keys to safer medication management and distribution · medication management and distribution s-o...

34 CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2017 VISIT US AT WWW.CORRECTIONSFORUM.NET

BY BILL SCHIFFNER, CONTRIBUTING EDITOR

Keys to safer medication

management and distribution

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MEDICATIONdistribution can be one of theriskiest procedures in any correc-tional facility due to the high vol-ume of inmate patients, possibleblack market selling scenariosand violent situations that couldoccur. Pharmacists, nurses andsupport staff administer thou-sands of doses of medication toinmate/patients in the generalpopulation, segregated units, andspecialty housing areas on a dailybasis. To make sure that things gosmoothly, there are steps thatmust be followed to the letter.The three most common waysmedications are administered are:Med Line (Watch Take), Keep onPerson (KOP) and Pre-Pour meds.

Annual Training is a KeyMartha Ingram, RN, CCHP,

CPHQ, director of Management& Performance Improvement atWexford Health Sources, Inc.,Pittsburgh, Pa., says their nursesare expected to annually trainand refresh themselves on med-ication administration due tohigh volume and high risk ofmedication administration incorrections environments. “There are several processes in

place to ensure this happens. Wehave policies that spell out theexpectations for a safe and accu-rate med pass which includeensuring the nurse uses two iden-tifiers for patient ID to perform-ing mouth checks to ensure medsare swallowed and not stashed fortrafficking purposes.” She points out that adminis-

tration at each site determines ifthe site allows a KOP system. “Ifa KOP system is in place at thefacility it is limited medicationsthat the patient can keep in theircell. Obviously medical staff haslittle control once the blisterpack is given to the inmate. AKOP system is usually limited tomedications for chronic condi-tions and not psychotropic med-ications, to cut down on the

potential for trafficking of thesemeds.”

EMR TechnologyLackingIngram says that technology in

corrections is far behind otherhealth care industries (e.g., hospi-tals, long-term care facilities).“While electronic medical records[EMRs] are being installed inmore facilities, we are far behindthose electronic systems in hospi-tals. Nurses can rely on technol-ogy a great deal in hospitals butvery little in corrections. ManyEMRs that are out there for cor-rections do not yet have a med-ication administration capability.Correctional facilities are oftenphysically old buildings with noability to accommodate wirelesstechnology and much of the careand meds are delivered on theunits themselves.”She says that Wexford Health

prefers to use an electronic med-ication administration record(eMAR) system for their medadministration to ensure efficientdistribution. “Once this tool is inplace and consistently used, wecan use the data to monitor com-pliance.” Ingram says they believe that

the benefits of adding an eMARto a facility will definitely help toincrease the safe and efficientmedication administrationprocess. “In turn, by utilizing aneMAR, nurses are provided a fail-safe method to ensure that med-ications are administered appro-priately, safely, and efficiently.”

More OptionsTodd Myers, director, IT

Business Development at CorizonHealth says with the increase inCorrectional HealthcareTechnology, facilities now havemultiple options for increasingquality patient care while reduc-ing medication administrationerrors. “While a fully integratedEHR would be the best option,some jail and prison systems haveopted to start the transition to

Healthcare Technology throughthe implementation of an eMAR.”He explains that building on

the 5R’s of medication adminis-tration, eMAR checks each bar-code scanned RX number beforeadministration to ensure Rightpatient, Right medication, Rightdose, Right route, and Right timeof day. “For certain diseases orpatient diagnoses, the eMAR willprompt with alerts to ensure ade-quate measures are taken for spe-cific medication administration.”Myers adds through the use of

barcode scanners, the fully inte-grated eMAR is synchronized withthe pharmacy, ensuring patientprofiles are up to date with activemedications that have beenchecked for Drug to Drug andDrug to Allergy contraindications.“This close integration also grantsthe pharmacy added confidencethe discontinued medications areimmediately flagged and automat-ically removed from the patients’profile prior to the next adminis-tration. Other functions such asMedication Hold, Refusals, andKOP workflows can be appliedwith eMAR technology.”

Blister PackagingSolutionsGregg Puffenberger, Pharm. D.

MBA, vice president of PharmacyManagement for MHM Services,Inc., reports that a unit dose/blis-ter packaging drug distributionand control system is recom-mended and should focus onpatient safety and result in a min-imal incidence of medicationerrors and adverse drug reactions.“Ongoing processes for the moni-toring and reporting of adversedrug reactions and the detectionand prevention of medicationerrors should exist. The systememployed should foster drug-con-trol and drug-use monitoring.” He says that the system should

also foster patient compliance,recovery of drugs because ofexpired orders, and ultimatedestruction of all unusable andoutdated medications. “Inmates

VISIT US AT WWW.CORRECTIONSFORUM.NET CORRECTIONS FORUM • SEPTEMBER/OCTOBER 2017 35


should not be used in the distrib-ution process. Patient confiden-tiality should be ensured in thedistribution process. The facilityshould also ensure the propersecurity of medications stored ineach location and that drug prod-ucts are stored in accordancewith manufacturer or USPrequirements,” he explains.Puffenberger adds that a

process for minimizing and elimi-nating unauthorized use of med-ications by anyone other thanthe intended patient should exist.“A process for minimizing andeliminating pilferage should be inplace as well as a process formonitoring and preventing thedispensing of unusually largequantities of medications shouldexist as well.” He adds that a process for pre-

venting the dispensing of suffi-cient doses of any medication toenable potential suicide shouldalso exist. “Individuals who areevaluated as high risks for suicideshould be identified. A processfor the security and dispensing ofcontrolled substances should bein place.” He says that the facility’s med-

ical staff and other responsiblehealth authorities, should main-tain policies and procedures forthe routine review and renewal ofmedication orders and for anyautomatic discontinuance oforders. “Access to patients’ med-ication records should be limitedto authorized personnel only,” hepoints out.

AutomatedDispensing anEmerging TrendPuffenberger reports that auto-

mated dispensing devices areincreasingly being used for cen-tralized filling of individualpatient prescriptions and unit-dose medication orders, decen-tralized dispensing, and otherpurposes. “When such devicesand the systems that supportthem are not used appropriately,

their complexity, design andfunction variations, maintenanceand education requirements, andother factors can compromisepatient safety and have otherharmful effects.”He says the appropriate, accu-

rate, and timely distribution ofmedications to patients is a well-established responsibility of thenursing and pharmacy staff.“Automation has evolved to easefulfillment of pharmacists’ dis-tributive responsibilities, expanddistribution system capabilities,and improve efficiency in distrib-ution. Automated dispensing devices

are starting to become tailored foruse in the correctional environ-ment to increase accountability,security, decrease waste, andstreamline the administrationprocess for the healthcare staff,”he concludes.

Manual Blister PackSolutionsWhile automation systems are

beginning to be utilized, still themost efficient systems are in man-ual unit dose/blister packaging.One of the biggest players in

this area is Medi-Dose. RobertBraverman, president at Medi-Dose/EPS, Ivyland, Pa., points outthat the Medi-Dose manual tam-per-evident packaging systemprovides a solution for all typesof correctional facilities.“We provide any type of facili-

ty complete pharmacy solutions.Even if they have automated sys-tems in place, they still will havemedications that need to be man-ually packaged on a short runbasis or if they need a back up toan existing system. That’s wherewe come in. We provide a manu-al tamper-evident system withcomplete labeling capabilities.”Braverman points out while

they are primarily a hospital-basedpharmacy company; the beauty oftheir system is that it works greatin a correctional setting. He reports there are many

medications that can’t be pack-

aged via an automated machine.“With Medi-Dose, any time youpull a blister from our system it’sa clean sheet. In just under oneminute you can package 25 dosesof medication with completelabeling capability. It’s a greatway for any facility to packagetheir medication either as a pri-mary, back up or for meds thatrequire special handling thatcan’t be packaged by a machine.Automated machines have theirplace and we co-exist with any ofthose systems,” he concludes.If your facility is looking for

additional products and servicesin the pharmacy area, here aresome providers.

Pharmacy ServicesProviderDiamond Pharmacy Services is

the nation’s largest correctionalpharmacy services provider, ser-vicing over 500,000 inmates inover 900 facilities across 44 states,the company says. With over 30years correctional experience,they promise to deliver the high-est quality of healthcare service.

www.diamondpharmacy.com,1.800.882.6337

Packaging SystemMedi-Dose is a tamper-evident,

solid oral unit dose packagingsystem. Medi-Dose features 13


MedicationKeepers

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types of blisters, including newMini Medi-Cup Blisters for smallmedications and Deep & Jumboblisters for larger or multiplemeds. Medi-Dose features 1 yearbeyond use dating and tamper-evidence protection. Their MILTsoftware complements the Medi-Dose system and provides a vari-ety of innovative features for allmedication labeling needs…solids, liquids, IV’s, syringes,ampules, even equipment.Facilities can design labels anyway they want. 1-D and 2-D barcodes, graphics, numbering, spe-cial fonts; tall man lettering,shapes and logos and packaginglogs are all included.

www.medidose.com, 1.800.523.8966

Dispensing System Talyst’s InSite In-Facility

Dispensing System was the firstmedication management system

designed specifi-cally for correc-tions. It enablessecure, automat-ed medicationd i s p e n s i n gthroughout a cor-rectional facility24/7/365, and is

scalable to work across multiplefacilities. The InSite pharmacyautomation system is said to pro-vide better inventory control andmore efficient workflow to virtu-ally eliminate expensive medica-tion waste. Through effectivemedication management, theInSite System gives nurses moretime to perform other importanttasks, and improves overallpatient and staff safety.

www.talyst.com, 1.425.289.5400

Electronic MedicationAdministration Record In 2010 Corizon Health part-

nered with Health Care Systems’(HCS) to implement their eMAR.Since then Corizon has deployedthe product for three large DOCclients spanning 45 correctionalfacilities and 40,000 patients.Today, Corizon is actively work-

ing to deploy the latest eMARrelease for its PhiladelphiaDepartment of Corrections part-ner. Corizon Health will be work-ing closely with PhiladelphiaDOC to integrate the eMAR with

the existing eClincial Works EHR.www.corizonhealth.com, 1.800.729.0069

Correctional ServicesMHM Correctional Services is a

wholly owned subsidiary ofMHM Services, Inc. MHM and itssubsidiaries are under contractwith correctional systems nation-

wide to provide a wide range ofbehavioral health, pharmacy,medical specialty and compre-hensive medical services. In 2017,MHM provides services on site toover 350 facilities in 16 statesnationwide.www.mhm-services.com, 1.800.416.3649

Health Care ProgramsNaphCare provides a proactive

approach to health care programsfor correctional facilities rangingfrom comprehensive health care,

on-site dialysis, off-site manage-ment, in-house pharmacy andTechCare, their electronic healthrecord (EHR) clinical operationaltool.

www.naphcare.com, 1.800.834.8400

Health Care SolutionsWexford Health Sources pro-

vides medical, mental health,pharmacy, rehabilitation, utiliza-

tion management, claims pro-cessing, and technology servicesto state, regional, and localclients across the country. Thecompany aids governments, cor-rectional facilities, and otherinstitutions control inmatehealth care costs while maintain-ing quality of care. www.wexfordhealth.com, 1.888.633.6468



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