N.J. Admin. Code § 10:47-6.6 - Psychoactive medication

Current through Register Vol. 54, No. 7, April 4, 2022

(a) The facility shall have a written policy governing the use of psychoactive medication.
(b) The use of psychoactive medication shall be premised on the grounds that it constitutes an appropriate intervention either alone or in conjunction with other strategies to treat a psychiatric disorder or to manage a behavior disorder, as follows:
1. For treatment of psychiatric disorders, the medication shall be prescribed for the purpose of reducing or eliminating the symptoms of a psychiatric disorder which is diagnosed by a psychiatrist using the DSM-IV. (DSM-IV can be obtained from the American Psychiatric Association, 1900 K Street, Washington, D.C. 20005.) Except in an emergency, the IDT shall meet and determine if behavior interventions should be used in conjunction with psychoactive medication. The decision of the team shall be documented.
2. For behavior management, the psychoactive medication shall be prescribed for the purpose of managing a severe problem behavior when no specific psychiatric diagnosis has been made. Before the psychoactive medication is administered, the IDT shall meet. The use of psychoactive medication shall not be considered the sole modality to address the behavior but shall be supplemented by appropriate interventions based on functional analysis, for example, environmental strategies and/or behavior modifications, staff training, and individual management strategies. The IDT may decide to use other appropriate behavior interventions in lieu of psychoactive medication.
(c) When a psychiatric condition is not diagnosed and a psychoactive medication is being recommended for behavior management, the Behavior Management Committee and the chairperson of the Human Rights Committee shall review and recommend their approval of the medication prior to implementation.
1. Review by the full Human Rights Committee, with medical input, shall occur within 30 days of implementation.
(d) Psychoactive medication shall not be used for punishment, for the convenience of staff, or as a substitute for programmatic intervention.
(e) Informed written consent shall be required for each generic class of psychoactive medication. A new consent would not be needed if there is a change of medication within the same generic class.
(f) All individuals receiving psychoactive medication and the legal guardian, where applicable, shall be informed of the generic class of psychoactive medication proposed, the purpose, the dosage, and possible side effects of the medication. Steps to inform each individual shall be documented in their record.
(g) Individuals receiving psychoactive medication shall be personally examined by the prescribing physician prior to the initial administration.
(h) Except in emergencies, psychoactive medication shall always be prescribed in writing prior to its administration. Telephone orders shall be permitted in an emergency and countersigned by the physician within 24 hours.
(i) Short-acting injectable psychoactive medication used in emergencies shall be administered only by a licensed physician or licensed professional nurse.
1. The individual shall be monitored continuously by a staff person trained to observe potential adverse effects.
2. The physician ordering the intramuscular psychoactive medication shall examine the individual within a 48 hour time period.
(j) "As needed" or "PRN" usage of psychoactive medications shall be prohibited.
(k) Persons receiving services shall be maintained on the lowest possible effective dosage of psychoactive medication.
(l) All psychoactive medication shall be monitored by the prescribing physician for clinical effectiveness as necessary but at least quarterly.
(m) Because of potential serious toxicity, lithium, carbamazepine, valproic acid, clozapine, and clomipramine shall be used only after a complete history, physical examination, and laboratory assessment of the individual has been made by a physician. Lithium shall be administered under the surveillance of a physician, or advance practical nurse, preferably a psychiatrist, to include monitoring of blood levels.
(n) The use of psychoactive medication shall be incorporated in the individual's habilitation plan.
1. The IDT shall review the use of psychoactive medication quarterly. If, after a reasonable length of time, there is no apparent improvement, other treatment options should be considered. The IDT shall determine whether the individual is being negatively affected by the medication or other concerns associated with the medication are noted.
2. The results of the review shall be documented in the individual's record. Concerns of the IDT shall be referred to the Physician, Behavior Management Committee and/or Human Rights Committee.
3. When a psychotropic medication is prescribed and administered in an emergency, the IDT shall meet to review the use of the psychotropic medication within the next five working days. The results of this review shall be documented in the client record.


N.J. Admin. Code § 10:47-6.6

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