Page 23 - Delaware Medical Journal - April 2016

PUBLIC HEALTH
PHARMACEUTICAL SUPPORT
In keeping with the philosophy of approximating within the security constraints and public safety the medical care a person could readily access if they were not incarcerated, the Bureau has contracted with a pharmaceutical services provider to supply the medications needed to treat the offender’s medical needs. The Bureau has designated the State of Delaware Medicaid Preferred Drug List (PDL) as the formulary for the Department. As such, every medication can be available to an offender within the Scope of Care for the facility. In addition, the pharmaceutical services provider employs Clinical Doctors of Pharmacy (PharmD) pharmacists who consult with the medical services contract provider’s Physicians and Nurse Practitioners to optimize the medication treatment for the offenders.
ELECTRONIC HEALTH RECORD
In January 2014 the Bureau and a software developer began development of an electronic health record known as iCHRT. The electronic health record is a module of the Department’s electronic demographic system of offender information known as the Delaware Automated Computer System (DACS). As
a web-based program able to run on computers or iPads, it
has numerous automated scheduling features, longitudinal records of intake screening, continuity of care medical and behavioral health visits including dental care, and prescription order-entry with a direct interface with the pharmaceutical contract provider Correct Rx’s computers. iCHRT will have the ability to interface with the Delaware Health Information Network (DHIN) with the future development of uploading offender discharge summaries for continuity of care with the community medical and mental health professionals after an offender’s release.
CLINICAL EDUCATION OPPORTUNITIES
The Bureau of Correctional Healthcare Services actively supports higher education with Memoranda of Agreements (MOA)
with multiple academic centers. These MOAs provide clinical experience for Advanced Practice Nursing students from Acadia University; Advanced Practice Nursing and Registered Nurse students from the University of Delaware, Wilmington University, Temple University, and Widener University; Physician Assistant students from the University of Maryland Eastern Shore; and the Nursing Assistant program at PolyTech Adult Education Center.
CONTINUOUS QUALITY IMPROVEMENT PROGRAM
The Continuous Quality Improvement (CQI) Program consists of two arms; the medical services contract and the pharmaceutical services contract providers each have their proprietary CQI programs which they report to the Bureau on a periodic basis.
In addition, the Bureau conducts a separate CQI program in its oversight capacity that validates some of the data of the provider CQI but also has distinct audits within the Bureau. The results of these programs and corrective action plans, when necessary, are discussed frequently.
The Bureau has both a Morbidity & Mortality (M&M) Review of all natural deaths, suicide attempts, and completed suicides and an Adverse Clinical or Near-Miss Sentinel Event Review for situations that are not reviewed by an M&M Review but may offer opportunities to improve the medical care to offenders. These reviews are held under the peer-review process and are not available for public disclosure to ensure the integrity of the review process in accordance with Title 10 U.S.C., Section 1102 and Delaware Code.
ACCREDITATION AND OVERSIGHT
The medical units of each Level 4 and Level 5 facilities are accredited by the NCCHC as of the Spring of 2013 with the next round of audits scheduled to occur in 2016. The Department is also preparing for accreditation by the ACA. The ACA audit of the Administration Building has been awarded and the individual site audits began in November 2015. All correctional facilities must comply with the Standards of the Prison Rape Elimination Act (PREA) compliance audit directed by Federal Regulations and the Department has completed nine of the 11 facility audits to date and will complete the remaining sites in 2016.
Extra-departmental oversight of the Bureau of Correctional Healthcare Services (BCHS) is provided by the Adult Correctional Health Review Committee (ACHRC) whose members are appointed by the Governor to review the health care programs and contracts administered by the Bureau.
CONTRIBUTING AUTHOR
■ VINCENT F. CARR, DO, FACP, is the Medical Director of the Delaware Department of Correction.
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