August 25, 2009 By Elaine Rundle
Corrections departments are responsible for so many burdensome tasks that many of their everyday functions, like administering prescription drugs to inmates, are afterthoughts for the public. However, dispensing medication was so laborious and wasteful for the San Bernardino County (Calif.) Sheriff-Coroner Department that officials sought a way to streamline the process. The end product was essentially a vending machine that links to correctional facility databases and dispenses prescription medications.
San Bernardino County -- the largest county by area in the United States -- has seven correctional facilities scattered across its more than 20,000 square miles. Terry Fillman, health services supervisor of the county sheriff's West Valley Detention Center, said at one of the locations it took four nurses -- each working four hours every day -- to prep medicine for delivery to prisoners. The time-intensive process also generated medical waste because inmates might be moved between facilities or released during the time it took to prepare their medications, which left some prescriptions unused.
Pharmaceutical regulations require that if medication is prepared for a patient and he or she can't be reached, it's deemed undeliverable and must be destroyed. The leftovers are typically flushed down the toilet or incinerated. Also, many medications are packaged in 30-count blister packs that are prescribed for individual patients and must be disposed of if that person no longer needs the medicine or is released from the correctional facility.
The county corrections department needed a streamlined process to save time and decrease waste, so it teamed up with its pharmacy system to find a solution that would benefit both entities. The result was an automated system composed of software that connects directly to the pharmacy and dispenses medications on a per-patient basis.
"One of the corrections-specific things that was pretty much eluding everybody was if the patient moves in the time period from when you prepare the medications to the time period you deliver them, then you have an enormous percentage that are undeliverable -- waste," Fillman said. He estimated that the county delivers 1.5 million pills to inmates annually. Although the corrections department didn't track the amount of medicine that had to be disposed of, Fillman said it was an enormous amount.
To reduce the amount of medical waste the sheriff's department was creating, in 2006 it teamed up with the Arrowhead Regional Medical Center (ARMC), which houses the pharmacy that serves the county's correctional facilities.
"We needed a better solution. We needed something corrections-specific that would address the issues we had -- eliminating the waste of time and money, while providing accuracy and efficiency for the delivery of health care," Fillman said.
Apurva Patel, pharmacist director of inpatient services at ARMC, said they contacted vendors in search of a new pharmaceutical system. After researching the different available offerings and the processes used by other corrections departments, they started working with vendor Talyst. "We presented to them what kind of system we were looking for and what they could do for us," Patel said.
The ARMC had its own reasons for wanting an automated system. "What we were looking to get out of the system was mainly accuracy, so we're decreasing the medication errors and having an accurate account from the time the doctors write the orders to the time the nurses enter them [in the system]," Patel said.
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