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Policy 722Santa Ana Police Department Custody Manual Copyright Lexipol, LLC 2024/02/21, All Rights Reserved. Published with permission by Santa Ana Police Department***DRAFT*** Nursing Assessment Protocols - 1Nursing Assessment Protocols 722.1 PURPOSE AND SCOPE The purpose of this policy is to establish standards for evaluating and treating incarcerated persons with medical issues that are easily and effectively treated or triaged by nursing personnel who have been properly trained in the use of nursing assessment protocols. 722.1.1 DEFINITIONS Definitions related to this policy include: Nursing assessment protocols - Written instructions or guidelines that specify the steps to be taken in evaluating an incarcerated person's health status and providing medical treatment. Protocols may include first-aid procedures for the identification and care of ailments that ordinarily would be treated with over-the-counter (OTC) medication or through self-care. These protocols also may address more serious symptoms, such as chest pain, shortness of breath, or intoxication. The protocols provide a sequence of steps to evaluate and stabilize an incarcerated person until a qualified health care professional is contacted and orders for further care are received. 722.2 POLICY It is the policy of this department that medical care performed by personnel other than a physician shall be performed pursuant to a written protocol or order of the Responsible Physician. 722.3 PROTOCOL DEVELOPMENT AND AUTHORIZATION The facility's Responsible Physician or the authorized designee shall develop, review, and authorize all nursing protocols used for the treatment of incarcerated persons, and shall develop, deliver, or procure appropriate training for the nurses on their use. Each nursing assessment protocol will have a signed declaration indicating it has been reviewed and approved by the nursing administrator and the Responsible Physician. The protocols developed shall be appropriate for the training and experience of the health care services staff members who will deliver the services. Each protocol shall comply with the standards of practice for the level of care the health care services staff members are authorized to provide. The protocols shall only include the use of OTC medications. The Responsible Physician shall review the nursing assessment annually, revising as necessary and dating and signing approved protocols (15 CCR 1204). 722.4 TRAINING Nurses will be trained and approved in the nursing assessment protocols prior to their use. The training shall be documented and should include: (a)Evidence that new nurses have been trained. (b)Demonstration of knowledge and skills. (c)Evidence of annual review of skills. Santa Ana Police Department Custody Manual Nursing Assessment Protocols Copyright Lexipol, LLC 2024/02/21, All Rights Reserved. Published with permission by Santa Ana Police Department***DRAFT*** Nursing Assessment Protocols - 2(d)Evidence of retraining when protocols are introduced or revised. 722.5 AUTHORIZED USE OF PROTOCOLS Nursing staff may use a nursing assessment protocol only after they have been trained and authorized by the Responsible Physician. Nursing assessment protocols shall only be used after a nurse fully evaluates the incarcerated person's complaint and the incarcerated person's condition meets the appropriate criteria. The assessment protocols only include the use of OTC medication. When OTCs are administered per the protocol, they do not require the signature of a physician. However, the order and the administration of the medication shall be documented on the medication administration record. A registered nurse (RN) is considered the minimum certification level required to independently initiate medical treatment, except in an emergency to render first aid. The RN must be present to physically assess the incarcerated person; an assessment cannot be done via telephone or electronically. Licensed vocational nurses (LVNs) are generally prohibited from independently initiating any standardized protocol. Under specific circumstances (e.g., early detoxification, a history of a seizure disorder), an LVN may initiate a standing order following a telephone consultation with a physician, physician's assistant, psychiatrist, dentist, or other person who meets the minimum certification level to initiate such orders. Under these circumstances, the incarcerated person will be evaluated within 24 hours by a physician's assistant, nurse practitioner, registered nurse, or physician. Nursing assessment protocols shall not include the administration of any prescription medication, with the exception of protocols addressing an emergency or a life-threatening situation. Treatment with prescription medication may only be initiated upon a written or verbal order from a physician, physician's assistant, psychiatrist, dentist, or other person who is licensed to dispense medication in the state, either independently or under the supervision of a physician.