Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Conditions for use of psychotropic medications.
When psychotropic medications are administered to a resident
in a facility certified under parts
2960.0580 to
2960.0700, the license holder is
responsible for ensuring that the conditions in items A to C are met.
A. Use of the medication must be included in
the resident's individual treatment plan and is based on the prescribing
physician's diagnosis and the diagnostic and functional assessments defined in
Minnesota Statutes, section
245.4871.
B. The license holder must document subitems
(1) and (2) in the resident's individual treatment plan:
(1) a description in observable and
measurable terms of the symptoms and behaviors that the psychotropic medication
is to alleviate; and
(2) data
collection methods the license holder must use to monitor and measure changes
in the symptoms and behaviors that are to be alleviated by the psychotropic
medication.
C.
Psychotropic medication must not be administered as punishment, for staff
convenience, as a substitute for a behavioral or therapeutic program, or in
quantities that interfere with learning or other goals of the individual
treatment plan.
Subp. 2.
Monitoring side effects.
The license holder must monitor for side effects if a
resident is prescribed a psychotropic medication and must have the prescribing
physician or a pharmacist list possible side effects. The license holder, under
the direction of a medically licensed person, must document and check for side
effects at least weekly for the first six weeks after a resident begins taking
a new psychotropic medication or a significantly increased or decreased dose of
a currently used psychotropic medication, and at least quarterly thereafter.
Minor increases or decreases in the dose of a currently used psychotropic
medication need not be monitored as frequently as a new medication or a
significant increase or decrease of a currently used psychotropic medication.
In addition to appropriate physical or laboratory assessments as determined by
the medically licensed person, standardized checklists or rating scales, or
scales developed for a specific drug or drug class, must be used as monitoring
tools. The license holder must provide the assessments to the medically
licensed person for review.
Subp.
3.
Monitoring for tardive dyskinesia.
The license holder, under the direction of a medically
licensed person, must monitor for tardive dyskinesia at least every three
months if a resident is prescribed antipsychotic medication or amoxapine and
must document the monitoring. A resident prescribed antipsychotic medication or
amoxapine for more than 90 days must be checked for tardive dyskinesia at least
30 and 60 days after discontinuation of the antipsychotic medication or
amoxapine. Monitoring must include use of a standardized rating scale and
examination procedure. The license holder must provide the assessments to the
physician for review if the results meet criteria that require physician
review.
Subp. 4.
Training required to administer psychotropic medications.
An employee other than a medically licensed person who is
responsible for medication assistance must provide a certificate verifying
successful completion of a trained medication aide program for unlicensed
personnel. The program must be offered through a postsecondary institution or
the medication aide must be trained according to a formalized training program
offered by the license holder that must be taught and supervised by a medically
licensed person to provide medication assistance. The specific medication
administration training provided by a medically licensed person to unlicensed
personnel must be documented and placed in the unlicensed employee's personnel
records. A medically licensed person must provide consultation and review of
the license holder's administration of medications at least weekly. The
consultation must review the license holder's compliance with subparts
5 and
6.
Subp. 5.
Psychotropic medication
review.
If a resident is prescribed a psychotropic medication, the
license holder must conduct and document a psychotropic medication review as
frequently as required by the physician, but at least monthly for the first six
months and at least quarterly thereafter. The license holder must consider and
document items A to D at the quarterly review and provide the information to
the physician for review:
A. targeted
symptoms and behaviors of concern;
B. data collected since the last
review;
C. side effects observed
and actions taken; and
D. status of
the resident's goals in the individual treatment plan.
Subp. 6.
Informed consent.
The license holder must obtain informed consent before any
nonemergency administration of psychotropic medication. To the extent possible,
the resident must be informed and involved in the decision making.
A. Informed consent is required either orally
or in writing before the nonemergency administration of psychotropic
medication, except that for antipsychotic or neuroleptic medication, informed
consent must be in writing. If oral informed consent is obtained for a
nonantipsychotic medication, subitems (1) to (4) must be followed:
(1) an explanation why written informed
consent could not be initially obtained;
(2) documentation that the oral consent was
witnessed and the name of the witness;
(3) oral and written communication of all
items required in subpart
7; and
(4) an explanation that written informed
consent material is immediately being sent by the license holder to the
resident's parent or legal representative, that the oral consent expires in one
month, and that the medication must be discontinued one month from the date of
the telephone consent if written consent is not received.
B. Informed consent for any psychotropic
medication must be renewed in writing at least yearly.
C. Informed consent must be obtained from an
individual authorized to give consent. An individual authorized to give consent
is specified in subitems (1) to (4).
(1) If
the resident has a legal representative or conservator authorized by a court to
give consent for the resident, consent is required from the legal
representative or conservator.
(2)
If subitem (1) does not apply, consent is required from at least one of the
resident's parents. If the parents are divorced or legally separated, the
consent of a parent with legal custody is required, unless the separation or
marriage dissolution decree otherwise delegates authority to give consent for
the resident.
(3) If the
commissioner of human services is the resident's legal representative, consent
is required from the county representative designated to act as legal
representative on behalf of the commissioner of human services.
(4) If the resident is an emancipated minor
according to Minnesota Statutes, section
144.341,
or the resident has been married or borne a child, the resident may give
consent under Minnesota Statutes, section 144.432.
D. Informed consent is not necessary in an
emergency situation where the physician determines that the psychotropic
medication is needed to prevent serious and immediate physical harm to the
individual or others. In the event of the emergency use of psychotropic
medication, the license holder must:
(1)
inform and document that the individual authorized to give consent was informed
orally and in writing within 24 hours or on the first working day after the
emergency use of the medication;
(2) document the specific behaviors
constituting the emergency, the circumstances of the emergency behaviors, the
alternatives considered and attempted, and the results of the use of the
emergency psychotropic medication; and
(3) arrange for an interdisciplinary team
review of the individual treatment plan within seven days of the emergency to
determine what actions, if any, are required in light of the emergency. If a
psychotropic medication continues to be required, the license holder must seek
a court order according to Minnesota Statutes, section
253B.092,
subdivision 3.
E.
Informed consent must be obtained by the license holder within 30 days to
continue the use of psychotropic medication for a resident admitted with
prescribed psychotropic medication.
Subp. 7.
Information communicated in
obtaining consent.
The information in this subpart must be provided both orally
and in writing in nontechnical language to the resident's parent, the
resident's legal representative, and, to the extent possible, the resident. The
information must include:
A. the
diagnosis and level of severity of the symptoms and behaviors for which the
psychotropic medication is prescribed;
B. the expected benefits of the medication,
including the level to which the medication is to change the symptoms and
behavior and an indication of the method used to determine the expected
benefits;
C. the pharmacological
and nonpharmacological treatment options available and the course of the
condition with and without the treatment options;
D. specific information about the
psychotropic medication to be used, including the generic and commonly known
brand name, the route of administration, the estimated duration of therapy, and
the proposed dose with the possible dosage range or maximum dose;
E. the more frequent and less frequent or
rare but serious risks and side effects of the psychotropic medication,
including how the risks and possible side effects must be managed;
F. an explanation that consent may be refused
or withdrawn at any time and that the consent is time-limited and automatically
expires as described in subpart
6; and
G. the names, addresses, and telephone
numbers of appropriate professionals to contact if questions or concerns
arise.
Subp. 8.
Refusal of routine administration of psychotropic medication.
If the authorized person refuses consent for a routine
administration of psychotropic medication, the conditions in items A to C
apply.
A. The psychotropic medication
must not be administered or, if the refusal involves a renewal of consent, the
psychotropic medication for which consent had previously been given must be
discontinued according to a written plan as expediently as possible, taking
into account withdrawal side effects.
B. A court order must be obtained to override
the refusal.
C. Refusal to consent
to use of a specific psychotropic medication is not grounds for discharge of a
resident. A decision to discharge a resident must be reached only after the
alternatives to the specific psychotropic medication have been attempted and
only after an administrative review of the proposed discharge has occurred. If
the refusal to consent to the routine administration of a psychotropic
medication results in an emergency situation, then the requirements of subpart
6, item D, must be met when
psychotropic medication will be administered to a resident.
Statutory Authority:
L
1995 c 226 art 3
s
60; MS s
241.021;
245A.03;
245A.09
