SA Prison Health

Services

Caring for Prisoners

Shaping the future of health

with world-class care and world-class research

.

We acknowledge and respect the Traditional Custodians whose ancestral

land the Central Adelaide Local Health Network (CALHN) provides services

on. We acknowledge the deep feelings of attachment and relationship of

Aboriginal and Torres Strait Islander peoples to country.

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>Central Adelaide Local Health Network (CALHN) came into

effect on 1 July 2011 as a directorate of SA Health.

>South Australian Prison Health Service

>The SAPHS Director of Nursing reports directly to the

CALHN Executive Director of Mental Health / Prison Health.

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Primary Health Care Within Prison

SAPHS Model of Care •Aim Community Equivalence •Detection, assessment and intervention •Prompt and effective treatment •Community standard of care •Prevention measures •Health education •Continuity of care in the community via collaboration with local health care providers

Reducing Health Ineqaulities

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“Access to health is a basic human right not a privilege”

—Recognise impact of economic and social policies and conditions on health.

—Physical, social and economic environs impact on health and wellbeing of individuals.

—Socioeconomic status a key social determinant of health explaining the inequality between the rich and the poor

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Adelaide Remand Health Centre

Cit

Adelaide Remand Health

Centre

(24 hr 10 inpatient beds)

274 Prisoners

Port Augusta Prison Health

Clinic

592 Male Prisoners

25 Female Prisoners

Yatala Labour Prison Health Centre (24hr 12 Inpatient beds)

576 Prisoners

ARC / PAP / YLP

Patient Contact Hours

• 0830 – 1130

•1300 - 1600

Health Clinics

•Nursing

•Medical

•Psychiatrist

•Dental Services

•Physio

•Sites Specialised

Clinics

Adelaide Remand Centre (ARC) - SERCO

Port Augusta Prison (PAP)

Yatala Labour Prison (YLP)

YLP Health Centre / High Dependency Unit

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Adelaide Womens Prison 176 Prisoners Adelaide Pre-Release Clinic 80 Prisoners

Cadell Training Centre

Health Clinic 210 Prisoners

Mobilong Prison Health Clinic 472 Prisoners

Port Lincoln Prison Health Clinic 178 Prisoners

Mount Gambier Prison

653 Prisoners

AWP

Cadell Training Centre (CTC)

Mobilong Prison (MOB)

Port Lincoln Prison (PLP)

MGP (G4S)

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South Australia Adult Prisoner Numbers 49% of adults entering a prison within Australia report that they have been told by a health professional that they have a mental health disorder1. Prisoners can be in a cell for up to 23 hours a day in some prison environments.

1. Australian Institute of Health and Welfare, 2018, The Health of Australia’s Prisoners, Australian Government, Canberra

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The Role of the Prison Health Nurse

SAPHS Nurses undertake the same tasks as they would in any community primary health care setting including:

Comprehensive clinical assessments of all new

prisoners

Coordination, triage and/or delivery of health clinics

Medication management

Assessment and management of high risk patients

Management and treatment of chronic conditions

Responding to medical emergencies

Professional practice and portfolio management

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SAPHS Nursing Led Journey of Care

Stage One - Entry / Admission to Prison Assessment (Health Risk Assessment/ Health Needs Determination) Stage Two – Health Summary (Transfers / Discharge / Assessment / Care Planning / ISBAR Clinical Handover / Inter health Service Facility transfers / Immunisation record / ROI responses to GP requests) Stage Three - Clinical Health Care / Pathways (Health Care Planning) Stage Four - Discharge (Release) Planning Nursing Assessment

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Prisoner Morbidity and Mortality

Chronic Disease

Cardiac / Respiratory Disease

Mental Health Conditions

Musculoskeletal conditions

Drug / Substance Abuse

Infectious Diseases

Ageing

Trauma inc. Deliberate harm to self or others

Surgical Condition

ENT

Foreign body / ingestions / hoarding

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HEALTH ASSESSMENT One HEALTH ASSESSMENT Two Primary Survey DRABCDE / DRSABCD (BLS) Secondary Survey OLDCARTS Past Medical History / Meds

Head & Face Inspect - Deformities; Infestations; Symmetry; Palpate - Swelling (lymph nodes)

Psychosocial History Smoking Nutrition Alcohol use Illicit drug use Occupational history Religious, spiritual and cultural beliefs

Eyes Inspect - Eyelids, conjunctiva, sclera, iris, pupil Test - visual acuity

General Observation Posture & movement Facial expression Interaction Colour, diaphoresis

Ears Inspect - External ear – shape, colour, size, lesions Internal ear – tympanic membrane, swelling, infection, wax, foreign body, bony growthsPalpate – external ear, mastoid bone, lymph nodes of neck

Vital Signs TPR, BP, SaO2, BGL, UA, Height, Weight, BMI, Waist Circ. Mental Status ABCAPC

Nose & Sinuses Inspect – symmetry of nose, breath through nose, discharge Palpate - frontal & maxillary sinuses

Neurological AVPU GCS – Eyes Open (1-4) Best Verbal Response (1-5) Best Motor Response (1-6)

Mouth & Throat Inspect – odour, lips & mucosa; gums; tongue; tonsils; swallow; gag; taste; reflux

Integumentary Inspect - Colour, Oedema, Rashes, Lesions, Palpate - Temperature, Texture, Turgour

Neck Inspect – skin & colour; muscles; trachea; thyroid; lymph nodesPalpate - muscles; lymph nodes/glands

HEALTH ASSESSMENT Three HEALTH ASSESSMENT Four Arms & Hands Inspect – nails; muscle size; deformity Palpate – texture; joints; temperature; pulses Assess - ROM; Cap refill CWSM – Colour, Warmth, Sensitivity & Movement

Legs & Feet Inspect – nails; muscle size; deformity; veins; hair distribution Palpate – texture; joints; temperature; pulses Assess - ROM; Cap refill CWSM – Colour, Warmth, Sensitivity & Movement

Anterior Thorax Inspect – Size & shape of chest wall; angle of ribs, use of accessory muscles Auscultate – anterior thorax; identify bilateral breath sounds; wheeze; crackles Palpate – Anterior thorax

Genitalia Inspect - discharge Inguinal Inspect – Inguinal lymph nodes; inguinal hernias Palpate – inguinal lymph nodes; femoral pulses

Posterior Thorax Inspect – Cervical, Thoracic & Lumbar Spine; size & shape of chest wall; shoulders; scapula Auscultate – posterior & lateral thorax Palpate - Spine

Care Planning Discuss findings with patient • Negotiate plan of care • Carry out immediate interventions • Arrange R/V by M.O. if required • Refer appropriately Handover to other staff

Abdomen Inspect – size; shape; colour; pigmentation; scars; stretch marks; visible peristalsis; masses; pulsations; umbilicus Auscultate – bowel sounds over each quadrant Palpate – each quadrant; soft; rigid; rebound tenderness; pain; guarding

Documentation Record in systems • Identify problems & record in order of

priority • Initial treatment and plan of care Ongoing short & long term plan including monitoring

Mental Status Examination (ABCAPC)

Primary Survey

A – appearance Posture, body movement Dress, grooming and hygiene Nutrition, wasting

Unconscious Patient (BLS) D R S A B C D Conscious Patient D R A B C D E

B – behaviour Attitude /Rapport/ Facial expression, Speech Engagement, attention

Secondary Survey OLDCARTS

Presenting Concerns

.C – cognition Insight Judgement Thought processes & content Mini Mental State Exam

O – Onset L – Location D – Duration

A – affect Mood & affect, anxiety Screening for suicidal thoughts

C- Characteristics A – Aggravating Factors

P – perceptions Though Content Hallucinations Delusions

R – Relieving Factors T – Treatment S – Signs / Symptoms / Other

C – (level of) consciousness Alertness, orientation, attention,concentration

Consider effect on patient, patient’s understanding of problem Prioritise other concerns

Comprehensive Patient Health Assessment

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Provide Nursing Care in Custody Is a Balancing Act

Information Sharing Guidelines

Transfer to Hospital

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Prisoners and Hepatitis C

The prevalence of Hepatitis C in the general Australian population is

1-1.5% in the prison setting it is as high as 45%.

Psychosis

Medication – Assisted Treatment for Opioid Dependence (MATOD) Benefits – Treat Opioid dependence, prevent overdose, reduces harm, reduction in recidivism Treatment Options – Maintenance therapy or pre-release treatment . Officers Role – Supervision Prisoners Role – to take the medication as per their signed contract

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Health Video Conferencing

MATOD Clinics

Pain Clinics

OPD Clinics

Forensic Mental Health Clinic

Infectious Diseases Clinic

General Medicine

Education / Training

Burns / Spinal/ Colorectal

SAPHS

Mental Health

Services

Notice of Concern

(NOC)

High Risk Assessment Team

(HRAT)

HRAT / Mental Health Review

OACIS / CBIS

Forensic Mental Health

Security / Safety.

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Be aware at all times of your:

> Physical (personal) security

> Relational Security

> Procedural Security

> Professional Security

Contraband

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Model of Care for Aboriginal Prisoner Health and Wellbeing for South Australia.

Aboriginal people within prisons have complex health needs.

The isolation from family and community compounds the profound intergenerational trauma, associated grief and loss, and resulting mental

illness and other chronic health conditions, such as diabetes, heart and respiratory diseases, cancer and substance abuse disorders.

This make the care of Aboriginal prisoners challenging, and therefore needing careful consideration and management in terms of risks to their

health and wellbeing while in prison.

Source: pg. 4. Model of Care for Aboriginal Prisoner Health and Wellbeing for South Australia. 2017. 31

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Prisoners In Hospital No visitors

No phone calls

Under direct supervision

Secured

Don’t

> Discuss appointments

> Contact family members

> Be alone without an officer

nearby

> Leave equipment

unattended

> Tolerate verbal abuse or

rudeness

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Prisoners In the Operating Theatre

> Security Level / No of Restraints

> DCS / G4s officer in attendence

> Anaesthetic induction

> Release of restraints

> Officer visual site of prisoner

> O/T Procedure

> Recovery

> Application of restraints

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Point of Call

>First point of contact

>Able to liaise with all prison sites

>Provide accurate and up to date information

between prison sites and hospitals

>Facilitate individualised discharge planning

SAPHS Liaison Nurse

Phone: 7002 3110

Email: Health:SAPHSClinical@sa.gov.au

Questions