MICHAEL D. CREWS
SECRETARY
PROCEDURE NUMBER: 403.007
PROCEDURE TITLE:
MEDICATION ADMINISTRATION AND
REFUSALS
RESPONSIBLE AUTHORITY: OFFICE OF HEALTH SERVICES
EFFECTIVE DATE:
APRIL 8, 2014
INITIAL ISSUE DATE:
APRIL 26, 2001
SUPERSEDES:
NONE
RELEVANT DC FORMS:
DC4-701, DC4-701A, DC4-701L, DC4-711A, DC4-714B,
AND DC4-714C
________________________________________________________________________________
ACA/CAC STANDARDS: 4-4378 AND 4-4401
STATE/FEDERAL STATUTES: NONE
FLORIDA ADMINISTRATIVE CODE: RULES 33-401.105 AND 33-602.210, F.A.C.
Procedure 403.007
PURPOSE: To provide uniform guidelines for the administration of single-dose medications and
specified missed medication in an orderly and efficient manner.
DEFINITIONS:
(1) Keep-on-person Medication refers to medication kept by the inmate after being prescribed
by the clinician and issued by nursing staff for the number of doses specified in the
prescription.
(2) No-show refers to the failure of an inmate to report to the medication window for a
medication appointment.
(3) Single-dose Medication refers to the process for the administration of medication during
which nursing staff issues medication by unit or single-dose and observes the inmate as the
medication is taken.
________________________________________________________________________________
SPECIFIC PROCEDURES:
(1) Inmates will be provided information related to the dispensing and administration of
medication during initial orientation at the reception centers and subsequently at permanent
institutions by the nurse providing the orientation. The prescribing clinician will advise the inmate
who is prescribed single-dose medication of the times that the inmate is to report to the medication
window.
(2) Every effort will be made to designate a minimum of two (2) single-dose administration times.
Direct-observed therapy of single-dose medication is most efficiently administered through the
medication window by a Nurse.
(a) Psychotropic and non-psychotropic medications will be administered at the same location
using the same nursing staff.
(b) Single-dose administration times will be established by the institution. The institution will
establish a specific time for administering morning and afternoon medications at the
medication window. Prescriptions will be written for daily or twice daily dosing but time
adjustments can be made by the prescribing provider for medications with specific
administration criteria, such as those that are time sensitive or meal related. The clinician
will indicate the time of administration within the medical order if s/he believes it to be
clinically significant and necessary. Security staff will be present at the medication
window at all times when single-dose medication is being administered to an inmate.
1. All medication transcriptions to the Medication Administration Record (MAR) are to
include the specific time(s) a medication is to be administered if such administration
times have been indicated by the clinician or they will default to the time as noted in
section (2)(b) above. This time will be documented using military time. (Example:
Bactrim DS one [1] tablet p.o. b.i.d. MAR times: 0600 and 1800.)
2. Every effort should be made to administer medications within thirty to sixty (30-60)
minutes of the MAR administration time. If a medication is administered greater than
sixty (60) minutes past its administration time, the actual time it is given should be
2
Procedure 403.007
noted on the front page of the MAR along with an explanation for the lateness, e.g.,
“Repeat dorm count had to be done by security,” on the back page of the MAR.
(c) Nursing staff will ensure inmates sign for keep-on-person medication received on a
duplicate label which is placed in a medication receipt log. Keep-on-person medications
must remain in the labeled package dispensed by the pharmacy and medication must be
taken by the inmate as directed on the label. Each label contains an expiration date for the
prescription and the medication will be considered contraband on the tenth (10th) day past
the expiration date. Security staff may confiscate medication that is ten (10) days past the
labeled expiration date and return it to the medical staff for disposition.
(d) There is no general requirement for medications to be crushed or floated. A clinician’s
order is needed to crush or float a medication.
(e) Medications may be pre-poured as long as they are administered by the person who prepoured the medication. Medications may not be pre-poured for other shifts, days, or
personnel. Medications will be documented on the “Medication and Treatment Record,”
DC4-701A, at the time they are poured. Each dose of medication not administered will be
circled and an explanation written on the back of the DC4-701A.
(f) Registered Paramedics may give emergency medications in a code situation under the
direct supervision of a clinician.
(3) NO-SHOWS: No-shows at the medication window will result in the following actions:
(a) At the end of scheduled single-dose medication administration, a list of inmates who have
failed to appear will be documented on the “No Show Call Out Log,” DC4-701L, by the
medication nurse(s) and delivered to the security officer assigned to medical or Shift
Supervisor. An inmate’s no-show and action taken (including the name of the security
officer notified of the no-show) will be documented on form DC4-701A, by nursing staff.
(b) The Shift Supervisor will ensure the inmates listed on the DC4-701L are located and
ordered to report immediately to the clinic.
1. No-shows at the medication window will be considered a tacit refusal of single-dose
medication, with the exception of HIV, insulin, and INH medication. The DC4-701A
will reflect a refused dose of medicine and a comment reflecting the no-show will be
made in the comments section.
2. Exceptions to no-shows at the medication window will be handled on an individual
basis as determined by the medication nurse(s) as directed by the clinician.
Counseling/education related to the problem(s) resulting from non-adherence with the
medication will be provided to the inmate by the staff nurse and documented on the
DC4-701A.
(c) Any inmate who fails to report to the medication window may be charged with disobeying
a verbal/written order to report for medication administration. Disciplinary action and
preventative disciplinary action in such cases will be taken in accordance with Rules 33601.301 through 33-601.314, F.A.C., as circumstances require.
3
Procedure 403.007
(4) MEDICATION REFUSALS:
(a) Inmates who refuse a dose of medication may do so verbally upon presenting to the
medication window. The DC4-701A will be noted as a refused dose of medication and
documentation of the appropriate medication counseling will be made in the comments
section of the DC4-701A. A “Refusal of Health Care Services,” DC4-711A, will not be
signed for each dose of medication refused.
(b) Any inmate who has refused either three (3) consecutive doses of a medication or five (5)
doses over the course of one (1) month will be required to sign a DC4-711A and will be
referred to the prescribing clinician. If the medication refusal will put the inmate’s health
at risk, the nurse will immediately notify the clinician. The prescribing practitioner will do
the following:
1. either continue or discontinue the prescribed medication using the “Physician’s Order
Sheet,” DC4-714B, and the “DEA – Controlled Substances Physician’s Order Sheet,”
DC4-714C;
2. make an entry in the “Chronological Record of Health Care,” DC4-701, reflecting the
decision to continue or discontinue the medication(s), and rationale for the decision;
3. request that nursing staff educate the inmate on the necessity to continue medication at
the time of refusal and document the request on the DC4-701A; and
4. complete a “Refusal of Health Care Services,” DC4-711A. The medication will not
be offered by nursing personnel based on the completion of the DC4-711A. The
completed DC4-711A, along with the chart, will be forwarded to the clinician for review
and further clinical disposition. This review will be documented on the DC4-701 in
chronological order.
(c) If an inmate states s/he no longer wants to take the medication and will refuse all future
doses:
1. a DC4-711A will be completed including appropriate medication counseling;
2. the inmate will no longer be required to report to the medication window, with the
exception of inmates being treated for Latent Tuberculosis Infection; and
3. a Physician referral will be made requiring the same documentation as stated in
section (4)(b) of this procedure.
(d) An inmate is no longer required to report to the medication window when the practitioner
discontinues medication.
(5) SPECIAL HOUSING:
(a) Inmates in special housing will be allowed to have keep-on-person medication in their
cells and self-administer as prescribed. Special circumstances will be addressed
individually.
(b) Single-dose medications will be taken to the special housing unit(s) and administered by
nursing staff. A “no-show” will not occur in special housing.
(c) Inmate refusal of medication will be addressed using the process identified in section (4)
above.
4
Procedure 403.007
(6) The administration of psychotropic medications by a clinician without an inmate's informed
consent will be restricted to emergency situations, described in Health Services Bulletin 15.05.19,
“Psychotropic Medication Use Standards and Informed Consent.”
(7) Staff will ensure that uses of force to administer medication are documented in accordance with
Rule 33-602.210, F.A.C.
___/S/_____________________________
Secretary
5