HEALTH SERVICES UNIT ORIENTATION. 1. Sick call is to be available to all inmates five days per week.

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1 TI Appendix D 4/03 Page 1 of 8 HEALTH SERVICES UNIT ORIENTATION A. SICK CALL 1. Sick call is to be available to all inmates five days per week. 2. Sick call provides access for requested medical attention for nonurgent health needs. 3. Inmates are required to complete a DC4-698A Inmate Sick Call Request either prior to arriving at sick call or upon arrival. These forms are triaged daily. Inmates reporting for sick call are seen by nursing staff when they present to medical, according to urgency of need. 4. The RN, LPN, CMT-C, and other identified nonlicensed nursing staff are responsible for the delivery of health care within their scope of practice, license/certification and training. Nursing assessment guidelines, CMT-C, and HST/UTRS protocols, and departmental procedures provide the framework for this process. 5. Nursing personnel, based on the assessment of the problem, makes physician/ca referrals. Assessment forms are used to assist in this process. If nursing determines that a referral is needed, it can be done immediately if the physician is present or if the inmate is scheduled for doctors call out (depending on the urgency of the problem). Respiratory distress and chest pain require physician/ca notification immediately. 6. Sick call is to be documented in the medical record, on a nursing assessment form (DC4-683 series). Incidental notes on the DC4-701 may be used to document non-assessment type encounters. 7. Inmates are charged a co-pay fee for each sick call visit. If the inmate is referred to the physician or it is determined to be a true emergency, there is no additional charge. Scheduled follow-up visits are exempt from co-payment. B. EMERGENCIES 1. An emergency is defined as any condition which, lacking timely intervention, would subject the inmate to substantial risk of personal injury or cause other serious degradation of the inmate s health status. A health care staff member makes this decision after an assessment. No co-pay is charged for valid declared emergencies. 2. A self-declared emergency is one which the inmate identifies the problem/situation as an emergency. This can be a medical or mental health

2 Appendix D 4/03 TI Page 2 of 8 emergency. emergencies. A health care provider must evaluate inmate self-declared 3. After an assessment by health care staff, if it is determined the problem/event was not an emergency, the inmate will not be treated and referred back to the next sick call. A co-pay fee will be charged and an additional co-pay when the inmate presents at sick call. Appropriate education to prevent the problem from exacerbating is not considered treatment and should be provided. 4. An event or situation can also be declared an emergency by security staff, health care staff, or another inmate. C. EMERGENCY SERVICES 1. The emergency treatment room is used for situations requiring immediate care. 2. Situations beyond the scope of the institution are to be immediately referred outside through the emergency medical services (EMS) system. The physician and security must be notified of any call to EMS. 3. Emergency equipment must be inspected in accordance with HSB/TI D. CHRONIC ILLNESS CLINICS 1. Inmates in a chronic illness clinic (CIC) are seen routinely at a frequency determined by the physician to keep their medical conditions stabile (see TI Chronic Illness Monitoring and Clinic Establishment Guidelines). 2. Chronic illness clinics are established for chronic conditions. Some of these are: E. INFIRMARY 1. Asthma/Pulmonary 2. Diabetes 3. General Medicine 4. Hypertension 5. INH Therapy 6. Immunity 7. Psychotropic 8. Seizure Disorder 1. The infirmary is used to house inmates requiring inpatient observation or medical care. An infirmary admission requires orders by a physician/ca.

3 TI Appendix D 4/03 Page 3 of 8 2. Observation is housing less than 24 hours. Medical documentation is still required and is completed on the DC4-701 Chronological Record of Health Care). This remains part of the outpatient record. 3. A separate record of the inpatient admission must be created upon discharge from the infirmary. All inpatient records are to remain with the inmate s primary record when transferring. F. REFUSAL OF MEDICAL TREATMENT All inmates have the right to refuse medical and mental health services. Medication and/or medical or mental health treatment without consent can only be initiated in emergency situations, which endanger the inmate or others. These circumstances are specifically identified in departmental procedures. G. MEDICAL RECORDS 1. All inmates will have an individual health record, which is maintained by the medical record department (see TI Health Records). 2. Encounter forms are used to document daily encounters with inmates and/or their records. This may be done using an encounter form or by direct computer entries. 3. This information is entered into the offender based information system (OBIS) computer screen and is the basis for budgetary decisions relating to staffing and resource allocation for each institution. H. NURSING DOCUMENTATION 1. Details of inmate health care are documented on nursing assessment forms (mental health or medical admission and daily assessment forms, or DC4-701 Chronological Record of Health care). 2. Entries must be legible. White out cannot be used. Errors should be crossed out with a single line, initialed and dated. 3. Black ink only is used for documentation except for noting orders. 4. Inmate encounters are documented on the DC4-701 or the DC3-683 series of assessment forms. All notes must include the date, time, signature, and stamped by the health care provider. 5. When SOAP charting (problem-oriented charting) is used to document an incident/encounter, the following format shall be followed:

4 Appendix D 4/03 TI Page 4 of 8 a. S (subjective) The patient s perspective or statements regarding the problem. b. O (objective) Your observation regarding the problem and data from the chart that are relevant (for example; temperature, blood pressure, bleeding). A (assessment) Your interpretation of the meaning of the data c. P (plan) Your plan of action to deal with the problem. Be sure to include patient teaching when indicated. d. Three SOAP format examples (1) First example (a) (b) (c) (d) S "My dressing needs to be changed." O Dressing loose and unsecure. Light yellow drainage noted coming through dressing. A Dressing change required P Instructions provided regarding infection and wound cleanliness. Return to medical as needed. (2) Second example (a) (b) (c) (d) (e) S I can t go on any more. O Patient tearful throughout day, isolating. Refuses to discuss feelings or what above statement means. A Possible suicidal thoughts. P Place on 15-minute observation and request immediate assessment by psychiatrist. Initiate periodic one-on-one interactions and attempt to assess level of intent. E Instruct patient to call someone if feelings of self-harm increase. (3) Third example (a) S They have microphones in my room that can listen to my thoughts. (b) O Refusing to go to room. Sitting in corner with hands over ears. (c) A Actively delusional. (d) P Monitor behavior for safety. Check medication compliance. Reassure frequently that s/he is safe. (e) Education not appropriate at this time.

5 TI Appendix D 4/03 Page 5 of 8 I. LABORATORY Laboratory services are provided in all health units. Some institutions may contract with an outside provider for this service. J. RADIOLOGY (X-RAY) Radiology services are employed for routine or non-urgent procedures. Emergency or urgent X-rays are usually done in a community facility by referral. (Except where institutional x-ray services are established, such as RMC). K. PHARMACY Pharmacy services are provided to each facility by cluster pharmacies, each serving a number of institutions. Prescription drugs are prescribed according to the state formulary. (Reference: State Drug Formulary) L. MEDICATION ADMINISTRATION AND DELIVERY Medications are provided to inmate in four ways: 1. Direct Observed Therapy (DOT): Nursing personnel administers medication at prescribed times. The purpose of this method is to assure compliance. 2. Over-the-Counter (OTC): Medications that can be provided to the inmate by nursing staff according to protocols, for specific complaints/problems, without a physician s order. 3. Carry-on: Medication given to inmates after a prescription has been written by a clinician. The inmate is responsible for taking these medications independently and notifying nursing when refills are needed. 4. Dorm meds: Over-the-counter medications maintained in the dorms and provided to the inmate by security staff. These medications are specified by the legislature. (Refer to appropriate TI for additional information.) M. SPECIAL HOUSING (CONFINEMENT) 1. Nursing staff makes daily confinement rounds to assess nonurgent health care needs. 2. Sick call is provided five days a week. This is an American Correctional Standards (ACA) requirement. 3. Medication is administered/provided in the confinement area, by nursing staff, in compliance with physicians orders and departmental procedures.

6 Appendix D 4/03 TI Page 6 of 8 4. The CHO or designee must make confinement rounds at least weekly. N. OUTSIDE REFERRALS Inmates are referred to the Reception and Medical Center (RMC) and Central Florida Reception Centers for specialized services. Services not available within our system will be provided on a referral basis initiated by the clinician. Utilization management approval is required for outside consults and procedures. O. OFFICIAL LOGS There are a number of official logs required by health services to track things such as appointments, instruments, and labwork. These are maintained either electronically or on paper. Your preceptor will review these with you during your orientation period. P. OTHER 1. Sharps a. The following items are considered sharps (or sensitive items) and require tool control inventory (counting and securing): b. Needles, syringes c. Instruments 2. Inmate Education a. Periodic inmate education is required on a variety on topics. All education must be documented in the record including: b. Initial (new gains) c. Special (HIV, TB, etc.) d. Medication 3. Transfer Process a. Inmates often move within or outside the DC system during the course of incarceration for a variety of reasons such as medical or custody needs, family situations, court appearances, etc. Inmate records and medications should always accompany inmate during transfers. For health care purposes, the areas that inmates move to and from are: (1) Reception centers (2) Between institutions (3) Hospitals (4) Local

7 TI Appendix D 4/03 Page 7 of 8 b. The inmate medical record does not accompany the inmate to local hospitals for emergencies. There is a specific transfer form (DC4-760 Health Information Summary for Transfer to Outside Hospital) used for this purpose and a copy of the nursing assessment form when used. Q. MENTAL HEALTH/DENTAL 1. Mental health and dental services are available to all inmates. Specific program information will be provided by individuals from these entities and include the following areas: a. Mental Health (1) Program information (2) Personnel (3) Roles and responsibilities (4) Emergencies: (a) Physician/clinician responsibilities during administrative hours and after hours (b) Mental health nursing responsibilities during administrative hours (5) CSU/TCU/CMHI b. Dental R. OTHER PROGRAMS (1) Program information (2) Personnel (3) Emergencies 1. Specific program information, to include the following, will be provided by individuals at the institution working with these programs. 2. TB Program a. Reporting to the Department of Health b. Reports to central office: (1) IC tables (2) PPD testing for inmates (3) PPD testing for employees c. Prevalence walks in clinic (how to) d. AFB rooms

8 Appendix D 4/03 TI Page 8 of 8 3. Clinical Quality Management Program a. Infection control b. Risk management c. Mortality review