DEPARTMENT OF CORRECTIONS
2017-19 Biennial Budget
Issue Paper
Topic: DIN 5905 - Juvenile Medication Administration
Request
The Department of Corrections (DOC) requests $620,800 GPR, ($527,300) PR, and 9.00 GPR FTE in FY18
and $769,000 GPR, ($703,100) PR, and 9.00 GPR FTE in FY19 to provide for the safe and effective
administration of controlled medications to Division of Juvenile Corrections (DJC) youths by trained
medical personnel.
Problem Description
Medication delivery at DJC’s Lincoln Hills School (LHS) and Copper Lake School (CLS) is not acceptable
practice. Until recently, all medications were delivered by Youth Counselor (YC) and Youth Counselor
Advanced (YCA) staff. Best practice involves the administration of medications by nurses. Currently,
medication management is a hybrid system which involves the use of health care professionals and security
staff.
Medication delivery by non-health care staff is recognized on a national level as an unsafe practice. YCs
and YCAs are neither professionally trained nor experienced in, nor do they hold the fundamental
knowledge of, the safe and correct methods of administration of medications. This practice, as
implemented, could subject nurses and physicians to exposure and sanctions related to scope of practice
issues if perceived to be delegating to non-licensed employees. In addition, patient medication requires a
scientific knowledge and an understanding of the patient’s basic and complex health needs.
DOC has made efforts to provide medication delivery training to YCs; however, medication administration
involves knowledge of medication and an understanding of how medications interact with a patient’s health
status. The result of the practice of YCs delivering medications has resulted in medication errors,
omissions, and safety concerns which all increase the possibility of litigation. As of May, 2016 DOC has
begun taking steps toward having only healthcare professionals (nurses) administer medications at both LHS
and CLS, but additional positions are necessary to entirely shift the responsibilities from security staff to
nursing.
Background
Administration of medications to inmate patients by licensed health care staff, which includes Registered
Nurses (RN) and Licensed Practical Nurses (LPN), occurs at the female Taycheedah Correctional Institution
(TCI). Permanent positions for this purpose were allocated to TCI through the 2007-09 and 2009-11
Biennial Budgets. The role of the nurse in the Department is critical to the safe provision of health care to
inmates and to ensuring access to care; therefore, it is important to ensure adequate staffing.

 The 2007-09 Biennial Budget included authorization for 7.00 Licensed Practical Nurse (LPN) FTE
predominantly for the distribution of medications at TCI’s Monarch Unit (a specialized management unit for
offenders who have difficulty in adjusting to the prison environment due to mental or emotional problems
and/or cognitive deficiencies or who have a special need identified by medical staff or via other means
requiring specialized care) and in TCI’s Restrictive Housing (previously known as Segregation).
The 2009-11 Biennial Budget authorized an additional 10.50 Nurse Clinician 2 (NC2) (equivalent to
Registered Nurse) FTE for administration of medication to the rest of TCI’s population. These positions
were subsequently reallocated to LPNs.
Until May, 2016 all medications at CLS/LHS were being delivered to the youth by YCs and YCAs. Nursing
staff transcribed orders and also prepared and refilled the blister packs of medications for the housing units.
As of May 23, 2016, LHS had 362 active prescriptions that were being administered on a daily basis while
CLS had 135 active prescriptions.
Analysis
Medication management involves a considerable amount of time. In a nation-wide study 13, medical experts
estimate that as much as 40% of nurses’ time is involved in medications before, during, and after
administration. The utilization of an assembly line approach for medication administration does not equate
to a great reduction in nurses’ time spent distributing medication, given the complexities and time-intensive
nature of the task.
All of these factors increase the risk of medication errors and harm to juvenile patients when YC’s perform
medication administration and delivery. Medication administration requires knowledge of medication, side
effects of medications, and knowledge of potential contraindications. Despite the Department’s best efforts
to provide training to YCs and YCAs on the delivery of medications, errors continued to occur.
Therefore, in May, 2016 DJC instituted new policies and procedures at LHS and CLS for the administration
of medication. In the housing unit with the highest percent of youth on medication (DuBois), it became a
requirement that nursing staff administer all medications. In the other housing units, only senior staff
(YCAs and YCs with more than 2 years of experience) are now permitted to deliver medications.
DOC’s next step in the transition started in June, 2016 when contracted health care staff (1 Registered Nurse
and 1 LPN each for 1st and 2nd shifts) were hired to administer medications. Now only nursing staff are
administering medications to CLS housing units and LHS’ DuBois housing unit. The first medication
administration occurs on the housing unit prior to the start of school (which occurs at 07:45 AM), the last
administration occurs at approximately 10:30 PM, with two other medication passes during the day. This
schedule is maintained 7 days/week. In June, 2016 the Department changed the classification on an
existing 1.00 FTE into an NC2, thereby increasing the number of permanent nursing staff at LHS/CLS.

13

Armitage and Knapman. “Adverse events in drug administration.” Journal of Nursing Management (2003): 130-140.

 As of May, 2016 CLS consists of two housing units which are both open. CLS is separated from the male
side of the facility by a fence. LHS consists of 10 housing units, of which seven are currently open. One of
LHS’ housing units is completely surrounded by fencing that allows the unit to be switched from a male to a
female unit, when there is a need for additional female beds. As shown in the map of the LHS/CLS campus
in Appendix I, these housing units (cottages) are spread out across the entire campus, therefore there can be
significant travel time from one housing unit to the next.
The Department would like to fully transition to utilizing permanent nursing staff to administer medication
to all youth at LHS and CLS in October, 2017. In order to completely stop utilizing YCs and YCAs to
administer medications, a total of 10.00 nursing FTE will be needed.
The Department would hire 5.00 FTE NC2s and 5.00 FTE LPNs, which would be above their currently
authorized nursing staff. These 10 positions would provide the equivalent of a 3-3-0 staffing pattern (three
on first shift, three on second shift, zero on third shift), 7 days per week. On occasion the Department may
still need to use contract staff, but prefers to have permanent positions to provide consistency of medication
administration to all youth. DJC recently reallocated a vacant non-institution GPR position to create one of
the 10.00 FTE necessary for a more permanent method of administering medications at both LHS and CLS.
When medications are administered there is an expectation that the patient is assessed for ability to take the
medication, and some medications require checking the patient’s pulse, and ensuring proper orientation of
the medications. The nurse also evaluates the patient for the effectiveness of the medication. Patients with
significant health needs such as chronic disease or mental health needs will require assessment and
thoughtfulness of medications administered.
In alignment with scope of practice and best practice, LPNs do not practice independently while RNs
(NC2s) are allowed to practice independently. The LPN may participate in care of patients with basic health
needs, and may therefore administer medications. However, patients with complex health needs must be
assessed by an RN. It is due to these reasons that a mixture of NC2s and LPNs are being requested, rather
than just LPNs.
Because the juvenile institutions are almost completely funded through PR, using existing PR positions
would result in the salary and fringe expenditures being paid through revenues collected from the daily rate
charged to counties, the Serious Juvenile Offender appropriation, and the Adult contract bed appropriation.
In the Department’s 2017-19 Biennial Budget request, funding for agency (contract) nursing staff was
included, but could be reduced if this proposal is approved.
Given recent reductions to the institution populations (which also corresponds to reductions to revenues),
the Department would prefer all 9.00 FTE be funded by GPR in the future so the costs aren’t included on the
daily rate.

 Summary
GPR
PR
TOTAL

FY 18
Funding
$620,800
($527,300)
$93,500

FTE
9.00
0.00
9.00

Prepared by: Dawn Woeshnick, Budget and Policy Supervisor
240-5417

FY 19
Funding
$769,000
($703,100)
$65,900

FTE
9.00
0.00
9.00