411-055-0370 Emergency Medications (1) Service providers must have Department-approved policies and procedures regarding the use of emergency medications. Documentation must exist and be available when requested, stating that all direct care staff have reviewed these procedures on an annual basis. Policies must include, but are not limited to the following: (a) Emergency medications must never be given to discipline an individual or for the convenience of the direct care staff. (b) Emergency medications must never be given to individuals until other interventions have been attempted. (c) Individuals and their legal representatives must be informed of the service provider's policies and procedures regarding emergency medications before admission. (d) The provider should have established policies to ensure that emergency medications are removed or discontinued as soon as possible. (2) Prior authorized PRN (as needed) Medication. (a) The Licensed Medical Practitioner who conducts the required Psychotropic Medication Review and who is a member of the individual's IDT can write a PRN order for a medication to be provided as part of the individual's prior authorized intensive intervention Crisis Plan or Behavior Support Plan if the following conditions are documented: (A) The use of the medication is intended to reduce the need for and duration of the Safeguarding Interventions. (B) The individual must accept the medication voluntarily without the need for the Safeguarding Interventions. (C) The PRN. order must include specific behavior triggers necessitating the use of medication and instructions regarding frequency of monitoring, named side effects, and reporting procedures. (D) Involuntary medications may be included as a PRN. only if a RN or LMP is onsite and have followed the steps listed in section (3) of this rule. (b) Failure to comply with these requirements may be considered abuse if a protective services investigation determines the required steps and documentation have not occurred. (3) Involuntary Medications. (a) Individuals in IIC may have involuntary medications prescribed and administered only if these medications are prescribed by a physician, agreed to beforehand by the individual or the individual's legal representative, are included in the individually-based limitation, and administered by a trained nurse. (b) Administering an involuntary medication during implementation of the Safeguarding Interventions may be permitted if the following conditions are documented: (A) The use of this medication is intended to reduce the duration of the episode or is deemed to be more beneficial to the individual than a Safeguarding Interventions. (B) A RN or LMP is onsite to document the order and administer the medication. (C) The RN or LMP must document justification of why administration of the medication protected the individual's health and safety and provide and document any clinical assessments required by their licensure. (D) The RN or LMP must remain onsite and monitor the individual's response to the involuntary medication for a minimum of one hour after administration, or longer if needed to ensure the individual's health and safety. (E) The RN or LMP must provide documented instructions to direct care staff regarding potential side effects, adverse reactions, and reporting requirements for the 24-hours following the administration of an involuntary medication. (F) The Behavior Coordinator and the administrator must be informed within one hour of the incident. (G) The individual's Behavior Support Plan and medication record must be reviewed and updated within 48 hours of the incident. (H) Members of the individual's IDT must be informed of the incident within 24 hours and be provided with all relevant documentation. (I) All uses of involuntary medications must be reported to the Contract Administrator and the Service Provider within 48 hours of the incident. (J) If abuse, as defined by OAR chapter 411, division 20, is suspected, staff must immediately report abuse, as required by OAR chapter 411, division 54. (c) A of any involuntary medication administration must be reviewed and documented. The review must include an examination of all prescriber's orders, related administration records, and consultation with a pharmacist and nurse. (d) Failure to comply with these requirements may be considered abuse if so determined by a protective services investigation. Statutory/Other Authority: ORS 409.050, 410.070, 443.450 Statutes/Other Implemented: ORS 409.050, 410.070, 443.400 - 443.455, 443.991 History: APD 20-2019, adopt filed 06/26/2019, effective 06/28/2019