Every facility’smission of med-ication dispens-

ing is fraught with problems:Securing medications, dispellingdiversions all the while untan-gling tracking and compliancecomplications. These just scratchthe surface with deeper problemsstacking up right behind: fund-ing, staffing, and medicationissues themselves such as over-doses, over prescribing, and han-dling hazardous medications.“Correctional facilities, regard-

less of their size, need an orga-nized, effective method for safelydistributing and administeringhigh volumes of medications totheir inmates on a daily basis,”

acknowledges Wendelyn R.Pekich, MBA, CCHP, director,Marketing & Communications,Wexford Health. “While medica-tion distribution and administra-tion is typically the responsibilityof nursing staff, custody officersare often required to accompanythem.” Facilities are looking forthe most efficient method tolimit the time custody personnelare engaged. “It is also importantthat the medication is accuratelygiven to each person and docu-mented appropriately. “As an experienced health care

provider, Wexford Health recog-nizes that medication administra-tion is a high-volume, high-riskcomponent of correctional health

care programs,” she says. “Toaddress this, we created anIntensive Medication Pass Review(IMPReview) program. The goalof the IMPReview is to preparenurses for the many distractions,security requirements, and sheerpatient volume they will faceevery day as a correctional med-ication distribution nurse. Byproactively addressing the chal-lenges of medication administra-tion, we are able to educate nurs-es on what to expect. This equipsthem to better manage theprocess, thereby increasingpatient safety as well as job satis-faction and nurse retention.”Medical staff in nearly all cor-

rectional facilities are dealing

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BY G.F. GUERCIO, CONTRIBUTING EDITOR

Med Control: Mission Impossible?

Managing med-ication dispens-ing, and all theinherent issuesthat come withit, can be har-rowing withoutproper systemsand equipment.

Medi-Dose PresidentRobert Braverman securesmedication with their flag-ship system for solid oralmedication.

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with limited resources in terms offunding or staff, inmate turnoverand frequent medicationchanges, medication accuracyand security during administra-tion, and state regulations aroundpre-pouring and repackagingdrugs, assesses Craig Davis, seniorprogram manager/product man-ager for Vial Filling Technologies,Parata Systems.Pharmacy automation such as

the Parata Max high-speed robot-ic dispenser automates the pre-scription filling process. “Thisallows even the busiest pharma-cies to accommodate a highervolume and has a positive impacton safety and patient care. This isa vial-filling solution that wouldgreatly benefit correctional facili-ties that use primarily a medica-tion line or Keep-on-Personadministration.”To control access to medica-

tions in the pharmacy, bothParata Max and Parata Mini sup-port locking cells that restrictaccess based on operator permis-sion levels, and replenishment,dispensing, and return-to-stocksare tracked and reported. Further, says Davis, Parata

PASS packaging, which organizesa patient’s medications by dateand time of dose in individual,clearly-labeled pouches, elimi-nates the need for pre-pouringand repackaging. For correctionalfacilities that use an EMR (elec-tronic medical record), pharma-cies can print an optional bar-

code on each pouch, which isscanned when those medicationsare administered to the patient.A problem with administering

in some facilities is the majorityof inmates are prescribed medica-tions, reports Rebecca Luethy,MSN, RN, director of OperationsDevelopment, Centurion, LLC.“This requires many hours ofstaff time to administer, especial-ly when medications are adminis-tered a dose at a time.”

Human Error ReducedIf the facility is not using an

electronic medication orderingsystem, the factors that lead to adelay in timely—possibly conse-quential—medication dispensingincrease dramatically, says Dr.Gregg Puffenberger, PharmD,MBA, vice president of PharmacyManagement at Centurion.Human error and system mal-function can double the opportu-nity for mistakes. “Utilization ofan Electronic Ordering andMedication AdministrationRecord may alleviate some of theproblems that occur due tostaffing and the use of a manualpaper system,” he says. And security problems such as

lost/stolen medication can bediminished with bar code scan-ning, notes Vince Grattan, RPh,Centurion’s director of PharmacyManagement, at each step of theway: as medications are checkedinto inventory at the site, againscanning with electronic medica-tion administration records totrack Keep-on-Person or DOT(Direct Observation Therapy)administration, and scanning totrack returns.Darrelle Knight, PharmD,

MSM, CCHP, director of ClinicalPharmacy Services, Naphcare,Inc., concurs that the electronichealth record (EHR) reducesissues with diverted medicationsbecause the medications can betracked from the moment theyleave the pharmacy to the admin-istration to the patient. “TheEHR has effectively closed theloop on the gaps that paperrecords left open.”Once medications are dis-

pensed from the pharmacy, theyare reconciled by staff at the site.This reconciliation verifies thateverything that has been dis-pensed has been received at thejail. Tracking and diversion arecontrolled at every encounterwith the medication recordedwith a date and time stamp. TheEHR gives clinicians opportuni-ties to review compliance by

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A sample Corizon Medication Therapy Management Program report. To datethe program has reviewed 1,227 patient profiles and, within those, flagged1,437 potential medication-related issues for providers to further evaluate.

Wexford Health’s Medication PassReview (IMPReview) program pre-pares health care staff for the issuesthey will face as a correctional med-ication distribution nurses.

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recording medication administra-tions. “The EHR we use,TechCare, gives our clinicians aunique advantage. After threeconsecutive missed doses of amedication, an alert is sent to theclinician’s daily work queue.”

The Verification Process Other than tracking/diversion,

one of the biggest challenges isthe verification process, contendsChris Bove, president, LocalDetention Division, Correct CareSolutions (CCS). “As a company,our patients undergo a very thor-ough intake procedure and proto-col which typically providessome context about the patient’s

medical background, but thatinformation is not always reliableor verifiable.” Because a correc-tional facility is booking newpatients on a 24/7 schedule,resources are not always availablefor verification purposes. “Wecan speak with a physician andprovide a patient profile, howev-er, this can be difficult with nofamiliarity with the patient’sbackground.

“The industry needs a robust,dedicated and unified nationaldatabase that incorporates sharedcorrectional patient informationbetween accredited community,regional and national healthcareagencies, and correctional med-ical professionals. The ideal sys-tem needs to digitally track cor-rectional patient information.This would, of course, be a mas-sive undertaking; however, itwould go a long way to improv-ing efficiencies and administra-tive procedures within correc-tional facilities across the UnitedStates,” Bove points out. “Thinkabout it in the same light as anational crime database, but

based on electronic medicalrecords of those who have beenincarcerated.”In addition to verification,

Bove notes the prevalent problemof opioid withdrawal andmethadone administration. “Bypractice and by law, CCS doesnot continue a patient’smethadone treatment except incases where the patient is preg-nant and in that circumstance,

methadone is administered dur-ing an incarceration to protectthe fetus. Opioid withdrawal ingeneral has become a very signifi-cant issue in the correctionalhealth care environment.Addressing these issues is a priori-ty for CCS’s team across thecountry.”The ability to dispense medica-

tions efficiently and with thelowest possible error rate is themost important benchmark ofservice in corrections pharmacy,according to Zane Gray,Pharm.D, with DiamondPharmacy Services. As thenation’s largest corrections phar-macy provider, serving over

600,000 inmates in facilitiesacross 45 states, the volume cre-ates many medication controlchallenges that require customer-and technology-driven solutions. Diamond utilizes a double veri-

fication process to assure accuratedispensing of all medicationorders, they report. First, phar-macists review regimens andidentify any therapy duplicationsand drug-drug interactions and

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Both Parata Max and Parata Minisupport locking cells to restrictaccess based on permission levels.

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communicate them to the pre-scriber. Bar code scanning is thenused to verify that the correctmedication, dose and directionsare dispensed and delivered tothe correct facility and patient.The pharmacy further reducesmedication errors by workingwith clients at the facility levelindividually to streamline boththe sending of medication ordersand reception of prescriptions. Technology plays an impor-

tant role in medication controland pharmacy-client relations,Gray says. “The Reconciliationprogram, for example, allowsboth Diamond and facility staffto track reception of medicationinto the facility through the barcode system. This system alsoallows the staff to instantly refillmedication, reducing the timespent on medication ordering.”Online Reporting software allowsthe staff to track medication uti-lization, ensuring facilities under-stand which exact medicationsare being used and the costs asso-ciated with them. There are times manual dis-

pensing overcomes issues, saysRobert Braverman, president,Medi-Dose, especially for haz-ardous medications and for facili-

ties that can’t afford automation.“If we’re dealing with a sheriff’sdepartment jail or a small facilitywe’re perfect for that; there’s nomachinery, no extensive in-ser-vice training.” The flagship prod-uct is for solid oral medication—the blister pack. “The foil adhe-sive is an aggressive system, so it’sthe same degree of protection asthe heat seal. It’s similar for liquidpackaging: it’s a tamper-evidentseal on top of the bottle with thescrew top. We have a whole arrayof other products for tamper evi-dence: Labels, bags, etc.” As an added benefit,

Braverman says the system labelsthe packaging to suit specifica-tions. “For accountability, eachdose can be numbered and youcould even include an image ofthe inmate—checking from a pri-vacy standpoint first, of course—as well as bar coding.”The aging inmate patient pop-

ulation becomes an issue withcancer and other diseases occur-ring due to age, he cites. NewUSP 800 drugs for cancer, AIDS,etc. are hazardous but need to bedispensed. “Medi-Dose ideallyaddresses the needs of thesepatients while protecting thehealth care professional or those

distributing oral chemo or med-ication such as Avodart whichpregnant women can’t touch.”

New EfficienciesPolypharmacy—the over-pre-

scription of medications—is aserious issue, Peter Lee, Pharm.D.MBA CCHP, vice president ofClinical Pharmacy Services,Corizon Health/PharmaCorrexplains, especially when statis-tics show the average patient isprescribed five different medica-tions, some of which may be con-tra-indicated or may simply beinappropriate, leading to unnec-essarily higher pharmacy costs.“At Corizon Health, we are

adopting an exciting newMedication Therapy ManagementProgram modeled after the pro-gram used by Medicare Part D,but tailored for corrections.” Todate, the program has reviewed1,227 patient profiles and, withinthose, flagged 1,473 potentialmedication-related issues forproviders to further evaluate. In addition, Corizon

Health/PharmaCorr is piloting aclinical pharmacy interventionprogram that utilizes technologyto inform providers of the mostcost-effective drug option, doseoptimization, the latest clinicalguidelines and other drug infor-mation. “Not only does this solu-tion help minimize errors andensure the most therapeutic solu-tions, this system already hassaved clients more than $1.2 inunnecessary pharmacy costs.”He adds that at one state con-

tract they developed a medicationrefusal form that includes valuableinformation about possible conse-quences of refusing medications“and we hope will inspire a changeof attitude and result in compli-ance. We anticipate this beingconverted to an electronic formthat may be captured in the EHRto better inform providers of possi-ble health issues with patients.” All in all, organizing these

practices can neutralize med con-trol concerns and transform themission to: possible. �

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Centurion commends utilization of Electronic Ordering and MedicationAdministration Records to alleviate problems that may occur due to staffingissues and manual paper systems.

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