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					Florida Department of Juvenile Justice


Detention Program
Technical Assistance Report
Program Name
Medical Services
Office of Health Services
Site Visit Date:
Contract Number:
Site Visit Type:
Report Date:
Frank Peterman, Jr.                      Lisa Johnson, M.D.
Secretary                                Chief Medical Director
                                                          Florida Department of Juvenile Justice
                                                                 Office of Health Services




                                                                           Medical Services
                                                            Detention Program Technical Assistance Report


Program:                                                                               Provider:
County                                                                                 Address:
Circuit:                                                                               City/State/Zip:
                                                                                       Records Reviewed
Reviewer:                                                             IHCR reviewed:                        Census:
Title:                                                                MARS reviewed:
Office:


          Entrance Summary:
A.
          Explanation of Technical Assistance Visit:
B.
          The purpose of the technical assistance visit is

C.                        Requested By:          Regional Directors       SMA II’s        Office of Health Services   Other: RNC______________
D.        Previous QA Score:

                                                                                        Health
Item                                                                                   Services
           Yes    No                             Criteria                                                                  Comments
  #                                                                                     Manual
                                                                                      Reference
                                                                                     Chapter: 2
                         4.01 – Designated Health Authority
                                                                                     Section: VI
                         By written agreement there is a designated health           Page: 11
 1.                      authority that is licensed pursuant to Florida Statutes,
                         Chapter 458 or Florida Statutes, Chapter 459.



          OHS: Detention Technical Assistance - Medical                                  Page 2 of 16                                            May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                  Health
Item                                                                             Services
        Yes    No                             Criteria                                            Comments
  #                                                                               Manual
                                                                                Reference
                       There is a process for the following mandatory          Chapter: 1
                       healthcare components at the facility as defined in     Section: Vii-A
                       the DJJ Health Services Manual:                         Page: 5, 6

                           a.   Intake and other routine screenings;
                                Assessments; (e.g., Facility Entry
                                Screening, Health Related History,
                                Comprehensive Physical Assessment);
                           b.   Follow-up, periodic evaluations and on-going
                                treatment;
                           c.   Episodic care;
 2.                        d.   Sick call care;
                           e.   Physician Referrals;
                           f.   Consultation/Specialty Care;
                           g.   Medication management systems;
                           h.   Infection control measures;
                           i.   Health education;
                           j.   Documentation and record management;
                                and
                           k.   Transitional health care planning;
                           l.   Transitional discharge planning.

                       The following staff positions are employed/contracted   Chapter: 2
                       according to the contract: Explain discrepancies        Section: VI-B
                           MD or DO                                           Page: 11, 12
                           P.A.
                           ARNP
 3.                        RN
                           LPN
                           Dentist
                           Clerical
                           Other

                      All health care professionals have the appropriate,      Chapter: 2
                      current licensure and/or certifications. (Refer to       Section: VI
 4.                                                                            Page: 11, 12
                      www2.doh.state.fl.us/MQA services).

       OHS: Detention Technical Assistance - Medical                               Page 3 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                    Health
Item                                                                               Services
        Yes    No                             Criteria                                             Comments
  #                                                                                 Manual
                                                                                  Reference
                      4.02 – Healthcare Admission Screening                     Health
                                                                                Services
                                                                                Manual 2006
                      The medical, mental health and substance abuse            Chapter 3
                      needs of youth are identified through a                   Quality
                      comprehensive screening process with every                Assurance
                                                                                Standard 4.02
                      admission to the facilityWhen a n-licensed staff          #2&
                      member completes the initial medical and mental           4;Suicide Risk
                      health, screenings, the licensed nurse reviews the        Screening
                      entry screenings within 24 hours of admission.            Instrument;
                                                                                QA Standard
                                                                                3.02 Mental
                                                                                Health,
                                                                                Substance
                                                                                Abuse, and
                                                                                Suicide Risk
                                                                                Screening
                                                                                Chapter: 3
                                                                                Section: III-A
                      There is documentation to support that a system is in     Page: 2, 3
 5.                   place for emergency medical response for youth upon
                      admission. Facility Operating Policy – Standard
                      Operating Policy

                                                                                Chapter: 3
                      This is accomplished through the appropriate              Section: VI
                      procedures and within set timeframes, for all youth       Page: 3, 4
                      admitted with the conditions listed in Chapter 3 of the
                      Health Services Manual, 2006.                             Chapter 4 II A
 6.                                                                             &B
                      Referrals to the facility’s Physician, PA or ARNP must
                      be made for youth who are admitted with known or          Chapter 5 (7)
                      suspected chronic conditions not requiring emergency
                      treatment on admission.                                   Chapter 6
                                                                                II C & D


       OHS: Detention Technical Assistance - Medical                                Page 4 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                    Health
Item                                                                               Services
        Yes    No                             Criteria                                              Comments
  #                                                                                Manual
                                                                                  Reference




                                                                                Chapter: 5
                      Comprehensive Physical Assessment
                                                                                Section: II
                      Youth’s baseline health and risk factors shall be         Page: 1
                      identified through a comprehensive physical
                      assessment (CPA) and health related history
                      (HRH). The first medical grade is assigned at the
                      time of the first CPA.


 7.                   The Health-Related History is completed,within 10
                      calendar days of admission and re-admission, or
                      sooner     &reviewed and updated prior to the
                      completion    of   the  Comprehensive    Physical
                      Assessment.




                      The Comprehensive Physical Assessments (CPA) is           Chapter 5
                      completed fully within the required time.
                                                                                Chapter: 5
                      All youth with Medical Grades of 3-5 shall be placed      Section: (III)
                      on the Facility Medical Alert System.                     (IV) ( V)
 8.                   All screenings and measurements are completed prior
                      to the CPA being commenced

                      Gender specific examinations are conducted/offered
                      to females

                      A qualitative urine pregnancy test is done for sexually
       OHS: Detention Technical Assistance - Medical                                 Page 5 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                   Health
Item                                                                              Services
        Yes    No                             Criteria                                              Comments
  #                                                                               Manual
                                                                                 Reference
                      active females > 12 y/o/a and when clinically indicated

                      For females who are not sexually active, but
                      who are at least 18 years or older, a gynecological
                      exam is clinically recommended. Does documentation
                      or procedure reflect this practice?




                      There are standardized DJJ Comprehensive Physical         Chapter: 15
                      Assessment forms and all other standardized health        Section: IV
                      forms available. The Program is using all the required    Page: 5

 9.                   DJJ Health Services Forms for medical screenings
                      and examinationse..



                      Medical/nursing staff conducts vision and hearing         Chapter: 5
                      screening, BMI, and vital signs prior to completion of    Section: III
                      the Comprehensive Physical Assessment.                    Page: 2, 3

                      Tuberculin Skin Test information, Tanner Staging, and
                                                                                Chapter 5 III A
                      gender specific examination results are present on the
                                                                                6
10.                   CPA

                      When any part of the examination is refused or
                      deferred youth initials are notes and the clinician
                      documents actions regarding the




       OHS: Detention Technical Assistance - Medical                                 Page 6 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                    Health
Item                                                                               Services
        Yes    No                             Criteria                                               Comments
  #                                                                                 Manual
                                                                                  Reference
                      There is a two-tiered process for tuberculosis             Chapter: 3
                      evaluation that includethe following components:           Section: VI
                       a. Youth initial symptom screening;                       Page: 4, 5
                       b. Mantoux Tuberculosis skin testing with
                        Purified Protein    Derivative;

11.                    c. Process for transporting youth with suspected or
                          confirmed infectious TB;
                       d. Annual re-screening of youth;
                       e. Treatment for latent and active TB infection.
                      The Procedure (FOP) and practice demonstrate agree
                      ment with the policy

                      Sexually Transmitted Diseases                              Health
                                                                                 Services
                                                                                 Manual 2006
                                                                                 Chapter: V
                      All youth are screened for sexually transmitted
                                                                                 Section: III-C
                      diseases, including a confidential interview, a clinical   Page: 4, 5
                      assessment for youth in a high-risk status, and
                      treatment as clinically indicated.

                      A youth that reports signs or symptoms consistent with
                      an STD, or reports engaging in unprotected
                      intercourse shall be referred to the DHA or Physician
12.
                      Designee, PA, or ARNP for evaluation and screening
                      with testing.

                      Re-screening should be conducted if the sexually
                      active youth has been out of DJJ physical custody for
                      over thirty (30) days, and/or symptoms present.

                      Documentation of the STD screening results, clinical
                      evaluation and diagnosis shall be filed in the IHCR,
                      using the appropriate forms (infectious &
                      Com,municabl;e Disease form and filed in the section
                      of the IHCR reserved for laboratory results.

       OHS: Detention Technical Assistance - Medical                                  Page 7 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                       Health
Item                                                                                  Services
        Yes    No                              Criteria                                                Comments
  #                                                                                   Manual
                                                                                     Reference




                      Youths' immunization records are obtained through            Chapter: 3
                      the school system process or by registering with             Section: XI
                      Florida Shots                                                Page: 14

                      Youth whose immunization status is unknown or not
                      current are referred to the DHA for evaluation and
13.                   direction & arrangements made to have the youth
                      immunized

                      Specific parental notification and consent is required &
                      present



                       The following on-site tracking logs and/or a written        Chapter: 15
                       Inventory processes when applicable are in place and        Section: II, IX
                       current:                                                    Page: 2, 20
                        a. Sick call complaints;                                   (letters: a-c)
                        b. Periodic evaluations;                                   Chapter: 11
14.                                                                                Section: VI,
                        b. Episodic care;
                        c. Tuberculosis screening tests and results;               VII
                        d. Over-the-Counter medication administration;             Page: 14
                        e. Sharps/syringes.                                        (letters: d, e)

                       Sick Call                                                   Chapter: 6
                                                                                   Section: III-A
                      The program ensures that all youth have timely
                                                                                   Page: 3
                      access to healthcare services through an established
15.                   sick call system, which includes designated times for
                      sick call. All youth are oriented to and familiar with the
                      sick call process.

       OHS: Detention Technical Assistance - Medical                                    Page 8 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                       Health
Item                                                                                  Services
        Yes    No                             Criteria                                                 Comments
  #                                                                                   Manual
                                                                                     Reference
                      There is a mechanism to ensure that if an LPN
                      conducts sick call, all cases are reviewed on a daily
                      basis with an RN, MD/DO, ARNP and documented.

                       If healthcare staff is not on-site, the shift supervisor
                      shall review the sick call requests no later than four (4)
                      hours after submission by the youth. to determine
                      urgency andconfer with the DHA as needed

                      Sick call encounters are conducted in such a manner
                      that the youth’s privacy is maintained.

                      Youth who present with the same complaint 3 times in
                      a 2-week period are referred to the MD, DO, ARNP,
                      PA or Dentist for further
                      evaluation and treatment. Youth can be referred
                      sooner based on symptoms and sound medical
                      judgement

                      There is a tracking system to note referrals and
                      evaluation completion

                      Staff are educated that even if a youth presents to sick
                      call with a complaint, the complaint may actually be an
                      emergency and/or require immediate referral.

                      Youth are being advised, both verbally and in writing        Chapter: 3
                      during orientation, of the availability and methods to       Section: XVI
                      access medical care, the times of the regularly              Page: 18, 19
16.
                      scheduled sick call, emergency medical care and
                      dental care.

                      Health Discharge Summary/Transitional planning is            Chapter: 17
                      conducted utilizing all the required components to           Section: I, II
17.                   ensure that there is no interruption of youth’s care         Page: 1, 2
                      upon release from the facility.

       OHS: Detention Technical Assistance - Medical                                    Page 9 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                     Health
Item                                                                                Services
        Yes     No                             Criteria                                               Comments
  #                                                                                  Manual
                                                                                   Reference
                      There are written sick call procedures for common           Chapter: 6
                      complaints that have been approved by the                   Section: II-C
                      Designated Health Authority. The facility has medical       Page: 3
18.                   protocols for all nursing levels and direct care staff, &
                      that are reviewed and signed annually by the
                      Designated Health Authority.

                      A process for sick call is in place and includes            Chapter: 6
                      documentation of all mandatory components.                  Section: V-
19.
                                                                                  A, & B
                                                                                  Page: 5, 6
                      There is a process for the Designated Health Authority      Chapter: 6
                      or designee to provide on-call services twenty-four         Section: I
20.                   hours a day, seven days a week to address staff and         Page: 1
                      nursing concerns.

                      There is a posted schedule for Sick Call and Clinic         Chapter: 7
21.                   hours.                                                      Section: II
                                                                                  Page: 2
                      Episodic and Emergency Care                                 Chapter: 9
                                                                                  Section: V
                      The program has a comprehensive process for the
                                                                                  Page: 5, 6
                      provision of episodic and emergency care.Twenty-four
22.                   hour a day emergency medical and dental care is
                      available including documentation to support that
                      there is an arrangement with a licensed general
                      hospital for the provision of emergency off-site care.

                      A current list of emergency contact information             Chapter: 9
                      including the poison information center is posted for       Section: VI-B
23.                                                                               Page: 7
                      ready access to all staff.

                      Emergency drills are held on each shift and are             Chapter: 9
24.                   conducted at least quarterly.                               Section: II-B
                                                                                  Page: 2, 3

       OHS: Detention Technical Assistance - Medical                                  Page 10 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                      Health
Item                                                                                 Services
        Yes     No                             Criteria                                                Comments
  #                                                                                   Manual
                                                                                    Reference
                      Emergency medical services (EMS) transfer/transport          Chapter: 9
25.                   of youth can be accessed if needed.                          Section: I, VI
                                                                                   Page: 1, 6
                      First aid kits (inclusive of transportation vehicles) are    Chapter: 9
                      located appropriately throughout the facility with           Section: III-A
                      content’s approved by the Designated Health                  Page: 3-5
26.
                      Authority. They are monitored monthly and
                      replenished as needed.

                      If the facility has an Automated External Defibrillator      Chapter: 9
                      (AED), it is placed in a secured area that is easily staff   Section:
                      accessible and procedures are established to ensure
27.
                      that the batteries, pads, etc. are replaced at the
                      requisite intervals.

                       Medication Administration                                   Chapter: 11
                                                                                   Section: II-
                      The program ensures that prescription medications
                                                                                   A&D
                      are administered in a safe
                                                                                   Page: 2-3, 5
                      and timely manner. All medications have a current,
                      valid order and are given
28.                   pursuant to a current prescription.


                      Prescribed medications brought to the facility with the
                      youth at admission are verified and disposed of
                      appropriately if they cannot be verified.

                      Medications are being transported according to the           Chapter: 11
                      procedures detailed in the Health Services Manual            Section: III
29.                                                                                A&B
                      (2006) and STOP policy
                                                                                   Page: 6, 7
                      There is documentation of the administration of              Chapter: 11
                      medications, both prescription and non-prescription,         Section: V, IX
30.
                      including times and locations and accurate accounting        Page: 12-17,
                                                                                   23
       OHS: Detention Technical Assistance - Medical                                   Page 11 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                  Health
Item                                                                             Services
        Yes     No                             Criteria                                            Comments
  #                                                                               Manual
                                                                                Reference
                      and inventory procedures.                                Section: XIII
                                                                               Page: 27, 28
                      The Medication Administration Record (MAR) is used
                      to document medication administration according to
                      the HSM requirements.

                      There is a working system in place for psychotropic      Chapter: 12
                      medication management and psychiatric care, which        Section: II- A,
                      includes psychiatric evaluations, psychiatric            B, C
                                                                               Page: 2, 3
                      consultations, medication management and medical
                      supportive counseling provided by a licensed             Section: IV, V
                      Psychiatrist or a licensed and certified Psychiatric     Page: 7-12
                      Advanced Registered Nurse Practitioner (ARNP)
                      working under the clinical supervision of a licensed     Section: VIII
                      Psychiatrist (on-site supervision must occur bi-         Page: 14, 15
31.                   weekly).

                       All youth taking psychotropic medication(s) have a
                      current Authority for Evaluation and Treatment, and
                      parental notification and authorization for new or
                      changed psychotropic medications. All medication
                      monitoring and all initial diagnostic psychiatric
                      interviews and/or psychiatric evaluations are
                      conducted within the time frames mandated in the
                      Health Services Manual (2006).

                       Medication Control                                      Chapter: 11
                                                                               Section: V
                                                                               Page: 11-14
                      There is a provision for safe and secure storage of
32.                   sharps and all forms of medications with special
                      precautions (double locked) for controlled substances.

                      There is a refrigerator for medication storage only

       OHS: Detention Technical Assistance - Medical                               Page 12 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                    Health
Item                                                                               Services
        Yes     No                             Criteria                                              Comments
  #                                                                                 Manual
                                                                                  Reference
                      The medication area has limited access and is further      Chapter: 3
                      secured by appropriate key control. Non-healthcare         Section XI &
                      staff who provide oral medication are appropriately        Chapter 11
                      trained and designated by name and title, and are          Section: V,
33.
                      required to discuss any medication-related issues with     C2
                      designated incoming staff.                                 Page: 12, 13


                      There are no bulk or "non-patient specific" inventories    Chapter: 11
                      of any prescription medications, except as authorized      Section: VII-E
34.                   in the DJJ Health Services Manual or as granted by         Page: 16, 17
                      exception (in writing) or licensure.

                      There is a working process for the daily and perpetual     Chapter: 11
                      inventory of prescription and over-the-counter             Section: VII
35.                                                                              Page: 14
                      medication.

                      Facility holds current Class II B Pharmacy License.        Chapter: 11
36.                                                                              Section: XIX
                                                                                 Page: 34
                      There is a medical alert system that contains a roster     Chapter: 3
                      of youths' names that have or may have a high-risk         Section: XV
                      condition (allergies, medication interactions, head        Page: 16-18
37.                   trauma/injury, pregnancy, infections disease, or a
                      chronic medical condition or disability, e.g., diabetes,
                      asthma, etc.).

                      Critical medical alerts are entered into JJIS and closed   Chapter: 3
                      if no longer active as required.                           Section: XV
                                                                                 Page: 16
38.
                                                                                 DSM
                                                                                 Chapter: 5
                                                                                 Page: 5-7
                                                                                 Chapter: 13
                       Environmental and exercise precautions include:
39.                                                                              Section: I-V
                         a. General exercise regimens;                           Page: 1-9
       OHS: Detention Technical Assistance - Medical                                 Page 13 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                     Health
Item                                                                                Services
        Yes     No                             Criteria                                               Comments
  #                                                                                 Manual
                                                                                   Reference
                         b. Inclement weather conditions
                         c. Heat Index Criteria
                         d. Environmental Stressors

                      Individual Health Care Records are assembled and           Chapter: 15
                      maintained, according to the Health Services Manual        Section: II, IV
40.                                                                              Page: 1-18
                      (2006).

                      Appropriate locked storage, marked "confidential", is      Chapter: 15
41.                   provided for the individual healthcare records.            Section: VII
                                                                                 Page: 18
                      There is age appropriate, gender specific health           Chapter: 16
                      education/prevention programs, including AIDS, diet,       Section: II-V
42.                   exercise, responsible sexual behavior, parenting skills,   Page: 1-2
                      etc.

                      Confidential HIV testing is provided with appropriate      Chapter: 16
                      counseling, confirmatory tests and medical follow-up       Section: III
43.                                                                              Page: 2
                      as indicated.

                       Infection Control                                         Chapter: 14
                                                                                 Section: I
                      The program provides for the management infectious,
                                                                                 Page: 1
                      communicable diseases provides for screening,
                      prevention, containment, and treatment when needed.
44.                   Written procedures (FOP and Infection Control Plan)
                      outline the methods of surveillance, screening, testing
                      and treatment


                      The program utilizes a specific facility exposure          Chapter: 14
                      control plan in compliance with the OSHA standard          Section: II, III
45.                                                                              Page: 1-5
                      related to blood borne pathogens.

                      There is a refrigerator utilized for the storage of        Chapter: 11
46.                                                                              Section: C
                      medications. A separate refrigerator is If specimens
       OHS: Detention Technical Assistance - Medical                                  Page 14 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                   Health
Item                                                                              Services
        Yes     No                             Criteria                                             Comments
  #                                                                                Manual
                                                                                 Reference
                      are stored prior to pick up by the laboratory provider,   Page: 13
                      (Note:Neither refrigerators can be utilized for the
                      storage of foodstuffs.)

                      Visual dental screenings, education and referrals for     Chapter: 6, 7
47.                   emergency dental problems are provided.                   Section: II, IV
                                                                                Page: 2, 3
                      There is appropriate health services review of the use    Chapter: 9
                      of force, mechanical restraints and placement in          Section: B
48.                   precautionary observations, secure observation,           Page: 14
                      confinement, etc.

                      Post-PAR medical reviews are conducted.                   Chapter: 9
49.                                                                             Section: B
                                                                                Page: 14
                      All youth in restricted housing are questioned daily      Chapter: 6
50.                   about any health related complaints.                      Section: B
                                                                                Page: 2
                      4.11 – Consent and Notification
                                                                                DJJ Health
                      The program ensures appropriate consent and
                                                                                Services
51.                   notification of all treatment.
                                                                                Manual,
                                                                                Chapter 4


                      4.12 – Prenatal/Neonatal Care                             Chapter: 10
                                                                                Section: IV
                      The program has an organized plan for the
                                                                                Page: 4
                      identification of pregnancy and provision of prenatal
                      care. High-risk pregnant youth are provided additional
52.                   testing and services as recommended.

                      Pregnancy testing is available at the youth's request
                      or when otherwise clinically indicated (as applicable).

                      Prenatal care for pregnant youth begins immediately       Chapter: 10
53.                                                                             Section: IV
                      upon determination that the youth is pregnant and
       OHS: Detention Technical Assistance - Medical                                Page 15 of 16              May 2010
                                                       Florida Department of Juvenile Justice
                                                              Office of Health Services

                                                                                   Health
Item                                                                              Services
        Yes     No                             Criteria                                            Comments
  #                                                                                Manual
                                                                                 Reference
                      includes the services outlined in the Health Services     Page: 4
                      Manual (2006), at a minimum (as applicable).

                      All pregnant youth have a documented offering of, or      Chapter: 10
54.                   signed refusal of an HIV test.                            Section: Iv
                                                                                Page: 6
                      Data is collected on a monthly basis for compilation of   Chapter: 15
55.                   required health services reports.                         Section: X
                                                                                Page: 20


INTERVIEW OF YOUTH:
   Yes        No

COMMENTS:
INTERVIEW OF STAFF:
   Yes        No
  QA STANDARDS REQUIRING FOCUSED TECHNICAL ASSISTANCE




TRAINING CONDUCTED:
    Yes        No (If No, Please explain the program’s plan to become compliant.)

COMMENTS, RECOMMENDATIONS & TECHNICAL ASSISTANCE:

       OHS: Detention Technical Assistance - Medical                               Page 16 of 16              May 2010

				
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