Policy for the Storage and Administration of Medication in Custody Suites

Not Protectively Marked Policy for the Storage and Administration of Medication in Custody Suites Policy Reference No. P22:2000 Portfolio Holder Assistant Chief Constable Policy Owner Superintendent Donnell Owning Department Criminal Justice Division Approved at SOPG Approval Date 16/01/01 Authorised by Chief Constable Implementation Date 01/03/01 Review Date 01/10/06 Protective Marking Not Protectively Marked Version Date Reason for Change Amended by 1.0 16/10/00 Initial Document 1.1 29/12/00 Consultation Mr N K Girdler 1.2 29/11/04 Reformatting Ms M Ashdown 1.3 19/9/05 Amendments Miss L Whittle

1. POLICY AIM From time to time persons coming into police custody will have with them medication prescribed to them for treatment of a condition or illness from which they are suffering. On occasions persons, while detained, will need the services of a police surgeon and examination may result in medication being prescribed for that detainee. The purpose of this guidance is to set out precisely how, once prescribed, medication will be stored and dispensed. It will also give clear direction as to the storage and auditing of the supplies of medication kept in the three 24 hour custody suites at Bournemouth, Poole and Weymouth, and arrangements for the disposal of unused medication. The aims of the policy are: To provided a safe regime for the administration of medication To ensure that correct medication is given To ensure records are kept of all medication administered To ensure unused medication is accounted for. 2. RATIONALE/LEGAL BASIS The Force has adopted the principles from the guidelines for forensic physicians and custodians entitled, The Safety and Security of the Administration of Medication in Police Custody prepared by the Association of Forensic Physicians in consultation with the Association of Chief Police Officers as force policy and a statement of best practice on the subject. This procedure is to be applied in conjunction with, and not in substitution for, any instructions contained in Code C of the Codes of Practice on the detention and treatment of detained persons made under the Police and Criminal Evidence Act 1984. 3. LEGISLATIVE and RISK CONSIDERATIONS Human Rights Act 1998 This policy has been drafted with the Human Rights Act 1998 taken into consideration Race Relations Amendment Act and Disability Discrimination Act This policy has been drafted with Diversity Policy and the Race Equality Scheme taken into consideration Freedom of Information Act The whole of this policy document is suitable for release to the public

Health and Safety This policy has been drafted with Health and Safety legislation and guidance taken into consideration Anti Corruption This policy has been drafted with risk to integrity and unethical conduct taken into consideration 4. POLICY 4.1 Introduction 4.1.1 All Police Officers and Detention Officers will comply with the Instructions to Custodians contained within the Guidelines The Safety and Security of the Administration of Medication in Police Custody (a copy of which will be issued to each officer individually), save as varied by this policy. 4.1.2 Central to the management of the procedure are the Medication Schedule, Form P33 (MS), and the printed plastic envelopes which are to be used to contain all medication. 4.1.3 When medication is prescribed the required details will be recorded in the medication schedule by the prescribing police surgeon. The medication will be placed into the plastic envelope and the details on the outside completed by the police surgeon before being handed to the custody officer. 4.1.4 In this way there will exist a complete record of both the medication itself, the frequency with which it is to be administered and details of administration, together with instruction as to the disposal of the medication when the detainee leaves police custody. 4.1.5 The Medication Schedule forms part of the Custody Record and must not be detached from it. 4.1.6 The requirement for the Police Officer or Detention Officer administering the medication to be accompanied by another officer as witness will be complied with wherever possible. Where circumstances do not allow a second officer to be present the administering officer must obtain the authority of the custody officer before administration takes place. 4.1.7 On occasions medication prescribed to a detainee may require administration of an intimate nature, for example the application of ointment or the use of a suppository. In such cases the requirement to observe the medication being taken to prevent hoarding may not be necessary. If however the administering

officer considers, in all the circumstances, that it is necessary to observe the detainee while such medication is applied that decision must be fully documented in the detention log. 4.2 Procedure for Detainee in Possession of Medication Prescribed Prior to Detention 4.2.1 If, when brought to a custody suite, a detainee is in possession of medication that they must take, or apply, in compliance with medical direction, a Police Surgeon must be consulted forthwith and approval obtained for the medication to be administered by the custody officer. If the medication is in the form of loose tablets, pills or capsules they must not be administered unless they have been examined by a police surgeon to confirm their authenticity. 4.2.2 The administration details must be entered on form P33(MS) and the medication transferred to the plastic envelope, which will be appropriately completed by the Police Surgeon. 4.2.3 On no account will medication of any description be administered to a detained person without the express authority of a police surgeon, which must be recorded in the detention log. 4.3 Procedure for Detainee for Whom Medication Has Been Prescribed by a Police Surgeon 4.3.1 If, following examination by a Police Surgeon, it is deemed necessary that a detainee should have medication prescribed the following procedure will be followed. 4.3.2 The Police Surgeon will complete the required details in the P33(MS) Medication Schedule and on the outside of the plastic medication envelope. 4.3.3 If the medication is supplied from stock held at one of the 24 hour custody suites the register held in the secure cabinet will be completed by the Police Surgeon who will enter the date, the name of the detainee and their custody number, together with the quantity of medication withdrawn. 4.3.4 If the required medication is supplied by way of prescription from a local pharmacy it will nevertheless be placed in the plastic envelope when received in the custody suite. 4.4 Procedure for Storage of Prescribed Medication 4.4.1 Prescribed medication will only be kept in the printed plastic envelopes provided and no other container. 4.4.2 The envelope will be stored in the secure area of the custody suite designated for the storage of that detainee s property and will be locked away, except and

until access is required to it for the purpose of it being dispensed to the detainee. 4.4.3 Administration of medication to detainees will be carried out strictly in accordance with the AFP Guidelines. 4.5 Procedure for Storage of Supplies of Medication Held at 24 Hour Custody Suites 4.5.1 Stocks of commonly required medication are held in secure, lockable, cabinets situated in the medical rooms of the three 24 hour custody suites at Bournemouth, Poole and Weymouth. The following procedure will apply: 4.5.2 Each type of medication will be listed on a separate record sheet. 4.5.3 Access to the cabinet will be by key held by the Police Surgeon. 4.5.4 Whenever medication is withdrawn from the cabinet the Police Surgeon responsible will make an entry in the record sheet for the drug concerned showing the date, the name of the detainee, the custody record number, the amount of drugs withdrawn and the total of that drug left in the cabinet. The maker of the entry must sign each entry legibly. 4.5.5 Completed record sheets will be held by the Police Surgeon Administrator. 4.6 Procedure for Restocking and Audit of Supplies Held at 24 Hour Custody Suites 4.6.1 Responsibility for the restocking of the cabinet with necessary medication will be that of the Police Surgeons serving that particular custody suite. 4.6.2 When new stock is required the Police Surgeon will write the appropriate prescription and the medication will be obtained by the police. 4.6.3 New stock of medication will be placed in the cabinet by the Police Surgeon and recorded in the record sheet in the appropriate column. The entry will also show the date and the total of the drug then held in the cabinet. The Police Surgeon making the entry must sign it. 4.7 Procedure for Disposal of Unused and Out of Date Medication 4.7.1 When prescribing medication the Police Surgeon will indicate on the plastic envelope how that medication is to be disposed of in the event it is unused when the detainee leaves police custody. If the police surgeon gives no, or unclear, instructions the medication will be destroyed. The procedure for destruction is as follows: 4.7.2 Bournemouth, Poole and Weymouth

4.7.3 The officer destroying the medication must be accompanied by another officer to witness the destruction. 4.7.4 The unused medication contained within the plastic envelope will be placed in the dedicated disposal box provided. 4.7.5 Only prescribed medication and attendant packaging may be disposed of in this box. No other drugs, sharps or hazardous waste are to be placed in this bin. 4.7.6 The details of the medication disposed of will be entered in the P33(MS), noted in the detention log and signed by both officers. 4.7.7 Once removed from the secure cabinet and prescribed to a detainee on no account will unused medication, in the form of loose tablets, pills or capsules be returned to stock. 4.7.8 The Police Surgeon Administrator will be responsible for removing medication from the disposal bin, in the presence of the Custody Officer, wherever possible. This will take place in conjunction with the monthly audits of the medication cabinets. The medication will be treated as POTF and handed to the Property Store for destruction. 4.7.9 All other Custody Suites 4.7.10 The quantity of medication to be destroyed is likely to be minimal and does not warrant the provision of a disposal bin. 4.7.11 When medication is to be disposed of it will be taken to a local pharmacy for disposal. The officer taking it will make an appropriate pocket book entry and request a member of the pharmacy staff to endorse that entry. Details of the disposal will be entered in the P33(MS) Medication Schedule and signed by the officer who made it, and by their supervisor. 4.8 Out of Date Medication 4.8.1 On no account may medication be prescribed or administered to detained persons if the shelf life has expired. It can be assumed that all medication, in the form of loose tablets, pills or capsules obtained direct from a pharmacy for immediate administration to a detainee is not beyond its shelf life. The expiry date of medication supplied in blister or foil packs, bottles, sprays or tubes must be checked prior to administration. 4.8.2 Stocks of medication held at the three 24 hour custody centres must be checked regularly by the relevant Police Surgeon. 4.8.3 Any medication at the end of the shelf life recommended by the manufacturer will be destroyed.

4.8.4 The Police Surgeon carrying out the check will make an entry in the record sheet and hand the medication to the custody officer for witnessed destruction to be carried out. 4.9 Procedure for Auditing Contents of Medication Cabinets 4.9.1 It will be the duty of the Police Surgeon Administrator to carry out an audit of the stocks of medication held at each of the 24 hour custody centres not less than once in every month. 4.9.2 The audit will, wherever possible, be carried out in the presence of the Custody Officer who will countersign each Record Sheet. If the check reveals medication which is beyond its shelf life it will be immediately removed from the cabinet and destroyed in accordance the instructions above. 4.9.3 Any discrepancies in the stock will be notified immediately to the Custody Manager. 4.10 Appendices 4.10.1 Appendix A Association of Police Surgeons guidance - The Safety and Security of the Administration of Medication in Police Custody. 4.10.2 Appendix B P33(MS) Medication Schedule. 4.10.3 Appendix C Medication Cabinet Record Sheet. Name Signature Date Prepared: Mr N K Girdler 16/10/00 Quality assured: Chief Inspector G Donnell 30/10/00 HRA compliance: Sergeant S Strickland 30/11/00 Authorised: Superintendent M Summers 30/11/00 Approved: (Chair, Policy Group) 16/01/01

4.10.1 Appendix A THE SAFETY AND SECURITY OF ADMINISTRATION OF MEDICATION IN POLICE CUSTODY Revised June 2004 by the Education and Research Committee of the Association of Forensic Physicians Original produced by Dr Jo Howitt and Dr Vicky Evans, November 1997 AIM FOR A SAFE REGIME When non-medical police custodians are asked to administer medication it is particularly important to ensure that: The correct medication is given at the right dose; to the intended detained person (DP); and at the appropriate time; Record keeping is accurate; Instructions for administration are understood; Unused medications are accounted for. THE FP S ROLE The overriding consideration of the attending FP is the clinical safety and well being of the detained person (DP). The administration of medication is the responsibility of the prescribing doctor; therefore, the FP must be satisfied that it is safe for the police to perform this role. The standards of medical treatment should be as good for a detained person as for anyone else who is not detained. Prescribed medication regimes should be continued in custody when appropriate and possible. However, medication should not be given, or given at a higher dose, if this is considered unsuitable or bad practice. Careful consideration should be given to both risks and benefits prior to providing medication to any DPs who are under the influence of drugs, including alcohol. Medication should be prescribed, when possible and appropriate, for the duration of the time the DP is expected to spend in police custody (and, where applicable, in court). All doctors must comply with the Misuse of Drugs Act 1971, the Misuse of Drugs Regulations 1985 and Pace Codes of Practice with respect to controlled drugs. Always remember to confirm that the DP does not have an allergy to the treatment proposed, including dressings and plasters. The FP should be confident that any medications dispensed are in date, in good condition and have a recordable batch number. The FP should keep their own record of each medication authorised, the batch number and the expiry date. Drugs for the doctor s bag should be obtained from a pharmacist and ideally the same source should be used regularly.

HOW MEDICATION MAY BE SUPPLIED Medication may be: Provided by the police, held in a locked medical cupboard within the medical room; Provided by FPs from their medical bag; Collected by the police via private prescription issued by the FP (on headed notepaper); Brought in by DP, friend/relative or by police from an address (in these cases medication must be checked by FP before it is administered). TABLET BAGS (e.g. Henley tablet bags supplied by the police) Ideally plastic self-closing small tablet bags with printed labels should be used when FPs leave medication. Label each bag with name of DP, prescribing doctor, medication name and strength and quantity (number of tablets/capsules) required at stated times. It is strongly advised that separate bags should be used for each different medication supplied to a DP, but it is permissible to combine all the drugs due at the same time in one bag if this is deemed to be in the best interests of the detainee. If different drugs are supplied in the same bag the FP must ensure that: a) the bag is labelled with all the information listed above for each of the drugs in the bag; b) consideration is given to any potential interaction between the products being supplied in the same bag to ensure that no degradation occurs; c) certain medications are not placed in the bags (i.e. the following should not be included effervescent tablets, dispersible tablets, buccal tablets, sublingual tablets, significantly hygroscopic preparations and solid dose cytotoxic preparations); d) clear instructions are left for the custody staff to seek guidance from the FP should the detainee indicate that he or she does not wish to take one of the drugs in the bag (e.g. a painkiller). Custody staff should not attempt to remove the unwanted drug themselves without seeking guidance. Liquid medication should be clearly labelled and a measuring spoon or cup provided. INSTRUCTIONS TO CUSTODY STAFF Must be written, clear and unambiguous. The FP should confirm that instructions are understood. The FP should be informed if the DP refuses the medication and this should be recorded in the custody record. Instructions should include: a) name of DP, prescribing doctor, medication name and strength and quantity (number of tablets/capsules) required at stated times; b) special instructions e.g. with/without food;

CUSTODY STAFF c) disposal of medication if unused (DP released / transferred or refuses to take medication). Only after authorisation by the FP may the custody staff administer medication (but not Class A controlled drugs). Two police (or civilian) officers should administer medication, one as witness, to: a) check that correct medication is given to the right DP at the appropriate time; b) observe the DP taking the medication (to avoid hoarding); c) record that medication has been given (or refused) on the custody record (medication form); d) ensure compliance with the disposal of unused medication is also recorded on the medication form. The custody officer is responsible for the safekeeping of all medication, which should be held in a locked receptacle to prevent unauthorised access. The custody officer is also responsible for ensuring that the DP is given the opportunity to take or apply medication, which the FP has approved. Medication and instructions (via medication form) may need to travel with DP (via escort service) if transferred to court or another police station. In some Constabularies (unless there are exceptional circumstances) asthma inhalers and angina sprays are retained by the DP (after having been checked to exclude tampering or concealed other substances). The FP should be contacted and informed about this. Only on medical advice should other medication be left with the DP. Only on the advice of the FP should medication be given to DP to take home. UNUSED MEDICATION There will be times when medication is not used because the DP is to be released/transferred before dose is due or DP may refuse to take medication offered. A pharmabin should be provided for the safe disposal of unused prescribed medication; arrangements should be made for the providing company to collect and replace it on a regular basis. For clarity and to avoid accusations of unauthorised use, the FP should advise, in each case, what should be done with this spare medication and the police should record compliance on the custody record (medication form): a) to be given to DP on release; b) to be given to escort service (travel with FP); c) to be returned to FP or medical safe in the FP room; to be disposed of in a pharmabin.

4.10.2 Appendix B DORSET POLICE P33(MS) (1/01) MEDICATION SCHEDULE (To be completed by Police Surgeon) Detainee s full name: Custody Record No:.. (Please write clearly, in layman's terms and without the use of abbreviations) Medication Dose Frequency 1. 2. 3. 4. Signed (Doctor) Date MEDICATION ADMINISTRATION RECORD (To be completed by Police) Medication 1 Medication 2 Time Required Time Given Officer(s) Date Time Required Time Given Officer(s) Date Medication 3 Medication 4 Time Officer(s) Date Time Given Required Time Required Time Given Officer(s) Refusal by the detainee to take medication, or any other occurrence, must be fully documented in the Detention Log THIS FORM MUST BE ATTACHED TO THE P33 AND KEPT WITH THE CUSTODY RECORD

4.10.3 Appendix C DORSET POLICE - Medication Cabinet Record Sheet (One entry per line each line must be signed) Name of Drug - Strength - Type - Date Name of Detainee Custody Record No: Number withdrawn New Stock in Total now in cabinet Signature of Police Surgeon or Custody Officer