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CorrectCare is published quarterly by the National Commission on Correctional Health Care, a not-for-prot organization
whose mission is to improve the quality of health care in our nations jails, prisons and juvenile connement facilities.
NCCHC is supported by the leading national organizations representing the elds of health, law and corrections.
Care
BOARD OF DIRECTORS
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Features
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NCCHC News
News Watch
Clinical News Brief: Earlier ART
Yields Better Outcomes
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Yields Big Savingsand
Awardin Rhode Island
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Evidence-Based Nursing
Practice: The Time Is Right!
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Departments
CCHP Page
Field Notes
Classified Ads and Ad Index
Standards Q&A
news
Survey Findings Will Help to Bridge
Gaps in Pandemic Flu Assistance
As always, NCCHC is at the forefront in helping correctional facilities to provide high quality health care services.
A current concern for many facilities is how to properly
prepare for and respond to an influenza pandemic. Of great
importance is collaboration with county and state health
departments, which should have the resources to help correctional facilities before and during such an event.
As part of a nationwide effort to improve those relationships, NCCHC recently conducted a survey in cooperation
with the National Association of County and City Health
Officials and the Association of State and Territorial Health
Officials (both are NCCHC supporting organizations). We
sent an e-mail survey to the health administrators of all
NCCHC-accredited facilities asking about health department help in preparing for and responding to a possible
H1N1 flu outbreak, as well as satisfaction with the level of
support they received.
The results will be tabulated in July. The findings, which
we will share with our constituents, will enable NACCHO
and ASTHO to guide their own members in working more
effectively with correctional facilities.
Ca
alendaro
of events
June 26 Accreditation committee meeting
July 10-11 Medical Director Boot Camp, Seattle
July 12-13 Correctional Mental Health Seminar, Seattle
August 22 CCHP examination, multiple regional sites
October 17-21 National Conference on Correctional
Health Care, Orlando
November 20 Accreditation committee meeting
For the complete list of CCHP exams, including the
regional exam sites see www.ncchc.org/cchp.
2
Spring 2009 CorrectCare
www.ncchc.org
Risk Reduction
Visitors who had an influenza-like illness (ILI) in the
previous 7 days or who still have symptoms 7 days after the
illness began should not be permitted to enter the facility.
Inmates and potential visitors should be informed of this.
Staff with ILI should stay home (or be sent home if
they develop symptoms on site) and remain at home for 7
days or until 24 hours after symptoms resolve, whichever is
longer.
If ILI is present, cancel internal group gatherings and
stagger group meals and other activities to provide more
personal space between individuals. Consider temporarily
suspending or modifying visitation programs.
Click on Guidance,
then scroll down to
Clinician Guidance for
Specic Audiences.
Other Recommendations
Recommendations on general preventive measures and
workforce protection are generic in that they would apply
to any health care setting, discussing topics such as hygiene
practices and vaccinations.
Finally, .non-English speaking inmates should be given
educational materials and information that they can understand. If possible, provide a translator when evaluating and
treating persons with symptoms. The CDC H1N1 Web site
offers materials in Spanish and other languages.
3
www.ncchc.org
watch
17% of New Jail Inmates Have Serious Mental Illness
A study of more than 20,000 people entering jail found
that nearly 17% of have serious mental illness, says a recent
report from the Council of State Governments and Policy
Research Associates. Serious mental illness was found
among 31% of women and 14.5% of males, a particularly troubling finding given the growth in the female jail
population and the lack of research on the reasons for this
overrepresentation. Overall, these estimates are three to six
times higher than in the general population, and indicate
that as many as 2 million bookings of people with serious
mental illnesses may occur each year. The study is the most
Tel: 267/927-5000
Fax: 267/927-5007
4
Spring 2009 CorrectCare
www.ncchc.org
Meeting Challenges
Colorado-based Correctional Health Partners (CHP) is proud to announce that it has increased its
services to include the Oregon Department of Corrections. CHP is a clinically enhanced TPA with the
expertise to effectively address and manage the unique challenges inherent in the delivery of healthcare
services to correctional facilities. Our proven cost-containment systems have successfully increased the
efciency, managed the costs, and allowed for the highest quality of care for our clients.
The strong working relationship we have with CHP is unmatched in my experience with contract
agencies. Their staff is highly skilled, motivated, and experienced in managing a healthcare system.
They are consummate professionals who demonstrate their commitment to us and ultimately the
taxpayers. It is a true partnership in managing healthcare for the offender population.
Joan Shoemaker
Director of Clinical Services, Colorado Department of Corrections
We Deliver:
Claims processing
Quality improvement
1.866.932.7185 phone
www.chpnow.com
National Conference on
Correctional Health Care
October 17-21
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For even greater benefitt, attend
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Expploore prprobblelemm-solvinng prroducuctsts aannd services in the exhibiit haall
Im
mmerse your
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Skills Through Competencyy Deve
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AAssurin
Beyonond Diagnossis: The Soul of the Psychopathh
Chestst Pain: Getetinng to the Heart of the Matteteer
Efffecctitivev Corrrectioons Crisis Intervention Training
Esssentials of Corrrectional Juvenile Health Care
Excited Deliriuum and Sudden In-Custody Death
Manangementt of Hypertension and Diabetees
Mananagaing thee DiD ffficult Patient
MRSAA: The Supererbbug of Corrections
Pandeemimc Preppararedednness Plans
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CONTINUING EDUCATION
Up to 322 hours of CE credit may be earned
d in
n eacch ca
cate
tego
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belo
be
low.
w This
hiis ma
m ximum number includes crred
e its offfered
d at
preecon
pr
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coonffere
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Web site for details
CC
CCH
HP
Nurse
Physician
Ps
Psyychologist
Social Worker
General
V si
Vi
sitt th
thee Naati
t onnal
a Conference Web site for detailed information
ti
on,, inncl
on
clud
udin
in
ng registration fees and policies, a schedule of
sess
se
ssio
i ns
ns,, th
thee Preliminary Program and online registration. Or
call us to req
ca
eqque
u st Preliminary Program by mail.
www.ncchc.org
773-880-1460
6
Spring 2009 CorrectCare
www.ncchc.org
affairs
Beware of the Specialists Recommendations
by Robert P. Vogt, JD, CCHP
s a rule of thumb, courts prefer to leave the practice of medicine to those who are educated and
trained in the medical field. Courts will generally
not attempt to second-guess licensed physicians as to the
propriety of a particular course of medical treatment for
a given prisoner-patient. Medical
professionals are not required to provide proper medical treatment to
prisoners, but rather they must provide medical treatment that reflects
professional judgment, practice or
standards. The treatment decisions of
medical professionals are given deference by the courts unless no minimally competent professional would
have so responded under those circumstances.
The cases also hold that the
Constitution is not a medical code mandating that specific
medical treatment must be provided to an inmate. Inmates
do not have a constitutional right to demand a particular
type of medical treatment nor do they have the right to
demand that treatment is provided by a particular type of
specialist. Physicians do not violate the Constitution when,
in the exercise of their professional judgment, they refuse to
implement a prisoners requested course of treatment.
Furthermore, because the practice of medicine remains
an art, judges recognize that [T]here is not one proper
way to practice medicine in a prison, but rather a range of
acceptable courses based on the prevailing standards in the
field. Because several acceptable courses of treatment may
exist to address the same condition, deliberate indifference
does not arise simply because two physicians hold different
opinions on how to properly treat a condition.
continued on page 8
7
www.ncchc.org
Specialist
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(continued from page 7)
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8
Spring 2009 CorrectCare
www.ncchc.org
DRUG INTERACTIONS
Efavirenz: Efavirenz has been shown in vivo to induce CYP3A. Other compounds that are substrates of CYP3A may
have decreased plasma concentrations when coadministered with efavirenz. In vitro studies have demonstrated
that efavirenz inhibits 2C9, 2C19, and 3A4 isozymes in the range of observed efavirenz plasma concentrations.
Coadministration of efavirenz with drugs primarily metabolized by these isozymes may result in altered plasma
concentrations of the coadministered drug. Therefore, appropriate dose adjustments may be necessary for these
drugs. Drugs that induce CYP3A activity (eg, phenobarbital, rifampin, rifabutin) would be expected to increase the
clearance of efavirenz resulting in lowered plasma concentrations.
Emtricitabine and Tenofovir DF: Since emtricitabine and tenofovir are primarily eliminated by the kidneys,
coadministration of ATRIPLA (efavirenz 600 mg /emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg) with
drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of
emtricitabine, tenofovir, and/or other renally eliminated drugs. Some examples include, but are not limited to,
acyclovir, adefovir dipivoxil, cidofovir, ganciclovir, valacyclovir, and valganciclovir.
Coadministration of tenofovir DF and didanosine should be undertaken with caution and patients receiving this
combination should be monitored closely for didanosine-associated adverse reactions. Didanosine should be
discontinued in patients who develop didanosine-associated adverse reactions. Suppression of CD4+ cell counts
has been observed in patients receiving tenofovir DF with didanosine 400 mg daily. Atazanavir and
lopinavir/ritonavir have been shown to increase tenofovir concentrations. ATRIPLA should be discontinued in
patients who develop tenofovir-associated adverse reactions. Coadministration of atazanavir with ATRIPLA is not
recommended. There are insufficient data to support dosing recommendations for atazanavir, with or without
ritonavir in combination with ATRIPLA.
Efavirenz, Emtricitabine and Tenofovir DF: Other important drug interaction information for ATRIPLA is
summarized below. The drug interactions described are based on studies conducted with efavirenz, emtricitabine
or tenofovir DF as individual agents or are potential drug interactions; no drug interaction studies have been
conducted using ATRIPLA. The list includes potentially significant interactions, but are not all inclusive.
Established and Other Potentially Significant Drug Interactions*: Alteration in Dose or Regimen May Be
Recommended Based on Drug Interaction Studies or Predicted Interaction
Antiretroviral agents: Protease Inhibitors Atazanavirr: atazanavir concentration, tenofovir concentration.
Coadministration of atazanavir with ATRIPLA is not recommended. Coadministration of atazanavir with either
efavirenz or tenofovir DF decreases plasma concentrations of atazanavir. The combined effect of efavirenz plus
tenofovir DF on atazanavir plasma concentrations is not known. Also, atazanavir has been shown to increase
tenofovir concentrations. There are insufficient data to support dosing recommendations for atazanavir or
atazanavir/ritonavir in combination with ATRIPLA. Fosamprenavir calcium:amprenavir concentration. Fosamprenavir
(unboosted): Appropriate doses of fosamprenavir and ATRIPLA with respect to safety and efficacy have not been
established. Fosamprenavir/ritonavir: An additional 100 mg/day (300 mg total) of ritonavir is recommended when
ATRIPLA is administered with fosamprenavir/ritonavir once daily. No change in the ritonavir dose is required when
ATRIPLA is administered with fosamprenavir plus ritonavir twice daily. Indinavir:indinavir concentration. The optimal
dose of indinavir, when given in combination with efavirenz, is not known. Increasing the indinavir dose to 1000 mg
every 8 hours does not compensate for the increased indinavir metabolism due to efavirenz.
Lopinavir/ritonavir:lopinavir concentration,tenofovir concentration. A dose increase of lopinavir/ritonavir to
600/150 mg (3 tablets) twice daily may be considered when used in combination with efavirenz in treatmentexperienced patients where decreased susceptibility to lopinavir is clinically suspected (by treatment history or
laboratory evidence). Patients should be monitored for tenofovir-associated adverse reactions. ATRIPLA
should be discontinued in patients who develop tenofovir-associated adverse reactions. Ritonavir:ritonavir
concentration,efavirenz concentration. When ritonavir 500 mg every 12 hours was coadministered with efavirenz
600 mg once daily, the combination was associated with a higher frequency of adverse clinical experiences (eg,
dizziness, nausea, paresthesia) and laboratory abnormalities (elevated liver enzymes). Monitoring of liver enzymes is
recommended when ATRIPLA is used in combination with ritonavir. Saquinavir:saquinavir concentration. Should not
be used as sole protease inhibitor in combination with ATRIPLA.
NRTI Didanosine:didanosine concentration. Higher didanosine concentrations could potentiate didanosineassociated adverse reactions, including pancreatitis, and neuropathy. In adults weighing >60 kg, the didanosine
dose should be reduced to 250 mg if coadministered with ATRIPLA. Data are not available to recommend a
dose adjustment of didanosine for patients weighing <60 kg. Coadministration of ATRIPLA and didanosine
should be undertaken with caution and patients receiving this combination should be monitored closely
for didanosine-associated adverse reactions. For additional information, please consult the Videx/Videx EC
(didanosine) prescribing information.
Other Agents: Anticoagulant Warfarin:orwarfarin concentration. Plasma concentrations and effects
potentially increased or decreased by efavirenz.
Anticonvulsants Carbamazepine: carbamazepine concentration,efavirenz concentration. There are
insufficient data to make a dose recommendation for ATRIPLA. Alternative anticonvulsant treatment should be used.
Phenytoin, Phenobarbital:anticonvulsant concentration,efavirenz concentration. Potential for reduction in
anticonvulsant and/or efavirenz plasma levels; periodic monitoring of anticonvulsant plasma levels should be
conducted.
Antidepressant Sertraline:sertraline concentration. Increases in sertraline dose should be guided by clinical
response.
Antifungals Itraconazole:itraconazole and hydroxy-itraconazole concentration. Since no dose recommendation
for itraconazole can be made, alternative antifungal treatment should be considered. Ketoconazole:ketoconazole
concentration. Drug interaction studies with ATRIPLA and ketoconazole have not been conducted. Efavirenz has the
potential to decrease plasma concentrations of ketoconazole.
Anti-infective Clarithromycin:clarithromycin concentration,14-OH metabolite concentration. Clinical
significance unknown. In uninfected volunteers, 46% developed rash while receiving efavirenz and clarithromycin.
No dose adjustment of ATRIPLA is recommended when given with clarithromycin. Alternatives to clarithromycin, such
as azithromycin, should be considered. Other macrolide antibiotics, such as erythromycin, have not been studied in
combination with ATRIPLA.
Antimycobacterials Rifabutin:rifabutin concentration. Increase daily dose of rifabutin by 50%. Consider
doubling the rifabutin dose in regimens where rifabutin is given 2 or 3 times a week. Rifampin:efavirenz
concentration. Clinical significance of reduced efavirenz concentration is unknown. Dosing recommendations for
concomitant use of ATRIPLA and rifampin have not been established.
Calcium channel blockers Diltiazem: diltiazem, desacetyl diltiazem, and N-monodesmethyl diltiazem
concentrations. Diltiazem dose adjustments should be guided by clinical response (refer to the complete
prescribing information for diltiazem). No dose adjustment of ATRIPLA is necessary when administered with
diltiazem. Others (eg, felodipine, nicardipine, nifedipine, verapamill ): calcium channel blocker. No data are
available on the potential interactions of efavirenz with other calcium channel blockers that are substrates of the
CYP3A4 enzyme. The potential exists for reduction in plasma concentrations of the calcium channel blocker. Dose
adjustments should be guided by clinical response (refer to the complete prescribing information for the calcium
channel blocker).
HMG-CoA reductase inhibitors Atorvastatin: atorvastatin concentration, Pravastatin: pravastatin
concentration, Simvastatin:simvastatin concentration. Plasma concentrations of atorvastatin, pravastatin, and
simvastatin decreased with efavirenz. Consult the complete prescribing information for the HMG-CoA reductase
inhibitor for guidance on individualizing the dose.
Narcotic analgesic Methadone:methadone concentration. Coadministration of efavirenz in HIV-1 infected
individuals with a history of injection drug use resulted in decreased plasma levels of methadone and signs of opiate
withdrawal. Methadone dose was increased by a mean of 22% to alleviate withdrawal symptoms. Patients should be
monitored for signs of withdrawal and their methadone dose increased as required to alleviate withdrawal
symptoms.
Oral contraceptive Ethinyl estradiol:ethinyl estradiol concentration. Clinical significance unknown. Because the
potential interaction of efavirenz with oral contraceptives has not been fully characterized, a reliable method of barrier
contraception should be used in addition to oral contraceptives.
*Please see Full Prescribing Information (Table 4) for additional information; this list is not all inclusive.
ATRIPLA is a trademark of Bristol-Myers Squibb & Gilead Sciences, LLC. EMTRIVA, TRUVADA, and VIREAD are trademarks of Gilead Sciences, Inc.
SUSTIVA is a registered trademark of Bristol-Myers Squibb Pharma Company. REYATAZ and VIDEX are registered trademarks of
Bristol-Myers Squibb Company. Pravachol is a registered trademark of ER Squibb & Sons, LLC. Other brands listed are the
trademarks of their respective owners.
2008 Bristol-Myers Squibb & Gilead Sciences, LLC.
Based on: 21-937-GS-005
ST0062
SF-B0001A-10-08
697US08PBS00202
September 2008
Evidence-Based
Nursing Practice
The Time Is Right!
udging from the response to a recent NCCHC conference session, interest is growing for application of
evidence-based nursing practice (EBNP) in correctional
health care. Speaker Susan Laffan, RN, CCHP-A, considers
this a perfect time to apply the evidence-based approach to
nursing care. The trend toward evidence-based practice is
growing in the nursing profession, says Laffan, a consultant
based in Toms River, NJ. Our, clinical practice should rest
on solid research evidence where possible.
In fact, the origins of the modern nursing profession
in the 1800s with Florence Nightingale included seeds of
EBNP. In her 1861 landmark book, Notes on Nursingg, she
states, The most important practical lesson that can be
given to nurses is to teach them what to observehow to
observewhat symptoms indicate improvementwhich
are of nonewhich are the evidence of neglectand what
kind of neglect.
What Is EBNP?
10
Spring 2009 CorrectCare
www.ncchc.org
Web Site
Location
Comment
www.guideline.gov
Cochrane Collaboration
www.cochrane.org
www.joannabriggs.edu.au
www.rnao.org
Where to Start
Brown suggests starting with clinical issues that arent currently being handled well. Nursing issues with patient
groups that are high volume, consume a significant amount
of time or are not achieving good outcomes are good
places to start, she says. These issues often are identified
through the continuous quality improvement program. A
quality deficit generates an opportunity to pursue better
patient outcomes. The standard of care, the nursing interventions, should be based on available research.
EBN Example: Pressure Ulcer Prevention
Pressure ulcer prevention is an example of a thorny correctional nursing issue that could be improved by adopting
evidence-based interventions. The first step is to identify
the populations that are developing pressure ulcers in your
setting. Then, search the literature for research evidence
relevant to your population. Look first for evidence-based
clinical practice guidelines produced by respected organi-
continued on page 12
Rating
1A
11
www.ncchc.org
Cochrane Collaboration
Research reviews on ...
Surface support for pressure ulcer prevention
Repositioning for pressure ulcer prevention
Wound cleansing for pressure ulcers
Much more
Physicians
Lorry Schoenly, PhD, RN, CCHP, is a clinical education manager with Correctional Medical Services and is based in
Pennsylvania. Contact her at lschoenly@cmsstl.com. She also
hosts an Internet site dedicated to increasing awareness of
correctional nursing practice: www.correctionalnurse.net.
Follow her on Twitter: lorryschoenly.
We have OPPORTUNITIES!
Correctional Medical Services (CMS), is the nation's largest
private provider of contract healthcare services to correctional
facilities. As a Professional Healthcare provider, You have options,
We have opportunities!
We are currently seeking Physicians to fill the following positions:
12
Spring 2009 CorrectCare
www.ncchc.org
Guard against M R SA .
In prison, the last thing
you need is a break out.
Keep costly MRSA and staph infections at bay
with Hibiclens antiseptic skin cleanser
1
Tests 050338-201 and HIB 3-107-10-1. 2Jarvis WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infection Control and Hospital
Epidemiology 1996;17:552-557. 3Study #051120-201. 4Independent Lab Test Time-Kill Study 5 Minutes S. epidermidis ATCC #12228. 52Q06 HPIS data for antimicrobial skin cleansers. The Mlnlycke Health Care,
Biogel, Hibiclens and BARRIER names and logos are registered globally to one or more of the Mlnlycke Health Care Group of Companies. Distributed by Mlnlycke Health Care US, LLC, Norcross, Georgia 30092.
2009 Mlnlycke Health Care AB. All rights reserved. 1.800.843.8497 www.hibigeebies.com
Well-Suited to Corrections
Correctional medicine traditionally has focused on the conservative practice of scientific medicine, so it would seem
that holistic medicine would have no place in the correc-
A Sampling of Programs
In 2003 and 2004, the San Diego County Sheriffs
Department instituted a program for psychiatric patients
incarcerated in its facilities. The goals included identifying
mental health inmates who did not require care by a psychiatrist, treating this population using holistic methods,
reducing the number of patients who required treatment
with mental health medications, increasing the efficacy of
time spent with patients by psychiatrists and decreasing
wait times for patients in need of psychiatric evaluation.
Specially trained registered nurses identified patients who
met the criteria of sleep disturbance, anxiety, substance
abuse concerns and depressive symptoms in patients not
on psychotropic medications. These patients were referred
to mental health clinicians who had completed special
training. The patients also received handouts on improving
sleep and reducing stress.
As reported in the July 2006 issue of the Journal of
Correctional Health Care, a study to assess program outcomes found that approximately half of the inmates initially
seen needed no further follow up after holistic treatment.
A small group did require follow-up visits but were managed without medication. Approximately 30% of the group
required referral to the psychiatrist.
Study findings also showed a significant decrease in the
wait time to see a psychiatrist, as well as the time needed
by the psychiatrist to evaluate the patient. The more efficient use of time by the psychiatrists allowed more time for
the evaluation and care of acutely ill mental health patients.
A number of studies have examined the use of meditation in prisons and jails. One of the most recent was completed by a group from Old Dominion University in Virginia
and published in the January 2009 issue of the Journal of
Correctional Health Caree. The researchers hypothesized that
the use of meditation by inmate populations would be a
cost-effective way for institutions to deal with problems
from insomnia to conflict management. The primary focus
of the study was to determine if participation in a structured meditation program would decrease medical symptoms, emotions and behaviors in a female population.
14
Spring 2009 CorrectCare
www.ncchc.org
16
Spring 2009 CorrectCare
www.ncchc.org
A World of Opportunities
The GEO Group
Group, Inc
Inc. is currently recruiting in California
California,
Florida, Georgia, Louisiana, Mississippi, New York,
North Carolina, Oklahoma, and Texas for
opportunities in healthcare including:
17
www.ncchc.org
hether you think its a step forward or backward, the Supreme Court of Washington State
recently issued a ruling in a case that adds some
clarity to how correctional health care physicians should
deal with hunger strikers. The events in the case, McNabb
v. Department of Correctionss (2005) took place in 2004; the
court heard the case in 2005 and handed down its ruling in
2007.
Mr. McNabb arrived in WDOC from jail after being
sentenced for starting a fire in which family members were
hurt. He had been on a hunger strike for five months and
had lost around 90 pounds upon admission to WDOC;
therefore, WDOC began force feeding the patient via
nasogastric tube. Shortly after beginning force feeding, the
patient volunteered to eat, but brought suit against WDOC
claiming WDOC had violated his right to refuse treatment
under his right to privacy. He asked the court to declare
WDOCs force-feeding policy unconstitutional.
The court concluded that WDOC was correct in force
feeding Mr. McNabb. In arriving at their decision (which
can be viewed at www.courts.wa.gov/opinions/pdf/773599.
no1.pdf), the court did not deny that Mr. McNabb has a
right to refuse artificial nutrition. However, they felt that the
state has a greater interest in force feeding him. Specifically,
they wrote:
the court will weigh McNabbs right to refuse
artificial means of nutrition and hydration against
the existence of five compelling state interests:
(1) the maintenance of security and orderly
administration within the prison system,
(2) the preservation of life,
(3) the protection of innocent third parties,
(4) the prevention of suicide, and
(5) the maintenance of the ethical integrity of the
medical profession.
This is the first time a court has used this particular set of
litmus tests in this combination. However, the component
tests are not new. Indeed, the first test is also known as
the Turner Rule. In Turner v. Safleyy (1987), a case regarding
an inmates right to marry, the U.S. Supreme Court found
that the states interest outweighs the inmates interest
when the state has a legitimate penologic interest to deny
the inmates right. So, for example, if the state felt that
the inmates hunger strike might spread to other inmates,
impairing the states ability to maintain safety and order,
then the Turner Rule would be satisfied. Incidentally, the
risk of a hunger strike spreading is not just theoretical. In
fact, it is what happened in New York DOCS when Mark
David Chapman (sentenced in the death of John Lennon)
stopped eating in protest. The second through fifth tests
were borrowed from another Washington State case
(Welfare of Colyerr, 1983).
Unsettled Question
Whether increased authority on the part of correctional
systems to force feed inmates is a good thing is not a
settled question. That, certainly, is an ethical question for
each of us to ponder. However, from a legal standpoint, at
least, not all courts have agreed with the Washington State
Supreme Court that prison walls separate citizens from
their constitutional rights. At least three state courts have
reached an opposite conclusion (California Supreme Court:
Thor v. Superior Courtt, 1993; Georgia Supreme Court: Zane
v. Prevattee, 1982; Florida appeals court: Singletary v. Costelloo,
1996; all cited in AELE Monthly Law Journall, Jail & Prisoner
Law Section, December 2007).
Finally, the reader should carefully note that all the cases
discussed above concerned inmates who were otherwise in
good physical health. In the case of a patient with a severe
debilitating or terminal disease they would not, and should
not, apply.
18
Spring 2009 CorrectCare
www.ncchc.org
TRUVADA is a once a day backbone for combination therapy in adults with HIV-1
Trea
at HIV confidently
with TRUVADA in
corrrectional facilities
#1
prescribed
NRTI backbone
in
correctional
facilities1
Depend on TRUVADA to
be your partner with PIs
Safety information: drug interactions have been observed between tenofovir DF annd atazanavir or lopinavir/ritonavir. Atazanavir 300 mg should be boosted with ritonavir
100 mg and taken with food when administered with TRUVADA. Atazanavir without ritonavvir should not be coadministered with TRUVADA. Patients on atazannavir or lopinavir/ritonavir
plus TRUVADA should be monitored for tenofovir-associated adverse reactions. TRUVADA shhould be discontinued in patients who develop tenofovir-associateed adverse reactions.2
Indications and usage2
TRUVADA, a combination of EMTRIVA (emtricitabine) and VIREAD
(tenofovir disoproxil fumarate), is indicated in combination with other
antiretroviral agents (such as non-nucleoside reverse transcriptase inhibitors
or protease inhibitors) for the treatment of HIV-1 infection in adults. The
following points should be considered when initiating therapy with TRUVADA
for the treatment of HIV-1 infection:
It is not recommended that TRUVADA be used as a component of a triple
nucleoside regimen
TRUVADA should not be coadministered with ATRIPLA (efavirenz
600 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg),
EMTRIVA, VIREAD, or lamivudine-containing products*
In treatment-experienced patients, the use of TRUVADA should be guided
by laboratory testing and treatment history
WARNINGS
Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases,
have been reported with the use of nucleoside analogs, including VIREAD, a
component of TRUVADA, in combination with other antiretrovirals.
TRUVADA is not approved for the treatment of chronic hepatitis B virus
(HBV) infection, and the safety and efficacy of TRUVADA have not been
established in patients coinfected with HBV and HIV-1. Severe acute
exacerbations of hepatitis B have been reported in patients who are
coinfected with HBV and HIV-1 and have discontinued TRUVADA. Hepatic
function should be monitored closely with both clinical and laboratory
follow-up for at least several months in patients who are coinfected with
HIV-1 and HBV and discontinue TRUVADA. If appropriate, initiation of
anti-hepatitis B therapy may be warranted.
Dosage and administration
Recommended dose: one tablet (containing 200 mg of emtricitabine and
300 mg of tenofovir disoproxil fumarate) once daily taken orally with or
without food
Dose recommended in renal impairment: creatinine clearance (CrCl)
3049 mL/min: 1 tablet every 48 hours. CrCl <30 mL/min or
hemodialysis: do not use TRUVADA
No dose adjustment is necessary for patients with mild renal impairment
(CrCl 5080 mL/min)
Drug interactions
Didanosine (ddI): tenofovir disoproxil fumarate increases ddI concentrations.
Consider dose reductions or discontinuations of ddI if warranted
Atazanavir (ATV): coadministration decreases ATV concentrations and
increases tenofovir concentrations. Use ATV with TRUVADA only with
ritonavir; monitor for evidence of tenofovir-associated adverse reactions
Lopinavir/ritonavir: coadministration increases tenofovir concentrations.
Monitor for evidence of tenofovir-associated adverse reactions
*Combivir (zidovudine/lamivudine), Epivir or Epivir HBV (lamivudine), Epzicom (abacavir
sulfate/lamivudine), or Trizivir (abacavir sulfate/lamivudine/zidovudine).
References: 1. Derived from patient chart audit, Synovate Healthcare Data, US HIV Monitor.r 2008, Q3.
2. TRUVADAA (emtricitabine/tenofovir disoproxil fumarate) Prescribing Information. Gilead Sciences, Inc.
November 2008. 3. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of
antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services.
November 3, 2008; 1-139. Available at: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
Accessed February 3, 2009. 4. Johnson M, Grinsztejn B, Rodriguez C, et al. 96-week comparison of once-daily
atazanavir/ritonavir and twice-daily lopinavir/ritonavir in patients with multiple virologic failures. AIDS.
S
2006;20:711-718. 5. Riddler SA, Haubrich R, DiRienzo AG, et al, for the AIDS Clinical Trials Group Study
A5142 Team. Class-sparing regimens for initial treatment of HIV-1 infection. N Engl J Med.
d
2008;358:2095-2106. 6. Molina J-M, Podsadecki TJ, Johnson MA, et al. A lopinavir/ritonavir-based oncedaily regimen results in better compliance and is non-inferior to a twice-daily regimen through 96 weeks. AIDS
Res Hum Retroviruses.s 2007;23:1505-1514. 7. Young B, Smith K, Patel P, et al. Characterization of virologic
failure over 96 weeks by drug resistance and antiviral response in ART nave patients receiving abacavir/
lamivudine (ABC/3TC) or tenofovir/emtricitabine (TDF/FTC) each with lopinavir/ritonavir QD in the HEAT
study. Presented at: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC)
and the Infectious Diseases Society of America (IDSA) 46th Annual Meeting; October 25-28, 2008; Washington,
DC. 8. Mills A, Nelson M, Jayaweera D, et al. ARTEMIS: efficacy and safety of darunavir/ritonavir (DRV/r)
800/100 mg once-daily vs lopinavir/ritonavir (LPV/r) in treatment-nave, HIV-1-infected patients at 96 wks.
Abstract presented at: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy
(ICAAC). October 25-28, 2008; Washington, DC. 9. Molina J, Andrade-Villanueva J, Echevarria J, et al.
CASTLE: atazanavir-ritonavir vs lopinavir-ritonavir in antiretroviral-nave HIV-1 infected patients: 96 week efficacy
& safety. Abstract presented at: 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy
(ICAAC). October 25-28, 2008; Washington, DC.
Please see brief summary of full Prescribing Information on following page, including boxed WARNING information about lactic acidosis,
severe hepatomegaly with steatosis, and exacerbations of hepatitis B upon discontinuation of therapy.
2009 Gilead Sciences, Inc.
QD1065
04/09
50
Recommended Every
Dosing Interval 24 hours
patients receiving stavudine + lamivudine + efavirenz. Changes in BMD at the hip were similar
between the two treatment groups. In both groups, the majority of the reduction in BMD
occurred in the first 2448 weeks of the study and this reduction was sustained through
144 weeks. Twenty-eight percent of VIREAD (tenofovir disoproxil fumarate)-treated patients vs.
21% of the comparator patients lost at least 5% of BMD at the spine or 7% of BMD at the hip.
Clinically relevant fractures (excluding fingers and toes) were reported in 4 patients in the
VIREAD group and 6 patients in the comparator group. Tenofovir disoproxil fumarate was
associated with significant increases in biochemical markers of bone metabolism (serum bonespecific alkaline phosphatase, serum osteocalcin, serum C-telopeptide, and urinary N-telopeptide),
suggesting increased bone turnover. Serum parathyroid hormone levels and 1,25 Vitamin D
levels were also higher in patients receiving VIREAD. The effects of VIREAD-associated changes
in BMD and biochemical markers on long-term bone health and future fracture risk are
unknown. For additional information, please consult the VIREAD prescribing information.
Cases of osteomalacia (associated with proximal renal tubulopathy and which may contribute
to fractures) have been reported in association with the use of VIREAD[See
[ Adverse Reactions]].
Fat Redistribution: Redistribution/accumulation of body fat including central
obesity, dorsocervical fat enlargement (buffalo hump), peripheral wasting, facial
wasting, breast enlargement, and cushingoid appearance have been observed in
patients receiving antiretroviral therapy. The mechanism and long-term consequences
of these events are currently unknown. A causal relationship has not been established.
Immune Reconstitution Syndrome: Immune reconstitution syndrome has been
reported in patients treated with combination antiretroviral therapy, including TRUVADA.
During the initial phase of combination antiretroviral treatment, patients whose immune
system responds may develop an inflammatory response to indolent or residual
opportunistic infections [such as Mycobacterium avium infection, cytomegalovirus,
Pneumocystis jirovecii pneumonia (PCP), or tuberculosis], which may necessitate
further evaluation and treatment.
Early Virologic Failure: Clinical studies in HIV-infected patients have demonstrated that
certain regimens that only contain three nucleoside reverse transcriptase inhibitors (NRTI)
are generally less effective than triple drug regimens containing two NRTIs in combination
with either a non-nucleoside reverse transcriptase inhibitor or a HIV-1 protease inhibitor. In
particular, early virological failure and high rates of resistance substitutions have been
reported. Triple nucleoside regimens should therefore be used with caution. Patients on a
therapy utilizing a triple nucleoside-only regimen should be carefully monitored and
considered for treatment modification.
ADVERSE REACTIONS
Adverse Reactions from Clinical Trials Experience: Because clinical trials are
conducted under widely varying conditions, adverse reaction rates observed in the clinical
trials of a drug cannot be directly compared to rates in the clinical trials of another
drug and may not reflect the rates observed in practice.
The most common adverse reactions (incidence 10%, any severity) occurring in Study 934,
an active-controlled clinical study of efavirenz, emtricitabine, and tenofovir disoproxil
fumarate, include diarrhea, nausea, fatigue, headache, dizziness, depression, insomnia,
abnormal dreams, and rash. See also full Prescribing Information for the frequency of
treatment-emergent adverse reactions (Grade 24) occurring in 5% of patients treated
with efavirenz, emtricitabine, and tenofovir disoproxil fumarate in this study.
Skin discoloration, manifested by hyperpigmentation on the palms and/or soles was
generally mild and asymptomatic. The mechanism and clinical significance are unknown.
Study 934 - Treatment Emergent Adverse Reactions: In Study 934, 511 antiretroviralnave patients received either VIREAD + EMTRIVA (emtricitabine) administered in
combination with efavirenz (N=257) or zidovudine/lamivudine administered in combination
with efavirenz (N=254). Adverse reactions observed in this study were generally consistent
with those seen in other studies in treatment-experienced or treatment-nave patients
receiving VIREAD and/or EMTRIVA, including diarrhea, nausea, vomiting, fatigue, sinusitis,
upper respiratory tract infections, nasopharyngitis, headache, dizziness, depression,
insomnia, and rash event.
TRUVADA should
not be administered.
CONTRAINDICATIONS
None.
WARNINGS AND PRECAUTIONS
Lactic Acidosis/Severe Hepatomegaly with Steatosis: Lactic acidosis and
severe hepatomegaly with steatosis, including fatal cases, have been reported with the use
of nucleoside analogs, including VIREAD, a component of TRUVADA, in combination with
other antiretrovirals. A majority of these cases have been in women. Obesity and prolonged
nucleoside exposure may be risk factors. Particular caution should be exercised when
administering nucleoside analogs to any patient with known risk factors for liver disease;
however, cases have also been reported in patients with no known risk factors. Treatment
with TRUVADA should be suspended in any patient who develops clinical or laboratory
findings suggestive of lactic acidosis or pronounced hepatotoxicity (which may include
hepatomegaly and steatosis even in the absence of marked transaminase elevations).
Patients Coinfected with HIV-1 and HBV: It is recommended that all patients with
HIV-1 be tested for the presence of chronic HBV before initiating antiretroviral therapy.
TRUVADA is not approved for the treatment of chronic HBV infection and the safety and
efficacy of TRUVADA have not been established in patients coinfected with HBV and HIV-1.
Severe acute exacerbations of Hepatitis B have been reported in patients who are coinfected
with HBV and HIV-1 and have discontinued TRUVADA. In some patients infected with HBV
and treated with EMTRIVA, the exacerbations of Hepatitis B were associated with liver
decompensation and liver failure. Patients who are coinfected with HIV-1 and HBV should
be closely monitored with both clinical and laboratory follow up for at least several
months after stopping treatment with TRUVADA. If appropriate, initiation of antiHepatitis B therapy may be warranted.
New Onset or Worsening Renal Impairment: Emtricitabine and tenofovir are
principally eliminated by the kidney. Renal impairment, including cases of acute renal
failure and Fanconi syndrome (renal tubular injury with severe hypophosphatemia), has
been reported with the use of VIREAD [See Adverse Reactions].]
It is recommended that creatinine clearance be calculated in all patients prior to
initiating therapy and as clinically appropriate during therapy with TRUVADA. Routine
monitoring of calculated creatinine clearance and serum phosphorus should be
performed in patients at risk for renal impairment.
Dosing interval adjustment of TRUVADA and close monitoring of renal function are
recommended in all patients with creatinine clearance 3049 mL/min [[See Dosage and
Administration].] No safety or efficacy data are available in patients with renal impairment
who received TRUVADA using these dosing guidelines, so the potential benefit of TRUVADA
therapy should be assessed against the potential risk of renal toxicity. TRUVADA should not be
administered to patients with creatinine clearance <30 mL/min or patients requiring hemodialysis.
TRUVADA should be avoided with concurrent or recent use of a nephrotoxic agent.
Coadministration with Other Products: TRUVADA should not be coadministered
with ATRIPLA, EMTRIVA, or VIREAD. Due to similarities between emtricitabine and
lamivudine, TRUVADA should not be coadministered with other drugs containing lamivudine,
including Combivir (lamivudine/zidovudine), Epivirr or Epivir-HBVV (lamivudine), Epzicom
(abacavir sulfate/lamivudine), or Trizivir (abacavir sulfate/lamivudine/zidovudine).
TRUVADA should not be administered with HEPSERA (adefovir dipivoxil).
Decreases in Bone Mineral Density: Bone mineral density (BMD) monitoring
should be considered for HIV-1 infected patients who have a history of pathologic bone
fracture or are at risk for osteopenia. Although the effect of supplementation with calcium
and vitamin D was not studied, such supplementation may be beneficial for all patients. If
bone abnormalities are suspected then appropriate consultation should be obtained.
Tenofovir Disoproxil Fumarate: In a 144-week study of treatment nave patients,
decreases in BMD were seen at the lumbar spine and hip in both arms of the study. At Week 144,
there was a significantly greater mean percentage decrease from baseline in BMD at the
lumbar spine in patients receiving VIREAD + lamivudine (3TC) + efavirenz (EFV) compared with
Drugs Affecting Renal Function: Because emtricitabine and tenofovir are primarily
excreted by the kidneys, coadministration of TRUVADA (emtricitabine/tenofovir disoproxil
fumarate) with drugs that are eliminated by active tubular secretion may increase
concentrations of emtricitabine, tenofovir, and/or the coadministered drug. Some examples
include, but are not limited to acyclovir, adefovir dipivoxil, cidofovir, ganciclovir, valacyclovir,
and valganciclovir. Drugs that decrease renal function may increase concentrations of
emtricitabine and/or tenofovir.
USE IN SPECIFIC POPULATIONS
Pregnancy Category B: Emtricitabine: The incidence of fetal variations and
malformations was not increased in embryofetal toxicity studies performed with
emtricitabine in mice at exposures (AUC) approximately 60-fold higher and in rabbits at
approximately 120-fold higher than human exposures at the recommended daily dose.
Tenofovir Disoproxil Fumarate: Reproduction studies have been performed in rats and
rabbits at doses up to 14 and 19 times the human dose based on body surface area comparisons and
revealed no evidence of impaired fertility or harm to the fetus due to tenofovir.
There are, however, no adequate and well-controlled studies in pregnant women. Because animal
reproduction studies are not always predictive of human response, TRUVADA should be used
during pregnancy only if clearly needed.
Antiretroviral Pregnancy Registry: To monitor fetal outcomes of pregnant women
exposed to TRUVADA, an Antiretroviral Pregnancy Registry has been established.
Healthcare providers are encouraged to register patients by calling 1-800-258-4263.
Nursing Mothers: The Centers for Disease Control and Prevention
recommend that HIV-1-infected mothers not breast-feed their infants to
avoid risking postnatal transmission of HIV-1. Studies in rats have demonstrated
that tenofovir is secreted in milk. It is not known whether tenofovir is excreted in human
milk. It is not known whether emtricitabine is excreted in human milk. Because of both the
potential for HIV-1 transmission and the potential for serious adverse reactions in nursing
infants, mothers should be instructed not to breast-feed if they are
receiving TRUVADA.
Pediatric Use: TRUVADA is not recommended for patients less than 18 years of age
because it is a fixed-dose combination tablet containing a component, VIREAD (tenofovir
disoproxil fumarate), for which safety and efficacy have not been established in this age group.
Geriatric Use: Clinical studies of EMTRIVA (emtricitabine) or VIREAD did not
include sufficient numbers of subjects aged 65 and over to determine whether they
respond differently from younger subjects. In general, dose selection for the elderly
patients should be cautious, keeping in mind the greater frequency of decreased
hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Patients with Impaired Renal Function: It is recommended that the dosing
interval for TRUVADA be modified in patients with creatinine clearance 3049 mL/min.
TRUVADA should not be used in patients with creatinine clearance <30 mL/min and in
patients with end-stage renal disease requiring dialysis [See Dosage and Administration].]
NONCLINICAL TOXICOLOGY
Carcinogenesis, Mutagenesis, Impairment of Fertility
Emtricitabine: In long-term oral carcinogenicity studies of emtricitabine, no drug-related
increases in tumor incidence were found in mice at doses up to 750 mg/kg/day (26 times the
human systemic exposure at the therapeutic dose of 200 mg/day) or in rats at doses up to 600
mg/kg/day (31 times the human systemic exposure at the therapeutic dose).
Emtricitabine was not genotoxic in the reverse mutation bacterial test (Ames test), mouse
lymphoma or mouse micronucleus assays.
Emtricitabine did not affect fertility in male rats at approximately 140-fold or in
male and female mice at approximately 60-fold higher exposures (AUC) than in humans
given the recommended 200 mg daily dose. Fertility was normal in the offspring of mice
exposed daily from before birth (in utero) through sexual maturity at daily exposures
(AUC) of approximately 60-fold higher than human exposures at the recommended
200 mg daily dose.
Tenofovir Disoproxil Fumarate: Long-term oral carcinogenicity studies of tenofovir
disoproxil fumarate in mice and rats were carried out at exposures up to approximately 16
times (mice) and 5 times (rats) those observed in humans at the therapeutic dose for HIV-1
infection. At the high dose in female mice, liver adenomas were increased at exposures 16
times that in humans. In rats, the study was negative for carcinogenic findings at exposures up
to 5 times that observed in humans at the therapeutic dose.
Tenofovir disoproxil fumarate was mutagenic in the in vitro mouse lymphoma assay and
negative in an in vitro bacterial mutagenicity test (Ames test). In an in vivo mouse micronucleus
assay, tenofovir disoproxil fumarate was negative when administered to male mice.
There were no effects on fertility, mating performance or early embryonic development when
tenofovir disoproxil fumarate was administered to male rats at a dose equivalent to 10 times
the human dose based on body surface area comparisons for 28 days prior to mating and to
female rats for 15 days prior to mating through day seven of gestation. There was, however, an
alteration of the estrous cycle in female rats.
PATIENT COUNSELING INFORMATION
Patients should be advised that:
TRUVADA is not a cure for HIV-1 infection and patients may continue to experience
illnesses associated with HIV-1 infection, including opportunistic infections. Patients
should remain under the care of a physician when using TRUVADA.
The use of TRUVADA has not been shown to reduce the risk of transmission of HIV-1
to others through sexual contact or blood contamination.
The long term effects of TRUVADA are unknown.
TRUVADA tablets are for oral ingestion only.
It is important to take TRUVADA with combination therapy on a regular dosing schedule to
avoid missing doses.
Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been
reported. Treatment with TRUVADA should be suspended in any patients who develop
clinical symptoms suggestive of lactic acidosis or pronounced hepatotoxicity (including
nausea, vomiting, unusual or unexpected stomach discomfort, and weakness) [See
Warnings and Precautions].]
All patients with HIV-1 should be tested for HBV before initiating antiretroviral therapy.
Severe acute exacerbations of Hepatitis B have been reported in patients who are
coinfected with HBV and HIV-1 and have discontinued TRUVADA.
Renal impairment, including cases of acute renal failure and Fanconi syndrome, has been
reported in association with the use of VIREAD. TRUVADA should be avoided with
concurrent or recent use of a nephrotoxic agent [See Warnings and Precautions].] Dosing
interval of TRUVADA may need adjustment in patients with renal impairment [See
Dosage and Administration].]
TRUVADA should not be coadministered with ATRIPLA, (efavirenz 600 mg/
emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg) EMTRIVA, or VIREAD;
or with drugs containing lamivudine, including Combivir (lamivudine/zidovudine), Epivir
or Epivir-HBV (lamivudine), Epzicom (abacavir sulfate/lamivudine), or Trizivir (abacavir
sulfate/lamivudine/zidovudine) [See Warnings and Precautions].]
TRUVADA should not be administered with HEPSERA (adefovir dipivoxil) [See
Warnings and Precautions].
W
Decreases in bone mineral density have been observed with the use of VIREAD. Bone
monitoring should be considered in patients who have a history of pathologic bone
fracture or at risk for osteopenia [See Warnings and Precautions].]
*Calculated using ideal (lean) body weight.
Gilead Sciences, Inc. Foster City, CA 94404 November 2008
21
www.ncchc.org
on the standards
by Jennifer E. Kistler, MPH
D-02 Medication
Services
(essential)
Medication services are
clinically appropriate
and provided in a timely, safe, and sufficient
manner.
2008 Standards for
Health Services for jails
and prisons
M.D.
SYLVIA,
have verified the medication through the community prescribing clinician or pharmacy. Another option is authorizing nurses to give medications based on the community
clinicians valid order until the facility physician is able to see
the inmate. Some facilities do allow the use of medication
that is brought in if it is contained in the original pharmacy
packaging, labeled as required and staff have verified the
order with the community prescriber or pharmacist.
A physician, dentist or other legally authorized individual
may determine that a prescribed treatment is no longer
clinically indicated or that there is an alternative to a medication that the patient was taking before incarceration. It is
good practice to explain to patients the clinical justification
behind discontinuing or prescribing alternate medication
so that they understand that health care decisions are
made based on their health needs and not for any punitive
reason.
Importance of Continuity
Continuity of care is an important concept in this standard
as it intends to help prevent adverse patient outcomes. For
instance, it may not be possible to maintain a therapeutic
dose of medication unless medications are taken as prescribed. Inordinate delays in receiving clinically indicated
prescription medication may result in significant morbidity or mortality. Adverse patient outcomes can also occur
when there are frequent changes in medication orders,
medication histories are not reviewed by the clinician or
treating clinicians are unaware of each others prescribing
practices.
We all understand the importance of patients continuing
to take medication as prescribed for health conditions such
as high blood pressure or diabetes. There are also many
other prescription medications that could have adverse
health consequences if abruptly discontinued or not taken
in a timely manner; steroids, antidepressants, antibiotics,
and others require strict regimens in order to remain effective or prevent side effects. The facility provider will evaluate the medical necessity of prescriptions for newly admitted inmates to ensure that there is continuity of care and
that health needs are met.
Medication services should, of course, be clinically
appropriate and provided in a timely, safe and sufficient
manner commensurate with current community practice.
Therefore, the responsible physician should establish the
policies regarding all prescription medications administered
or delivered in the facility.
Jennifer E. Kistler, MPH, is NCCHCs director of accreditation. To contact her, e-mail jenniferkistler@ncchc.org, call
773-880-1460 or write to NCCHC, 1145 W. Diversey Pkwy,
Chicago, IL 60614. For an archive of Spotlight articles, visit
the Resources section at www.ncchc.org.
22
Spring 2009 CorrectCare
www.ncchc.org
voice
23
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page
To receive an application
caatio when itt bec
becomes
mes av
available,
e, co
contact
ontactt uus
at cchp@ncchc.org or 773-880-1460.
773-88
0. Also look
ok for updates
ates and
announcements on our Webb site
sitte at www.ncchc.org/cchp.
Seattle, WA
August 1
Bastrip, TXs
August 22
September 16
Sacramento, CA
September 19 & 20
Centennial, CO
October 18
Orlando, FL
24
Spring 2009 CorrectCare
NursingAd CC HalfIsland.ind1 1
12/4/08 5:12:29 PM
www.ncchc.org
notes
This department features news and information from
NCCHCs supporting organizations and other partners that
share our goal of promoting quality health care in correctional institutions. If your organization has news to share,
please contact editor@ncchc.org, 773-880-1460.
American Correctional
Health Services
Association
NCCHC
Standards
www.ncchc.org
www.ncchc.org.
25
6/10/08 7:56:04 AM
Exhibitor Opportunity
Exhibitor Benefits
Kerry Tranfa
ktranfa@infocuslists.com
800.708.LIST (5478), ext 3247
www.InfocusLists.com
Sponsorship Opportunities
Enhance your presence and maximize marketing dollars
through these outstanding opportunities.
Premier programming: Sponsorship of educational sessions on hot topics demonstrates support of the correctional field and gives your company high-profile exposure.
Final proceedings: The CD-ROM provides a lasting record
of concurrent sessions, with abstracts, handouts and
PowerPoints. The sponsor is acknowledged on the cover.
Internet Cafe: Enjoy a high-tech presence by sponsoring
the exhibit hall computer stations, where attendees gather
to check e-mail and browse the Web.
Exhibit Hall reception/luncheon/breaks: These events
enable attendees to meet with exhibitors and network
with colleagues while enjoying refreshments.
Other opportunities: Conference bags, lanyards, water
bottles, badges and banners are all good ways to boost visibility. Have an idea we havent mentioned? Let us know!
Registration Information
The meeting site is Disneys Coronado Springs Resort in
Orlando, FL. Standard booth sizes are 10' x 10'; double-size
and premium spaces are available. For details or to reserve
your space, please see the Exhibitor Prospectus, available at
www.ncchc.org, or contact us at info@ncchc.org or
773-880-1460.
26
Spring 2009 CorrectCare
www.ncchc.org
ads
EMPLOYMENT
Come Join Our Winning Correctional
Health Team, CFG Health Systems
CFG Health Systems, LLC (sister corp.
of Center for Family Guidance, PC) is a
physician-owned and operated behavioral healthcare organization providing a
full range of mental health services. We
offer many diverse career opportunities
with excellent benefits and are currently
looking to place professionals within several correctional facilities in New Jersey or
Pennsylvania:
Physicians (Psychiatry, General Medicine)
Dentists (General Dentistry)
Nurse Practitioners
PhD/RNs/LPNs
Interested candidates please contact:
Physician/Dentists: Frank Zura, Coordinator,
Phone: 856-797-4760, fzura@cfgpc.com
Nurses: Nancy DeLapo, Director, Phone
856-797-4761, ndelapo@cfgpc.com
MARKETPLACE
10% discounts are offered for Academy members (single copies) and for bulk purchases of a
single title. To order, or for an NCCHC catalog,
visit www.ncchc.org or call 773-880-1460.
About CorrectCare
CorrectCaree is the quarterly magazine of the
National Commission on Correctional Health Care.
Its mission is to publish news, articles and commentary of relevance to professionals in the field of
correctional health care.
Subscriptions: CorrectCaree is mailed free of
charge to members of the Academy of Correctional Health Professionals, key personnel at
accredited facilities and other recipients at our
discretion. To see if you qualify for a subscription,
submit a request online at www.ncchc.org or by
e-mail to info@ncchc.org. The magazine is also
posted at www.ncchc.org.
Change of Address: Send notification four weeks
in advance, including both old and new addresses
and, if possible, the mailing label from the most
recent issue. See page 1 for contact information.
Editorial Submissions: Submitted articles may be
published at our discretion. Manuscripts must be
original and unpublished elsewhere. For guidelines,
contact Jaime Shimkus at editor@ncchc.org or
773-880-1460. We also invite letters or correction
of facts, which will be printed as space allows.
ADVERTISER INDEX
Bristol-Myers Squibb / Gilead Atripla ..................Insert, 9
CCHP-Nursing..............................................................................................24
Correctional Health Partners (CHP) ...........................................5
Correctional Medical Services (CMS) ....................................12
Dentrust Dental.............................................................................................4
Geo Group ......................................................................................................17
Gilead Sciences Truvada ........................................................19-20
Hibiclens ............................................................................................................13
InFocus Marketing ...................................................................................26
MHM Services ............................................................................................BC
www.ncchcbuyersguide.com
27
www.ncchc.org
Q&A
Expert Advice on NCCHC Standards
by Jennifer E. Kistler, MPH, and
R. Scott Chavez, PhD, MPA, CCHP-A
Q
A
We perform 15-minute checks on our potentially suicidal inmates. Is this practice in compliance with the
G-05 Suicide Prevention Program standard?
Tuberculosis Screening
Q
A
Q
A
No. A patient may have just had a health assessment prior to being placed in the infirmary, so
an additional history and physical would not be
required. An infirmary order should include the admitting diagnosis, medication, diet, activity restrictions,
diagnostic testing required, frequency of vital sign monitoring and other follow-up (Compliance Indicator 8a).
Admission to and discharge from the infirmary should
occur only on the order of a physician (or other clinician
where permitted by virtue of his or her credentials and
scope of practice).
Jennifer E. Kistler, MPH, is NCCHCs director of accreditation. R. Scott Chavez, PhD, MPA, CCHP-A, is NCCHCs vice
president and liaison to the policy and standards committee.
If you have a question about the NCCHC standards, please
write to info@ncchc.org or call 773-880-1460.
For an archive of past Standards Q&A questions, visit
www.ncchc.org and go to the Resources section. There
you will also find an archive of Spotlight on the Standards
columns. These articles shed light on the nuances of various
standards, explaining the rationale behind them, the intended outcomes, compliance concerns and the impact on the
accreditation process.
28
Spring 2009 CorrectCare
www.ncchc.org
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