COMMISSIONER'S DIRECTIVE

ADMINISTRATION OF MEDICATION

Policy Bulletin 154

POLICY OBJECTIVE

1. To ensure the safe and legal management, storage, recording, dispensing and administration of medication in order to meet the Service's obligation to provide health care in accordance with the Corrections and Conditional Release Act.

AUTHORITIES

2. Sections 85-89 of the Corrections and Conditional Release Act;
Controlled Drugs and Substances Act;
Provincial Pharmacy Acts.

CROSS-REFERENCES

3. Commissioner's Directive 821 - Management of Inmates with Human Immunodeficiency (HIV) Infections;
Commissioner's Directive 835 - Health Care Records;
Standards for Health Services.

DEFINITIONS

4. Administration of Medication - The process of giving medication to an inmate as prescribed by a clinician.

5. Clinical Orders for Medications - Pharmaceutical orders prescribed by an institutional clinician to be used during his or her absence from the institution.

6. Delivery of Medication - The process of giving medication prepared in a sealed and labeled envelope to an inmate.

7. Dispensing of Medication - The process of preparing medications for future administration.

8. Formulary - A list of approved pharmaceuticals for use in a region.

9. Institutional Clinicians - Includes physicians, dentists and psychiatrists who have the authority to order medications due to their contractual scope of work.

10. Narcotics and Controlled Drugs - All drugs listed in the Controlled Drugs and Substances Act.

11. Pharmaceuticals - All prescription and over-the-counter drugs.

12. Storage - The maintenance of pharmaceutical supplies in an appropriate area within the Health Services Centre.

REGIONAL RESPONSIBILITIES

13. The Regional Administrator, Health Services (RAHS) is the activity centre manager responsible for all pharmacy services in the region. These services may be obtained through a contract or provided by a CSC staffed pharmacy. The RAHS must ensure that there is a Regional Pharmacy and Therapeutics Committee in place.

14. The Pharmacy and Therapeutics Committee will develop and maintain a Regional Drug Formulary and regional pharmacy policies. The region shall develop its own formulary or use the formulary of the province in which the institution is situated.

INSTITUTIONAL RESPONSIBILITIES

15. The institutional Chief, Health Services shall be responsible for the audit and monitoring of all elements of the institutional pharmaceutical process including:

1. the audit of drugs listed in the Controlled Drugs and Substances Act;
2. invoices from the regional pharmacy;
3. medication incidents and errors;
4. institutional medication trends; and
5. prescribing practices of institutional clinicians.

16. The institutional Chief, Health Services shall ensure that the clinical orders are reviewed at least annually, and that the original orders signed by the institutional physician are kept in an administrative file.

17. The institutional Chief, Health Services shall ensure that medications are prescribed only by a duly licensed clinician.

18. The pharmacist shall be responsible for the dispensing of medication.

19. After a nursing assessment, a registered nurse may administer appropriate medication as per the clinical order for medication.

20. When on site, the institutional nurse shall be responsible for the administration of medication as prescribed by the clinician.

21. In instances where there is no nursing coverage in the Health Services Centre, non-medical staff members shall deliver medications to inmates or give inmates controlled access to their medications.

22. Methadone shall be administered only by nursing or medical personnel.

23. Registered nurses shall be responsible for initiating the ordering, recording, receipt, safe-keeping and issue of all narcotics, controlled, prescription and over-the-counter drugs excluding those over-the-counter drugs available through the inmate canteen.

24. The institutional Chief, Health Services shall ensure that:

1. counts of dispensary stock of narcotics and controlled drugs are carried out at the end of each shift;
2. outgoing and incoming nurses record and countersign the balance on hand; and
3. a procedure for reporting discrepancies to institutional authorities and to Health Canada's Bureau of Dangerous Drugs is in place.

PROCEDURES

25. Medications shall be prescribed only when clinically indicated and shall never be used for disciplinary or control purposes. The clinician shall prescribe hypnotic or sedative medication only when there is evidence that the inmate's sleep is disturbed and only in exceptional circumstances.

26. The management, control, storage and dispensing of drugs and medical supplies shall be in accordance with generally accepted management and pharmacy practices.

27. Procedures shall be in place for the disposal of needles, syringes and outdated drugs, according to provincial standards.

28. Entry into the dispensary and supplies area of the Health Services Centre shall be restricted, and controlled by Health Services staff.

29. In community correctional centres and community-based residential facilities, offenders shall self-administer their over-the-counter and prescription medication unless otherwise directed by CSC policy or the institutional clinician.

30. Nurses are responsible for determining whether multiple doses of drugs shall be given to inmates for self-administration according to the following criteria:

1. it would contribute to the inmate's self-reliance;
2. the nature of the medication provides for it;
3. it does not interfere with the assigned activities of the inmate; and/or
4. the availability of nursing or correctional personnel indicates that this would be the most efficient way to administer the drug.

31. Health Services staff may make exceptions to multiple dosing based on individual and environmental factors.

32. Medication shall be prepared by a pharmacist in a separate container and each container shall clearly indicate date of preparation, name of the inmate, name and strength of the medication, and directions for use.

33. Medications shall be dispensed and administered in the solid, unaltered dosage wherever possible.

34. In preparation for the delivery of medication to inmates by non-medical staff according to paragraph 21, a nurse shall ensure that such medication has been dispensed by a pharmacist, and is secured in a sealed container with the inmate's name clearly marked. At a scheduled time, the inmate should present himself or herself to the appointed staff member, sign upon delivery of the medication and self-administer it. The staff member should then countersign. This process will be recorded in the inmate's health care record by the nurse.

35. The procedure for the delivery of medications by non-medical staff shall be set out in institutional Standing Orders.

36. Medication incidents and adverse drug reactions shall be reported to the clinician immediately.

37. The nurse or clinician who administered the medication shall record the following information in the inmate's health care record:

1. all medication dispensed and administered to an inmate by the Health Services Centre;
2. medication incidents and adverse drug reactions;
3. telephone and verbal orders from a clinician and signed by the nurse receiving the order (the clinician shall sign the order on the next visit to the institution).

Original signed by
Lucie McClung, Commissioner

Table of Contents