PrescQIPP

Optimising Medicines Safety in Prisons: A Whole Prison Team Approach (2025)

ABUHB Prison Pharmacy Team

Project summary

References: Altibi et al., 2021; Harris et al., 2007; Marshall et al., 2001; Watson et al., 2004; Potter, 2017; Johnson et al., 2021; Sattar, 2001.

In early 2024, HMP Usk (Category C) and HMP Prescoed (Category D) established a new prison pharmacy team. This change offered a timely opportunity to reflect on current practices and enhance medication safety within the prison setting.

Prisoners represent a vulnerable population with significantly higher rates of morbidity and complex health needs than the general public. Research consistently highlights the disproportionate burden of mental health disorders, chronic conditions, substance misuse, and increased mortality—especially during and shortly after custody.
In the UK, rising concerns around self-harm, suicide, and deaths in custody have intensified the focus on prison healthcare. Pharmacy services face unique challenges, including medication diversion, compliance issues, inappropriate polypharmacy, and an ageing prison population.

Pharmacy-Led Improvements

To address these, the new pharmacy team implemented several targeted improvements:

  • Increased face-to-face clinical reviews to improve patient engagement.
  • A structured compliance process to support safe medication use.
  • Health promotion campaigns (e.g., Ramadan medication use, sun safety).
  • Reviews and reduction strategies for high-risk medications like Codeine.
  • Enhanced audit and reporting to governance boards.
  • Active participation in MDT meetings and improved access to pharmaceutical advice.
  • Oversight of high-risk and shared care medications in line with ABUHB guidelines.
  • New SOPs and collaboration with the All-Wales Prison Pharmacy Group.
  • Cell Medication Checks to identify compliance and safety issues.
  • A Homely Medication Policy to reduce unnecessary GP appointments.
  • Proactive responses to medication shortages and MHRA alerts.
  • Support during public health incidents (e.g., flu, COVID-19).

A Yellow Card champion to promote adverse event reporting.

A Whole-Prison Approach.

A key factor in the success of these initiatives has been the adoption of a whole-prison team approach. The pharmacy team works closely with healthcare staff and prison officers. The Prison Governor actively supports medicines safety by attending Medicines Management meetings and ensuring pharmacy input in Drug Strategy and MDT forums.

Outcomes and Impact.

This collaborative, safety-focused approach has led to more frequent and effective medication reviews, successful high-risk medication reduction, and improved oversight—laying a strong foundation for high-quality, patient-centred pharmacy services in the prison environment.