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RULE §554.1207Prescription of Psychoactive Medication

(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.

Source Note: The provisions of this §554.1207 adopted to be effective July 1, 2002, 27 TexReg 4362; transferred effective January 15, 2021, as published in the Texas Register December 11, 2020, 45 TexReg 8871; amended to be effective January 2, 2022, 46 TexReg 9037

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