood that they could be punctured with sharp objects, to include knives, razors and needles, To this end, officers should ensure that they use a flashlight and mirror if they are entering or searching an area where their sight is obstructed; 5, Jail detention officers will ensure that sharp objects be placed in puncture resistant containers. 6, Jail detention officers will wear disposable or rubber gloves and will use a disinfectant composed of a solution of bleach and water when cleaning up spills and surfaces exposed to blood or body fluids; POLICY 4.11, "ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)" 5~- PAGE 7 OF 8 7. .Tail detention officers will place contaminated items in plastic bags or containers and will mark the containers "CONTAMINATED;" 8. .Tail detention officers will use a pocket mask or a pocket mask with aone- way valve when performing CPR on any individual, to include another employee (NOTE: Any officer refusing to perform CPR on an inmate with the use of a pocket mask will be subject to disciplinary action): 10, Steps to be Taken Upon Exposure to Blood or Body Fluids: A. Any jail detention officer exposed to blood or body fluids should immediately wash and cleanse the exposed area with warm water and soap. Jail detention officers exposed to blood and/or body fluids will be provided the opportunity to schedule an appointment with the contract medical physician, if the HIV status is known, the consultation should be as soon as practicable and if the HIV status is unlrnown, the consultation will be within the shift in which the exposure occurred to discuss the likelihood of transmission. B, Jail detention officers will be required to complete an official Incident Report anytime they have been exposed to blood and/or body fluids of another individual while at the facility, If medical attention was provided to the officer by the contract physician, the jail officer will also be required to complete a Workman's Compensation Form. (Staff shall insure that inmates exposed shall receive equal treatment) C. Copies of the Incident Report and, if complete, the Worker's Compensation Report will be submitted to the Jail Administrator for review and for necessary distribution, maintenance and filing. D. Jail detention officers exposed to blood and/or body fluids may request that they be tested for Hepatitus B, Hepatitus C or HIV infection. The results of any such test do not need to be reported to the facility. 11. Confidentiality: A, All ,jail detention officers will be instructed to never reveal any information pertaining to the HIV or AIDS status of any inmate to any other officer, inmate or individual. Any jail officer found to be disclosing such information will be immediately reported to the Sheriff and/or Jail Administrator and may be subject to disciplinary action, B, Contract medical personnel may reveal the HIV/AIDS status of an inmate to any of the following individuals or for any of the following reasons: 55 POLICY 4.11, "AQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS)" PAGE8OF8 1. To another health care provider who will be responsible for caring or providing services to the inmate; 2 To another individual with the written permission of the inmate; 3. To the Director of Health Services, North Carolina Department of Corrections, and to the receiving facility administrator; anytime an inmate is transferred to the North Carolina Department of Corrections for housing; 4. Pursuant to the mandates of a court order or subpoena for such information; 5. Pursuant to any other requirements stipulated in G.S. 130A-143 or by the regulations adopted by the Commission for Health Services. C. Should an inmate or' other individual inadvertently reveal the HIV/AIDS status of an inmate to a .jail officer, the ,jail detention officer will be required to treat this information as confidential and will not disclose this information to any other individual. Disclosure of such information may result in disciplinary action. Reviewed and Approved: ~m i~~~ (Sheriff) Date: C Reviewed and Approved: (Contract Health Care Physician) Date: Reviewed and Approved: (Health Department Official) Date: ~~ - _ Attachment ,~1 ORANGE COUNTY JAIL "CERTIFICATION OF RECEIPT AND UNDERSTANDING OF INFORMATION PROVIDED RELATIVE TO AIDS AND HIV" z HEREBY CERTIFY THAT I WAS PROVIDED THE BELOW LISTED INFORMATION RELATIVE TO AIDS AND HIV INFECTION AND THAT I READ AND UNDERSTOOD THIS INFORMATION: SIGNED: DATE: ATTACHMENT #1 ORANGE COUNTY JAIL `" 144 E. Margaret Lane Hillsborough, North Carolina 27278 POLICY #: 4.12 PAGE 1 OF 2 POLICY TITLE: COMMUNICABLE DISEASES DATE: NLY 1, 2003 RELATED N.C. STANDARDS: ,340.3 (a) (8); 3201(b) (.3); .3202 POLICY STATEMENT: Irr order to promote the well-being of inmates and to provide protection against the spread of illnesses throughout the facility, jail detention officers will be required to conduct a routine health evaluation of all inmates upon their admission to the facility. Newly admitted inmates who appear or admit that they are suffering from a communicable or contagious disease will be required to be placed in administrative sepazation housing until such a time that they are examined by a licensed health care provider, Upon the orders of a licensed physician contracted by the facility to provide for health care services or Health Care Professional, irunates who are suffering from a known communicable or contagious disease will be required to be placed in medical segregation status until such a time that the physician recommends the uunate for placement to the general population or for transfer to an outside facility. Any information or documentation identifying an inmate with a communicable disease will be kept strictly confidential. SPECIFIC PROCEDURES: 1. Jail detention officers will ensure that all newly admitted inmates are screened for health/medical problems pursuant to the procedures contained in Orange County Jail Policy 2.11, "Preliminary Health Screening." Should an inmate reveal that he/she has a communicable and/or contagious disease, the admitting officer should ensure that this information is noted on a separate Preliminary Health Screening Form for filing in the inmates medical record only. 2. Any inmate who admits or appears to be suffering from a communicable or contagious disease will be placed in administrative separation as soon as identified until such a time that they are examined by a licensed physician contrasted by the facility to provide health care services to inmates. 3 The contracted medical professional or the Orange County Health Department shall be responsible for recommending a housing assignment or alternative to the Jail Administrator and/or Sheriff for an inmate with a known communicable or contagious disease,. 58 POLICY 4.12, "COMMCINICABLE DISEASES" PAGE 2 OF 2 The contracted medical professional and or the Health deparhnent may recommend any of the following actions: A. That the inmate remain on medical separation status at the facility; B. That the inmate be placed in the general population; or, C, That the inmate be transferred to an outside facility for treatment/care (e.g., transfer to the North Carolina Department of Corrections). 4. Should the physician recommend that the inmate be transferred to an outside facility for treatment, the procedures outlined in Orange County Jail Policy 4.13, "Transportation of Imnates for Medical Care," will be followed by.jail officers. 5. Any record(s) or information that would identify an 'inmate as having a communicable or contagious disease will be kept strictly confidential and will be maintained and filed in the inmate's medical file only. Under no circumstances will information that identifies an inmate as having a communicable disease be placed in the inmate's confinement record. (remember you are not to discuss anything about an inmate's medical condition) 6, Jail detention officers shall follow universal safety precautions when coming in contact with inmates with communicable and/or contagious diseases or when coming in contact with any items that may be considered contagious. 7. Jail detention officers will receive formal training regarding communicable/contagious diseases during their first 30 days of employment and continue training through instruction at Basic Jail Certification School. Reviewed and Approved: (Sheriff') Date: 51 ORANGE COUNTY JAIL 144 E, Margaret Lane Hillsborough, Nortii Carolina 27278 POLICY #: 4.13 PAGE 1 OF :3 POLICY TITLE: DATE: RELATED N.C. STANDARDS: TRANSPORTATION OF INMATES FOR MEDICAL CARE IDLY 1, 2003 .2403 (a) (8); .3201 POLICY STATEMENT: In order to ensure, to the extent possible, that thorough health care deliver services are provided inmates, ,jail detention officers will arrange for the transportation of inmates to outside medical care providers for both routine appointments and for emergency purposes, In an effort to ensure thatjail detention officers are not being required to perform duties that would interfere with the continuous supervision of inmate housed at the facility, inmates being transported out side the facility will be required to be accompanied by an Orange County Sheriff's Office Deputy at all times. SPECIFIC PROCEUDRES: 1. Transportation for Routine Medical Care: A. The lieutenant will be responsible for coordinating the transportation of inmates outside the facility for routine medical care with Deputies from the Orange County Sheriff's Office, B, The lieutenant will ensure that should a female inmate require transportation to a medical provider, that a female Deputy/detention officer is available to provide transportation, C. Once transportation arrangement have been made, the Lieutenant or, designee will insure no one will advise inmate with medical appointments of the time that they will be picked-up for transportation to the same. D The lieutenant or designee will ensure that all Deputies providing transportation for an inmate is provided with a copy of the inmate's "Prisoner Medical Report Form" for delivery to the health care provider. E. The Orange County Deputy will be required to remain with the inmate at all times when the inmate is not within the confines of the facility. However, inmates will be allowed privacy during medical examinations and conferences with qualified medical personnel, (,~ POLICY 4.1.3, "TRANSPORTATION OF INMATES FOR ROUTINE MEDICAL CARE" PAGE 2 of .3 F. All inmates being transported outside the facility for routine medical care will be required to be physically restrained with handcuffs, belly-chains and leg irons, only under emergency circumstances shall restraints be removed. (unless the use of such restraints shall prohibited a medical procedure). G. Upon completion of the medical examination, the physician or attending medical person will provide instructions that may need to be followed by jail officers to provide proper care for the inmate (e.g., prescriptive medications, special housing, eta). H. When any inmate is transported to be seen by an (outside of the Orange County Jail physician) the deputy/detention transporting officer shall provide the physician a copy of our (the) inmates "Prisoner Medical Report Form" to be completed by the physician.. I. Upon completion the transporting deputy/detention officer shalt not fail to return the inrnate medical form back to the Orange County Jail for our facility, shift supervisor. The shift supervisor shall give the inmates medical form to the facility nurse practitioner "who shall read and place" the outside physician's diagnosis for treatment into the inmate's medical record. 1. The transporting deputy/detention officer transporting the inmate shall not communicate anything told to them by the physician or anything they may have read when receiving the inmate's medical form from the physician. Exception to this rule shall not apply when speaking to Jail Medical personnel or the .Jail Nurse Practitioner. Should a deputy/detention officer discuss with anyone anything they have been told or they have read with regard to an inmate's medical diagnosis they are in violation of breaching the confidentiality of the inmate's medical report. 2. Transportation of Inmates for Emeruencv Medical Care: A. The emergency transportation of any inmate to an outside health care provider will be conducted only upon the recommendation of the facility nurse practitioner, EMS or the jail shift supervisor, Lieutenant, Major or Sheriff. B. Depending upon the situation, either an Orange County deputy will provide transportation of an inmate to an outside health care provider or Emergency Medical Services (EMS, or ambulance) will provide transportation. The Lieutenant will be _ responsible for coordinating emergency transportation through the Orange County Sheriff's Office. Should EMS be used, an Orange County Deputy will be required to escort the ambulance to its destination. ~( POLICY 4.13, "TRANSPORTATION OF INMATES FOR ROUTINE MEDICAL CARE" PAGE.30F3 C. In all emergency situations, the Jail Administrator and/or Sheriff should be contacted immediately to advise them of the situation. D. Should an inmate be transported and a determination is made that the inmate should remain hospitalized, the Orange County Deputy escorting the inmate to the hospital will be required to contact the Jail Administrator and/or Sheriff and advise them of the situation. The Deputy will provide for the supervision of the inmate until such a time that the Jail Administrator and/or Sheriff sends another off-duty jail detention officer or Deputy to relieve this person. E. The Jail Administrator or the Sheriff will be responsible for notifying the next-of kin of any inmate requiring hospitalization. Reviewed and Approved: 9" "`~° ~%~~~~l~l/J _ (Sheriff)~~G G~~~ Date: ORANGE COUNTY JAIL 144 E. Margazet Lane Hillsborough, North Carolina 27278 POLICY #: 4.14 POLICY TITLE: MEDICAL RECORDS DATE: JULY 1, 200.3 RELATED N.C. STANDARDS: 240.3 (a) (8); 3201(b) (6); .3208 PAGE 1 OF 3 POLICY STATEMENT: In order to protect the privacy of inmates and to comply with state and federal statutes and case law, inmate medical records will be filed and maintained in a secure azea separate from inmate confinement records, Authorized medical professionals shall be responsible for the maintenance of inmate medical records and will be the only individual authorized access to izunate medical records. SPECIFIC PROCEDURES: 1, Inmate Medical Records: A. During the admission process, the admitting officer will ensure that a medical record is established for each inmate confined to the facility. A copy ~f the inmate's "Preliminazy Health Screening Form" and "Inmate Medical Screening Report" will be included in the medical record and another in the inmate's confinement record. B. The "Preliminary Health Screening Form" and "hrmate Medical Screening Report" should be the only medical documents filed in the inmate's confinement record.. No part of an inmate's medical file should be made a part of his/her confinement record. Copies of any instructions written by an attending physician for ,jail officers to follow (e.g., inmate medication schedules; special housing authorizations; etc.) may also be filed in the inmate's confinement record inasmuch as officer's must and are required to have access to this information. HOWEVER, UNDER NO CiRCUMSTTANCES WILL ANY MEDICAL INFORMATION OR DOCUMENT THAT MAY CONTAIN INFORMATION RELATIVE TO AN INMATE'S DIAGNOSIS BE FILED IN AN INMATE'S CONFINEMENT RECORD. C Should an inmate disclose information during the admission process that may suggest that he/she is infected with any disease or condition deemed confidential either by state or federal statute, case law, standard, or regulation, the officer will ensure that this information is recorded on a separate "Preliminary Health Screening Form" and "Inmate Medical Screening Report' and filed only in the inmate's medical record (see also, Orange County Jail Policy, 2.11, "Preliminary Health Screening"). POLICY 4.14, "MEDICAL RECORDS" PAGE20F3 ~3 D. The following documents/information will be required to be filed in the inmate's medical record: 1. Preliminary Health Screening Form and Inmate Medical Screening Report; 2. Medical evaluation results (usually recorded on a "Prisoners Medical Report Form"}; 3. Medical information/prescription information; 4. Reports of laboratory, x-ray and any diagnostic tests; 5 Progress notes; 6. Inmate consent and refusal of treatment forms; 7. Release of information forms; 8. Hospital discharge forms; 9. Special treatment plans; and/or, 10, Medical appointment information, to include the time, place, date and with whom the appointment is with. 2. Access to Medical Records: A A locked filing cabinet will be maintained in the Medical Examination Room of the facility for the purposes of filing inmate medical records. B. Only the following individuals will be allowed access to medical records under the following circumstances: 1. Unlimited access to inmate medical records will only be granted to authorized medical professionals. Z. Limited access will be granted to the .Jail Administrator and/or Sheriff during emergency situations when either the physician or other medical personnel are unavailable at the facility to access such records; 3. Upon the written consent of an inmate, or when the Jail Inspector as part of his inspection asks to check inmate's medical records far proper filing and storage. Pursuant to state law, an inmate must be given written notice of his/her right to object prior to allowing a Jail Inspector access to his/her record (NOTE: Tlris information is provided to inmates in the Inmate Handbook), (~ POLICY 4.14, "MEDICAL RECORDS" PAGE 3 OF :3 _ 3. Release of Medical Information/Records to Other Authorities: A. Medical records should not be allowed outside the facility, However, in special situations (e.g,, an attorney may request a medical record for a legal case involving the inmate; another health care provider may request the file), it may become necessary to release an inmate's medical record to an outside authority. In these cases, jail officers must receive a written consent form from the inmate authorizing his/her release of their medical record to the authority. Under no circumstances will any inmate medical record be released to any authority without the written consent of an inmate. B. Medical information for inmates being transferred to another correctional facility will be handled in the following manner: 1, A sealed written statement from the Facility Medical Personnel may be provided the transporting officer for delivery to the receiving institution's health care provider, The written statement will include general information concerning the inmate's medical history and will authorize the receiving facilities medical staff to contact the physician for more information. 2. Should a sealed, written statement not be provided the transporting officer, the Facility Medical Personnel will contact the receiving facilities medical staff and verbally provide information concerning the inmate's medical history to him/her, C. The Facility Medical Personnel will be responsible for advising the Director of Health Services, Division of Prisons, whenever an inmate is transferred from the facility to the Department of Corrections, who is known to be infected with HIV or AIDS. 4. Retention of Inmate Medical Records: A. Inmate medical records will be maintained for a period of at least three (3) years as required by state standards. B. Facility Medical Personnel will be responsible for ensuring that all inmat medical records are properly maintained pursuant to state standard~s~ _ Reviewed and Atrroved: (Sheriff) Date: i_L,~1~~~U~ ORANGE COUNTY JAIL 'i44 E. Margaret Lane Hillsborough, North Carolina 27278 POLICY #: 4.15 PAGE 1 OF 8 POLICY TITLE: Duties and Responsibilities of Orange County Jail Med Passers DATE: JULY 7, 2004 RELATED N.C, STANDARDS 2403; .2701 ~n5 POLICY STATEMENT: In order to properly administer medications to inmates confined in the Orange County Jail the following responsibilities and duties shall be followed as prescribed. T~o provide a safeguard against the improper passing of medications to inmates confined in the Orange County Jail, detention officers assigned to this duty shall attend and complete the State of North Carolina Med Technician Course. SPECIFIC PROCEDURES: Duties and responsibilRies of the morning daytime shift Med Passer: The 0530 a.m. to 1330 p.m, Med Passer is scheduled to work mornings Monday thru Friday, eight (8) hours daily. This schedule is subject to change based on the need for the moming med passer to work other hours when needed to cover another Med Passer who may be out sick, on vacation or in school, NOTE: Only "pre-approved" overtime approved by the Lieutenant will be - considered for comp or paid time. All unapproved overtime will not be tolerated. Med passer will report for duty on time, mentally prepared and physically alert to perform assigned duties. 2. Briefing with Duty Supervisor. • Verbal briefing with the Duty Supervisor of any unusual medical incidents, • Transportation of an inmate to and from the hospital, • The Emergency Department Physicians medical report on the Inmate should be filed in the inmate's medical record and Inmate's medical record should be placed in ,Jail Health Provider's box for review. • Med passer will receive any Inmate medical request or Intake forms when logged in the medical forms/request log, initiaUdate/and time as required. • Med passer will also check the Inmate medical forms/request log and receive arry Inmate medical requests that have been made during the night shift. If coming in on Monday moming the med passer will check the inmate medical forms/request log for all that have been listed over the weekend and read the medical red book notes. The med passer will familiarize themselves with any medical or medication issues that have occurred over the weekend. • Med passer will check the form(s) to ascertain if any need immediate attention • Med passer will place the Intake farms with charts if applicable in the To Be Reviewed Box. The ,tail Health Provider shall be informed of any significant health information. POLICY #: 4.15 PAGE 2 OF 8 Duties and Responsibilities of Orange County Jail Med Passers (~(p 3. inmate Cell Assignment The Med Passer will view the Inmate Board in the control roam for Inmate cell assignments. Check jail log printout for any inmates that have been released ar moved from previaus cell assignment. Remove any MAR fram the MAR Book and medication from the cart of Inmates tha# have been released. 4. Red Book Review The Red book is to be located in the center of the desk next to the telephone in the medical office, It is crucial to check the red bank each day for information being left by the day and night shifts, Important infom~ation should be documented here far communication to oncoming shifts.. 5. Narcotic Drug Count Narcotic count is required as outlined below, 1. When an inmate has narcotic medications an the cart to be administered, Narcotic count should be done when a med passer arrives for a new shift with Shift Supervisor, with the present/off-going med passer and when med passer ends shift at night with shift Supervisor, 2, When an inmate is being #ransferred out to DOC, 'or FEDERAL inmate is transported AND hislfier narcotic medication needs to go with himlher: The med passer shall document the narcotic count of the inmate with the Shift SupervisoNMed passer. Each will initial the MAR narcotic control sheet to validate their Gaunt 3, When a narcotic medication comes into the Jail it should be counted and dacumented by 2 Med Passers or a Med Passer acid Shift Supervisor.. if it is approved by a Provider to be administered it should be documented on the narcotic count sheet and counted as listed above, If it is not approved for administration it should be counted, count documented and seated with tamper proof seal. Daily Gaunt of that medication should continue until destroyed ar inmate releasedltransfen•ed out. 4, When narcotic medication is designated for destruction.,, 5. When destroying narcotic drugs. (They shall be destroyed only under supervision of the Jail Administrator or Detention Supervisor and wilt be documented on the back of the MAR.) 6. Glucose Monitoringflnsulinadministration. In the front of the MAR Log book the fist of inmates requiring glucose monitodng or insulin administration should be reviewed, The Med Passer will take the Glucose Monitoring tray (containing jail approved supplies and those appropriate for testing,} to each cell where the inmate will be tested andlor administered insulin. Inmates requiring testing/Insulin administration will be identified by their arm band. Blood sugar readings will be obtained and dacumented on the MAR. Inmates requiring insulin administration will be given an alcohol pad and pie-filled syringe with appropriate dose/type of insulin. 7'he inmate will administer the insulin and the inmate will place the used syringe into the sharps container for proper disposal. The med passer wil( document administration of the insulin on the MAR.. The med passer will ensure all used supplies are removed fram the cell and properly disposed.. POLICY #: 4.15 PAGE 3 OF 8 Duties and Responsibilities of Orange County Jaii Med Passers ~, _. 7. MAR Log and Med cart • The Med Passer is to check the MAR book before leaving the medical room to ensure the MARS are in alphabetical order by Inmate name and have Inmate photo/identification sticker attached, • Med Passer shall check MAR's and ensure changes/updates are reflected on the MAR. Changes/updates of Treatments should also be reflected on the MAR, New Diabetic inmates should also be added to Glucose Monitoring list if applicable. • The drawers of the medication cart are clearly marked Annex and QId Jail. Each drawer shall have all drug cards filed by Cell Block clearly marked with each inmate's name in alphabetical order. Medication cards should follow in order as listed on the MAR and shall have each inmate's photo/identification attached, 8. Breakfast Medication Administration Before leaving the medication room for medication administration, the Med Passer shall prepare the medication cart with necessary supplies. • Med Passer will enter their I.D, button in the medication probe before the medication pass. Time of entry and exit of each cell by the Med Passer will be documented by this probe, When administering any drug to an inmate, the inmate shall approach the Med Passer and display his/her photo-identification arm band. The arm band is to be viewed for verification of inmate to receive medication. If an Inmate does not have an arm band, the Shift Supervisor is to be notified for their intervention. Medications are not to be administered to Inmates without Photo-identification arm bands, The med passer will administer all tablets and capsules by pouring the medication from a medication cup into the inmate's hand. Disposable medication paper cups may be given to the inmate when administering medication.. The med passer will ensure that the Inmate swallows the administered medication. • The med passer will administer inhalants by the ordered administration method. • The med passer will administer creams, powders, liquids, etc,.. in disposable medication paper cups. The med passer will initial the MAR to verify administered medication. • The med passer will mark the MAR to verify refused medication. • The med passer will note the back of the MAR for any unusual medication issues. • At completion of administration of medications, the Med Passer will review the MAR book fo ensure all medications have been signed as administered/refiised, etc. 9. Med Passer will hourly check the Inmate Medical screening and Requests Bins for new forms. New forms will be reviewed and action taken for appropriate requests andlor medical information. Medical requests for PRN medications shall be placed in the Charts for Review box with the Inmates chart attached. Jail Health Provider shall be contacted for medication that the Med Passer feels needs to be initiated sooner than the next scheduled Clinic Day. Medical requests to see the Jail Health provider should be reviewed for urgencylneed. If it is felt to be an urgent request, Jaii Health Provider should be contacted for discussion of the complaint. ff the request is not urgent, the Medical Request and Inmate chart should be placed in the Next Clinic box for the Provider's next clinic day. Medication orders obtained from a Provider shall be documented in the Inmate chart and chart placed in the Charts for Review Box. Provider shall sign at next clinic day. POLICY #: 4.15 PAGE 4 OF 8 Duties and responsibilities of the morning daytime shift Med Passer: x.48 9. contd; Medication orders obtained to be initiated as STAT or Next Med Pass, shall be documented on the Inmate's MAR according to Jait Protocol. Medical Intake forms should be screened for medications to be initiated and significant health problems (Heart disease, Diabetes, Seizures, Alcohol/Drug use daily, etc.) The appropriate Provider shall be contacted at time of review of the intake for initiation of medication. Any Health problem in question of significance should be discussed with a Provider. Information about medications to be initiated (name, dose, frequency) should be ascertained from the Inmate by the Med Passer prior to contacting the Provider. However, obtaining medication information from the Inmate should not delay contacting the Provider for any sign cant length of time. ff information is not readily available, the Provider should be contacted with this information. Med Passer conducting preliminary screening of inmate i.e.; blood pressures, vital signs, urine dips, accu checks, etc. shall be written on the medical request form. When completed the results of each vital sign taken of any inmate shall be written on the inmates medical request fore and be returned to the Nurse Practitioner (medical professional) file in the med room paper clipped to the front of existing or new inmate folder. The Provider shall be contacted about above information obtained if the Med Passer feels information needs to be reviewed prior to next scheduled clinic day. 10. Clinic Preparation Clinic scheduled during the Moming Med Passer shift shall be prepared by the Moming Med Passer. All Inmate Medical requests and medical records shall be prepared by the Moming Med Passer prior to the arrival of the Jail Health Provider. • Med passer shall attach Medical Request form, Clinic Documentation Form, laboratory results, and Inmate records obtained to the Inmate chart and place in Clinic box. • Med passer will check each Inmate's Chart to ascertain if any medical records are needed from another Jail, Hospital, or other Medical Provider for the Jail Health Provider. If past medical record need to be obtained for review by Jai) Health Provider or if they have been requested to be obtained by Jail Health Provider, a records release should be signed by the inmate. The Medical Facility or other Detention/Comectional Facility care was obtained should be contacted by the Med Passer and records release should be faxed. If information requested is needed for same day clinic, the urgency of obtaining information should be conveyed to the prior Facility to expedite receipt of information. Documentation of contacts made to other Facilities is imperative. Names of those contacted, phone number and fax numbers should be documented on a Progress note and placed in Inmate chart.. If receipt of information is expected during shift other than that of the Med Passer who requested the information, this should be verbally conveyed to the oncoming Med Passer/Shift Supervisor, Alert the on Duty Supervisor of the Clinic schedule to prepare staff of Inmate transport to clinic. PALICY #: 4.15 PAGE 5 OF 5 Duties and responsibilities of the morning daytime shift Med Passer: ~9G 11. Assistance of Jail Health Provider in clinic. • Any Inmate Medical RequesUlntake form the Med Passer feels is priority should be verbally communicated to the Jail Health Provider upon arrival to the Clinic The Jail Health Provider and Med Passer will compile the list of Inmates to be seen„ The Med Passer will give the list of Inmates to be seen in the Clinic to the Detention Officer designated by the Shift Supervisor to transporUsupervise Inmates to the Clinic.. • The Med passer will assist the Jail Health Provider as needed during clinic. • Med passers will write notes on any special orders the Jail Health Provider may give for an Inmate. • Med passer assisting in Clinic is responsible for execution/communication of any orders written during Clinic. Med passer will communicate with Shift Supervisor/Lieutenant of any behavior concerns/suicide watches recommended by Jail Health Provider during clinic., • Inmate charts with medication orders that have been completed should be placed in Medication Completed box.. Med Passer receiving new medications from Pharmacy will have these charts to compare new medication orders. • Medications to be initiated as NOW/STAY orders should be transcribed per Jail Protocol on Inmate MAR. • Medication refill forms completed during clinic shall be faxed to Pharmacy facility. These forms should be placed in Medication Completed box for review of Med Passer receiving medications from Pharmacy facility. • Treatments should be documented on Inmate MAR per Jail Protocol. Verbal communication to next Med Passer of any unusual treatments/circumstances or information Jail Health Provider wants obtained later in shift should be discussed during shift report, 12. Federal Inmates Responsibilities • Prepare charges for Federal Inmates seen in clinic if applicable. • It is especially important any charges that are sent to the Marshall's service are accurately recorded; this will assist in completion of monthly billing. • Upon arrival of new Federal Inmates, the Med Passer should be available to review Medical History, medication information, Intake form and any new Medical Requests. Review medications/medical records, if information is needed from transferring facility, that facility should be contacted immediately and information obtained verbally or faxed to our facility. • Jail Health Provider should be contacted in reference to information obtained on new Federal Inmates. Orders given should be documented in the Inmate chart on a Progress sheet and on MAR as appropriate. • Obtain list of Inmates leaving the facility from the on Duty Supervisor. • Preparation of Federal Inmates for departure is to be done by the Med Passer the day before departure.. • Medical records are to be copied of any Federal Inmate leaving the facility. Medications are to be packaged for transport with inmate. PALICY #: 4.15 PAGE 6 OF 8 Duties and responsibilities of the morning daytime shift Med Passer: '7p New FEDERAL inmates are to be medically processed by the Daytime or Afternoon Med passers. tf emergency situations prevent processing from being completed, the Night Med passer should complete processing. Verbal communication between off going and on coming tiled Passers as to what has been completed is imperative. • Check to see if any Federal medical transport summary sheets confidential envelopes for inmates booked in during that day have not been opened.. • Open any unopened confidential envelopes to ascertain if any immediate needed medication needs to be ordered before 1730 hours. • Call Medical provider to give order on medication order from MAST.. • Fax order to MAST for any immediate needed medication. • Read over the medical information on the sheets to ascertain if any needed medical care needs to be done. i.e. TB tests , BP checks, Accu checks, etc... • Pull any immediate needed medication in stock from the cabinet. Sign out the medication from the stock cabinet on a medication receipt in the cabinet. • Make labels with photo id and adhere to all new medication cards or containers. • Label blank MAR with inmate photo id and write all new medicine information on MAR according to MAR guidelines. • Put medication in cart, MAR in MAR Log and put inmate transport summary sheet in inmates' medical file, (If inmate has no medical file, create a new one for them) 13, Medical Record Maintenance Responsibilities • Med passers shall be responsible for placing inmates records in the inmate's medical folder • Each Med passer is responsible for accurately filing Inmate's Medical Chart in the file cabinet with completion of use. • Inmate Mars should be filed in chart if Inmate is transferred/released from facility. 14. Referral appointments as indicated by medical professional • Med passer shall be responsible for scheduling referral appointments as recommended by the Jail Health Professional, or other Health Care Provider inmate has seen while in our Facility. • Lieutenant and Major should be notified of these referals and appointment dates. • Inmate information concerning referrals should be placed in an envelope and placed in appointment box on Clinic wall. Date of appointment should be clearly marked on outside of envelope and visible for Med Passers. Names of Inmates should not be placed on outside of envelopes. • Coordination for transportation will be done by the the Lieutenant and Major. 15. Medication Refills lMAR • Med passer will inventory cart & room daily for needed medication refills according to the quantity protocol. These orders will be FAXED to MAST at the first available opportunity. • Medication refill requests received by fax from Pharmacy should be placed in Review box for Jail Health Provider. • Med passer will assist at end of each month in the review of next month's MAR's for those cells assigned. New MAR will be placed in MAR log book according to procedure previously outlined, previous month MAR will be filed in inmate's chart. POLICY #: 4.15 PAGE'7 OF 8 Duties and responsibilities of the morning daytime shift Med Passer: 16. Inmate Diet Information • Med passers are responsible for placing any dietary changes made by Jail Health Provider on the Special Diet form in the kitchen. Food allergies noted an Inmate Intake form should be placed nn Special Diet farm in kitchen. Documentation in chart of above communicated information should be done by Med Passer. 17. Dental Requests Inmate Dental requests are to be logged into Medical Log according fo Jail Protocol by Shift Supervisor. • Dental requests reviewed by Med Passer are initialed in Log book, A copy of the Inmate Dental request is to be placed on the Major's board far review. Appointments will be arranged by the Major, Communication of these appointments will he made to the Med Passer to prepare information as appropriate, 18. Conduct twice weekly blood pressures and blood sugar checks of the inmates that the medical provider orders. Documentation of readings should he placed on MAR in designated area, 19. Clean and prepare the clinic area for the next Med Passer's shift. Empty any trash • Pickup any medical equipment and place them back in proper place NOTE: Med passer is to assist jail staff under supervision of the Shift Supervisor during any medical situations that need immediate attention. If med passer is not occupied with assigned med passer duties then the med passer will assist the jail staff under the supervision of the shift supervisor. POLICY #: 4.15 PAGE 8 OF 8 Duties and responsibilities of the morning daytime shift Med Passer: SUMMARIZATION '7a Morning Shift -Med Passer #1 0530 BRIEFING WITH SHIFT SUPERVISOR 0530-Q600 -SCANS MEDICAL. REQUEST FORMS AND MEDICAL SCREENING FORMS THAT HAVE BEEN TURNED IN DURING THE NIGHT. PRIORITIZES MEDICAL ISSUES BY URGENCY. -0600-0745 PASSES BREAKFAST MEDICATIONS -0745.0950 -PREPARES FOR AND WORKS CLINIC 1. PULLS MEDICAL FILES ON INMATES THAT NEED TO BE SEEN,. 2. DOES PRELIMINARY SCREENING IF NEEDED. StJGH AS URINE DIPS, ACCU CHECKS, VITAL SIGNS, ORDERS MEDICAL RECORDS FROM OTHER FACILITIES. 3. OBTAINS INMATE'S SIGNATURE AND ATTACHES CHARGE SHEET TO MEDICAL RECORD IF APPLICABLE. 4. ASSIST NP DURING CLINIC. 5. AFTER CLINIC, CLEAN UP CLINIC AREA. 6, READ CLINIC NOTES ON EACH INMATE. 7. ORDER OR DISCONTINUE MEDICATIONS AS INDICATED ON CLINIC NOTES. 8. SCHEDULE REFERRAL APPOINTMENTS AS INDICATED. 9. CHECK MAR TO BE SURE THAT IT REFLECTS UPDATED ORDERS, 10. INFORM KITCHEN STAFF OF ANY CHANGES FOR INMATES FOOD TRAYS (LOW SODIUM, DOUBLE PROTEIN, ETC),. 11. INFORM JAIL. STAFF OF ANY INMATES WITH CHANGES IN BEHAVIOR OR MENTAL STATUS THAT THEY SHOULD BE AWARE OF (SUICIDE WATCH, ETC...). 12. REFER INMATES WITH DENTAL ISSUES AFTER LOGGING TO THE MAJOR'S BOARD. 13. COMPLETE PAPERWORK FOR LABS THAT WERE DONE DURING CLINIC, AND RECORD ON THE SEND OUT LOG. CALL LABCORP AND MAKE THEM AWARE OF PICKUP. 14. FILE CHARTS BACK IN THE ACTIVE FILE. -0950-1000 BRIEFING WITH MED OFFICER #2 -1000-1200 -COMPLETES AFTER CLINIC DUTIES -1200-1330 HANDLES FEDERAL INMATE ISSUES, TB TESTS, MEDICATION APPROVAL, ORDERING MEDICATION, OBTAINING RECORDS. IF NO FEDERAL INMATE ISSUES BECOMES BOOKING OFFICER SECOND ONLY TO ITEMS OF MEDICAL URGENCY. THIS OFFICER ALSO READS TB AND CORRECTLY DOCUMENTS TB TESTS RESULTS. WED-THUR _ -0530-0745 SAME -0745-0900 CHECKS CART AND ORDERS ANY NEEDED MEDICATIONS/ MAKES SURE CART AND MAR BOOK ARE IN ALPHABETICAL ORDER BY CELL ASSIGNMENT. -09D0-1000 81-WEEKLY BP CHECKS AS INDICATED BY'THE NP -1000-1030 BRIEFING WITH MEDICAL OFFICER #Z -1030-1100 ORDERS ANY NEEDED CLINIC SUPPLIES OR DNA TESTING SUPPLIES.. -1100-1330 HANDLES ANY FEDERAL. INMATE ISSUES IF NEEDED BECOMES BOOKING OFFICER IF NEEDED ORANGE COUNTY JAIL 144 E, Margaret Lane Hillsborough, North Carolina 27278 POLICY #: 4,15 ~3 PAGE 1 OF 7 POLICY TITLE: Duties and Responsibilities of Orange County Jail Med Passers DATE: JULY 7, 2004 RELATED N.C. STANDARDS .24Q3; .2701 POLICY STATEMENT: In order to properly administer medications to inmates confined in the Orange County Jail the following responsibilities and duties shall be followed as prescribed. To provide a safeguard against the improper passing of medications to inmates confined in the Orange County Jail, detention officers assigned to this duty shall attend and complete the State of North Carolina Med Technician Course. SPECIFIC PROGEDURES: Duties and Responsibilities of the Afternoon Shift Med Passer: The 1000 a.m. to 1800 p. m. Med Passer is scheduled to work daytime Monday thru Friday, eight (8) hours daily. This schedule is subject to change based on the need for the Morning Med Passer to work other hours when needed to cover another med passer who may be out sick, on vacation or in schooh NOTE: Onty "pre-approved" overtime approved by the Lieutenant will be considered for comp or paid time. All unapproved overtime will not be tolerated. 1. Med passer will report for duty on time, mentally prepared and physically alert to perform assigned duties. 2. Briefing wkh Duty Supervisor. Verbal briefing with the Morning Med Passer of any unusual medical incidents. • Transportation of an Inmate to and from the hospital, The Emergency Department Physicians medical report on the Inmate should be filed in the inmate's medical record and Inmate's medical record should be placed in Jaii Health Provider's box for review. • Med passer will receive any Inmate medical request or Intake fdnms when logged in the medical fonms/request log, initial/date/and time as required. • Med passer will also check the Inmate medical formslrequest log and receive any Inmate medical requests that have been made during the Moming shift. • Med passer will check the form(s) to ascertain if any need immediate attention • Med passer will place the Intake forms with charts if applicable in the To Be Reviewed Box, The Jail Health Provider shall be informed of any significant health information, 3. Inmate GeII Assignment a. The Med Passer will view the Inmate Boarl in the control room for Inmate cell assignments. b. Check jail log printout for any inmates that have been released or moved from previous cell assignment. b. Remove any MAR from the MAR Book and medication from the cart of Inmates that have been released. 4. Red Book Review -_ • The Red book is to be located in the center of the desk next to the telephone in the medical office., It is crucial to checc the red book each day for information being left by the day and night shifts. • Important information should be documented here for communication to oncoming shifts, POLICY #: 4,15 PAGE 2 OF 7 Duties and responsibilities of the afternoon shift Med Passer: -7 _ 5, Narcotic Drug Count r~ a. Narcotic count is required as outlined below.. 1, When an inmate has narcotic medications on the cart to be administered. Narcotic count should be done when a mad passer arrives for a new shift with Shift Supervisor, with the presentloff-going mad passer and when mad passer ends shift at night with shift Supervisor. 2. When an inmate is being transferred out to DOC, or FEDERAL inmate is transported AND his/her narcotic medication needs to go with him/her. The mad passer shall document the narcotic count of the inmate with the Shift Supervisor/Med passer. Each will initial the MAR narcotic control sheet to validate their count. 3. When a narcotic medication comes into the Jail it should be counted and documented by 2 Med Passers or a Med Passer and Shift Supervisor, If ft is approved by a Provider to be administered it should be documented on the narcotic count sheet and counted as i'rsted above. If it is not approved for administration it should be counted, count documented and sealed with tamper proof seal. Daily count of that medication should corrtinue until destroyed or inmate releasedttransferred out. 4 When narcotic medication is designated £or destruction. 5.When destroying narcotic drugs. (they shall be destroyed only under supervision of the Jail Administrator or Detention Supervisor and will be documented on the back of the MAR.) 6. Glucose Monitoring/Insulin administration. • In the frorrt of the MAR Logbook the list of inmates requiring glucose monRoring or Insulin administration should be reviewed.. • The Med Passer will take the Glucose Monitoring tray {containing jail approved supplies and those appropriate for testing,) to each cell where the inmate will be tested and/or administered insulin. Inmates requiring testing/insulin administration will be identified by their arm band. • Blood sugar readings will be obtained and documented on the MAR. • Inmates requiring insulin administration will be given an alcohol pad and pre-filled syringe with appropriate dose/type of insulin. The inmate will administer the insulin and return the used syringe to the mad passer for proper disposal. • The mad passer will document administration of the insulin on the MAR. The mad passer will ensure all used supplies are removed from the cell and property disposed, 7. MAR Log and Med cart The Med Passer is to check the MAR book before leaving the medical room to ensure the MARS are in alphabetical order by Inmate name and have Inmate photo/identification sticker attached. Med Passer shall check MAR's and ensure changeslupdates are reflected on the MAR. Changes/updates of Treatments should also be reflected on the MAR. New Diabetic inmates should also be added to Glucose Monitoring list if applicable. • The drawers of the medication cart are clearly marked Annex and Old Jaii. Each drawer shall have all drug cards filed by Cell Block clearly marked with each inmate's name in alphabetical order. Medication cards should follow in order as listed on the MAR and shall have each inmate's photo/identification attached. 8. Lunch 8 Dinner Medication Administration Before leaving the medication room for medication administration, the Med Passer shall prepare the medication cart with necessary supplies. Med Passer will enter their LD. button in the medication probe before the medication pass.. Time of entry and exit of each cell by the Med Passer will be documented by this probe. • When administering any drug to an inmate, the inmate shall approach the Med Passer and display his/her photo-identification arm band. The arm band is to be viewed for verification of inmate to receive medication. If an Inmate does not have an arm band, the Shift Supervisor is to be notified for their intervention. Medications are not to be administered to Inmates without Photaidentification arm bands. The mad passer will administer all tablets and capsules by pouring the medication from a medication cup into the inmate's hand. Disposable medication paper cups may be given to the inmate when administering medication. • The mad passer will ensure that the Inmate swallows the administered medication. The mad passer will administer inhalants by the ordered administration method. POLICY #: 4.15 PAGE 3 OF T Duties and responsibilities of the afternoon shift Med Passer: ~ J Lunch & Dinner Medication Administration contd; • The med passer will administer creams, powders, liquids, etc,... in disposable medication paper cups. • The med passer will initial the MAR to verify administered medication. • The med passer will mark the MAR to verify refused medication. • The med passer will note the back of the MAR for any unusual medication issues. At completion of administration of medications, the Med Passer will review the MAR book to ensure all medications have been signed as administered refused, etc. 9. Med Passer will hourty check the Inmate Medical screening and Requests Bins for new fortes. New forms will be reviewed and action taken for appropriate requests andlor medical information. Medical requests for PRN medications shall be placed in the Charts for Review box with the Inmates chart attached. Jail Health Provider shall be contacted for medication that the Med Passer feels needs to be initiated sooner than the next scheduled Clinic Day, Medical requests to see the Jail Health provider should be reviewed for urgency/need. If it is felt to be an urgent request, Jail Heahh Provider should be contacted for discussion of the complaint. ff the request is not urgent, the Medical Request and Inmate chart should be placed in the Next Clinic box for the Jail Health Provider's next clinic day. Medical requests to see the Jail Health provider should be reviewed for urgency/need. ff it is felt to be an urgent request, Jail Health Provider should be contacted for discussion of the complaint. ff the request is not urgent, the Medical Request and Inmate chart should be placed in the Next Clinic box for the Jail Health Provider's next clinic day. Medication orders obtained from a Jail Health Provider shall be documented in the Inmate chart and chart placed in the Charts for Review Box. Jail Health Provider shall sign at next clinic day, Medication orders obtained to be initiated as STAT or Next Med Pass, shall be documented on the Inmate's MAR according to Jail Protocol. Medical Intake forms should be screened for medications to be initiated and significant health problems (Heart disease, Diabetes, Seizures, Alcohol/Drug use daily, etc,) The appropriate Jail Health Provider shall be contacted at time of review of the intake for initiation of medication, Any Health problem in question of significance should be discussed with a Jail Health Provider, Information about medications to be initiated (name, dose, frequency) should be ascertained from the Inmate by the Med Passer prior to contacting the Jail Health Provider. However, obtaining medication information from the Inmate should not delay contacting the Jail Health Provider for any sign cant length of time. If information is not readily available, the Jail Health Provider should be contacted with this information. Med Passer conducting preliminary screening of Inmate i.e.; blood pressures, vital signs, urine dips, accu checks, etc. shall be written on the medical request form. When completed the results of each vital sign taken of any inmate shall be written on the inmates medical request form and be returned to the Nurse Prectkioner (medical professional) file in the med room paper clipped to the front of existing or new inmate folder, The Jail Health Provider shall lie contacted about above information obtained if the Med Passer feels information needs to be reviewed prior to next scheduled clinic day. 10. Clinic Preparation Clinic scheduled during the Afternoon Med Passer shift shall be prepared by the Moming Med Passer. Inmate Medical requests and Medical Intake sheets should be reviewed daily as already described. The Moming Med Passer should be responsible for review only of those that were received after the Night Med Passer shift and prior to the beginning of the Clinic. • All Inmate Medical requests and medical records shall be prepared by the Moming Med Passer prior to the arrival of the Jail Heath Provider. • Med passer shall attach Medical Request form, Clinic Documentation Form, laboratory results, and Inmate records obtained to the Inmate chart and place in Clinic box. POLICY #: 4,15 PAGE 4 OF 7 Duties and responsibilities of the afternoon shift Med Passer: ~/ Clinic Preparation contd; ~! • Med passer will check each Inmate's Chart to ascertain if any medical records are needed from another Jail, Hospital, or other Medical Provider for the Jail Health Provider. • If past medical reconis need to be obtained for review by Jail Health Provider or if they have been requested to be obtained by Jail Health Provider, a recorcis release should be signed by the inmate, The Medical Facility or other DetentioNCorrectional Facility care was obtained should be contacted by the Med Passer and records release should be faxed.. If information requested is needed for same day clinic, the urgency of obtaining infonnaticn should be conveyed to the prior Facility to expedite receipt of information. Documentation of contacts made to other Facilities is imperative. Names of those contacted, phone number and fax numbers should be documented on a Progress note and placed in Inmate chart. If receipt of information is expected during shift other than that of the Med Passer who requested the information, this should be verbally conveyed to the oncoming Med Passer/Shift Supervisor. Alert the on Duty Supervisor of the Clinic schedule to prepare staff of Inmate transport to clinic. 11. Assistance of Jail Health Provider in clinic. • Any Inmate Medical RequesVlntake form the Med Passer feels is priority should be verbally communicated to the Jail Health Provider upon arrival to the Clinic. • The Jail Health Provider and Med Passer will compile the list of Inmates to be seen. The Med Passer will give the list of Inmates to be seen in the Clinic to the Detention Officer designated by the Shift Supervisor to transporUsupervise Inmates to the Clinic. • The Med passer will assist the Jail Health Provider as needed during clinic. Med passers will write notes on any special orders the Jail Health Provider may give for an Inmate, • Med passer assisting in Clinic is responsible for execrrtionlcommunication of any orders written during Clinic. • Med passer will communicate with Shift Supervisor/Lieutenant of any behavior concems/suicide watches recommended by.lall Health Provider during clinic, • Inmate charts wtth medication orders that have been completed should be placed in Medication Completed box. Med Passer receiving new medications from Pharmacy will have these charts to compare new medication orders. Medications to 6e initiated as NOW/STAY orders should be transcribed per Jail Protocol on Inmate MAR. • Medication refill forms completed during Ginic shall be faxed to Pharmacy facility, These forms should be placed In Medication Completed box for review of Med Passer receiving medications from Pharmacy facility, Treatments should be documented on Inmate MAR per Jail Protocol. Verbal communication to next Med Passer of any unusual treatments/circumstances or information Jail Health Provider wants obtained later in shift should be discussed during shift report. 12. Federal Inmates Responsibilities • Upon arrival of new Federal Inmates, the Med Passer should be available to review Medical History, medication information, Intake form and any new Medical Requests. • Review medicationslmedical records, if information is needed from transfening facility, that facility should be wntacted immediately and information obtained verbally or faxed to our facilfty, • Jail Health Provider should be contacted in reference to information obtained on new Federal Inmates. Orders given should be documented in the Inmate chart on a Progress sheet and on MAR as appropriate. • Obiain list of Inmates leaving the facility from the on Duty Supervisor. Preparation of Federal Inmates for departure is to be done by the Med Passer the day before departure.. • Medical records are to be copied of any Federal Inmate leaving the facility, • Medications are to be packaged for transport with inmate, POLICY #: 4.15 PAGE 5 OF 7 Duties and responsibilities of the afternoon shift Med Passer: Federal Inmates Responsibilities contd; New FEDERAL inmates are to be medically processed by the Daytime or Afternoon Med passers. ff emergency situations prevent processing from being completed, the Night Med passer should complete processing. Verbal communication between off going and on coming Med Passers as to what has been completed is imperative. Check to see if any Federal medical transport summary sheets confidential envelopes for inmates booked in during that day have not been opened. Open any unopened confidential envelopes to ascertain if any immediate needed medication needs to be orciered before 1730 hours. • Call Medical provider to give order on medication order from MAST.. Fax order to MAST for any immediate needed medication. Read over the medical information on the sheets to ascertain if any needed medical care needs to be done. i,e. TB tests , BP checks, Accu checks, etc... Pull any immediate needed medication in stock from the cabinet. Sign out the medication from the stock cabinet on a medication receipt in the cabinet. • Make labels with photo id and adhere to all new medication cards or containers, Label blank MAR with inmate photo id and write all new medicine information on MAR according to MAR guidelines. Put medication in cart, MAR in MAR Log and put inmate transport summary sheet in inmates' medical file, (If inmate has no medical file, create a new one for them) 13. Medical Record Maintenance Responsibilities • Med passers shall be responsible for placing inmates records in the inmate's medical folder • Each Med passer is responsible for accurately filing Inmate's Medical Chart in the file cabinet with completion of use. • Inmate MARS should be filed in chart if Inmate is transferred/released from facilfty.. 14. Referral appointments as indicated by medical professional Med, passer shall be responsible for scheduling referral appointments as recommended by the Jail Health Professional, or other Health Care Provider inmate has seen while in our Facility. Lieutenant and Major should be notified of these referrals and appointment dates, Inmate information concerning referrals should be placed in an envelope and placed in appointment box on Clinic wall. Date of appointment should be clearly marked on outside of envelope and visible for Med Passers. Names of Inmates should not be placed on outside of envelopes. Coordination for transportation will be done by the the Lieutenant and Major. 1S, Medication Refills /MAR • Med passer will inventory cart & room daily for needed medication refills according to the quantity protocol. These orders will be FAXED to MAST at the first available opportunity. • Medication refill requests received by fax from Pharmacy should be placed in Review box for .tail Health Provider, • Med passer will assist at end of each month in the review of next month's MAR's for those cells assigned. New MAR will be placed In MAR Log book according to procedure previously outlined, previous month MAR will be filed in inmate's chart. 16. Inmate Diet Information • Med passers are responsible for placing any dietary changes made by Jail Health Provider on the Special Diet form in the kitchen, • Food allergies noted on Inmate Intake form should be placed on Special Diet form in kitchen. • Documentation in chart of above communicated information should be done by Med Passer. POLICY #: 4.15 PAGE 6 OF 7 Duties and responsibilities of the aitemoon shift Med Passer: 17. Derrtai Requests ~S • Inmate Dental requests are to be logged into Medical Log accoRiing to Jail Protocol by Shift Supervisor. • Dental requests reviewed by Med Passer are initialed in Log book, A copy of the Inmate Dental request is to be placed on the Major's board for review, Appointments will be ananged by the Major, Communication of these appointments will be made to the Med Passer to prepare information as appropriate, 18, Clean and prepare the clinic area for the next Med Passer's shift. • Empty any trash Pickup any medical equipment and place them back in proper place 19, Afternoon Med Passer is responsible for DNA blood drawing as mandated by NC. Med Passer responsibilities during this time will be conducted by the Morning Med Passer or Shift Supervisor. NOTE: Med passer is to assist jail staff under supervision of the Shift Supervisor during any medical situations that need immediate attention. ff med passer is not occupied with assigned med passer duties then the med passer will assist the jail staff under the supervision of the shift supervisor. NOTE: The daytime/afternoon med passer will do the DNA blood drawing as mandated by NC for the Court. Necessary medical issues during this time witl be done by an on duty med passer or the shift supervisor. POLICY #: 4.15 PAGE 7 OF 7 Duties and responsibilities of the afternoon shift Med Passer: -l~ SUMMARIZATION Daytime/Afternoon Shift -Med Passer #2 MON-THUR -1000 BRIEFING WITH MORNING MED PASSER#1 -1000-1115 -COUNT CONTROLLED MEDS W/ MORNING MED PASSER -SCANS MEDICAL REQUEST FORMS AND MEDICAL SCREENING FORMS THAT HAVE BEEN TURNED IN DURING THE MORNING. PRIORITIZES MEDICAL ISSUES BY URGENCY. READ THE RED BOOK, -1115-1215 PASSES LUNCH MEDICATIONS -1215-1400 CHECKS CART AND ORDERS ANY NEEDED MEDICATIONSI MAKES SURE CART AND MAR BOOK ARE IN ALPHABETICAL ORDER BY CELL ASSIGNMENT. -1400••1800 ORDERS ANY NEEDED CLINIC SUPPI-IES OR DNA TESTING SUPPLIES, PROCESS OR CALL FOR ANY NEEDED MEDICAL INFORMATION -1600-1745 PASS DINNER MEDICATIONS -1745-1800 BRIEFING WITH NIGHT MED PASSER#3 FRIDAYS •1000.1215 SAME AS MON-THURS -1215-1500- -PREPARES FOR AND WORKS CLINIC (AFTERNOON CLINIC ) 1. PULLS MEDICAL FILES ON INMATES THAT NEED TO BE SEEN. 2. DOES PRELIMINARY SCREENING IF NEEDED. SUCH AS URINE DIPS, ACCU CHECKS, VITAL SIGNS, ORDERS MEDICAL RECORDS FROM OTHER FACILITIES. 3. OBTAINS INMATE'S SIGNATURE AND ATTACHES CHARGE SHEET TO MEDICAL RECORD IF APPLICABLE. 4. ASSIST NP DURING CLINIC.. 5. AFTER CLINIC, CLEAN UP CLINIC AREA. 6. READ CLINIC NOTES ON EACH INMATE. 7. ORDER OR DISCONTINUE MEDICATIONS AS INDICATED ON CLINIC NOTES, 8, SCHEDULE REFERRAL APPOINTMENTS AS INDICATED. 9. CHECK MAR TO BE SURE THAT IT REFLECTS UPDATED ORDERS. 10, INFORM KITCHEN STAFF OF ANY CHANGES FOR INMATES FOOD TRAYS (LOW SODIUM, DOUBLE PROTEIN, ETC). 11. INFORM JAIL STAFF OF ANY INMATES WITH CHANGES IN BEHAVIOR OR MENTAL STATUS THAT THEY SHOULD BE AWARE OF (SUICIDE WATCH, ETC..,). 12, REFER INMATES WITH DENTAL ISSUES AFTER LOGGING TO THE MAJOR'S BOARD. 13. COMPLETE PAPERWORK FOR LABS THAT WERE DONE DURING CLINIC, AND RECORD ON THE SEND OUT LOG. CALL LABCORP ANU MAKE THEM AWARE OF PICKUP, 14, FILE CHARTS BACK IN THE ACTIVE FILE, -1500-1630 -COMPLETES AFTER CLINIC DUTIES -1630-1800 (DINNER MEDS WILL BE PASSED OUT BY A SHIFT MED PASSER) HANDLES FEDERAL INMATE ISSUES, TB TESTS, MEDICATION APPROVAL, ORDERING MEDICATION, OBTAINING RECORDS. IF NO FEDERAL INMATE ISSUES BECOMES BOOKING OFFICER SECOND ONLY TO ITEMS OF MEDICAL URGENCY. THIS OFFICER ALSO READS TB AND CORRECTLY DOCUMENTS TB TESTS RESULTS.. ORANGE COUNTY JAIL 144 E. Margaret Lane Hillsborough, North Carolina 27278 POLICY #: 4.15 PAGE 1 OF 6 POLICY TITLE: Duties and Responsibilities of Orange County Jail Med Passers DATE: JULY 7, 2004 RELATED N,C. STANDARDS .2403; .2701 POLICY STATEMENT: In order to properly administer medications to inmates confined in the Orange County Jail the following responsibilities and duties shall be followed as prescribed. To provide a safeguard against the improper passing of medications to inmates confined in the Orange County Jail, detention officers assigned to this duty shall attend and complete the State of North Carolina Med Technician Course,. SPECIFIC PROCEDURES: Duties and Responsibilities of the Night Shift Med Passer: The 1700 hours to 0100 hours Med Passer is scheduled to work nights Monday thni Friday, eight (8) hours daily, This schedule is subjed to change based on the need for the night Med Passer to work other hours when needed to cover another med passer who may be out sick, on vacation or in school. NOTE: Only "pre approved" overtime approved by the Lieutenant will 6e considered for comp or paid time. All unapproved overtime will not be tolerated. 1. Med passer will report for duty on time, mentally prepared and physically alert to pertonn assigned duties. 2. Briefing with Afternoon Med Passar • Verbal briefing with the Afternoon Med Passer of any unusual medical incidents. • Transportation of an inmate to and from the hospital. • The Emergency Department Physicians medical report on the Inmate should be filed in the inmate's medical record and Inmate's medical record should be placed in Jail Health Provider's box for review. 3. Inmate Cetl Assignment • The Med Passer will view the Inmate Board in the control room for Inmate cell assignments. • Check jail log printout for any inmates that have been released or moved from previous cell assignment, • Remove any MAR from the MAR Book and medication from the cart of Inmates that have been released, 4. Red Book Review • The Red book is to be located In the center of the desk next to the telephone in the medical office. • It is crucial to check the red book each day for information being left by the day and night shifts. • Important information should be documented here for communication to oncoming shifts.. 5. Narcotic Drug Count • Narcotic count is required as outlined below. 1,When an inmate has narcotic medications on the cart to be administered. Narcotic count should be done when a med passer arrives for a new shift with Shift Supervisor, with the presenUoff-going med passer and when med passer ends shift at night with shift Supervisor, POLICY #: 4.15 PAGE 2 OF 6 Duties and responsibilities of the night shift Med Passer: Narcotic Drug Count contd; 2. When an inmate is being transferred out to DOC, or FEDERAL inmate is transported AND his/her narcotic medication needs to go wfth him/her. The med passer shall document the narcotic count of the inmate with the Shift Supervisor/Med passer. Each will initial the MAR narcotic control sheet to validate their count.. 3. When a narcotic medication comes into the Jail ft should be counted and documented by 2 Med Passers or a Med Passer and Shift Supervisor, If it is approved by the Jaii Mealth Provider to be administered it should be documented on the narcotic count sheet and counted as listed above.. If it is not approved for administration ft should be counted, count documented and sealed with tamper proof seal. Daily count of that medication should continue until destroyed or inmate releasedl transferred out, 4. When narcotic medication is designated for destruction..,. 5. When destroying narcotic drugs. (They shall be destroyed only under supervision of the Jaii Administrator or Detention Supervisor and will be documented on the back of the MAR.) 6. Glucose Monitoring insulin administration. • In the front of the MAR Logbook the list of inmates requiring glucose monitoring or insulin administration should be reviewed. • The Med Passer will take the Glucose Monitoring tray (containing jail approved supplies and those appropriate for testing,} to each cell where the inmate will be tested and/or administered insulin. • Inmates requiring testing/Insulin administration will be identified by their arm band, • Blood sugar readings will be obtained and documented on the MAR. • Inmates requiring insulin administration will be given an alcohol pad and pre-filled syringe with appropriate dose/type of insulin. The inmate will administer the insulin and return the used syringe to the med passer for proper disposal. The med passer will document administration of the insulin on the MAR. • The med passer will ensure ail used supplies are removed from the cell and properly disposed, 7. MAR Log and Med cart • The Med Passer is to check the MAR book before leaving the medical room to ensure the MARs are in alphabetical orcJer by Inmate name and have Inmate photo/identification sticker attached. • Med Pesser shall check MAR's and ensure changes/updates are reflected on the MAR, Changes/updates of Treatments should also be reflected on the MAR. New Diabetic inmates should also be added to Glucose Monitoring list if applicable. • The drawers of the medication cart are clearly marked Annex and Old .tail. Each drawer shall have all drug cards filed by Celi Block Dearly marked with each inmate's name in alphabetical order. • Medication cards should follow in orrier as listed on the MAR and shall have each inmate's photo/identification attached. • Night Med Passer will ensure Med cart and MAR are accurate Friday evening to facilitate weekend Med Passer medication administration. 8. Bed-time Medication Administration • Before leaving the medication room for medication administration, the Med Passer shall prepare the medication cart with necessary supplies, Med Passer will enter their I.D. button in the medication probe before the medication pass, Time of entry and exit of each cell by the Med Passer will be documented by this probe. • When administering any drug to an Inmate, the inmate shall approach the Med Passer and display his/her photo-identification arm band.. The arm band is to be viewed for verification of inmate to receive medication. If an Inmate does not have an arm band, the Shift Supervisor is to be notified for their intervention. Medications are not to be administered to Inmates without Photo- identification arm bands, The med passer will administer all tablets and capsules by pouring the medication from a medication cup into the inmate's hand. Disposable medication paper cups may be given to the inmate when administering medication. • The med passer will ensure that the Inmate swallows the administered medication. • The med passer will administer inhalants by the onlered administration method. • The med passer will administer creams, powders, liquids, etc... in disposable medication paper cups. • The med passer will initial the MAR to verify administered medication. POLICY #: 4.15 PAGE 3 OF 6 Duties and responsibilities of the night shdt Med Passer: Bed-time Medication Administration contd; Q (1 • The med passer will mark the MAR to verify refused medication. C.~oS • The med passer will note the back of the MAR for any unusual medication issues. • At completion of administration of medications, the Med Passer will review the MAR book to ensure all medications have been signed as administered/refused, etc. 9. Med Passer wilt hourly check the Inmate Medical screening and Requests Bins for new forms. New forms will be reviewed and action taken for appropriate requests and/or medical information. Medical requests for PRN medications shat) be placed in the Charts for Review box with the Inmates chart attached. Jaii Health Provider shall 6e contacted for medication that the Med Passer feels needs to be initiated sooner than the next scheduled Clinic Day. Medical requests to see the Jaii Health provider should be reviewed for urgencylneed. if it is felt to be an urgent request, Jail Health Provider should be contacted for discussion of the complaint. tt the request is not urgent, the Medical Request and Inmate chart should be placed in the Next Clinic box for the Jail Health Provider's next clinic day. Medication orders obtained from a Jail Health Provider shall be documented in the Inmate chart and chart placed in the Charts for Review Box. Jaii Health Provider shall sign at next clinic day. Medication orders obtained to be initiated as STAT or Next Med Pass, shall be documented on the Inmate's MAR according to Jail Protocol. Medical Intake forms should be screened for medications to be initiated and significant health problems (Heart disease, Diabetes, Seizures, AlcohoUDrug use daily, etc.) The appropriate Jai{ Health Provider shall be contacted at time of review of the intake for initiation of medication. Any Health problem in question of significance should be discussed with a Jail Heahh Provider. Information about medications to be initiated (name, dose, frequency) should be ascertained from the Inmate by the Med Passer prior to contacting the Jaii Health Provider. However, obtaining medication information from the Inmate should not delay contacting the Jail Health Provider for any sign cant length of time. if information is not readily available, the Jaii Health Provider should be contacted with this information. Med Passer conducting preliminary screening of inmate i.e.; blood pressures, vital signs, urine dips, accu checks, etc. shall be written on the medical request forth. When completed the results of each vital sign taken of any inmate shall be written on the inmates medical request forth and be returned to the Nurse Practitioner (medical professional) file in the med room paper clipped to the front of existing or new inmate folder. The Jail Health Provider shall be contacted about above information obtained if the Med Passer feels information needs to be reviewed prior to next scheduled clinic day. 10. Clinic Preparation Night Med Passer responsibiliiy of Clinic Preparation is ongoing.. • Inmate Medical requests received during Night Med passer shift shall be reviewed for urgency. Jail Health Provider shall be contacted for orders. • Med passer shall attach Medical Request and Inmate charts that do not need immediate attention in appropriate clinic box. • Evenings prior to clinic, the Med Passer will review the CIiNc Schedule located in Log. notebook, Inmates listed to be seen will have their charts pulled, reviewed for reason for scheduled clinic visit to ensure information needed Is present. Inmates chart then will be placed in Next Clinic box. POLICY #: 4.15 Duties and responsibilities of Night Strift Med Passer: 11. Assistance of Jail Medical HealthlMental Health Provider in clinic. PAGE 40F 6 g3 Clinic hours generally are not scheduled during Night Med Passer shift. • Night Med Passer would be expected to assist Provider as outlined below.. • Any Inmate Medical Request/Intake form the Med Passer feels is priority should be verbally communicated to the Provider upon arrival to the Clinic. • The Provider and Med Passer will compile the list of Inmates to be seen. The Med Passer will give the list of Inmates to be seen in the Clinic to the Detention Officer designated by the Shift Supervisor to trensporf/supervise Inmates to the Clinic. • The Med passer will assist the Provider as needed during Ginic, • Med passers will write notes on any special Orders the Provider may give for an Inmate. • Med passer assisting in Clinic is responsible for execution/communication of any orders written during Clinic. • Med passer will communicate with Shift Supervisor/Lieutenant of any behavior concems/suicide watches recommended by Provider during clinic. Inmate charts with mediraiion orders that have been completed should be placed in Medication Completed box, Med Passer receiving new medications from Pharmacy will have these charts to compare new medication orders. • Medications to be initiated as NOW/STAY orders should be transcribed per Jail Protocol on Inmate MAR. • Medication refill forms completed during clinic shall be faxed to Pharmacy facility. These forms should be placed In Medication Completed box for review of Med Passer receiving medications from Pharmacy facilfty, • Treatments should be documented on Inmate MAR per Jail Protocol, Verbal communication to next Med Passer of any unusual treatments/ciroumstances or information Provider wants obtained later in shift should be discussed during shift report. 12. Federal Inmates Responsibilities • Upon arrival of new Federal Inmates, the Med Passer should be available to review Medical History, medication information, Intake form and any new Medical Requests. • Review medications/medical records, if infornation is needed from transferring facilfty, that facility should be contacted immediately and information obtained verbally or faxed to our facility, • Provider should be contacted in reference to information obtained on new Federal Inmates. Orders given should be documerrted in the Inmate chart on a Progress sheet and on MAR as appropriate.. • Obtain list of Inmates leaving the facility from the on Duty Supervisor. • Preparation of Federal Inmates for departure 15 to be done by the Med Passer the day before departure. • Medical recors are to be copied of any Federal Inmate leaving the facilfty.. • Medications are to be packaged for transport with inmate. New FEDERAL.. inmates are to be medically processed by the Daytime or Afternoon Med passers. If emergency sftuations prevent processing from being completed, the Night Med passer should complete pracessing. Verbal communication between off going and on coming Med Passers as to what has been completed is imperative. • Check to see if any Federal medical transport summary sheets confidential envelopes for inmates booked in during that day have not been opened. Open any unopened confidential envelopes to ascertain if any immediate needed medication needs to be orclered before 1730 hours. • Call Medical provider to give order on medication orcler from MAST. • Fax order to MAST for any immediate needed medication. • Read over the medical information on the sheets to ascertain if any needed medical care needs to be done, i.e. TB tests , BP checks, Accu checks, etc... • Puli any immediate needed medication in stock from the cabinet. Sign out the medication from the stock cabinet on a medication receipt in the cabinet.. • Make labels with photo id and adhere to all new medication earls or containers.. Label blank MAR with inmate photo id and write all new medicine information on MAR according to MAR guidelines.. POLICY #: 4.15 Audes and responsibilities of Night Shift Med Passer: Federal Inmates Responsibilities contd; PAGE 5 OF 6 Label blank MAR wfth inmate photo id and write all new medicine information on MAR according to MAR guidelines.. Put medication in cart, MAR in MAR Log and put inmate transport summary sheet in inmates' medical file, (If inmate has no medical file, create a new one for them) 13. Medical Record Maintenance Responsibilities • Med passers shall be responsible for placing inmates records in the inmate's medical folder • Each Med passer is responsible for accurately filing Inmate's Medical Chart in the file cabinet with completion of use. • Inmate Mars should be filed in chart if Inmate is transferedlreleased from faciliy 14. Medication Refills /MAR '• Med passer will inventory cart & room daily for needed medicatlon refills according to the quantity protocol These orders will be FAXED to MAST at the first available opportunity. • Medication refill requests received by fax from Pharmacy should be placed in Review box for Provider. • Med passer will assist at end of each month in the review of next month's MAR's for those cells assigned. New MAR will be placed in MAR Log book according to procedure previously outlined, previous month MAR will be filed in inmate's chart. 15. Inmate Diet Information • Med passers are responsible for placing any dietary changes made by Jail Health Provider on the Special Diet form in the kitchen. • Food allergies noted on Inmate Intake form should be placed on Special Diet form in kftchen,. • Documentation in chart of above communicated information should be done by Med Passer. 16. Conduct twice weekly blood pressures and blood sugar checks. Documentation of readings should be placed on MAR in designated area. Alternating with Morning/Afternoon Med passer. Clinic hours generally are not scheduled during Night Med Passer shift. Night Med Passer would be expected to assist Jail Health Provider as outlined below. 17. Clean and prepare the clinic area for the next Med Passer's shift. • Empty any trash • Pickup any medical equipment and place them back in proper place 18. Receipt of medication from Pharmacy facility. • Medication received in bucket is compared to pharmacy Iqg ensuring accuracy. • Medication cams received from pharmacy are compared with orders on patient charts. • Compare medication stickers received with orders on chart. • Apply verged medication stickers to Inmate's MAR, if not already hand written, date and initial with Med Passer's initials. • File Inmate's MAR in MAR Log book under cell assignment and in alphabetical order. • Apply Inmate Photo Identification labels to medication cards. • Place Medication cards in Drug cart according to procedure previously described. • Place Inmate chart in appropriate box or file. NOTE: Med passer is to assist jail staff under supervision of the Shift Supervisor during any medical situations that need immediate attention. tf mad passer is not occupied with assigned mad passer duties then the mad passer will assist the jail staff under the supervision of the shift supervisor. POLICY #: 4.15 PAGE 6 OF 6 Duties and responsibilities of Night Shifr Med Passer: SUMMARIZATION taC, Night Shift -Med Passer -1700.1745 SCANS MEDICAL REQUEST FORMS AND MEDICAL SCREENING FORMS THAT HAVE BEEN TURNED IN AND READ RED BOOK. - PRIORITIZES MEDICAL ISSUES BY URGENCY, -1745-1800 BRIEFING AND COUNT CONTROLLED MEDS W! DAYTIME/AFTERNOON MED PASSER -1800-1900 1 READ CLINIC NOTES ON EACH INMATE AND MEDICATION REORDERS TO PREPARE MEDICATION ID LABELS AND MARS FOR MEDICATION DELIVERY, -1900-2130 2. DOES PRELIMINARY SCREENING IF NEEDED. SUCH A3 URINE DIPS, BI-WEEKLY ACCU CHECKS, VITAL SIGNS, BLOOD PRESSURES, ETC.. 3, CHECK MAR TO BE SURE THAT IT REFLECTS UPDATED ARDERS 4. PREPARE MEDICAL SCREENING FORMS 5. INVENTORY AND PROCESS MEDICATION DELIVERY 6. -PROCESS ANY FEDERAL INMATES PAPERWORK THAT ARE LEAVING THE NEXT DAY. 7. NOTES TO INFORM KITCHEN STAFF OF ANY CHANGES FOR INMATES FORD TRAYS (LOW SODIUM, DOUBLE PROTIEN, ETC). 8. INFORM JAIL STAFF OF ANY INMATES WITH CHANGES IN BEHAVIOR OR MENTAL STATUS THAT THEY SHOULD BE AWARE OF (SUICIDE WATCH, ETC.,.).. 9 PUT COPIES OF DENTAL ISSUES TO THE MAJOR'S BOARD. 10, FILE CHARTS BACK IN THE ACTIVE FILE.. -2130-2200 11. PREPARE AND ADMINISTER MEDICAL SNACKS -2200-2330 12. PASSES NIGHT MEDICATIONS -2330-0100 COMPLETE ANY UNFINISHED PROCESSING MEDICATION DELIVERY. PUT CART AND MAR IN ORDER FOR THE NEXT MED PASSER. COMPLETE ANY MEDICAL SCREENING AND REQUEST FORMS. CLEAN UP CLINIC AREA. HANDLE ANY OTHER MEDICAL ISSUES, HELP THE DETENTION STAFF, WHEN ALL MEDICAL DUTIES ARE COMPLETE. POLICY #: 4.16 PAGE 1 OF 4 POLICY TITLE: MEDICAL CART PROCEDURES g~ DATE: MARCH 16, 2004 RELATED N.C. STANDARDS: .15A-266:1 POLICY STATEMENT: In order to comply with North Carolina Generai Statutes, members of the Orange County Sheriffs Office assigned the duty of administering medicines prescribed by our contracted medical professional shall be trained in achninistering medicines and record keeping of medicines administered to inmates housed in the Orange County Jail. Our med passers shall be responsible for preparing the med cart, which is used to store and transport medicines to inmates in cellblocks. Med passers assigned to the medical office to assist our contracted medical professional are solely responsible for preparation and maintenance of the med cart. SPECIFIC PROCEDURES: Preparation and maintenance for the medical cart: The first duty and responsibility of everyone that administers medicine from the med cart is to keep the cart organized for distribution, neat and clean. By doing so the med cart will at all times remain in order for everyone that has to administer medicines. Anyone who fails to comply with this directive is subject to disciplinary action. Before organizing the med cart, it is imperative that the jail log is reviewed to insure that all _, inmates who are to be administered medicines are: (1) in the jail and have not been released or transferred to another jail or (2) are not in court. Preparing the lbled Cart: 1. When preparing the med cart or when receiving medication for an inmate to be placed in the cart, a. The med passer will check the medicine label and compare the name with the MAR book (it is important to know we have the correct name) b. The med passer shall check the inmates M.AR record to insure the medicine received is the medicine to be administered. (it is important to know we have the correct medicine) 2. The med passer shall place a computer copy of the inmates' photo and name on each medicine card or medicine container. (per directive for this duty) THE MED CART IS ORGANIZED AS FOLLOWS: I. On the top left side of the cart there is a small trash bin attached to the cart FOR'I'RASH. As meds are administered, all wrappings or any litter shall be deposited in the trash bin. Upon rehuning the med cart to the med office the med passer shall empty the trash bin for the next round of meds. 2. Below the trash bin there is a SHARPS CONTAINER. It is most important that all needles and other sharp instnrments used by med passers or inmates, after injectio:rs, aze placed in the SHARPS container No med passer shall ever place any needle on the cart in any manner whereby another med passer might accidentally get cut or scratched by a needle or sharp instrument, POLICY 4.16, "MEDICAL CART PROCEDURES" PAGE2OF~ ~7 3. Drawer lettered (G) is the Nazcotic Drawer: The narcotic drawer is identified as drawer letter (G) The narcotic drawer shall remain lacked at all times, unless, when the med passer is taking out a medication to administer, and then re-locked after the med passer administers the medicine. The med passer, on returning to the medical office, shall check the drawer to insure it is locked when returning to the med room. (Note. no nazcotics shall be left in the narcotic drawer for anyone who is not in our jail. Leaving nazcotics in the drawer shall not be allowed. When a state inmate leaves our facility, the inmate's nazcotic drug is to be destroyed. If the inmate is a federal inmate, the drug goes with him/her, if not it is destroyed by procedures.) THIS PROCEDURE CANNOT BE VIOLATED. MISTAKES CAN BE EASLLY MADE, 4. Drawer lettered (A) is the ointments, creams and diabetic supply drawer. This drawer is the center top drawer and is identified as drawer letter (A) on the cart. This drawer is divided and stocked as listed below. The drawer contains various ointments, creams, diabetic supplies, Q-tips, gauzes and labeled medicine cups for inmates who are confined in the jail. This drawer has dividers, which can keep these items separated. • Antibiotic Ointment, Hydrocortisone Cream, Bacitracin Ointment, Diabetic Supplies, 2x2 Gauze , Orajel, Q-tips (MED PASSERS UPON COMPLETION OF A MED ROiIND S i.T. CHECK TflE SUPPLIES LISTED ABOVE) Medicine cups with each inmate's name and photo on them aze stocked in the drawer. The drawer in this area is divided by cells and is in alphabetical order for the Old Jail and J, A- Pod, 106, 109, and B-Pod order for J Cell and Annex, (med passers should ascertain from the shift supervisor or check the cell assignment board to see if any inmate has left or been moved from an assigned cell block before leaving the med room with the cart) by doing this one thin, possible confusion on the floor could be eliminated. 5. Drawer lettered (B) is identified for federal and (B, C,H&.I cell) inmates housed in the old jail. 1, This drawer is cleazly mazked as letter (B) on the cart. 2. Medications on for federal and (B,C,H&J cell) inmates shall be placed in this drawer 3. Medications shall be in order by cell assignment 4 Medications shall be in order by cell and in inmate name by alphabetical order and as medicine to be administered is listed on the M A R. from first to last medicine order. 5 Med passer shall look at the prepared package and insure the inmates picture and name. match. (it is crucial that the med passer preparing the cart check and re-check the drawer before leaving the cart for the neat shift med passer) POLICY 4.16, "MEDICAL CART PROCEDURES" PAGE 3 OF 4 6. Drawer lettered (C) is identified for state inmates housed in the annex. 86 1 This drawer is clearly mazked as letter (C) on the cart 2 Medications only for state inmates shall be placed in this drawer 3 Medications shall be in order by cell assignment 4 Medications shall be in order by cell and in inmate name by alphabetical order and as medicine to be administered is listed on the M.A.R. from first to last medicine order. 5 Med passer shall look at the prepared package and insure the inmate's picture and name match. (it is crucial that the med passer preparing the cart check and re-check the drawer before leaving the cart for the neat shift med passer) 7. Drawer lettered (D) is identified for stock medications for all inmates federal and state. 1. This drawer is cleazly marked as letter (D) on the cart.. 2 Stock medications for state and federal inmates are stored in this drawer. 3. Medications shall be neatly placed in order by cell assignment . 4 Medications shall be neatly placed in order by cell assignment and inmate name in alphabetical order for the Old Jail and A-Pod. 106, 109, and B-Pod order with inmate name in alphabetical order For the Annea. All medicine in this drawer is to be £ded in each inmate's name as the medicine to be administered is listed on the M.A.R. from first to last medicine order. 5 Med passer shall look at the grepared package and insure the inmate's Dictate and name match. (It is crucial that the med passer preparing the cart check and re-check the drawer before leaving the cart for the neat shift med passer to insure that a sufficient quantity of medicine needed is in the cart, either in the stock or in the correct inmate drawer.) 6. WHEN AN INMATE'S MEDICINE CARD IS EMPTY THE MED PASSER MUST C,O IN THE STOCK DRAWER. to replenish the INMATES medication WITH A CARD FROM THE OVER STOCK MEDICATION DRAWER " TT IS ESSENTIAL AND MOST Il1g'ORTANT THAT'I'HE MED PASSER COMPARES THE INMATE'S EMPTY CARD WITH 'THE NEW CARD FOR ACCURACY. THE CARD THAT HAS'THE "LABEL REORDER " SHALL BE THE LAST CARD USED BY THE MED PASSER Med passers shall be observant and diligent to never use any REORDER CARDS before all others are administered. REMEMBER THE REORDER CARD IS NOT TO BE USED UNTIL ALL OTHER CARDS WITH CHECK OVERSTOCK HAVE BEEN ADMINISTERED. POLICY 4.16, "MEDIC AI, CART PROCEDURES" PAGE 4 OF 4 8. Drawer letter (E) is identified for both state and federal inmates. 89 This drawer is cleazly marked as (E) on the cazt This drawer contains Asthma inhalers, and a zip lock bag containing the keys to the cart This drawer also contains a zip lock bag which has the cart key and the key to the nazcotics drawer. 9. Drawer lettered (F) is identified for both state and federal inmates. 1. This drawer is clearly marked as (F) on the cart. 2. This drawer contains cups for nuxing powdered medications, plastic spoons, cream type medications, and liquid medications. 10. Drawer lettered (G) is identified for both state and federal inmates. 1 This drawer is cleazly mazked as (G) on the cart. 2 This drawer contains narcotic medications. 3 This drawer shall be locked at all times. 4. Narcotic medications shall be counted with each shift change by the on coming and off going med passer. 11. Drawer number (F~ is identified for both state and federal inmates 1 This drawer is clearly mazked as ~ on the cart. 2 This contains powdered medications.. NOTE SOME THINGS TO REMEMBER q6 • THE MED CART HAS A SAFETY FEATURE IN CASE THE KEYS ARE EVER LOCKED INSIDE. A KEYPAD COMBINATION LOCATED ON T`HE TOP LOWER RIGHT HAND CORNER OF THE CART, WITH THE COMBINATION 4321 WILL OPEN I'HE CART. • TT WILL BE THE RESPONSIBILITY OF EVERYONE THAT USES 'THE CART TO LEAVE THE CART CLEAN AND FULLY STOCKED FOR T'HE NEXT MED PASSER • WHEN AN INMATE'S MEDICINE CARD IS EMPTY, WHOM EVER LS USING THE CART SHALL REPLACE THE EMPTY CARD WITH ONE FROM THE (D} DRAWER IN14IATE MEDICINE STOCK. BE SURE TO COMPARE THE CARDS FOR ACCURACY. CHECK T'HE NAME ON THE EMPTY CARD TO COMPARE WITH THE ONE IN THE STOCK DRAWER TO BE SURE TT IS THE SAME PERSON AND SAME MEDICATION. EMPTY CARDS ARE TO BE PUT IN THE TRASH IN THE MEDICAI, ROOM. • IF THERE IS NO REPLACEMENT IN THE STOCK DRAWER AND MEDICAL FACIIITY PERSONNEL ARE; NOT AVAH,ABLE, CALL THE MEDICAL ~~ PROFESSIONAL FOR INSTRUCTIONS. MEDICAL FACILITY PERSONNEL WILL BE ~, RESPONSIBLE FOR KEEPING THE CART STOCKED WITH PRESCRIl'TION MEDICATION.