How Can We Use GUARDIAN RFID to Issue Medications?

On average, 60% of inmate populations using GUARDIAN RFID software will either be prescribed medication or request over-the-counter medication during scheduled medication passes. This high demand for medication management underscores the importance of meticulous documentation to ensure staff remain compliant with facility healthcare policies.  

Failing to maintain accurate records of medication administration increases the risk of litigation and allegations of deliberate indifference. In fact, the most common type of inmate lawsuit involves claims of inadequate medical care, even surpassing claims of excessive force or denial of religious practices.

In this blog, we’ll cover:

• How standards of care are established

• Best practices for managing prescription medication administration

• Guidelines for managing over-the-counter (OTC) inmate medications

Establishing Standards of Care

For younger correctional officers and those new to the profession, the 1976 U.S. Supreme Court case, Estelle v. Gamble, is pivotal in understanding how inmates may legally claim cruel and unusual punishment.

In the Estelle v. Gamble case, an inmate named J.W. Gamble who was incarcerated in the Texas Department of Corrections sustained a work-related injury due to a 600-pound bale of cotton falling on him. For the next several months, he reported being unable to work due to the pain caused by the accident. Prison administrators then placed Gamble in administrative segregation for refusing to work.

Gamble subsequently filed a pro se complaint, alleging cruel and unusual punishment. The Supreme Court ultimately ruled that prison authorities must address inmates’ medical needs to avoid violating their Eighth Amendment rights.

Managing Prescription Medication Administration

If you’re using GUARDIAN RFID, the most effective way to manage prescription medications (actually, the only way) is to create a formal medication order. These are medications ordered by a provider, physician assistant, or advanced practice registered nurse.

When you create an electronic medication order, it’s essential to follow the “five rights” of medication use:

1.      The right patient

2.      The right drug

3.      The right time

4.      The right dose

5.      The right route

While healthcare professionals commonly know these rights, they may be less familiar to correctional officers who frequently create these orders via their electronic devices and supervise the delivery and acceptance of medications. Not taking these five rights into account can heighten the risk of errors – some of which may be deadly.

Creating the medication order in GUARDIAN RFID is straightforward, involving a simple series of text fields and drop-down menus to enter the necessary information. You can also add notes relevant to the individual responsible for the point of delivery. In smaller jails, correctional officers may have a heavy hand in the entire cycle of medication administration, from creating the order to delivering the medications.

When it comes to delivering inmate medications, correctional officers must be vigilant to ensure that inmates accept and consume their medication in its entirety. Inmates may try to “cheek” their medications by pretending to swallow a medication to then store them for later use. Once they have collected enough over time, they’ll consume most or all of them to get high or overdose. They can also trade them with other inmates, posing significant safety and security issues. To mitigate this risk, prescription orders can specify liquid formulations or crushed pills to prevent "cheeking" altogether. 

Occasionally, an inmate may accept a portion of their medication order due to not liking its side effects. For example, if an inmate is prescribed 300 mg of Trazadone in divided doses (e.g. breakfast, lunch, and dinner), they might decline the full lunchtime dose because of side effects like blurred vision and dizziness. GUARDIAN RFID technology empowers officers to document the accepted dosages as well as any portions that were refused, and—most importantly—requires the inmate to electronically sign for the medication offered. Any unused medication remains in the inmate’s physical count for future administration, ensuring proper security and accountability.

Managing Over-the-Counter Medications

Your facility may have a list of common over-the-counter (OTC) medications available to most or all inmates on a PRN, or an “as needed” basis. These medications include Tylenol, Ibuprofen, Tums, Dulcolax, vitamin supplements, etc.

Just as the Estelle v. Gamble case established the standards of deliberate indifference in healthcare, it is important to capture when OTC medications are offered and accepted by an inmate.

There are a couple of ways to do this in GUARDIAN RFID:

1. You can create a set of Nested WordBlocks in your Supply module. System Administrators can set a rule to establish whether an inmate signature is required or not (we highly recommend that inmates do sign for medication offers – even OTC medications).

2. In Command Cloud, you can create a custom Workflow module, naming it “OTC Med” for example, and populate this module with WordBlocks that represent the OTC medications on your med cart. (Again, System Administrators can set a rule to establish whether an inmate signature is required, which GUARDIAN RFID highly recommends.)

For our legacy GUARDIAN RFID OnDemand users who have Medication Manager, you should use the “Non-Med Order” module to accomplish the above in Mobile Command.

When you pass an OTC medication to an inmate, you can select your module (e.g. OTC Med), then scan the inmate’s RFID wristband or ID Card – or, if they’re a mental health consumer, select their name manually. Tap the WordBlock of the medication being accepted, then have the inmate provide their signature.

Mistakes to Avoid in Logging OTC Medication Administration

1.      Not logging the medication administration at all – or not being clear and firm with staff about your expectations (policies) surrounding medication administration. If this isn’t clear, strongly consider fixing it.

2.      Never use “Offered” as your WordBlock. This does you no good. Did the inmate accept or decline? “Offered” doesn’t make this clear; it’s far too ambiguous to be of value and is not a recommended practice.

3.      Not capturing an inmate’s signature is a cardinal sin. Always capture a signature on medication-related events – regardless of whether the inmate accepts or declines the offer. You want as much definitive proof as possible about your inmate interactions to prevent allegations of deliberate indifference.

How do I find this information in reports?

Finding this information in reports depends on how you collected the data in the first place.

• If you’re using Medication Manager, you’ll use the pre-built Medication History Report and filter by date range and inmate name.

• If you’re using nested WordBlocks in the Supply module, you’ll need to run a report based on date, module name, inmate name, and WordBlock(s).

• If you’re using a custom workflow module to log, you’ll build a report based on your module name, date range, inmate name, and WordBlock(s).

Medication administration – and allegations of improper medical care – is the most litigious area of corrections. Every facility is fallible. However, the clearer your internal governance can be through sound policy, continuing education, and monitoring for continuous improvement, you can dramatically reduce legal risk and allegations of deliberate indifference.