Risk factors

Factors will be considered in terms of those that confer risk, those that reduce risk and those factors that have the potential to influence risk either way, depending on other variables.

Examples of setting

Offender healthcare settings include:

• Prisons
• Immigration removal centres
• Young offenders institutes
• Secure training centres
• Secure children’s homes

Healthcare setting factors

Conferring risk

• Use of stock medicines in clinical areas presents risk because transcribing errors in the pathway may result in administration due to the accessibility of the medicine.

Variable risk

• Medicines supplied by external prescribers (e.g. out of hours medicines or hospital supplied medicines) will require entering onto the secure environment’s clinical record and e-medicine chart (for non in-possession medicines).
• On-admission, verified patient’s own medicines are used to supply doses until a new prescription can be fulfilled.

Reducing risk

• All English prisons have electronic prescribing, which reduces the need for transcribing.
• Electronic prescribing system allows legal prescription to be in place when inter-prison transfers occur.
• Majority of medicines supplied as own labelled medicines which identifies medicines for each individual, and may reduce picking errors

Personnel factors associated with setting

Conferring risk

• May have limited medical input.
• May have limited clinical pharmacy involvement.
• In secure children’s homes, non-registered care staff may use paper drug charts to transcribe prescription information to record the supply.

Reducing risk

• Registered staff should be familiar with medicines and indications.

Process factors associated with setting

Variable risk

• Patient’s own labelled medicine provides a transcription of the prescription, but this might not reflect any recent changes or have adequate instructions for some medicines (e.g. insulin).

Reducing risk

• Medicines reconciliation on admission should reduce risk, but may not be available within 24 hours.
• Administration undertaken by registered staff who should act as layer of defence if error in transcribing.

Medicine factors associated with setting

Conferring risk

• Will have high risk medicines.

Variable risk

• Unlikely to have high risk administration methods.

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