Magazine article Corrections Forum

Managing Meds

Magazine article Corrections Forum

Managing Meds

Article excerpt

The inmate population, just like the nation's population, is growing and aging, and filling their medication needs is a more time consuming, expensive and labor intensive procedure than many outsiders might consider. Pharmacy regulations, time delays, safety, security, diversion, the lack of accountability, the transient nature of incarceration and a shortage of nurses have only compounded the situation. In an effort to streamline the process of distributing medications to inmates, some correctional institutions, including those in Los Angeles County and San Bernardino County (which alone is home to seven correctional facilities) have adopted automated systems of packaging, sorting and distributing medications. They go by many names: Automated Dispensing Cabinets, Unit Based Cabinets, Automated Dispensing Devices and Automated Dispensing Machines. The devices, common in hospitals since the 1980s (an American Society of Health System Pharmacists survey found that 83% of hospitals use them), have shown positive results in areas such as time and inventory control management, safety, accountability, accuracy and expethency in corrections. In fact, one of these systems, InSite, created by Talyst, a Bellvue, Washington-based company, was designed specifically for use in correctional facilities.

The devices are more than vending machines that dispense medication. The software and barcode technology involved is very sophisticated and capable of being adapted to meet emerging compliance and safety regulations. These computer-controlled units offer the ability to store, dispense, track and document the dispensing of medications at a decentralized (located at the point of care rather than at the pharmacy) location. They can also be made to interface with other databases such as admissions, billing and, in the case of the Los Angeles County Sheriff's Department, the Jail Health Information System QHIS).

LA, County Sheriff

The L.A. County Sheriff's Department Custody System houses between 18,000 and 20,000 inmates at any given time, one third of which require five medications a day. The amount of time required to prepare medications in correctional facilities, especially one that size, is a time-consuming and labor-intensive task. In an attempt to streamline the process of distributing the $1 million worth of medication the department purchases every month, the facility adopted the use of three AutoMed ADUs. These automated drug packaging systems contain cassettes with an option of 330 pills and capsules. Each unit can package 60 single prescription bags or 40 multiple prescription bags in a minute. When running at optimal efficiency, the three together can package nearly 11,000 bags an hour. The meds are packed according to the inmate's name, facility, module, room and bed.

The AutoMed system interfaces with the JHIS into which the inmate's medical information had been entered upon arrival. A pharmacist then verifies the dosage and potential interactions with other medications and releases the prescription. According to the County of Los Angeles Quality and Productivity Commission 20th Annual Productivity and Quality Awards Program, prior to the Sheriff's Department Medical Services Bureau's adoption of AutoMed, it was estimated that a single facility's nursing staff spent nearly 3,900 hours a year preparing medications for inmates. After incorporating AutoMed into the JHIS, that preparation time has been reduced by one third.

San Bernardino realized similar results. As Terry Fillman, health services supervisor for the San Bernardino County Sheriffs West Valley Detention Center (WVDC) in Rancho Cucamonga, the first correctional facility to incorporate the technology, discussed with Elaine Rundle, staff writer at Government Technology, it used to take four nurses four hours a day to prepare the daily 10,000 doses of medication to be distributed to inmates. This was a daunting task when, even in a bitter cold economic climate, there still remains a shortage of qualified nurses. …

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