Current through Register Vol. 56, No. 18, September 16, 2024
(a) The home 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 home
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. 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;
ii. The dosage; and
iii. How possible side effects will be monitored
and reported to the physician who prescribed the medication.
(c) Within two weeks after admission,
the home shall ensure that all children already receiving psychotropic medication
receive a clinical assessment by a physician, as specified in (b) above. The home
may extend this two week time period to a maximum of 30 days in which a child
receives a clinical assessment, provided that:
1.
The home has the necessary amount(s) of medication to administer to the child during
any extended time period;
2. The home
has consulted with the physician who previously prescribed the medication;
and
3. The home documents the
above-noted consultation in the child's record.
(d) The home 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 home, the physician shall complete the pre-treatment clinical assessment as
specified in (b) above.
4. The home's
staff members shall document that the psychotropic medication was administered in an
emergency situation. The documentation shall identify possible side effects to be
monitored as described in (b)3iii above.
(e) Before administering psychotropic medication,
the home shall obtain written informed consent from the parent(s) or legal guardian
of children under the age of 18, and from all children 14 years of age and older
unless the home documents that the child lacks the capacity for informed consent. In
cases where both a parent and legal guardian exist, the home 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;
and
iii. How possible side effects of
the medication will be treated.
3. When a request for written informed consent is
made by a non-medical staff member, the non-medical staff member shall inform the
parent or legal guardian that a physician is available for consultation regarding
the proposed medication.
4. The home may
obtain verbal informed consent by telephone from the child's parents or legal
guardian when the home, physician, registered nurse or staff member is unable to
obtain written informed consent, provided that:
i.
The home documents the telephone call in the child's record; and
ii. The home obtains the written informed consent
from the child's parents or legal guardian within 72 hours of receiving the verbal
informed consent.
5. If the
home cannot obtain written informed consent or verbal informed consent, the home
shall use certified mail, return receipt requested, and shall send the request to
the parents or legal guardians 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 Divisions worker or other placing agency to
grant consent for the medication.
6. The home 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 or legal guardian
continues to refuse or revokes 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 home shall invite the
child and parent to attend a meeting with the treatment team to discuss the treating
physician's recommendations and the concerns of the child or parent or legal
guardian; and
ii. The treatment team
shall attempt to formulate a viable treatment plan that is acceptable to the child,
parent and legal guardian;
3.
If, after the treatment team meeting, the child or parent or legal guardian
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 home
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, and provide a written report for the child's treatment
team; and
4. If the independent
psychiatric review supports the need for the medication and the child or parent or
legal guardian continues to refuse or revoke consent to medication, the home may
initiate an emergency discharge, as specified in 3A:56-6.2(b) and 10.5.
(g) The home 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 home 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 home shall ensure that
psychotropic medication is stored as specified in 3A:56-7.4(e).
(h) The home shall ensure that all children
receiving psychotropic medication are monitored in the following manner:
1. Staff members directly involved with the child
shall record:
i. At least weekly progress towards
treatment objectives; and
ii. Daily
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 home shall ensure that:
i. The physician or his or her designee reviews
every 30 days the child's status, behavior, well-being and progress towards
treatment objectives, side effects and reason for continuing the
medication;
ii. The review is documented
in the child's medical record; and
iii.
The home informs the child, parents, legal guardian, the Divisions worker, or other
placing agency about the outcome of the review.
(i) The home shall ensure that any staff member
involved in administering psychotropic medication receive the following training:
1. Indications for drug use; and
2. Therapeutic and side effects.
(j) The home shall record all
information about a child's psychotropic medication, as specified in 3A:56-7.4(d),
and the home shall ensure that the child's medication record is available to the
physician for review when additional medication is prescribed.
(k) Where the term "physician" is referenced in
this section, an advanced practice nurse (APN) may provide the indicated service, as
licensed and supported by a collaborative agreement with a psychiatrist and joint
protocol document as specified in N.J.A.C.
13:37-8.1
.
