Texas Register, Volume 23, Number 15, Pages 3631-3764, April 10, 1998 Page: 3,695
3631-3764 p. ; 28 cm.View a full description of this periodical.
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If emergency interventions are needed more than twice during two
consecutive months a functional analysis is undertaken to determine
if a program to reduce the frequency and severity of the identified
behaviors is needed.
(d) Restrictive and/or intrusive interventions may be used as
part of an individualized plan that is intended to lead to less restrictive
means of managing and eliminating the behavior or controlling the
symptoms of mental illness.
(e) Monitoring of the consumer during all restrictive and/
or intrusive interventions is at the appropriate level for the type of
intervention being used and assures that the consumer's rights are
protected.
(f) All restrictive and/or intrusive interventions addressing
the management of targeted behavior are justified by the functional
assessment, the current level of behavior, and are reviewed by the
treatment team at least annually to determine the ongoing need and
to assess for the possible decrease in the use of the intervention,
based on current clinical evidence. When possible, the acquisition of
adaptive replacement behaviors is also measured.
(g) Other interventions (e.g. environmental engineering,
counseling) are similarly evaluated for their effectiveness through the
use of individualized and quantified measures.
(h) Except in an emergency, written informed consent for
a period not to exceed one year is obtained when restrictive and/or
intrusive interventions are included as part of a behavior management
program.
(1) The HRC should review the situation carefully as a
matter of due process. When the failure to obtain written informed
consent is based on the consumer's assessed inability to provide
legally adequate consent, the need for obtaining a guardian should
be considered. When applicable, surrogate decision making will be
considered as described in Chapter 405, Subchapter J of this title
(relating to Surrogate Decision-Making for Community-Based ICF/
MR and ICF/MR/RC Facilities.)
(2) The consumer or guardian have the right to withdraw
consent to treatment at any time without regard to any time limit
specified in the consent form.
(3) A comsumer does not have the right to cause injury
to self or others, but does have a right to be free of unnecessary
drugs and other restrictive interventions and to receive appropriate
treatment. This can best be ascertained when planned interventions
are evaluated and determined to be effective.
412.365. Psychoactive Medications.
In accordance with accepted principles of practice, the local MRA or
designated provider shall ensure that:
(1) psychoactive medications are used judiciously as
part of an individualized plan in which the following are carefully
considered:
(A) rationale including current DSM diagnosis;
(B) benefits of treatment in light of potential risks of
the targeted behavior;
(C) overall impact on the consumer's quality of life;
(D) adjunctive procedures;
(E) monitoring of side effects; and
(F) monitoring for efficacy;(2) the physician obtains a second opinion to review and
determine the safety of any usage of polypharmacy or dosage levels
over the maximum when clinically indicated prior to the consumer
receiving such medications;
(3) when tardive dyskinesia is suspected, the physician:
(A) informs the consumer and/or LAR;
(B) discusses treatment options; and
(C) documents in the record that the consumer and/or
LAR has been informed of the suspected condition, possible treatment
options, and the rationale for the treatment chosen;
(4) informed consent in writing for a period not to exceed
one year from the consumer, LAR, or a surrogate decision-making
committee, if applicable, as described in Chapter 405, Subchapter J
of this title (relating to Surrogate Decision-Making for Community-
Based ICF/MR and ICF/MR/RC Facilities) is obtained prior to
initiation of the medication unless the use is necessitated by an
emergency as described in 412.364 of this title (relating to Behavior
Management). Informed consent must include:
(A) an explanation of the medication and its purposes;
(B) expected beneficial effects, side effects and risks;
(C) probable consequences of not taking medication;
(D) the existence and value of alternative less restric-
tive forms of treatment, if any, and why the physician rejects the
alternative therapy;
(E) instruction that the consumer with the ability to
provide legally adequate consent or the LAR may withdraw consent
at any time without negative actions on the part of staff;
(F) an offer to answer any questions concerning the
medication and its use; and
(G) a specification of the time period to be covered
by the consent document;
(5) informed consent will be obtained on at least an
annual basis or any time the medication regimen is altered in a way
which would result in a change of medication class or result in a
significant change in the risks or benefits to the consumer; and
(6) if the consumer with the ability to provide legally
adequate consent or the LAR consents to the administration of
psychoactive medication but is physically unable to provide written
consent, the physician will document the verbal consent in the
consumer' s record.
412.366. Consumer Records.
(a) In accordance with accepted principals of practice, each
local MRA or designated provider must insure that a separate
confidential record is established and maintained for each consumer
receiving services. This record must provide accurate documentation
of the organization's efforts to provide health care, habilitation and
support services, social information, and the protection of rights. The
record should provide a readily accessible means of communication
among all service providers.
(b) The local MRA or designated provider will ensure that
record entries:
(1) are accurate;
(2) are legible;
(3) are chronological;ADOPTED RULES April 10, 1998 23 TexReg 3695
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Texas. Secretary of State. Texas Register, Volume 23, Number 15, Pages 3631-3764, April 10, 1998, periodical, April 10, 1998; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth113834/m1/65/: accessed April 27, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.