California State Prison San Quentin

1. California State Prison �San Quentin Reception Center Intake Screening and Health Assessment

3. Admission Profile 33% with significant health care risks and needs Age group Under 40 � 63% 40 and Over � 37% Range of 22-130 admissions per day, Tues & Thurs as heaviest Parole Violators/RTC � 70% New Commits � 30% Peak Admission Hours 0900-1100 1300-1500 Santa Rita Jail Admissions

4. Time of Arrival

5. Total Number of Arrivals �July 2006

6. Total Number of Arrivals �August 2006

7. Total Number of Arrivals � September 2006

8. Total Number of Arrivals �February 2007

9. Total Number of Arrivals �March 2007

10. Why do we screen each incoming inmate? Identify health care conditions needing immediate referral to primary care, mental health or dental Identify inmate/patients who are potentially contagious Educate on wellness and how to access health care services Timely referral, evaluation and ongoing management of high risk patients

11. The Change Drivers Inmate Medical Services Program Policies and Procedures (Plata) National Commission on Correctional Health Care Standards 2003 Title 15, California Code of Regulations United States Preventive Services Task Force A & B Evidenced-based Community Standards

12. Major Changes from IMSPP (Plata) #1 Health screening by LVN or LPT and referral to RN if with �yes� answer on Form 7277 Change: RNs will do health screening #2 MD, PA or NP performs Physical Assessment within 14 days of patient�s arrival. Change: RNs will perform Physical Assessment on patients immediately upon arrival. MDs, PAs and NPs will be onsite to perform primary care intake evaluation. Borderline hypertension follow up within 14 days.

13. Policy Upon arrival, each incoming inmate, including parole violators, shall be screened and assessed for health care risks and needs by Registered Nurses, who shall establish the initial treatment plan and ensure continuity of care by appropriate referral and linkage to needed services.

14. General Requirements RC health care staff responsible for health screening and assessment Immediate evaluation and treatment of emergent and urgent medical conditions Certified interpreter or translator services Privacy of health information

15. What is the process?

16. CNA�s Role Hand out Inmate Orientation Handbook with revised RC process insert Obtain vital signs, height, weight Test visual acuity Direct flow

17. RN�s Role (con�t) Conduct TB history and symptom screening History of TB disease or treatment Cough over 3 weeks Blood in sputum Chest pain Systemic symptoms: fever, chills, night sweats, weight loss

18. RN�s Role (con�t) Screen for Chronic Disease Cardiovascular Disease (Hypertension) Diabetes Mellitus Chronic Infectious Disease (HIV, Hepatitis) Chronic Pulmonary Disease (Asthma, emphysema, COPD) Seizure Disorder Other (Kidney/Bladder Disease, Sickle Cell, Thyroid Problem, Arthritis) Cocci Screening Current Medications (dose and frequency)

19. RN�s Role (con�t) Pain Assessment (7 or over � refer to Provider) Blood sugar check (if indicated) Oral Screening Pain from or near mouth Visible signs of trauma or swelling to jaw or mouth Uncontrolled bleeding from or near mouth Unable to open or close mouth Mental Health Screening Thoughts or plans of hurting self or others Taking medications for mental illness (documented)

20. RN�s Role (con�t) Health Assessment � Hands-On / Head-to-Toe Appropriate Disposition TTA Emergent/Urgent (See Attachment) Sick Call Under 40 and Healthy Mid-Level Provider 40 and Over and Healthy (to be evaluated w/in 30 days) Any Age with 1 Chronic Disease (to be evaluated w/in 14 days) Physician Any Age with 2 or more Chronic Diseases (to be evaluated w/in 7 days) RN Care Managers BP 140-159/90-99 and no history of hypertension ( BP check w/in 14 days)

21. RN�s Role (con�t) Essential Medications (Anti-infectives, Insulin, Cardiac, Psychotropic, TB meds) with documentation from sending facility Renew order for up to 14 days supply (if no MD/NP/PA on site) MD/NP/PA writes order RC Care Manager follow-up

22. RN�s Role (con�t) Completes Medical Chrono Under 40 and healthy � full duty Other � consult with MD NP or PA Referral to Public Health Inform custody of possible changes in housing Offer HIV and Hep C testing for IVDU Sharing of test results with DHS Documentation � sign (name/title), date/time Provide applicable Health Education material

23. Mental Health Screening Mental Health Clinicians perform mental health screening on the same day of arrival Completes MH Chrono if passes MH Screening Questionnaire Ducated within 18 days for further evaluation if does not pass MH Screening

24. Dental Screening RNs complete oral screening on the same day of arrival Completes Dental Chrono for Class 3 only All other conditions must be referred to Dental Comprehensive dental exam within 14 days of arrival for new commitments

25. Laboratory Intake Tests Based on USPSTF A&B and Other Community Standards VDRL/RPR (blood draw) Gonorrhea/Chlamydia urine test for under 30 Non-fasting Total Cholesterol and HDL for over 35 HIV with informed consent HCV if with hx of IVDU and consents Other tests

26. Continuity of Care & Health Information Management Reception Center Daily Inmate/Patient Intake Log (completed by RNs) Reception Center Activity Tracking (RCAT) database IMSATS Data Entry Unit Health Records Tracking Indicators

27. Process and Outcome Measures Inmate/patients identified with two (2) or more chronic diseases are evaluated by an MD within 7 calendar days of arrival. Inmate/patients of any age but with one (1) chronic disease are evaluated by a Mid-Level Provider within fourteen (14) calendar days of arrival. Inmate/patients age forty (40) or over and healthy are evaluated by a Mid-Level Provider within thirty (30) calendar days of arrival. Inmate/patients with Blood Pressure of 140-159/90-99 upon arrival at the RC had their Blood Pressures checked within fourteen (14) calendar days of arrival. Inmate/patients on essential medications and with verifiable documentation receive their medications by the next day of arrival. Inmate/patients with chronic/high risk conditions have zero or reduced visits to TTA or Community Hospital Emergency Department within the first thirty (30) days of arrival.

28. Care Management Overarching philosophy that begins at RC Comprehensive screening and assessment Development of initial treatment plan and appropriate disposition Multidisciplinary Continuity of services Accountability

29. RN Training Requirements Complete CDCR approved �Physical Assessment for Registered Nurses in Most Circumstances� class and Oral Screening Documentation of training � DON, RN Staff Development file, Proof of Practice Binder 30-day close supervision and mentoring Annual retraining and testing RN�s responsibility to ensure ongoing competency and documenting relevant findings

30. Peer Education Peer Educators Role 10-15 inmates kept in holding tanks at all times Groups of 10-15; 2 groups/day between 11-1 pm Health Educational Videos

31. Thank you for coming! Your role is crucial to the success of this Pilot Program!