FLORIDA DEPARTMENT OF CORRECTIONS by n6q4b0

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									                        FLORIDA DEPARTMENT OF CORRECTIONS
                             OFFICE OF HEALTH SERVICES


       TECHNICAL INSTRUCTION NO. 15.05.20                                                Page 1 of 3

       SUBJECT:       MEDICAL AND DENTAL CARE FOR MENTALLY DISORDERED
                      INMATES

                                                                        EFFECTIVE DATE: 8/9/00

I.     PURPOSE:

       To ensure that mentally disordered inmates, especially those receiving inpatient mental
       health care, have access to medical and dental care.

II.    CHANGES:

       A.      Decrease in frequency of vital signs in mental health inpatient units.

       B.      Decreased time frame for opening inpatient record after admission.

III.   POLICY:

       Mentally disordered inmates, especially those who are housed in crisis stabilization units
       and transitional care units, shall be given access to physical health care services in
       accordance with their needs.

IV.    PROCEDURE:

       A.      Mentally disordered inmates who are receiving outpatient mental health care, that is,
               those who are classified as S-II or S-III, shall receive the same access to medical and
               dental services as nonmentally disordered (S-I) inmates, except that S-III inmates
               shall receive a periodic health assessment in accordance with HSB/TI 15.03.04. A
               physical assessment must be done within a reasonable period (consistent with safe
               practice for the patient as determined by the psychiatrist and patient’s treating
               physical health physician) of the patient being started on psychotropic medication.
               If the inmate has had a complete physical assessment within the past six months,
               another physical assessment need not be completed unless clinically indicated by
               current history and/or complaints. Thereafter, the periodic physical assessment is
               conducted annually. Required medical care including, but not limited to, periodic
               health assessments shall be performed by medical staff, e.g., nonpsychiatric
               physician, physician assistant, or advanced registered nurse practitioner (ARNP).

       B.      Mentally disordered inmates who are housed in isolation management rooms shall
               be considered as infirmary admissions and shall be given medical care in accordance
               with HSB/TI 15.03.26.
TECHNICAL INSTRUCTION NO. 15.05.20                                            Page 2 of 3

SUBJECT:    MEDICAL AND DENTAL CARE FOR MENTALLY DISORDERED
            INMATES

C.   Mentally disordered patients who are housed in a transitional care unit or crisis
     stabilization unit shall receive the following:

     1.     Assessment of vital signs within a reasonable period of the patient's arrival,
            including temperature, pulse, respiration, blood pressure, and body weight.
            Temperature, pulse, respiration, and blood pressure will be taken daily for
            seven days. Transfers (IMR/CSU/TCU) within the same facility do not need
            to be considered new admissions. Thereafter, vital signs (including weight)
            must be taken at least two (2) times per week in CSUs and once per week in
            TCUs, or more frequently as indicated by the condition of the patient.

     2.     Comprehensive physical examination (including basic neurological
            examination) by a nonpsychiatric physician or clinical associate and the
            following studies within a reasonable time consistent with safe medical
            practice and the patient’s overall condition of the patient's arrival (unless
            there are lab reports available within the past two weeks):

            a.      A complete blood count.

            b.      Urinalysis.

            c.      Full chemistry screen.

            d.      Urine drug screen.

            e.      Free T4 and TSH.

           The above tests should be repeated if clinical condition indicates the need to
           do so. See D below for recent or current inpatients.

D.   Discretion must be utilized when ordering lab tests that have recently been
     completed within the past six (6) months, especially when a patient is being
     readmitted to the CSU within several months of discharge or when a patient is being
     transferred from a CSU directly to a TCU.

E.   DC4-673 Mental Health Inpatient Nursing Admission Assessment shall be
     completed and an inpatient record shall be opened within two (2) hours of
     admission.
       TECHNICAL INSTRUCTION NO. 15.05.20                                                  Page 3 of 3

       SUBJECT:       MEDICAL AND DENTAL CARE FOR MENTALLY DISORDERED
                      INMATES


       F.      Daily triaging of complaints shall be as follows:

               1.     Each patient in a CSU shall be seen at least two times daily by nursing
                      personnel who will triage complaints. At least one of these encounters will
                      be performed by a nurse. Each patient in a TCU shall be seen at least once
                      per day by a nurse who will triage complaints. After triaging complaints, the
                      nurse will make a referral, if necessary, to a physician or clinical associate (if
                      medical in nature), to a dentist, or to the assigned psychiatrist (if mental in
                      nature). Those TCU patients whose level of functioning permits access to
                      sick call may be instructed to seek assistance at the next sick call (in lieu of a
                      direct referral). In such cases, TCU staff shall verify that the inmate
                      received attention for his/her complaints at sick call.

               2.     The complaint will be entered in the inmate's record on DC4-692 Shift
                      Mental Health Nursing Assessment.

               3.     Emergency requests by inmates will be triaged by the nurse on an immediate
                      basis and documented on DC4-692 Shift Mental Health Nursing Assessment
                      or DC4-701 Chronological Record of Health Care.

               4.     Periodic health assessments (as defined in technical instruction 15.03.04)
                      shall be performed by a nonpsychiatric physician or clinical associate every
                      90 days in CSUs and every 180 days in TCUs.

V.     IMPLEMENTATION DATE:

       Each institution is expected to implement this technical instruction no later than 30 days
       after signature.




 Director of Health Services                                       Date

This Technical Instruction Supersedes:                    HSB 15.05.20 dated 4/15/91 and 12/15/94

								
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