Current through Register Vol. 56, No. 18, September 16, 2024
(a) The facility shall not administer medication
to children as a punishment, for the convenience of staff members or as a substitute
for a treatment program.
(b) The
facility shall ensure that a pre-treatment clinical assessment, based on behaviors
exhibited by the child and observed by staff members, is conducted by a licensed
physician before psychotropic medication is prescribed. This pre-treatment clinical
assessment shall include at least the following information:
1. A comprehensive drug history, including
consideration of the use of all prescription and non-prescription drugs by the child
as well as a history of cardiac, liver, renal, central nervous system or other
diseases, a history of drug allergies and dietary information;
2. A laboratory work-up, including, but not
limited to:
i. A complete blood count. If the
medication prescribed requires routine follow-up blood work, this blood count test
shall be administered prior to the child's beginning his or her medication regimen.
If the medication prescribed does not require routine follow-up blood work, a new
blood count test is not required as long as the child has had a blood count test
within one year of admission, unless the physician determines otherwise;
ii. Urinalysis;
iii. Blood screening to include an assessment of
liver and renal functions, if indicated; and
iv. Cardiogram (EKG) and electroencephalogram
(EEG), as indicated, on children with previous histories of cardiac abnormalities or
central nervous system disorders; and
3. A written description of:
i. Non-pharmacological interventions that were
considered or attempted to address the child's behavior;
ii. The purpose of the medication, the specific
behavior(s) of the child to be modified and ways in which progress towards the
treatment objectives will be measured;
iii. The dosage; and
iv. How possible side effects will be monitored
and reported to the physician who prescribed the medication.
(c) Within two weeks after admission,
the facility shall ensure that all children already receiving psychotropic
medication receive a clinical assessment by a physician as specified in (b) above.
The facility may extend this two-week time period up to 30 days in which a child
receives a clinical assessment, provided that:
1.
The facility has the necessary amount(s) of medication to administer to the child
during any extended time period;
2. The
facility has consulted with the physician who previously prescribed the medication;
and
3. The facility documents the
consultation in (c)2 above in the child's record.
(d) The facility shall not be obligated to comply
with (b) above and (e) below, for a pre-treatment clinical assessment and informed
consent for psychotropic medication, other than long-acting drugs, if the treating
physician certifies in the child's clinical record that the child presents a danger
to self and/or others.
1. The initial decision to
administer emergency medication shall be based on a personal examination of the
child by a physician.
2. The initial
administration of emergency medication may extend for a maximum period of 72
hours.
3. A physician may authorize the
administration of medication for an additional 72 hours upon determination that the
continuance of medication on an emergency basis is clinically necessary. This
authorization may be given by telephone, provided that it is countersigned by the
physician and certified as to the necessity in the child's clinical record within 24
hours. If this medication is then deemed necessary for the child's treatment while
in the facility, the physician shall complete the pre-treatment clinical assessment
as specified in (b) above.
4. The
facility's staff members shall document on a separate reporting form that the
psychotropic medication was administered in an emergency situation. The
documentation shall identify possible side effects to be monitored as described in
(b)3iv above.
(e) Before
administering psychotropic medication, the facility shall obtain written informed
consent from the child's parent(s) or legal guardian, and from all children 14 years
of age and older consistent with their age and level of functioning unless the
facility documents that the child lacks the capacity for informed consent. In cases
where both a parent and legal guardian exist, the facility shall seek written
informed consent from the legal guardian.
1. A
physician, registered nurse or staff member trained in administering psychotropic
medication shall obtain written informed consent.
2. The person requesting written informed consent
shall ensure that parents, guardians and children are informed about:
i. The behavior or symptoms which the medication
is intended to modify;
ii. The
dosage;
iii. Any change in type of
medication; and
iv. How possible side
effects of the medication will be treated.
3. When a request for written informed consent is
made by a staff member, the staff member shall inform the parent that a physician is
available for consultation regarding the proposed medication.
4. The facility may obtain verbal informed consent
by telephone from the child's parents when the facility, physician, registered nurse
or staff member is unable to obtain written informed consent, provided that:
i. The facility documents the telephone call in
the child's record; and
ii. The facility
obtains the written informed consent from the child's parents or legal guardian
within 24 hours of receiving the verbal informed consent.
5. If the facility cannot obtain written informed
consent or verbal informed consent, the facility shall use certified mail, return
receipt requested, and shall send the request to the parent's or legal guardian's
last known address at least 10 calendar days before the proposed date for the
commencement of treatment. The written notice shall specify:
i. The proposed date for beginning of treatment;
and
ii. That a failure to respond by the
proposed date for the beginning of treatment shall empower the director, after
consultation with the placing agency, to grant consent for the medication.
6. The facility shall document all
methods for requesting written consent in the child's record.
(f) When a parent, legal guardian or child refuses
or revokes consent for medication, the following procedures shall apply:
1. The treating physician or his or her designee
shall speak to the child or the parent or both to respond to the concerns about the
medication. This person shall explain the child's condition, the reasons for
prescribing the medication, the benefits and risks of taking the medication, and the
advantages and disadvantages of alternative courses of action;
2. If the child or parent continues to refuse or
revoke consent to medication and the physician or his or her designee still believes
that medication is a necessary part of the child's treatment plan:
i. The director of the facility shall advise the
child and the parent that the matter will be discussed at a meeting with the child's
treatment team and shall invite the child and parent to attend such
meeting;
ii. The director of the
facility may suggest that the child and parent discuss the matter with a person of
their own choosing, such as a relative, attorney, physician, or mental health
clinician;
iii. The treatment team shall
meet to discuss the treating physician's recommendations and the response of the
child or parent; and
iv. The treatment
team shall attempt to formulate a viable treatment plan that is acceptable to the
child and parent;
3. If,
after the treatment team meeting, the child or parent continues to refuse or revoke
consent to medication and the treating physician still believes that medication is a
necessary part of the child's treatment plan, the facility shall obtain an
independent psychiatric review. The psychiatrist conducting this independent
assessment shall review the child's clinical record, conduct a personal examination
of the child, provide a written report for the child's treatment team, and, if the
parent or child is refusing or has revoked consent to medication, speak with the
parent or child, respectively; and
4. If
the child or parent continues to refuse or revoke consent to medication, and the
facility feels that the child cannot be adequately treated without the medication,
the facility may initiate an emergency discharge, as specified in 3A:55-6.2(b) and
10.5.
(g) The facility shall
administer psychotropic drugs in the following manner:
1. Psychotropic medication shall be dispensed only
by licensed pharmacists and prescriptions shall always be labeled to reflect the
following information:
i. The name and address of
the dispensing pharmacy;
ii. The full
name of the pharmacist;
iii. The full
name of the child;
iv. Instructions for
use, including the dosage and frequency;
v. The prescription file number;
vi. The dispensing date;
vii. The prescribing physician's full
name;
viii. The name and strength of the
medication;
ix. The quantity dispensed;
and
x. Any cautionary information
appropriate to the particular medication;
2. The facility shall encourage the
self-administration of medication by properly trained and supervised children
whenever their intellectual, emotional, and physical capabilities make such practice
appropriate and feasible. The child's capability for self-administration of
psychotropic medication shall be documented in the child's treatment plan;
and
3. The facility shall ensure that
psychotropic medication is stored as specified in 3A:55-7.4(f).
(h) The facility shall ensure that all children
receiving psychotropic medication are monitored in the following manner:
1. Staff members directly involved with the child
shall record daily progress towards treatment goals and objectives and observed side
effects which are identified in the pre-treatment clinical assessment;
2. Staff members shall notify the prescribing
physician immediately, when side effects are observed;
3. The facility shall ensure that:
i. The physician or his or her designee reviews
the child's behavior, well-being and status towards treatment goals and objectives,
side effects and reason for continuing the medication every 30 days;
ii. The review is documented in the child's
medical record; and
iii. The facility
informs the child, parents, legal guardian, the placing agency in writing about the
outcome of a negative review.
(i) The facility shall ensure that each staff
member involved in administering psychotropic medication receives the following
training:
1. Indications for drug use;
and
2. Therapeutic effects and side
effects.
(j) The facility
shall record all information about a child's psychotropic medication, as specified
in 3A:55-7.4(d), and the facility shall ensure that the child's medication record is
available to the physician for review when additional medication is
prescribed.
