PRN Medication Administration Within Correctional Facilities

PRN medication administration presents a unique set of challenges in Correctional Facilities. Working within the confines of the Department of Corrections regulations, (hereafter known as DOC), the limitations set by the physical environment, subjectivity, manipulation, the prison culture in general, all of these obstacles create an environment that can be difficult in providing symptom management to Inmates. Of particular concern, is the management of pain. Chronic health conditions, acute illness, or surgical procedures, all predispose the Inmate to pain. Since medication administration times are strictly scheduled, obtaining medication for "breakthrough" pain is difficult. Opiod analgesics, such as codeine, are frequently utilized. While the abuse liability is high, the maximal pain relief is low; additionally, without the ability to administer the drug on a prn basis, Inmate’s symptoms are poorly controlled. Stronger opioids were not stocked in medical units. There is a delay in procurement of Class II narcotics which in turn, creates an environment where pain is uncontrolled, subsequently taking twice as much time and repeated doses of medication to manage a symptom that could have easily been managed had the medication been administered within the appropriate time frame. What I frequently found were the medications that the inmates were permitted to "Keep on Person" (hereafter known as KOP) were abused in an attempt to control unrelieved pain. Those medications, usually Acetaminophen, Ibuprofen, Ultram, even Diphenhydramine, were utilized in excess since the pain medication was not being administered within the suggested time frame. This in turn created issues with disciplinary action to the Inmate for abusing KOP privileges, loss of ability for the Inmate to manage even his/her minor pain, creating an atmosphere on non-compliance directed toward the Inmate, and perpetuated a negative feedback cycle with no possible resolution. And in the end, pain was unrelieved. If we as Clinicians are to effectively treat pain, proper administration of medication is mandatory.

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2 Responses to “PRN Medication Administration Within Correctional Facilities”

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