provided. Prevention and Wellness Prevention underlies effective population health management and is especially important in a DOC where the system is responsible for the long term (and sometimes lifetime) health care needs of many of the inmates. Age and gender‐appropriate health screenings, immunizations, and health education targeted at prevention and wellness must all be addressed. In most DOCs, preventive screenings and immunizations are addressed in the initial and annual health assessments. As CT DOC does not routinely conduct either of these encounters, prevention and wellness are insufficiently addressed. This creates some risk to the CT DOC and its inmates for preventable disease and preventable spread of disease. Capturing facility‐specific and statewide preventive care and immunization data is a critical component of prevention/wellness and also of a DOC infection control program. Data on screenings and immunizations should be a component of an annual systemwide QI review. Addressing prevention and wellness will be addressed in more detail in the proposed medical model. Pharmacy and Laboratory Services Pharmacy Vendor Operations CT DOC’s recent change in pharmacy vendors to Diamond Pharmacy Services has produced improved efficiency, service and significant cost savings to CT DOC. Regarding the latter, CT DOC reports savings of $500‐700K per month or $6M‐8.4M per year. Medication procurement is timely and chart reviews confirm that new medications arrive in time for first dosing as ordered in most cases. Although most staff report significant improvements over the process utilized with UConn, there were problems reported about duplicate prescriptions, time involved with medication returns, and blister cards. CT DOC fiscal leadership reports being very pleased at the performance of the pharmacy contractor, noting lower costs (high cost medications at near 340b pricing) and better customer service than the previous provider. Diamond clinical pharmacist and staff have been instrumental in spearheading process improvements and on‐site training for staff. Pharmacy reports are generated every month to CT DOC medical leadership, but the report package HMA saw contained only a few of Diamond’s large standard reports and focused on high‐priced medicines. CT DOC should review a much larger complement of pharmacy data. Also, fiscal analyses should track pharmacy costs as a total and percentage of all health care costs. Recommendation 23 Medication Administration The HMA team was not able to observe medication administration, which is a key component of a DOC evaluation. We cannot comment on the degree of efficiency or whether proper procedures are followed to ensure that a patient receives the right medication, the right way, and at the right time. We also could not evaluate practices to safeguard controlled substances, dispose of unused medications appropriately, return unused medications for refund, or check stock medication inventory to remove expiring medications. We were not able to assess practices to reduce diversion of psychotropic and other medications with high diversion potential through crushing, limiting formularies, and other means. These are all important elements to a well‐run pharmacy operation. Through interviews, we deduced the following: · CT DOC has a Keep on Person (KOP) program, which is key in reducing medication administration resources, but it does not include practices necessary to ensure that patients take their medication as prescribed or renew them when they should. · Medication renewal notifications from Diamond to providers seem to work efficiently. · Practices to observe patient ingesting medications to ensure they are not “cheeked” or diverted (“Direct Observation Therapy” or DOT) are not uniform. Custody does not seem to be involved in this process. · Instances of missed medications, due to patient refusals or otherwise, are not optimally incorporated into care management, which creates risk for patients and for CT DOC. Managing Pharmacy Operations Medication ordering, procurement, safeguarding, administration, and documentation require a significant amount of CT DOC staff hours each month. Accordingly, all DOCs are wise to ensure that all components of pharmacy operations work smoothly and efficiently. In addition to issues noted above, a well‐run pharmacy operation includes all of the following: · An active Pharmacy and Therapeutics Committee that: o Reviews a comprehensive panel of pharmacy reports and discusses changes in cost by drug class, pharmaceutical equivalents, etc. o Manages the formulary o Reviews adverse drug reactions · Computerized physician order entry for medications · eMAR produced monthly · Electronic documentation of medication administration using scanners · Use of Pharmacy Technicians and/or LPNs under supervision of RNs · Facility‐level electronic reconciliation of orders received against orders placed · Simple and efficient return‐for credit policies, practices, and reporting Recommendation 24 · Clinical Pharmacy services provided by the vendor to address drug interactions, polypharmacy, therapeutic substitutions, etc., with prescribers · Participation of the vendor in recommending cost‐saving measures · Efficient and timely processes for