North Dakota Department of Corrections & Rehabilitation

1. North Dakota Department of Corrections & Rehabilitation Correctional Medical Training I CMT I Course

2. Jo Ann Sund, RN Constance B. Kalanek PhD, RN November 16, 2007 November 16, 2007 NORTH DAKOTA BOARD OF NURSING CERTIFICATE OF APPROVAL Medication Assistant Program I Offered by NORTH DAKOTA DEPARTMENT OF CORRECTIONS AND REHABILITATION BISMARCK, NORTH DAKOTA Has met the standards for a medication assistant program I And is approved by the North Dakota Board of Nursing From November 2007 to November 2011

3. APPLICABILITY • Correctional officers employed in DOCR Adult and Juvenile Facilities. • DOCR correctional officers employed in North Dakota County Correctional Facilities and Regional Correction Centers. • DOCR employees responsible for care and custody of juveniles in DJS custody

4. LEGAL REQUIREMENTS • Ensuring that offenders receive adequate medical care. • It is inconsistent with contemporary standards of decency and a violation of the the Eighth Amendment to allow the infliction of unnecessary suffering on a prisoner by the failure to treat a serious medical need. • It is the Correctional facilities responsibility not to restrict medical care provided on the inmate’s ability to pay. There is not a lesser standard of medical care because a person is incarcerated. • Correctional staff adhere to the standard of not being deliberately indifference to the serious medical needs of incarcerated offenders.

5. CMT I REQUIREMENTS • CMT I formerly Unlicensed assistive persons competence will have the required knowledge, skills and ability to perform delegated nursing interventions safely, accurately and according to standard procedures. • A licensed nurse may delegate a nursing intervention to a CMT I only if all conditions for delegation set for the in Chapter 54-05-04 are met. • Only a licensed nurse may approve and supervise procedures related to nursing interventions.

6. REQUIREMENTS CONT’D • Correctional staff must first successfully complete the DOCR CMT I course in order to apply for the CMT II course and certificate. • Correctional staff will be able to demonstrate the required knowledge, skills and ability to perform delegated nursing interventions safely, accurately, and according to standard procedures in the components of CMT I course.

7. COMPONENTS • Infection Control • Safety and Emergency Procedures • Collection and Documentations of Basic Objective & Subjective Offender Data • Activities of Daily Living • Decision Making Skills • Offender Rights • Communication & Interpersonal Skills • Offender Cognitive Abilities & Age Specific Needs

8. INFECTION CONTROL • How illness and disease is spread • Infectious process: • Invading organism causes the illness/disease • Invading organism host or living environment • Method of leaving original host • Method of entering a new, susceptible host

9. INVADING ORGANISM • The invading organism is what causes the illness or disease. • The organism can be a result of: • Virus • Bacteria • Fungus • Intestinal parasite • Other small micro-organisms

10. INVADING ORGANISM HOST • The invading organism must have a place to live and multiply • There are 3 general environments where an organism will live and thrive • Human beings • Animal • Non-human & non-animal sources

11. INFECTIOUS PROCESS • In order to continue the infectious process, it must have a method or means of escape from the original host and then the organism will find and enter a new susceptible host.

12. METHODS OF ESCAPE • Respiratory tract spreads chicken pox & influenza virus by droplets. • Intestinal tract through elimination of bowel waste, dirty hands and reentry to the mouth or other body orifices. • Genitourinary tract such as sexually transmitted diseases. • Blood & Bodily fluids entering a break in the skin or a mucous membrane.

13. ENTRY INTO NEW HOST • Whether or not the person is susceptible to the invading organism depends on a number of different criteria including: • Amount of invading organism that is present at the time of exposure. • Length of exposure time to the organism. • Individual’s overall physical & emotional health. • Body’s ability to fight off the infection.

14. GOALS OF INFECTION CONTROL • There are two primary goals: • Preventing and controlling the transmission of illness and disease. • Providing early detection, intervention and referral.

15. PREVENTING SPREAD OF DISEASE • There are a number of preventative methods used, including: • Hand washing • Universal Precautions • Environmental Controls • Immunizations

16. HAND WASHING • Wet hands • Apply soap • Lather for at least 10-15 seconds • Apply friction to all surfaces of hands • Rinse with fresh water • Dry hands with paper towel or air dryer

17. WHEN TO WASH HANDS • After every use of bathroom • Before and after preparing, delivering or eating meals or snacks • Before and after medication administration. • Immediately after contact with all bodily fluids (includes vomit and discharge from eyes, nose and ears)

18. REMEMBER • Even if you are wearing gloves you must wash your hands. • Washing hands and wearing gloves are not substitutions for each other, they are meant to compliment each other

19. UNIVERSAL PRECAUTIONS • These apply to: • Blood • All body fluids, secretions, and excretions, EXCEPT sweat, regardless whether they contain visible blood • Non-intact skin • Mucous membranes

20. PROTECTIVE BARRIERS • Gloves • Protective face & eyewear • Gowns, aprons, and other protective clothing • Hand washing

21. AVOID ACCIDENTAL CUTS • Prevent injury from accidental needle sticks, broken glass, or other “sharps” by using the following safety measures: • Never recap a needle • Discard all “sharps” in appropriate container • Use broom or tongs to clean up broken glass • Cover open skin areas with band-aids • Clean & disinfect surfaces with disinfectant or 10% bleach (1/4 bleach to 1 gal. water) • Follow special laundry handling procedures for all contaminated laundry

22. ENVIRONMENTAL CONTROLS • It is important that we keep cells, offender common areas, recreation areas, patrol cars, transport vehicles, showers areas and correctional office work areas clean by: • Routine housekeeping • Cleaning & disinfecting all surfaces • Cleaning & disinfecting contact food surfaces

23. ACCIDENTAL EXPOSURE • In the course that correctional staff job assignment, staff may be “exposed” to an offenders’ blood or body fluids • The term “exposed” means contact between an individuals blood or body fluids and the eyes, nose, or mouth of another person, or on the skin where there is a wound or break in the skin

24. PROCEDURES FOR EXPOSURE • For exposure of the eyes, nose or mouth, immediately flush the exposed area with fresh water for 3-5 minutes • For a needle stick, or injury that results in a break of the skin; immediately wash the affected area well with soap and water for 3-5 minutes • Notify your primary physician, facility nurse and supervisor of the incident and refer to facility policy

25. BLOOD BORNE PATHOGEN CONCERNS FOR STAFF • Hepatitis C, B and HIV • Body searches • Cell searches • Bodily fluid exposures from offender-accidental or purposeful

26. RESPONSIBILITIES OF STAFF • Follow universal precautions and institutional policies • Practice good hand washing • Receive Hepatitis B vaccinations • Know institutions protocol regarding high-risk exposure of an employee

27. MRSA FOR CORRECTIONAL STAFF • Infections with MRSA have been associated with hospital or health care facilities • These community-onset MRSA infections have particularly affected athletes in close contact sports, military recruits, men who have sex with men, drug addicts, and inmate populations • Contributing to spread of MRSA in prison are illicit unsanitary tattoos and poor inmate hygiene

28. SPREADING OF MRSA • MRSA can be spread by sharing towels, linens or other personal items that are contaminated by wound drainage as well as inmates lancing their own or another inmates boils with fingers or tweezers • MRSA infections are often called “infected pimple, spider bite, or sore”

29. PREVENTION OF MRSA • Primary prevention is hand washing • Identify and do regular cleaning to all surfaces exposed to sweat such as a exercise bench • Modify hygiene practices for sweat lodge participants, including: • shower before and after the sweat lodge • wear clean clothing while participating in a sweat lodge

30. Medical Screening • An interview and assessment of an offender taken into custody. • Determine disposition and any immediate offender medical needs or offender mental health needs immediately upon arrival to a correctional facility. • Maintain safety and security in correctional institutions.

31. MEDICAL SCREENING • Collect and document information about offenders medical condition • Identify and document offenders conditions that may require immediate treatment • Identify and document offenders on-going & chronic conditions • Identify and document offenders medication and usage

32. MEDCIAL SCREENING BENEFITS • Uncover conditions that might require rapid medical treatment or evaluation. • Identify ongoing conditions. • Identify offenders that are taking medications. • Becomes a written record of the inmate's medical condition at time of admission.

33. Medical Screening Benefits cont. • Valuable tool to counter any claims that a condition was ignored. • Indicate that the staff is concerned about offenders health, this boosts offenders morale. • See if inmate displays symptoms of drug and alcohol abuse. • Insight to basic emotional or mental status of the offender.

34. MEDICAL CLEARANCE • Medical clearance is the written notice from the physician that the offender was examined by a physician and it’s the physician’s judgment that the offender, juvenile or adult, is medically stable to be placed in custody

35. Person is unconscious Having or recently had convulsions Bleeding and it cannot be controlled Suspected of having internal injuries or uncontrolled bleeding Broken bones Signs of head injury Suspect of spinal injury Appears to be in severe pain Cannot walk on own Going into shock Unable to answer any questions Experiencing alcohol/drug overdose or withdrawal Persons who indicate they are on medication but do not have that medication with them REASONS NOT TO ACCEPT A PRISONER

36. Offenders needing medical clearance before being taken into custody. • A female offender who is pregnant and having problems.

37. WHAT ARE SIGNS?assessment/interview process. • Signs are something that can be seen by correctional staff doing the interview or booking into custody. • Sweating • Pale skin • Restlessness • Blood-shot eyes • Bleeding • Deformity • Bruises or lumps

38. WHAT ARE SYMPTOMS?interview/assessment process • Symptoms is when the offender being interviewed tells the correctional staff how they feel. • Feels weak • Feels like throwing up • Pain • Tells you that he/she sees things

39. Abdominal pain Internal bleeding Shock Chest pain Hepatitis Isolation of Hepatitis A Diabetes Insulin shock Epilepsy Drug & Alcohol Abuse MEDICAL CONDITIONS that need careful evaluation when placing an offender in custody?

40. Shock • Pale • Sweating and cold clammy skin • Anxiety • Weak thready pulse • Nauseous • Drop in blood pressure • Body tissue is not receiving enough oxygen • Late stage become unconscious

41. Conditions that might produce shock • Major falls or accidents such as motor vehicle • Heart attack • Complications of diabetes, too much insulin • Result of a fight resulting in head or other body trauma causing internal bleeding. • Overdose drugs or alcohol

42. Disposition of an offender experiencing shock • Keep flat or position on offenders side if possible • Keep warm • Elevate feet • Stay with the offender • Call 911 and transport by ambulance to emergency department of local hospital.

43. Abdominal pain • Nausea and vomiting • Cramps or pain • Signs/symptoms of shock • Drop blood pressure • Increased temperature

44. Internal bleeding • Blood in stool or vomit could be bight red, tarry black or coffee ground appearance. • Smokey urine • Coughing up bloody mucous • Swelling at the ends of long bones.

45. Disposition of an offender with severe abdominal pain and/or internal bleeding • Allow to rest in a comfortable position. • Treat for shock • Call 911 and transfer an to emergency department of local hospital • Keep NPO that means give nothing to eat or drink

46. IMPORTANT!!! • It is very important for correctional staff to know who are the diabetics that are in custody. • Especially those inmates who take insulin.

47. DIABETES • A inmate with diabetes can be difficult for correctional staff to manage. • Not all diabetics are alike: • Juvenile diabetic • Adult onset diabetic • Diabetics who take oral medication • Diabetics who take insulin

48. DIABETIC HYPERGLYCEMIA • This occurs when a diabetic has too much sugar in their blood • If medical intervention does not occur this condition can lead to a coma • This is why it is important that all diabetics take their medication as prescribed • Blood glucose levels over 200 should be reported to medical staff immediately

49. SIGNS OF HYPERGLYCEMIA • Breath has a fruity odor • Red face/complexion • Irritability • Confusion • Dry skin • Thirsty • Increased urination

50. INSULIN SHOCK • Insulin shock is also known as hypoglycemia or low blood sugar • This occurs when there is an abnormally low level of glucose (sugar) in the blood