HMP HEWELL AND HMP LONG LARTIN In-Possession Medication Guidelines for Worcestershire Prisons Version: Final Version 20081223 Ratified by (name of Committee): Quality and Safety Committee Date ratified: 16 th December 2008 Date issued: December 2008 Expiry date: vember 2011 (Document is not valid after this date) Review date: vember 2010 Lead Executive/Director: Name of originator/author: Target audience: Sandra Rote, Director of Clinical Development and Executive Nurse Sue Lunec, Senior Pharmaceutical Adviser Clinical staff working in the Worcestershire Prisons
CONTRIBUTION LIST Key individuals involved in developing the document Name Designation Sue Lunec Senior Pharmaceutical Adviser Ursula Hare Prison Cluster Manager Bernie Gregory Clinical Director Worcestershire prisons Circulated to the following individuals for comments Name Designation Dr Marcus Abel HMP Long Lartin Gill Thomas HMP Long Lartin Jackie Cockrell Head of Healthcare HMP Hewell units 1 6 Trish Cerrone Professional Practice facilitator for prison nursing Davan Eustace Clinical Pharmacist, Lloyds Pharmacy Lesley Way Patient Safety Manager Carole Clive Infection Control Consultant Nurse HMP Long Lartin Clinical Governance Committee HMP Hewell Clinical Governance Committee In-Possession Guideline for Worcestershire Prisons 20081223 Page 2 of 12
CONTENTS PAGE 1. Introduction 4 2. Aim 4 3. Scope 4 4. Drug and Therapeutics Committee responsibilities 4 5. Dispensing Pharmacy Responsibilities 5 6. Healthcare responsibilities 5 6.1 Risk Assessment 5 6.2 Supervised Medication 5 6.3 Prescribing 6 6.4 Repeat medication 6 6.5 Issuing IP medications 6 6.6 Lost, stole and unused medication 6 7. Patient Responsibilities 7 8. Prison Staff Responsibilities 7 9. Monitoring 7 10. Disseminating 7 11. Appendix 1 Drugs t Suitable for IP 8 12. Appendix 2 Risk Assessment Guidance Sheet 9 13. Appendix 3 In Possession Medication Agreement 10 In-Possession Guideline for Worcestershire Prisons 20081223 Page 3 of 12
INTRODUCTION A Pharmacy Service for Prisoners, published in June 2003, recommends that In Possession (IP) medication should be the normal method of supply of medication in prisons. This helps prisoners feel more in control of one aspect of prison life and leads to an increase in personal responsibility for their own healthcare. All prisoners should be given responsibility for their medication unless there are clearly identified factors why this should not be the case. Some medication may not be suitable for giving IP due to security issues or high overdose risk. There may be individual factors that make IP medication unsuitable. In these cases medication will be supervised with each dose given by a nurse at the medication hatch. AIM This guideline is to ensure the safe and effective provision of medication in-possession for prisoners in HMP Long Lartin and HMP Hewell units 1 6 (Blakenhurst). This guideline does not apply to HMP Hewell units 7 and 8. SCOPE This guideline applies to all clinical staff working in the Worcestershire Prisons including visiting clinicians, locum clinicians and contracted clinicians. DRUG AND THERAPEUTICS COMMITTEE RESPONSIBILITIES There will be agreement on the classes of medication that will be given inpossession (IP), between the members of the Drug and Therapeutics Committee and ratified by the Clinical Governance Committee in each prison. A list of drugs that will not be allowed IP will be determined by each prison and is in appendix 1 of this guideline. The Drug and Therapeutics Committee will review medication suitable for IP administration as a standing agenda item. In-Possession Guideline for Worcestershire Prisons 20081223 Page 4 of 12
DISPENSING PHARMACY RESPONSIBILITIES IP medicines will be dispensed by the pharmacy for the patient, with the patients name and number and date of dispensing on the container. Alternatively double labelled stock can be issued where appropriate. Solid dosage forms of drugs to be given IP will be given in original packs, plastic bottles or cardboard boxes. Patients will be supplied with the complete course of medicine or with a patient pack for up to 28 days treatment at any one time. Inhalers and creams will be supplied in original packs. Items requested IP that are included on the list for HMP Long Lartin and HMP Hewell units 1 6 as being not allowed will be queried with the healthcare managers before being dispensed. Once approval has been received, a list of exempt patients will be held in the pharmacy and further checks with healthcare will not be required for these patients. HEALTHCARE RESPONSIBILITIES Risk Assessment The decision to allow a patient to have his medication IP will be made by the prescriber following risk assessment taking into account the individual and the drug prescribed. Appendix two has a risk assessment advice sheet. The prescriber will review the risk each time the drug is prescribed. Repeat prescriptions will continue IP until reauthorisation or until further risk information is provided. If patients are moved in or out of the segregation unit then a re-assessment must take place. If there is any abuse of the system by patients, the decision to continue IP medication will be made by the doctor and healthcare staff. Supervised medication Supervised medication administration takes place twice a day at HMP Hewell and three times a day at HMP Long Lartin with the midday session being limited. If the patient is on medication more than twice a day they should be switched to a long acting preparation or suitable alternative. All patients on Assessment Care Custody (ACCT) documents should have their medications supervised. The rules of the IP guideline should be explained to all new patients stressing their obligation to comply and that action will be taken if these rules are not adhered to. If necessary use language-line or reconsider IP until effective communication can be established. In HMP Long Lartin an agreement form at appendix 3 should be signed. In-Possession Guideline for Worcestershire Prisons 20081223 Page 5 of 12
Prescribing Any medicines to be given IP will be written on the IP part of the prescription chart. Supervised medication is prescribed on the inside of the chart. The number of repeats must be specified by the prescriber. Patients will be prescribed and supplied with the complete course of medicine or with a patient pack for up to 28 days treatment at any one time. Inhalers and creams will be supplied in original packs. Repeat Medication For medication prescribed for more than one month, further repeats should be requested by the patient using an application form or repeat medication card. Unless there are exceptional circumstances, repeat supplies will only be issued to the patient on the date the medication is due. Attempt should be made to recall patients who have failed to collect their medication in accordance with the DNA protocol. Medication that needs to be given to the patient urgently such as HIV medication will be flagged up on the delivery note. Issuing IP medications On issuing an IP medicine, nursing staff must make an entry on the patient s medication card. The date of issue, the staff member s initials, and the prescription number must all be stated. At HMP Hewell, the patient will sign on the prescription to state they have received their medication. If the patient presents when it is not possible to order from the pharmacy i.e at a weekend then if the medication is a stock item this can be supplied. If the medication is not available as stock then the nurse must assess the seriousness of being without medication and if necessary contact Healthcare at HMP Blakenhurst or contact the oncall doctor. Lost, stolen and unused medication If medication is not collected within 14 days it will be destroyed. An entry will be made in the patient s medical record that IP medication was not collected and what action has been taken and an assessment made and action taken accordingly. Medications returned to healthcare and those not collected by patients should be disposed of in the appropriate waste disposal unit. Healthcare staff will make a note in the inmate medical record (IMR) following information received of lost or stolen medication and this will be monitored and appropriate action taken. In-Possession Guideline for Worcestershire Prisons 20081223 Page 6 of 12
PATIENT RESPONSIBILITIES Patients can request up to six months medication according to the form used in each establishment. After that they be asked to make an appointment with the doctor to review their medication and authorise any further repeats. Except in exceptional circumstances, repeat supplies will only be issued to the patient on the date the medication is due. At HMP Hewell, the patient will sign on the prescription to state they have received their medication. Patients should report any lost or stolen medication immediately to Healthcare centre. An appointment should be made to see the Doctor. Continuation on the IP scheme will be reviewed. If healthcare staff suspect medication is being sold or distributed in any way then the use of IP for the prisoner will be reviewed. PRISON STAFF RESPONSIBILITIES IP medication and any take home medications must be taken with patient if they are moved or released. If patients are moved to the segregation unit then healthcare staff should be informed and a re-assessment of risk undertaken. MONITORING The guideline will be monitored by the pharmacist, doctors, nursing staff and healthcare manager by checking of prescriptions and evidence of non-compliance with the guideline. If there is any abuse of the system by patients, the decision to continue IP medication will be made by the Doctor and Healthcare staff. DISSEMINATING The guideline will be posted on the PCT Internet and hard copy will be disseminated to prison staff. Archiving will follow the WPCT Archiving Policy. All WPCT clinical policies are reviewed at least every two years. Where paper copies are disseminated to designated clinical areas, confirmation of receipt by the clinical area is required. In these instances an identified member of staff is clearly informed in writing whether any outdated paper document should be removed and destroyed. A form confirming receipt of the new guideline document must be signed and returned to Clinical Governance by the member of staff from the clinical area. Paper copies of current policies are kept in a clearly labelled folder at Policy Points in clinical areas. It is the responsibility of each member of staff to know where their Policy Point is located and to ensure they are familiar with the content of the policies In-Possession Guideline for Worcestershire Prisons 20081223 Page 7 of 12
Appendix 1 In-Possession Guideline Drugs not suitable for IP HMP Long Lartin / Hewell units 1-6 (Blakenhurst) Benzodiazepines Buprenorphine (Subutex) Clove Oil Controlled Drugs Cyclizine Cytotoxics including methotrexate Ergotamine (Migril etc) Fridge lines except insulin Gabapentin Injections except insulin and adrenalin (Epipens) Gaviscon tablets Lithium Methadone Opiates for pain including tramadol Paracetamol quantity more than 16. Pregabolin Pseudoephedrine (Sudafed) Night sedation except as in guideline Tramadol Tricyclic antidepressants Warfarin 3mg tablets* * Warfarin 3mg are blue in colour and can be passed off by prisoners as diazepam tablets which are also blue. Warfarin can be given In Possession following a suitable risk assessment but doses should be given in combinations of 5mg, 1mg and 0.5mg tablets. In-Possession Guideline for Worcestershire Prisons 20081223 Page 8 of 12
APPENDIX 2 RISK ASSESSMENT FOR IN-POSSESSION MEDICATION GUIDANCE SHEET NAME NUMBER. The following factors must be taken into consideration prior to patients being allowed inpossession medication. Current ACCT YES NO (self harm form) Comments History of self-harm YES NO Comments Previous discontinuation of IP contract YES NO Comments History of security breaches with medication such as passing on or concealing. YES NO Comments. Mental health team e.g. psychotic / depressed /suicidal YES NO Comments.. Issues of compliance YES NO Comments.. Other comments This patient has been approved for in-possession medication subject to the guideline please indicate which. YES NO In-Possession Guideline for Worcestershire Prisons 20081223 Page 9 of 12
APPENDIX 3 In possession medication agreement Client/Prisoner Name... Number 1. I understand that any medication I have in possession is for my use only, and should someone else be found in possession of it my right to medication in possession will be reviewed and I may be placed on report. 2. I understand that I am responsible for ensuring my medication is kept securely at all times and agree to keep it locked away if facilities are available. I will keep the medication in its original container. 3. I understand that if I lose any medication that I am allowed to have in possession it will not automatically be replaced and my right to in possession medication will be reviewed. 4. I understand that not all medications will be given in possession and I will need to report to healthcare at least daily to obtain these medications. 5. I understand that prescribers will undertake a risk assessment every time they prescribe for me. 6. I have been given sufficient information, and I understand the implications, benefits and risks of the treatment. 7. I understand that failure to attend for appointments in relation to my medication may result in my right to in possession medication being withdrawn. 8. I understand that any attempts by me to obtaining medication by deception, stockpiling medication, selling or distributing to others, will lead to my right to in possession medication being withdrawn. 9. I understand that any changes to my medication, or withdrawal of treatment will be explained to me by a member of the Healthcare Team. 10. I understand that unused medications must be returned to the Healthcare Team for safe disposal within 3 days of stopping medication. 11. I understand that I must inform the Healthcare Team when my medication supply is down to the last 3 4 days ( not including weekends), as it take 48 hours to reorder medicines. 12. I understand that I must return all empty inhalers, containers etc to the Healthcare Team before further medication is issued. 13. I understand that I will be occasionally checked to ensure I am following this agreement. I have read the above agreement and fully understand and agree to its terms and conditions. Client Signed...Date Nurse / HCA Signed...Date Doctor Signed...Date In-Possession Guideline for Worcestershire Prisons 20081223 Page 10 of 12
Title of the policy/guidance: Equality Impact Assessment Tool 1 Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins (including gypsies and travellers) Nationality Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems 2 Is there any evidence that some groups are affected differently? 3 If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable? 4 Is the impact of the policy/guidance likely to be negative? (If no, please go to question 5.) If so can the impact be avoided? What alternatives are there to achieving the policy/guidance without the impact? Can we reduce the impact by taking different action? In-Possession Guidelines for Worcestershire Prisons Yes/ no Comments In-Possession Guideline for Worcestershire Prisons 20081223 Page 11 of 12
5 Health inequalities 6 Please consider the following questions relating to Human Rights Act: Will it affect a person s right to life? Will someone be deprived of their liberty or have their security threatened? Could this result in a person being treated in a degrading or inhuman manner? Is there a possibility that a person will be prevented from exercising their beliefs? Will anyone s private and family life be interfered with? If you have identified a potential discriminatory impact of this procedural document, please complete Impact Assessment Action Plan identifying the action required to avoid/reduce this impact. For advice in respect of answering the above questions, please contact the PCT Equality and Diversity Manager.. Is further detailed impact assessment required? Yes/ If yes, please detail how this is to be processed and by whom Details (names and roles) of staff involved in this impact assessment Name Role Date completed Outcome Sue Lunec Della Lewis Vicky Preece Senior Pharmaceutical Adviser Clinical Governance Coordinator Associate Director of Nursing vember 2008 October 2008 vember 2008 further action further action required further action required Lisa Levy Associate Director vember 2008 further action required In-Possession Guideline for Worcestershire Prisons 20081223 Page 12 of 12