Prison pharmacy is an interesting and varied area, which gives exposure to many clinical areas and allows close working relationships with the multidisciplinary team. The nature of prison pharmacy brings about many ambiguous and unusual situations that may not be seen in community or hospital settings. Below is an overview of the duties that are involved in prison pharmacy. These will vary from prison to prison. Most pharmacy roles are based within the dispensary; however the pharmacy team can also be involved in patient clinics, or with administration on the wings.
Most prisons are now using SystmOne- an electronic, clinical system that brings together patients notes, pathology results, patient information, and prescriptions in one system.
On a daily basis there are usually GP and psychiatrist led clinics. Depending on staffing and expertise, there may often be pharmacist led clinics- which may consist of medicine use reviews, treatment of minor ailments, counselling patients on their medications. The area of substance misuse is often subcontracted out to a private company who have their own team of doctors and nurses. All the prescriptions are written electronically onto SystmOne.
Ensure patients regular medications are prescribed correctly, in a timely manner. Patients may often bring their medications with them. For most patients it is necessary to retrieve their summary care record to confirm their medication history.
It may be necessary to contact a patient’s pharmacy in community to confirm certain medications, for example methadone doses, or if a patient has a blister pack.
Things to be aware of when screening prescriptions include;
• In possession status- is the patient safe to have their medication in their own possession. Where ever possible patients should have their medication in possession as they would in community to encourage responsibility for their own health. However if a patient has a history of self harm or of diverting medications then they should not be given medication in possession.
• The type of medication- Is it a drug of abuse, or is it ‘tradable’ on the wings. It may be necessary for the pharmacist to assess the risk of the medication. These medications include drugs like pregabalin, opioids, benzodiazapines, sleeping tablets, etc. These medications are generally never given in possession and should only be given a dose at a time by the nursing staff.
• Be aware of drug seeking behaviour- which is very common- is the medication actually indicated or is the patient abusing the medication.
• Ensure that the patients are not requesting the medication too regularly- they may be stockpiling medications
The medications seen can be wide and varied, however the common types of medications include;
• BBV – HIV medications and Hepatitis C
• Medical withdrawal of alcohol/ benzodiazepines
• Methadone and buprenorphine prescriptions
• Mental health medications- antipsychotics, antidepressants, antianxiety
• Chronic health conditions- High blood pressure/diabetes etc
• Treatment of recurrent DVTs
• Pain medications- opioids/ pregabalin/ gabapentin/ TCAs
Advice to the Health care team
Prescribers and nurses generally work closely with the pharmacy team often asking for any information relating to medication, ranging from prescribing advice, information on administration, management of overdoses, switching formulations, etc.
The pharmacy team may be asked to identify unknown medications that have been found in inmates’ cells, to determine if the drugs are illicit or prescribed
Prison pharmacy is also an excellent opportunity to get involved with protocol writing. This could include clinical guidelines, SOP writing, audits, reviewing formularies etc. Datix reports should be filled in when errors are made to encourage improvement in quality of service.
It is important that the patients care is handed over to primary care when an inmate is discharged. Pharmacists must produce prescriptions supplying 7 days of medications when leaving. Letters need to be written to their registered GPs with any changes to their medications and any relevant information that has occurred during their stay in prison.
Please note this gues blog was kindly provide by Clare Tucker an expert recruitment consultant at total assist.
If you are interested in prison pharmacy please visit www.totalassist.co.uk