Communication of Patient Health needs
In my early career, the common practice for how we shared “sensitive” medical information was simply a call on the radio:
“Base to Officer Jones. Go ahead base.”
“You have Inmate Rogers?”
“Copy, I have Rogers. Clear. Universal precautions! Clear.”
Mental and physical well-being is a very important part of the overall staff safety picture. It may not be written in our policies and procedures, but it must be in our minds. I’ve lost a colleague to suicide. Another colleague’s son took his own life. And just this morning I read that a former officer of mine was involved in a murder/suicide. We must take care of each other.
I am extremely proud of and grateful to AJA Immediate Past President Mandy Lambert for taking on the initiative of staff health and wellness. She has lent her voice to efforts of finding solid and innovative solutions to managing correctional stress. This initiative is crucial, especially now as the pandemic goes on.
We need only look to the past two years to see the importance of keeping one another safe. Like many of you, I sometimes find the training related to infectious disease and bloodborne pathogens boring and monotonous. But, boy, how relevant it is to what we’ve been through, and are still going through, with COVID.
Before diving in to the NCCHC standard on Staff Safety, I want to say a few words about safety tools: No matter how bright, shiny, and high-tech they might be, they are only effective if they are used, and used correctly.
Have you ever purchased the newest technology only to abandon it after experiencing a few glitches? Ever invested in extensive software to automate, calculate, and organize all your daily functions only to leave some of the best options turned off because “we need to keep it simple”? Yeah …me too.
Clearly, there are times when health care staff and custody need to share medical information. This column discusses the purpose of NCCHC’s standard on the communication of patients’ health needs, why it is important, and when it is necessary. It reveals the common mistakes that we find in the field. As you reflect on these, take note of how you are handling situations like these in your facility.
Yes, it is important to keep our staff and our facility safe. Yes, it is important to protect the sensitive and confidential privacy of the incarcerated. Yes, HIPAA exists, and we need to be mindful of the privacy rules pertaining to protected health information, but not use it to eliminate any type of sharing when appropriate. And, yes, there are ways to do all the above.
Although we have evolved over the years, it took someone who knew the NCCHC standards to point out that the way we were “protecting” sensitive information was no protection at all. Once you understand the standard and what is and is not appropriate, the way you communicate will improve.
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JIM MARTIN, MPSA, CCHP Vice President, Program Development jamesmartin@ncchc.org
AMY PANAGOPOULOS, MBA, BSN, RN Vice President, Accreditation National Commission on Correctional Health Care amyp@ncchc.org
NCCHC Jail Commander Conversations: Communication of Patient Health Needs
The purpose of this standard is to provide guidance on what needs to be communicated between facility administration and treating health staff regarding inmates’ significant health needs. The standard provides key areas that must be considered in classification decisions to preserve the health and safety of that inmate, other inmates, or staff.
Why Is This Important? This standard is important since clear communication between custody and health staff keeps both groups aware of special considerations with inmate movement and decisions while keeping the inmate and staff safe. Medical or mental health problems, medication, and treatments may complicate housing assignments, bed assignments, work assignments, program assignments, disciplinary management (segregated inmates), or transfers to another facility.
Custody and health care staff will want to communicate the requirements of patients who have the following special needs or conditions. These conditions may include:
• chronic diseases such as diabetes or heart failure
• dialysis
• communicable diseases
• physical disability including types of support devices the inmate needs
• pregnancy
• frailty or old age
• terminal illness
• mental illness
• suicidal intent
• developmental disability
• intellectual disability
• physical or sexual abuse
• physical or mental contraindications to restraint or seclusion
• gender dysphoria, transgender
• special needs of adolescents in adult facilities
Standards and Indicators of Compliance Communication of health needs is documented in the patients’ medical records. Once the special need or condition is communicated and understood, custody will be able to make better decisions regarding the inmate’s needs that may affect:
• housing
• work assignments
• program assignments or selection
• disciplinary measures
• transport to and from outside appointments
• admissions to and transfers from facilities
• clothing or appearance
• activities of daily living
NCCHC Sample Survey Observations from Recent Surveys
Observations • Inmates with mobility issues were not assigned a bottom bunk or lower bunk since health care staff did not communicate the patients’ needs clearly.
• An inmate with multiple sclerosis was assigned yard cleanup duty during the heat of the day, which was inappropriate given the inmate’s chronic illness. Custody was not aware of the inmate’s disability and the impact the assignment had on multiple sclerosis.
• A pregnant inmate was given a work assignment that conflicted with doctor’s orders because the facility did not have a consistent way of tracking patient health needs or a good way of communicating those needs. The patient was to sit for her work assignment due to significant leg swelling and the jail did not provide a change to the work assignment or a chair.
• A patient on dialysis missed an appointment due to poor communication between health staff and custody.
• Medical staff required an inmate with a shoulder injury to be cuffed in the front, but custody continued to cuff behind the back. Custody was not aware of the shoulder injury due to poor communication between medical and custody.
• Transgender inmate’s gender identity was not shared and housing accommodations for the inmate were not offered or provided.
Potential Contributing Factors • No consistent way of communicating inmate/patient needs was developed for shift changes.
• There was a limited understanding by correctional staff as to what needs to be shared with health staff regarding an inmate’s health status.
• Facility policy did not address how to manage transgender inmates and housing assignments
• Facility was understaffed, which inhibited communication between medical and custody.
• An adolescent (in an adult facility) with an intellectual disability was not offered special housing protection. The facility did not have a clear policy or procedure when housing adolescents in an adult facility.
• When an ACE wrap is issued, it is frequently taken away when the inmate/patient does not have a slip saying they can have it. Communication between custody and medical was nonexistent.