Army Action Plan: Standard Operating Procedures for Medication Dispensing the Detainee Hospital at Guantanamo Bay

MEDICATION DISPOSING POLICY SOP: GIS
1

DETAINEE HOSPITAL.
SOP NO: 010
EFFECTIVE DATE: Ill JAN 2004
GUANTANAMO BAY, CUBA

Title: MEDICATION DISPENSING POLICY
SCOPE: Detention Hospital
I.
•
I. PURPOSE:
To provide guidelines for the procedmes to be followed in dispensing mom to thedetainees located at Camp Delta oink and Detention Hospital.
IL BACKGROUND:
The pharmacy technician (NEC 8482) provides pharmacy support by dispensing
medications pursuant to valid prescriptions Vain= by aeckatialed providers.
la RESPONSIBILITY:
The'Director for Ancillary Services has ovaall responsibility for pharmaceuticals and
reports directly to the Officer in Chugs. Tbe Leading Petty Maw (LPO) for the
Phamacy is responsible for the proper organization, efficient lavatory managesment. and
proper dispensing and intones of all plarmeceuticals. Operational procedures shall be
in compliance with all .of Chapter 21 of the Manuel of the MedicalDepartment.
Security of Pharmaceuticals: The Detention Hospital pharmacy technician will ensure
the proper security of the pharmaceuticals transported to Carp Delta. The pharmacy
satellite pharmacy will be run from the Delta Detention Hospital. which LPO will ensure that adequate medication stock is kept available at t he camp clinic. Awill providemost stock medication to the Camp Delta Clinic and to the Detention Hospital. At the camp, all pre-dispensed medicadons will be kept in a designated drug cabinet. All controlled substances will be kept in a locked cabinet and the clinic nurse will maintain
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MEDICATION DISPENONG 'DUCT. Mtme 2
the narcotics log and locker key. A small mock of frequently wed immunizations will be stored in the Detention Hospital Pharmacy reefer. Larger quantities of immunizations willbe stored at the Naval Hospital LIMO Pharmacy and transferred to Delta Clinic on m Is needed basis.
IV. DISPENSING OF MEDICATIONS:
1.
The Camp Delta medical= formulary will be determined by the Senior Medial
Officer. The formulary will be reviewed an an annual beds.

2.
The method provides will enter all pressiptions into CRC& A CHCS terminal and label primer will be available her the phermacy milldam to use in the cfspemeing at prescriptions. The *mom schnichm will fill all premsiptions and will apply CHCS &smarmed prescription libel and munlimy wings' lab* to the bottles as appropriate. Medications ordered beyond a onatime um mod &weaned by the Hospital Corpsmen willbidispeneed from the Detention Howled pbmtn ¦cy.

3.
The controlled subsumes se dispensed to the custody of the mining stag which will

be in charge of aiming the drugs and securing them in the lodger. AR other dispensed
medications will be kept a &missend ars within the clinic sod will be stared according

to type of drug and patient identification =Mbar.
4. Corpsmen may par mediations on the blocks dkc they have completed the five-day
Corpsman orientation to the asp and has bed direct obstevades by the Tem Loader.

V. WASTING OF NARCOTIC MEDICATIONS:
1. When a narcotic medication is returned for any reason, it will not be rimmed to the
Narcotic Locker. The medication will be animated as wasted on the Narcotic and
Controlled Drug AOCOOKII Record (NAVMED 761011) far t hat peticidar medication.
An arrow will be drawn to the debt of the Balance on Hand block pointing to the
beck of the form. On the back of the Narcotic and Controlled Drug Account Record,
at the same level of the arrow, the mom will be annotated as to how snuck time and
date, and the 11110101 of the two people who wasted the narcotic. Two muses or a none

and a corpsman are authorized to annotate the waste of the nesotia
VL DOCUMENTATION OF MEDICATION ADMINISTRATION
1. When the muse takes orders off the chin, the muss trill initial to the aide of each order as it is taken off and transcribed to the Medication Administration Record (MAR). After all of the orders of that provider we transcribed appropriately, the mass will sip, dateand time when be or she completed the transcrip6on of the orders.
MEDICATION DISPENIINC POUCT.
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2.When verifying the days charts, the RN will compare the MAR with CHCS and will annum "Chart verified with MAR, CHCS (and, when &wowing, peofiler and thensign and time on the doctor's order sheet.
3. When mediations are discontinued by a provider, musing staff will ensure all
discontinued medications are pulled from the pstient's drawer at the time the ceder is.

transcribed.
4. Each evening, in the absence of a phermecy tecinician, the RN and an HM will go through all the patient meld drawers with the MARS to assure the correct medications arein the pepper drawers and no drugs are pest their expiration date.
S. When mediations we given tea detainee, nursing sodf will annotate by signing
initials an the MAR to Mate medication were given.

6.Whenever a narcotic is given,rannotation will be made in the nurses notes stating the ,reason why the narcotic was IMO, including a petkoperceived pain scale (1-10), end.!
30 minute& or so Iner, the patient's remotion to the medication (e.g. less pin, patient
asleep, etc).
7.Whenever possible, no detainee will have more then one MAR at any given time.
When more than one MAR is noneasary become of the space rewired by mediations

already discontinued, a new MAR is to hi transcribed to seduce the nmnber of MAR
pages necendy.
8.When more than one MAR is necessary, each page will be numbered — "one of two,
two of two . and so fords.
9.When MABs me transcribed, either at the and of the month, or at points during themonth, a nem shall verify mod initial the new MAR to indicate It accurate* reflects the
current provider olden ler the dedinee.
10.At change of shift, the commies RN will review the MAR with the off going RN toensure all medication have been passed and to ask questions generated by the MAR
documentation.
YU. REFUSAL OF MEDICATIONS BY DETAINEES •
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MEDICATION DEIPENZINO POLICY . timet sic 4
I. Any medication refuels in the hospital, and on the block need to be brought to the attention of the MP on duty. They here to log this infirmities in to DIMS system for traddng pozposee. On the blown, t MP MUST be with your yon pass meld& taking note of any rdocals. Let the Clinic Mae know if this is not hoPPeninS
3. Certain types of medication refusals must be brought to the MA. 's =ad= inisedlately sitar the medication pas& List I coming inspormot medications the need to be addressed as soon as possible with the Medical salt Lim D consists of all adzes that do not wady impact the heath of the detainee immediately.
List I:
a. Cardiae medic adton- Ez.- Verspendi, .bona, etc.b. •High blood preemie medication,. BE.- Atenalol, Calm SR, etc. c. Tabercalada medicatims-d. Diabetic medications— EhL - Gincophage, Metformin, Cilipizide, Avandis, etc. • & Psychiatric mofications- Ex- Olsozipins, Mono*, Prone& Zolok eta. L And-same medication,- Ex. — Towed, Malin, Nakao, etc. g. Anglo** —.Anent Dionicelin, etc. h. Endocrine medications- Synthroid i. Asthma mediations —Flovent, Ammo, Advair, Samos, Albutend, .-Singcilar, etc. • • •••••• 7' -
List
a. All other medics:ions, i.e. Surfalt, Artificial teem &mac, Pdlosec, Mom, 3. Mylanta, Moor* etc. • If the detainee refuses mediation from List I, the cosponanot the end of that medication pass, will annotate a note in the cheat string which mad was reamed and handit DUMMY to the MO.
4. If the detainee refuses mole from List II more than three times in one week, the Doman win annotate a nose in the ciao and piece it in the "MO to Sign" bin. The amnion shall inform the detainee that if the caldron to ream the medication, the MO will be notified and the decision to continue the medication will be made.

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NrizioATION DEIPIICONG POUCY.
30P: aN
STANDARD OPERATING PROCEDURES Detention Hospital
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REVIEWED AND APPROVED BY:
Officer In Charge •
Date
IMPLEMENTED BY:
Director for Administration Dye
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ANNUAL REVIEW LOG:
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