Safety, Quality, and Informatics at Albion State Correctional Institution

There is a growing awareness of the need to improve quality across healthcare and general practice in Pennsylvania prisons. The whole prison system was indefinitely blocked after five employees from the Albion State Correctional Institution had been rushed to a hospital after exposure to unknown tainted drugs suspected to be synthetic ones (Paul, 2018). Considering the fact that this institution cannot be closed forever and will be reopened one day, there is a huge need to improve its healthcare system as well as to translate evidence-based practice (EBP) and electronic health records (EHRs) into practice effectively. Expectations of patients, who in this regard are staff members, and those of healthcare givers keep on changing. Curbing adverse outcomes related to this incident of the opioid epidemic at Albion Correctional Institution is a very important concern for all healthcare leaders, not only in Pennsylvania State but also in the national government. That is why this paper reviews the opioid crisis as a patient-safety issue within the Albion jail, describing what has caused it as well as comparing the way in which the facility has addressed the problem with concepts, principles, and practices that contribute to continuous quality improvement (CQI) and patient safety. Using published literature, the paper analyses legal and ethical consequences of not addressing the opioid crisis and describes the impact on the organization from the financial and regulatory perspectives. Basing its research on the opioid epidemic at Albion Correctional Institution, it identifies strategies to overcome specific organizational barriers to change. The closure of the facility can offer a temporary solution to the reduction of opioid addiction, but adhering to EBP and enhancing the effective use of technology using EHRs are necessary to prevent the occurrence of a future opioid epidemic.

Causes of the Opioid Epidemic

The opioid crisis that exists today started developing gradually many years ago. Rummans, Burton, and Dawson (2018) note that in the past, opioid drugs were mainly prescribed for severe pain due to an injury and surgery or connected to cancer or a terminal illness (p. 345). Physicians were unwilling to prescribe opioids for other conditions because there was no supporting evidence to do this, and there was also a concern of addiction. More so, they became afraid of investigations and state board disciplinary actions if they prescribed opioid drugs more freely. However as the National Institute on Drug Abuse (NIDA) (2018) indicates, in the late 1990s, pharmaceutical corporations assured the medical community that patients could not become addicts to opioid pain-relievers, and healthcare practitioners began to prescribe them at bigger rates. It had subsequently resulted in the extensive change and exploitation of opioids before it came to light that they could indeed be very addictive. Opioid overdose rates began to increase. Five employees of Albion Correctional Institution are some of the victims who have suffered from overdose rates of opioids.

Opioids Epidemic at Albion Correctional Institution

In August 2018, Pennsylvania ordered the closure of its state prison system after five staffers from Albion Correctional Institution had sickened because of contaminated synthetic drugs. According to the NIDA (2018), the opioid epidemic is the misuse and addiction to opioids, which are medications inclusive of pain-relievers, fentanyl, and heroin that act on the human body like morphine and are often used for pain relief. Paul (2018) writes that so far, a synthetic cannabinoid is linked to this incident, which is ten times stronger than heroin and morphine.

To ensure safety and security of Albion Correctional Institution employees after the epidemic, the facility was closed to visitors immediately and indefinitely. Paul (2018) also indicates that the mail service throughout the prison system was frozen, including the closure of all mailrooms to non-legal mails. No inmates were removed or transferred to other prisons but were restricted to leave their housing unit to go to their educational programs or eat meals. All these activities would take place in their cells. There was also the postponement of visits to inmates and the compulsory use of protective equipment like gloves by all workers that were offered by the Pennsylvania Department of Health. In addition, extra training would be provided to employees, and they were advocated to use extra caution when parole violators and new-comers entered the prison system.

How Albion Correctional Institution Handled the Opioid Epidemic

The Albion Correctional Institution addressed the opioid epidemic issue in accordance with healthcare concepts, principles, and practices that contribute to CQI and patient safety. The National Learning Consortium (NLC) (2013) defines patient safety practice as a kind of structure, the role of which is to minimize the likelihood of adverse events related to a variety of diseases and procedures in the healthcare system (p. 2). The Albion Correctional Institution adhered to this by trying to curb the spread of tainted drugs smuggled into the facility. It closed down the latter, restricted the movement of male inmates, suspended visits to inmates, froze the mail service, and gave protective clothing and equipment to the staff. By doing all these things, it delivered patient safety care in a way that it prevented more harm to inmates.

When a person is ill or just trying to be healthy, they ought not to be anxious about being wounded by the health system. According to the NLC (2013), principles of patient safety function to motivate healthcare providers to improve safety efforts incessantly (p. 8). They are as follows. Healthcare professionals must be encouraged to improve patient safety because of their ethical base, professional standards, and prospects of their respective disciplines. Organizational healthcare leaders are accountable for setting principles for attaining safety at the highest level and ought to do so in response to public expectations. There is a room for the advancement of the healthcare system and practices that will decrease errors and harm. The Albion Correctional Institution addressed the epidemic issue in relation to these patient safety principles. Paul (2018) states that in one month after the incident, Governor Tom Wolf met with the staff to discuss safety concerns and address the exposure that had left employees ill at the facility. Thereafter, the Pennsylvania Department of Corrections announced that it would introduce several new safety protocols in response to the opioid epidemic. Paul (2018) reports there will be a review and update of policies at Pennsylvania’s 25 state correctional facilities. Direct mails will no longer be received at state correctional facilities; instead, it will be scanned and processed at a separate address six days per week before it is delivered to inmates. Drone detection will be installed in all state correctional facilities, and surveillance will be intensified when prisoners are in the yard. Body scanners will be improved, and the number of staff members in visiting rooms will be doubled.

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Patient safety concepts are constantly linked with quality. In essence, when healthcare is safe, it does not cause harm (NLC, 2013). Having the lowest potential to cause harm through patient safety practice and principles, healthcare providers provide the highest quality of care. When the Albion Correctional Institution had made a choice to focus on protecting its staff, inmates, and the entire prison system to prevent the future opioid epidemic, it demonstrated to observe to the patient safety concept of delivering quality healthcare to its patients.

Analysis of Legal and Ethical Consequences of not Addressing the Opioid Issue

If the Albion Correctional Institution fails to address this opioid epidemic in the near future, it will experience several worse opioid crises than this one. There is no regulation that ethically outlines how pharmaceutical bodies, medical organizations, insurance companies, and pharmacies can prescribe opioids to consumers. Without the law, the same medical practitioners, who have intentions of improving patient care and decreasing costs, will continue prescribing opioids that will indirectly contribute to the aggravation of the opioid crisis. Rummans et al. (2018) assert that with this prescribing practice, a lot of consumers will receive large amounts of potent opioids that will increase their risk for dependence (p. 348). Also, opioids like heroin and fentanyl are easily obtainable at a cheaper price on the illegal market that does not ask for prescriptions. Even if patients take opioid drugs, the remaining pills can be misused by their family members. It implies that the Pennsylvania State must provide a legislation that will regulate the sale of these drugs eliminating the black market. Otherwise if it fails to do so, the number of deaths will continue to rise. Employees and inmates of Albion Correctional Institution will also consume more opioids and ruin their health or even die due to overdose.

The lack of a legislation to regulate the sale of opioids drugs will have negative financial implications for the Albion Correctional Institution. The NIDA (2018) approximates that the whole economic weight of opioid prescription exploitation in America alone is $78.5 billion yearly. In an attempt to address the opioid epidemic in the future and without the respective legislation, the Albion Correctional Facility will spend millions of dollars on healthcare costs, criminal justice participation, productivity losses, and addiction management. It will bring an extra economic burden to the Pennsylvania State and entire America.

Evidence-Based Interventions and Technology That Can Address the Patient-Safety Issue

EBP Interventions

The prescription and illicit misuse of opioids is a momentous public health threat and emergency to both local and federal governments. The NIDA (2018) affirms local health departments play a critical role in responding to the opioid epidemic and that their efforts should be through the implementation of EBP policies and programs for the prevention and treatment of the opioid use disorder and its related health consequences. EBP is best described as objective, balanced, and responsible use of existing research and available data to direct the patient safety policy and practice decisions that concern ways how patient health outcomes can be improved. it is an endless critical review of research literature that outlines what information is reliable, and what policies and practices will be operational given the best existing evidence. The first EBP local strategy that the NIDA (2018) recommends is improvements in surveillance and monitoring that can prevent medical errors and their adverse effects. It involves continuous acquisition, clarification, and creation of patient data, such as worksheets, interdisciplinary rounds, clinical information, and decision support systems used for making clinical decisions. Here, Albion Correctional Institution employees should be trained how to improve in surveillance and monitoring of inmates to be able to identify easily those who smuggle drugs into their facility. The second intervention is to increase awareness of prevention and education. Employees of Albion Correctional Institution need to be enlightened on risks and benefits of using opioid drugs. The third EBP strategy that the NIDA (2018) recommends is the promotion of appropriate opioid prescribing practices. With this regard, the existing law should be amended to allow all Albion Correctional Institution healthcare staff members to take responsibility for disseminating information about new drugs to their consumers. The last strategy is the improvement and expansion of treatment and recovery services for patients with opioid misuse in public and private hospitals. The Albion Correctional Institution should provide funding to facilitate this expansion in its facility to treat addicts.

Technology Interventions

The use of technology, precisely EHRs, can increase the quality of health care delivery. It is the primary duty of healthcare providers, health IT developers, and national and local policymakers. The NLC (2013) points out that to ensure a safe seamless inmate experience, if implemented at Albion Correctional Institution, EHRs can powerfully revolutionize staff identity and security. It will minimize the risk for medical identity inaccuracies and prevent medical errors across the healthcare prison system continuum. EHRs will also empower patient care everywhere. If laptops can be mounted on mobile carts of Albion Correctional Institution employees, it will make it easy to capture and access vital data on every staff member. It will offer the health professional staff flexibility they need to provide the continuity of patient care wherever they are. Healthcare workflow and patient responsiveness will be improved and streamlined. Technology will also increase safety efficiency, when any technological platform connects all employees of Albion Correctional Institution, no matter where they are located. They can easily monitor the staff and inmates and all activities taking place in the facility. It helps improve outcomes, optimize staff productivity, and identify criminals who smuggle harmful substances in prisons.

Strategies to Overcome Pennsylvania Prison’s Barriers to Change

Ending the opioid epidemic, Pennsylvania prisons need superior coordination of care and societal involvement in finding solutions that will eliminate barriers to implementing change in the entire prison system. According to McIver (2017), the first strategy of combating Albion Correctional Institution’s barriers to change is the involvement of the staff when implementing EBP (p. 478). Once clinical and educational research has been done, and a model has been developed to reduce ways of minimizing opioid drug usage in prisons, the healthcare staff in the facility must be involved by being educated on the use of the new framework that can assist them to find ways of helping their patients who are opioid-addicts. Giving each staff member a chance to participate in the implementation of EBP will make the one feel appreciated. It will empower the person with roles and responsibilities that will make him or her use skills to one’s best advantage. It will also provide a potential for personal and team development in the fight against this epidemic. McIver (2017) also suggests that the application of an electronic database and prescription drug monitoring programs (PDMPs) will help to overcome the barrier of information-sharing (p. 478). With this, information about substance prescriptions will be controlled and tracked, facilitating its sharing among the staff. The database is also vital in identifying opioid-addicted employees who may need help. Lastly, the staff, who provide primary care to inmates, must be involved in decision making, especially in relation to chronic pain management and safe opioid prescription. It will build a collaborative staff team with collective goals, where the information on overdoses can be shared, and tension that exists between the manager and subordinates will be reduced.

Conclusion

While most local governments appear to be hesitant in supporting radical EBP and technological policies and programs that can bring change, the existing treatment approach offered during incarceration is of the same old type. It is cheaper for correctional facilities to allow their employees and inmates to suffer for a while with opioid drug addiction, but in the long run, the whole society will bear a much greater expense. Opioids are smuggled with the intention of self-treatment and withdrawal. Yet numerous prisons in different states have taken this challenge for granted and regard these unsafe medications to have extra benefits than downsides. Society has no choice but to put opioid-addicted inmates on treatment. Even though the opioid endemic swallows the generation of Americans, it is apparent that a modification in the strategy is desperately needed. It is the right time for America to multiply its efforts in prisons and open a new face in a battle against this menace for people to be able to start to subdue it finally.