CCHP-RN cheat sheet

The Eighth Amendment (convicted inmates) and the Fourteenth Amendment (pretrial detainees) ground the constitutional right to adequate health care; the governing test is deliberate indifference to serious medical needs (Estelle v. Gamble, 1976).

Deliberate indifference requires actual knowledge of a serious medical need plus disregard of that need; isolated negligence, malpractice, or a difference of clinical opinion generally does not establish a violation.

National Commission on Correctional Health Care (NCCHC) standards are organized into care components: governance and administration, safety, personnel and training, health services support, inmate care and treatment, health records, and quality improvement.

Core timelines used in survey compliance: receiving screening on arrival before general-population assignment, comprehensive health assessment within 14 days of admission, sick call triage within 24 hours, and 24-hour emergency coverage.

Care that is not documented in the health record is treated as not performed; contemporaneous, objective charting is the principal legal protection for the nurse and the facility.

Written policies must exist for medical emergencies, use of force, restraint application and monitoring, segregation rounds, hunger strikes, and sexual assault response.

A continuous quality improvement program requires documented audits (medication errors, sick call timeliness, chronic care visit compliance) with corrective action plans and re-measurement.

Initial and annual staff training must cover correctional health topics, infection control, cardiopulmonary resuscitation, and security awareness; current licensure and credential verification is kept on file.

Health service co-payments are permissible only when they do not deter access to necessary care, with exemptions for emergencies, chronic disease management, and indigent inmates.

Triage tiers: life-threatening findings require immediate evaluation; urgent findings (probable deterioration within hours) require same-day clinician contact; routine complaints are scheduled; minor complaints receive self-care education.

Clinical concerns escalate through the nursing supervisor or medical director; security concerns escalate through the shift commander. Neither chain of command overrides the other's authority.

Standard precautions apply to every patient: gloves for contact with blood or body fluids, hand hygiene, puncture-resistant sharps disposal, and a written post-exposure prophylaxis protocol after needlestick or splash.

After any use of force or restraint application, assess before, during, and after; document injuries on a body diagram with location, size, color, and the inmate's statements in quotation marks.

Emergency equipment (automated external defibrillator, oxygen, suction, airway supplies, emergency medications) is checked each shift with documentation of the check and any deficiency.

Intake screening elements include chief complaint, chronic conditions, current medications, allergies, mental health and suicide risk, tuberculosis and infectious symptoms, pregnancy status, dental needs, and vital signs.

Female inmates are offered pregnancy testing, prenatal referral, and menstrual hygiene supplies; gynecologic and breast health screening follows age-based guidelines.

Inmates may not serve as interpreters for other inmates; use qualified interpreters and document the patient's language preference.

Chart objective, factual, time-stamped entries; avoid conclusory labels such as 'manipulative' or 'drug-seeking' and instead describe observed behavior and quote the patient's statements.

Every entry carries the date, time, and signature or initials with credentials as defined by facility policy.

Paper corrections: draw a single line through the error, write the correction, and add initials, credentials, date, and time; never erase, obliterate, or use correction fluid.

Late entries are labeled 'late entry' and contain both the date and time of the actual event and the date and time the entry was made.

The health record is confidential; release requires written patient authorization, a court order or subpoena reviewed by legal counsel, or a documented need-to-know disclosure for safety.

HIPAA permits disclosure of protected health information to correctional officers for the health and safety of the inmate, staff, or institution under 45 CFR 164.512(k)(5), limited to the minimum necessary.

Health records are retained per state law and accreditation requirements, and the record or a transfer summary accompanies the inmate on movement between facilities.

Never pre-chart care before it is delivered and never document care performed by another clinician.

Verify the five rights at the point of administration and record the drug, dose, route, time, and initials on the medication administration record (MAR) at the time given, not in batches afterward.

Directly observed therapy applies to tuberculosis, HIV, and other high-risk medications: watch the dose being swallowed and check the mouth when indicated.

Keep-on-person (KOP) status requires clinical stability, absence of hoarding or diversion history, and safe housing; security searches the cell and nursing reconciles quantities at defined intervals.

Controlled substances require perpetual inventory, shift-to-shift counts, witnessed wasting, secured storage, and immediate documented reporting of any discrepancy.

Medication errors and adverse drug reactions: assess the patient, notify the prescriber, document clinically relevant findings, and complete the incident report through the designated administrative process.

Standing orders and protocols authorize defined nursing actions (for example, over-the-counter analgesics or first aid) and require prescriber review and periodic renewal.

Medication refusal requires documentation of the refusal, patient education, prescriber notification, and continued monitoring rather than automatic discontinuation of observation.

Pharmacy coordination includes formulary and non-formulary requests, therapeutic substitution, medication reconciliation at intake, transfer, and discharge, and linkage to community prescriptions.

A suspected tuberculosis case triggers masking, placement in a negative-pressure room when available, chest radiography, and sputum collection for acid-fast bacilli before housing in general population.

Latent tuberculosis infection is treated with regimens such as isoniazid for 6 to 9 months or short-course rifapentine-based therapy, based on a positive interferon-gamma release assay or tuberculin skin test without active disease.

Tuberculin skin test interpretation: 5 mm induration is positive in HIV-infected, immunosuppressed, or close-contact persons; 10 mm in other high-risk groups; 15 mm in those with no risk factors.

HIV care includes opt-out testing, prompt antiretroviral therapy, CD4 and viral load monitoring, and screening for sexually transmitted infections, tuberculosis, and viral hepatitis, with strict confidentiality.

Viral hepatitis prevention includes hepatitis B vaccination and hepatitis C screening by risk; razors, tattoo equipment, and other sharps are never shared.

A chronic disease program maintains a registry with defined visit intervals, monitoring parameters, care plans, and documented follow-up for conditions such as hypertension, diabetes, asthma, HIV, and seizure disorders.

Hypertension is confirmed with repeat readings and monitored toward individualized targets (commonly below 130/80 mm Hg); diabetes is monitored with hemoglobin A1c, foot examinations, and a hypoglycemia protocol using 15 g of fast-acting carbohydrate with recheck in 15 minutes.

Withdrawal is managed with protocol-driven scoring (Clinical Institute Withdrawal Assessment for alcohol; Clinical Opiate Withdrawal Scale for opioids) including hydration and escalation criteria; suspected opioid overdose is treated with naloxone.

Reportable conditions such as tuberculosis, viral hepatitis, HIV, and sexually transmitted infections are reported to the local health department per state law.

Suicide risk is screened at intake and after triggering events such as new charges, court dates, segregation placement, loss, or assault; a positive screen requires immediate mental health referral, removal of means, and observation placement.

Observation levels: constant observation is uninterrupted line-of-sight; close observation is typically checked at intervals of about 15 minutes; the level is ordered by a qualified mental health professional and each check is documented in real time.

Suicide precautions include a ligature-resistant environment, suicide-resistant clothing per policy, and documentation of checks as they occur rather than after the shift.

Mental health referral triggers include psychosis, acute agitation, catatonia, self-harm, food refusal beyond 24 hours, and withdrawal; emergency psychotropic medication requires legal authority and documented justification.

Inmates in segregation receive at least daily nursing rounds with documentation of mental status, hygiene, and decompensation, plus periodic mental health review for prolonged placement.

Pregnant inmates receive early prenatal care, nutrition and folic acid supplementation, infection screening, postpartum depression screening, and avoidance of restraints during labor and delivery where law or policy prohibits them.

Juveniles require developmentally appropriate assent and consent procedures, mandatory abuse reporting, and coordination with school and family systems; they are housed separately from adults.

Older adults and inmates with disabilities receive accommodations under the Americans with Disabilities Act, fall-risk assessment, dementia screening, and chronic care coordination.

Lesbian, gay, bisexual, transgender, and gender-diverse inmates receive individualized housing and safety determinations, continuation of hormone therapy initiated in the community, and privacy protections during searches.

The state nurse practice act defines scope; an order from security that conflicts with clinical need is escalated through the chain of command rather than obeyed automatically.

Informed consent requires assessing capacity, explaining risks, benefits, and alternatives, and avoiding coercion, including implied promises of privileges or earlier release.

Emergency treatment may proceed without explicit consent under implied consent when delay would risk life or serious harm, with documentation of the emergency and the care provided.

Confidentiality exceptions include imminent danger to self or others, reportable communicable disease, suspected abuse or neglect, court order, and minimum-necessary disclosure to custody staff for safety.

Mandatory reporting covers suspected abuse, neglect, sexual assault under the Prison Rape Elimination Act, and professional misconduct; the nurse preserves evidence and does not conduct an independent investigation.

Professional boundaries prohibit personal relationships, gifts or favors, and disclosure of personal information; observed boundary violations are reported.

Clinical documentation may be read in court, so entries are written in neutral, factual language that describes findings rather than opinions about the inmate's character.

Advocacy tools include the chain of command, ethics committees, professional associations, and state boards of nursing; unsafe conditions and staffing deficits are documented in writing.

Inmate rights include access to care, confidentiality, informed consent, refusal of treatment, and freedom from experimentation; restraints are never a substitute for clinical treatment.