Current through Register Vol. 43, No. 39, September 26, 2024
(a) A provider
shall take proactive and remedial actions to ensure appropriate, effective, and
informed use of medications and other restrictive interventions to manage
behavior or to treat diagnosed mental illness. These actions shall be taken
before the provider initiates the use of any medication or other restrictive
intervention to manage behavior, unless the needs of the person served clearly
dictate otherwise and the provider documents that need. Otherwise, these
actions shall be taken promptly following the initiation of, or any change in,
the use of any medication or other restrictive intervention to manage behavior
or to treat diagnosed mental illness.
(b) These proactive and remedial actions
shall include all the following:
(1)
Safeguards, which shall include initial and ongoing assessment and responsive
modifications that may be needed to ensure and document the following, in
consultation with the person, the person's guardian, and the person's support
network:
(A) All other potentially effective,
less restrictive alternatives have been tried and shown ineffective, or a
determination using best professional clinical practice indicates that less
restrictive alternatives would not likely be effective;
(B) positive behavior programming,
environmental modifications and accommodations, and effective services from the
provider are present in the person's life;
(C) voluntary, informed consent has been
obtained from the person or the person's guardian if one has been appointed,
after a review of the risks, benefits, and side effects, as to the use of any
restrictive interventions or medications; and
(D) medications are administered only as
prescribed, and no "PRN" (provided as needed) medications are utilized without
both the express consent of the person or the person's guardian if one has been
appointed, and per usage approval from the prescribing physician or another
health care professional designated by the person or the person's guardian if
one has been appointed;
(2) management, which shall include initial
and ongoing assessment and responsive modifications that may be needed to
ensure and document the following:
(A)
(i) When restrictive intervention or
medication is being used to manage specific behaviors, those behaviors are
documented as to the frequency and objective severity of occurrence;
(ii) the provider periodically reviews and
reports to the person, the person's guardian if one has been appointed, the
person's support network, and the physician prescribing any medication to
manage behavior, the frequency and objective severity of the specific
behaviors, and the effectiveness of the restrictive intervention or medication
and any side effects experienced from any medication used to manage specific
behaviors, in conjunction with safeguard measures; and
(iii) the provider recommends to the person,
the person's guardian if one has been appointed, the person's support network,
and the physician prescribing any medication to manage behavior, reducing the
use of the restrictive intervention or medication being used to manage specific
behaviors, when appropriate, based upon the documented effectiveness of those
efforts in conjunction with safeguard measures; or
(B) when medication is used to treat
specifically diagnosed mental illness, the medication has been prescribed and
is being managed by a psychiatrist who is periodically provided information
regarding the effectiveness of and any side effects experienced from the
medication. The prescription and management may be by a physician, rather than
a psychiatrist, only when requested and agreed to by the person or the person's
guardian if one has been appointed, and when based upon the documented need of
the person; and
(3)
review by a behavior management committee established by the provider, which
shall meet these criteria:
(A) Be made up of
a selected number of persons served, guardians of persons served, family
members of persons served, interested citizens, and providers, at least 1/3 of
whom shall be otherwise unassociated with the provider; and
(B) periodically review the use of
medications and other restrictive interventions to manage behavior or to treat
diagnosed mental illness, to ensure that the provisions of this regulation are
met and to report to the provider each instance in which the committee
determines that any provision of this regulation has not been met. The provider
shall immediately correct any instance of noncompliance reported by the
behavior management committee.
(c) Requirements for consent from or
consultation with the person's guardian shall be considered to have been
complied with if the provider documents that it has taken reasonable measures
to obtain the consent or consultation and that the person's guardian has failed
to respond.
(d) This regulation
shall take effect on and after October 1, 1998.
