13/09/2013. I have no relevant financial or nonfinancial relationships to disclose

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1 Kory Sloan, BSc(Pharmacy) Pharmacy Manager Corrections Health Services, North I have no relevant financial or nonfinancial relationships to disclose Introduction to Corrections General overview of the Edmonton Remand Centre Health Services in Corrections Unique challenges of working in the correctional environment Role of Pharmacy Services in Edmonton Remand Centre Federal correctional facilities in Alberta are operated by Correctional Services Canada Drumheller Institution Bowden Institution Edmonton Institution Edmonton Institution for Women Grand Cache Institution Federal correctional facilities house sentenced to two years or greater Provincial correctional facilities in Alberta are operated by the ministry of Justice and Solicitor General (JSG) Adult Centre Operations Eight directly managed facilities across the province Community Corrections Young Offenders AHS is responsible for the provision of health services to detained in provincial correctional facilities The provincial correctional system in Alberta houses remanded to custody and those sentenced to a period of up to TWO years less a day All arrested in Alberta are processed through one of the four Remand centres in the Province For the five year period spanning 2005 to 2010 the average daily inmate population increased from 2374 to 2907 representing a 22.5% increase over that time 1

2 Aboriginals represent 36.5% of total admissions Average stay in custody for remanded is 18 days New Edmonton Remand Centre opened for occupancy in April 2013 Currently NERC can house up to 1952 on SEVEN different pods Future expansion can increase capacity to 2816 Each of the regular pods can house up to 288 on FOUR different living units Regular pods are three tiers of TWELVE cells Health care pod is referred to as the boomerang because of it s unique shape Health care pod has FIVE units Male Infirmary- capacity to house 68 Female Infirmary- capacity to house 16 Male Mental Health- capacity for 68 Female Mental Health- capacity for of these beds are for segregation Special Housing Unit (SHU)- capacity for 8 The centre is the approximate size of 10 CFL football fields To gain access to the facility state of the art biometric identification devices scan the vasculature of a persons hand to verify the identity of the individual LIVE specimen required for identification Scanners are located at staff entrance/exit Narcotics vault Tactical munitions vault The facility is monitored 24/7 buy some nearly 1500 cameras Offenders are entitled to health services Due to the nature and purpose of these facilities, security is the primary consideration when working in a correctional centre Provision of health services is only permitted when security standards are satisfied JSG staff determine when security standards are satisfied When health care staff work with, security staff are always nearby Before AHS took over responsibility for health services in Alberta s provincial correctional facilities, the health care team caring for consisted largely of Nurses Physicians Psychiatrists Dentists Psychologists Pharmacy services were provided by nearby community pharmacies 2

3 Since AHS took over health services, the team has expanded to also include Nurse practitioners Addiction workers Social workers Mental health and addictions nurses Transition workers Unit clerks Service Workers Pharmacy Technicians Pharmacy Assistants Given the massive size of ERC, this centre has the largest and most diverse health care team In the new facility health services are provided on the living pods where appropriate Goal of this decentralized model of care is to minimize the movement of throughout the building Offenders requiring more involved treatment or assessment are scheduled for clinic appointments and brought down to the health care clinic The most involved cases and critical issues are sent out to acute care sites for treatment Each offender must be accompanied by TWO Correctional Peace Officers (CPO s) at all times when out of the building for external appointments With the expansion of the health care team, a greater variety of offender health concerns can be dealt with in house ERC has the capacity to do x-rays on site Heath care clinic was built with the capacity for onsite physiotherapy services Offenders are not here for health services Population can be especially manipulative Placement determined by security classification not health needs For security reasons, can not be notified of outside appointments Maintaining patient confidentiality with security staff present Inability to use mobile devices as medical references in the facilities Medications used for inappropriate applications/indications Antibiotic ointment as hair gel or personal lubricant Diskus inhalers opened and used to store contraband items Turbuhaler springs removed and can be used as a weapon Intranasal use of bupropion and gabapentin Medications are commodities Diversion is a huge issue- inmates commonly cheek their medications Offenders have been observed regurgitating methadone for sale to other Medication packaging can become security concerns Common medical devices can become deadly weapons All medical supplies need to be accounted for at the beginning and end of every shift Multiple aliases make it very difficult to get accurate medical information for some 3

4 Pharmacy has grown from a staff of ONE to TWENTY SIX people ERC has more pharmacy staff than the rest of the correctional centres in the province combined ERC is the only correctional site with an electronic pharmacy platform ERC has a combination of traditional patient specific distribution and unit dose ward stock Estimates are that 50-60% of are on at least one medication Pharmacy team at ERC now consists of Assistants Technicians Pharmacists Operations Manager Pharmacy Manager Pharmacy services are available 07:00 to 21:00 SEVEN days a week A night cupboard is available for after hours access to medications Pharmacy Assistants Receive medication deliveries Fill and restock medication carts Repackaging of medications on site Deliver/porter medications around the centre Restock dispensary picking stations Process stock issues and returns through Centricity Pharmacy Technicians Enter medication orders into Centricity Respond/triage nursing requests Fill patient specific and stat orders Process court meds Make compounds as required Check repacked medications Final product verification of patient specific orders Daily preparation/verification of methadone/buprenorphine doses Audit of cart fills Pharmacists Comprehensive medication review with newly admitted Adaptation for continuity of current community medication orders on admission Refer patients to in house prescribers and practitioners after initial assessment Monitor ongoing drug therapy Order laboratory testing Discharge planning Liaise with and advise other health team members about medication therapy Collaborate on formulary development Sitting with to discuss medication related concerns helps build a trusting relationship A significant percentage of our patient population has not had a great deal of positive interactions with health care professionals Offenders tend to be very forward and forthcoming if they feel they can trust you A little patient education about proper use of medication can go a long way Dispelling myths can help improve compliance 4

5 Pharmacists can consult with other prescribers to ensure optimization of sustainable medication therapy Suggest safer alternatives with lower abuse/misuse potential in correctional setting Ensure the capacity for continuity as offender reintegrated back into community Bridge the gap between corrections and community care providers Offenders tend to have poor coping skills and having some arrangements made for them before release puts them in a greater position to succeed Expand the role of pharmacy staff to full scope of practice Initiate/Promote drug stewardship initiatives Develop and support pharmacist run clinics Play prominent role in key in house initiatives Medication Reconciliation Self medication program Develop programs to streamline care for with community programs i.e.) HIV, TB, ODP kory.sloan@albertahealthservices.ca Government of Alberta website-last accessed Sept onal_services/adult_centre_operations/correctional_and_rema nd_centres/pages/default.aspx Barloon L, Farley P, Hillard W et al. Bupropion Diversion and Misuse in the Correctional Facility. J Correct Health Care 2013 Jul;19(3): Baum R, Lieberman J, Reeves R et al. Successful Removal of Quetiapine from a Correctional Formulary. J Am Acad Psychiatry Law 2012; 40:502-8 Del Paggio D: Psychotropic Medication Abuse in Correctional Facilities. Pharmacology Newsletter 2005 June pp 1-5 5