Current through Reg. 49, No. 38; September 20, 2024
(a) In this section, the following words and
terms have the following meanings, unless the context clearly indicates
otherwise:
(1) Medication-related
emergency--A situation in which it is immediately necessary to administer
medication to a resident to prevent:
(A)
imminent probable death or substantial bodily harm (emotional or physical) to
the resident; or
(B) imminent
physical or emotional harm to another because of threats, attempts, or other
acts the resident overtly or continually makes or commits.
(2) Psychoactive medication--A medication
prescribed for the treatment of symptoms of psychosis or other severe mental or
emotional disorders and used to exercise an effect on the central nervous
system to influence and modify behavior, cognition, or affective state when
treating the symptoms of mental illness. The term includes the following
categories when used as described by this subdivision:
(A) anti-psychotics or
neuroleptics;
(B)
antidepressants;
(C) agents for
control of mania or depression;
(D)
anti-anxiety agents;
(E) sedatives,
hypnotics, or other sleep-promoting drugs; and
(F) psychomotor stimulants.
(b) A person may not
administer a psychoactive medication to a resident who does not consent to the
prescription unless:
(1) the resident is
having a medication-related emergency; or
(2) the person authorized by law to consent
on behalf of the resident has consented to the prescription.
(c) Consent to the prescription of
psychoactive medication given by a resident, or by a person authorized by law
to consent on behalf of the resident, is valid only if:
(1) the consent is given voluntarily and
without coercive or undue influence;
(2) the person who prescribes the medication,
that person's designee, or the facility's medical director provides the
resident and, if applicable, the person authorized by law to consent on behalf
of the resident, with a form containing the following information identified as
being for the purpose of consent to treatment with psychoactive medication:
(A) the specific condition to be
treated;
(B) the beneficial effects
on that condition expected from the medication;
(C) the probable clinically significant side
effects and risks associated with the medication, as reported in widely
available pharmacy databases or the manufacturer's package insert;
and
(D) the proposed course of the
medication;
(3) the
resident and, if appropriate, the person authorized by law to consent on behalf
of the resident, are informed in writing that consent may be revoked;
(4) consent is given in writing by a resident
or by a person authorized by law to consent on behalf of the resident, on a
form prescribed by HHSC, if the prescription is for antipsychotics or
neuroleptics; and
(5) the consent
is evidenced in the resident's clinical record by:
(A) a signed form prescribed by the facility,
or by a statement of the person who prescribes the medication or that person's
designee that documents consent was given by the appropriate person and the
circumstances under which the consent was obtained; and
(B) the original or a copy of the form
described in paragraph (4) of this subsection.
(d) Consent is valid until:
(1) consent is withdrawn; or
(2) the practitioner has discontinued the
medication.
(e) For
purposes of this rule, a medication will be considered to be discontinued if
therapy has been suspended for more than 70 days. If the suspended therapy is
resumed within the 70-day period, an oral explanation of side effects should be
documented in the clinical record.
(f) The Health and Safety Code, Chapter 313,
Consent to Medical Treatment, provides guidance on treatment decisions when a
resident is comatose, incapacitated, or otherwise mentally or physically
incapable of communication. An ethics committee also may prove helpful in such
situations.
(g) A resident's
refusal to consent to receive psychoactive medication must be documented in the
resident's clinical record.
(h) If
a person prescribes psychoactive medication to a resident without the
resident's consent because the resident is having a medication-related
emergency:
(1) the person must document the
necessity of the order in the resident's clinical record in specific medical or
behavioral terms; and
(2) treatment
of the resident with the psychoactive medication must be provided in the
manner, consistent with clinically appropriate medical care, least restrictive
of the resident's personal liberty.
(i) A physician, or a person designated by
the physician, is not liable for civil damages or an administrative penalty and
is not subject to disciplinary action for a breach of confidentiality of
medical information for a disclosure of the information provided under
subsection (c)(2) of this section made by the resident, or the person
authorized by law to consent on behalf of the resident, that occurs while the
information is in the possession or control of the resident or the person
authorized by law to consent on behalf of the resident.
