N.J. Admin. Code § 10:37-6.54 - Psychotropic medication

(a) "Psychotropic medication" shall include medications which have a direct effect upon the central nervous system and are capable of modifying behavior and/or mood. Drugs included, within the context of this chapter, are:

1. Anti-psychotics;

2. Anti-depressants;

3. Agents for control of mania and depression, such as lithium;

4. Anti-anxiety agents;

5. Anti-convulsants; and

6. Psychomotor stimulants.

(b) Before initiating treatment with psychotropic medication(s), a comprehensive drug history shall be obtained and documented with special emphasis on which drugs have, in the past, produced a positive response, and which drugs have caused allergic or toxic reactions. Unfavorable reactions shall be emphasized in the record and listed as individual risk factors. In cases where the client may have taken a combination of drugs prior to coming to the agency, inquiries shall be made, especially with regard to alcohol, street and over-the-counter drugs.

(c) Agencies shall establish protocols for early detection, intervention and documentation of response to troublesome side effects and allergic or toxic reactions to medication.

(d) To avoid serious drug interactions, communication shall occur between the physician or the certified nurse practitioner/clinical nurse specialist treating the mental illness and other physicians who may be treating other diseases in the same client. The patients medical record shall contain documentation by the treating physician or the certified nurse practitioner/clinical nurse specialist of the communication.

(e) Progress notes or a checklist for citing medication reaction shall be in each client's chart. This documentation shall be completed by a physician, a nurse or a certified nurse practitioner/clinical nurse specialist on admission, updated on the appearance of abnormal signs, and notes made each time the medication is reviewed.

(f) Target symptoms to be treated shall be recorded in the client's record, as a baseline against which the client's clinical condition is evaluated. Effects of medication on the target symptoms and behavior shall be reviewed and recorded.

(g) Medications shall be reviewed, at a minimum, each time the treatment plan is reviewed, based upon requirements stated within Division of Mental Health Services program rules. Results of these reviews and new treatment recommendations shall be recorded in the client's record by medical staff.

(h) The use of psychotropic drugs in children should be carefully scrutinized. In those situations where the manufacturer or the Food and Drug Administration does not recommend certain dosage levels, or where a specific medication is not approved for children, in spite of its apparent clinical effectiveness, the physician or the certified nurse practitioner/clinical nurse specialist should seek a second opinion in writing from a qualified child psychiatrist, pediatrician, or clinical pharmacologist. Written informed consent shall be secured from the parents or guardians, specific to the use of any psychotropic medication(s).

(i) Clients shall have the right to refuse medication and to be free from unnecessary or excessive medication. Consumers' medication experiences should be considered by physicians in their medication practices and their preferences granted whenever it is clinically and pharmacologically sound to do so.

Notes

N.J. Admin. Code § 10:37-6.54

Amended by R.1997 d.203, effective 5/19/1997.
See: 28 New Jersey Register 3859(a), 29 New Jersey Register 2471(a).
In (a)5, substituted "Anti-convulsants" for "Anti-parkinsonian agents"; rewrote (b); added (c) through (i); and made a nonsubstantive change.