Fla. Admin. Code Ann. R. 65E-5.1703 - Emergency Treatment Orders for the Administration of Psychotropic Medications

(1) An emergency treatment order for the administration of psychotropic medications shall be consistent with the least restrictive treatment interventions.

(a) The issuance of an emergency treatment order requires a physician's review of the individual's condition for causal medical factors, such as the following:

1. Insufficient blood levels of psychotropic medication;

2. Medication interactions with psychotropic or other medications;

3. Side effects or adverse reactions to medications;

4. Organic, disease or medication based metabolic imbalances or toxicity; or

5. Other biologically based or influenced symptoms.

(b) All emergency treatment orders may only be issued by a physician licensed under the authority of Chapter 458 or 459, F.S.

(c) The physician must review, integrate and address such metabolic imbalances in the issuance of an emergency treatment order.

(d) Absent more appropriate interventions, an emergency treatment order is for immediate administration of rapid response psychotropic medications to a person to expeditiously treat symptoms, that if left untreated, present an immediate danger to the safety of the individual or others.

(2) An emergency treatment order for psychotropic medication supersedes the individual's right to refuse psychotropic medication if based upon the physician's assessment that the individual is not capable of exercising voluntary control over his or her own symptomatic behavior and that these uncontrolled symptoms and behavior are an imminent danger to the individual or to others in the facility. When emergency treatment with psychotropic medication is ordered for a minor or an incapacitated or incompetent adult, facility staff shall document attempts to promptly contact the guardian, guardian advocate, or health care surrogate or proxy to obtain express and informed consent for the treatment in advance of administration where possible and if not possible, as soon thereafter as practical.

(3) The physician's initial order for emergency treatment may be by telephone or by telehealth but such a verbal order must be reduced to writing upon receipt and signed by a physician within 48 hours.

(4) Each emergency treatment order shall only be valid and shall be authority for emergency treatment only for a period not to exceed 48 hours.

(5) Standing orders, PRN orders, or other similar protocol are prohibited for emergency treatment.

(6) The need for each emergency treatment order must be documented in the individual's clinical record in the progress notes and in the section used for physician's orders and must describe the specific behavior which constitutes a danger to the individual or to others in the facility, and the nature and extent of the danger posed.

(7) If two emergency treatment orders are issued for the same individual within any seven (7) day period, the petition for the appointment of a guardian advocate pursuant to the provisions of Section 394.4598, F.S., to provide express and informed consent shall be filed with the court within two (2) court working days.

(8) While awaiting court action, treatment may be continued without the consent of the individual, but only upon the written emergency treatment order of a physician who has determined that the individual's behavior each day during the wait for court action continues to present an immediate danger to the safety of the individual or others and who documents the nature and extent of the emergency each day of the specific danger posed. Such orders may not be written in advance of the demonstrated need for same.

(9) To assure the safety and rights of the individual, and since emergency treatment orders by a physician absent express and informed consent are permitted only in an emergency, any use of psychotropic medications other than rapid response psychotropic medications requires a detailed and complete justification for the use of such medication. Both the nature and extent of the imminent emergency and any orders for the continuation of that medication must be clearly documented daily as required above.

(10) For children in the care and custody of the Department, policies and procedures shall include requirements for working with child protective investigators and case managers and obtaining necessary court authorizations to comply with section 39.407, F.S. and Chapter 65C-35, F.A.C., which are incorporated herein by reference.

Notes

Fla. Admin. Code Ann. R. 65E-5.1703

Rulemaking Authority 394.457(5), 394.46715 FS. Law Implemented 394.459(3), 394.4598, 394.463(2)(f), 394.46715 FS.

New 11-29-98, Amended 4-4-05, 4-9-13, Amended by Florida Register Volume 49, Number 153, August 8, 2023 effective 8/23/2023.

New 11-29-98, Amended 4-4-05, 4-9-13, 8-23-23.