The curious life of a prison pre-registration trainee

Xinyu (Lisa) Yu describes her experience of completing her pre-registration training in a prison.

Prison — where I spent the past year working as a pre-registration pharmacist. I was sceptical at first, but it turned out to be an amazing year. Here are a few differences to outside practice.

Security

Security is very important as expected. Every member of staff participates in an introductory ‘key’ talk. This includes education on security rules and key withdrawal with fingerprints. No doors should be left unlocked! Spot searches occasionally happen where you and your belongings are searched at the gates. Sniffer dogs are also present.

What I found hard to adapt to is not being allowed to bring your phone into work. Personally, I am used to relying on my phone when I need to look things up. However this year I have had to reacquaint myself with paper BNFs. Other prisons have trialled the use of laptops which have been successful, so maybe in the future laptops may become the norm.

Manipulation

This was part of our introductory talk where videos of example situations were shown. Manipulation of staff by prisoners can occur so all staff are trained to recognise and avoid this. For example, in multidisciplinary team meetings (MDTs) where decisions to prescribe gabapentin, pregabalin or stronger opioids for individuals are discussed. Extra thought and precautions are needed as these drugs can be abused. Therefore functional pain tests and past history of drug seeking behaviour are used in the overall decision. Prisoners can also be vulnerable; their prescription drugs can be taken by others. These should be considered when screening prescriptions.

Prisons are unique

Prison healthcare can vary between prisons as different organisations may run different institutions. There are also differences in prison category. These would affect how medication is regulated and dispensed. The prison I worked in is a high security, category B male prison. Most of our patients are serving long sentences. Therefore medications are managed tightly with different possession statuses. A lot of the health concerns are mainly respiratory and cardiovascular conditions. Mental health conditions are also present but not the most prevalent. This may vary in different prison populations. We also have a pharmacy onsite where others may not. This allows the pharmacist to carry out services onsite.

Dispensary

Patients are assessed when they first arrive to determine how much of their medication they can have on them. This can range from supervised, 1-day, 7-day or 28-day supply. There are also certain medications where only a 7-day supply may be given, such as anti-depressants. All Schedule 2 and 3 drugs are supervised medications. A batch is created when a 7-day supply is given and this generates a list by Pro-script every Monday. This would then be dispensed against the label rather than the original prescription. Reminders are created for requests for a new script once they run out. Our technicians also organise “to take out” (TTO) orders for transfers as well as running compliance clinics addressing adherence.

Clinical screening

We use Systmone where all communications regarding a patient is recorded including recent blood tests. This helps us to clinically screen prescriptions with detailed information regarding the patient. Reports can be generated allowing identification of potential pharmaceutical interventions. Tasks can be created to communicate with prescribers and for more urgent issues, instant messaging on Systmone can be used.

After working here I realised there is little guidance on the practice of pharmacy in prisons. A lot of the work I was involved in was creating that guidance. Medicines reconciliation for example is a new service I was involved in the implementation of. Overall responsibilities for pharmacists are not set, this provides opportunities to carve out your own roles. For example, there has been an increase in pharmacy led clinics including medicines reconciliation, medicines compliance clinics and pharmacists’ diabetes and asthma clinics. In the future there may be even more input from the pharmacy team.

Day-to-day schedule

Staff are all very friendly, everyone says hi. The gardens are very pretty. It is not how I imagined it being!

My normal routine involves medicines reconciliation clinics in the morning. Then chasing prescriptions for patients to sync them on a Friday collection.  In the afternoon I help in the dispensary or with any other queries when they come to me as well as help screen prescriptions clinically. If there are any complex patients in our inpatient unit I would also help manage medicines there.

Pre-reg year

My year has been very hectic and interesting. Not only was I finding my feet in prison pharmacy, I was also given rotations in surrounding hospitals in both clinical and technical rotations. Prison pharmacy had been described as a mix of community and hospital pharmacy but more so to me it is a unique experience.  A good source for cake as well!