Nursing Manual

Psychotropic Medication Use

• Psychotropic drugs should not be used as punishment, for the convenience of caregivers, as a substitute for a meaningful behavior plan, or in excessive amounts that interfere with the individual's quality of life.
• Psychotropic drugs must be used within the individualized support plan designed to improve the person's quality of life. The plan should have a diagnosis, the drug name, and names of ISP team member(s) who is responsible for the coordinating, planning, implementing and monitoring of the psychotropic medications. As a nurse who provides direct, holistic nursing services to a person receiving psychotropic medications, you may share in these responsibilities, or be responsible for all. Be certain the ISP team is clear regarding who is accountable and for which responsibilities. If changes are made in the plan, communication with the team members must take place and be documented.
• The use of a psychotropic medication should be based on a psychiatric diagnosis or a specific behavioral/medication hypothesis resulting from a functional analysis of the targeting behaviors. This does not mean that a drug cannot be changed, as long as the functional analysis is still valid.
• As with medical treatment, informed consent should be obtained from the person, the person's guardian, or health care representative if available, before initiation of a psychotropic drug. In addition, the ISP team should discuss whether the use of the drug is in the person's best interest by addressing: a) the feasibility of alternative treatment, b) the right or the person to refuse treatment, c) the risk and benefits of proposed treatment.
• OARs for twenty-four Hour Residential Services, Supported Living Services and Adult Foster Homes require what is called a balancing test. This is the term used to describe the documented process whereby the data or information collected by the program regarding psychiatric symptoms or behavior and/or effectiveness and side effects of the medication usage is presented to the prescribing practitioner. This allows him/her to make a determination that the harmful effects of not taking the medication clearly outweigh the potentially harmful effects of taking the medication. Balancing tests are completed by the prescribing practitioner whenever a psychotropic medication is initiated or the medication is changed.
• The individual must be monitored for medication efficacy by the program and ISP team. Monitoring must involve targeted behaviors as specified in the ISP. Measurements must occur on an ongoing and consistent basis.
• The individual must be monitored for side effects regularly, based on physical assessment, caregiver's reports and information from the individual. Frequency of monitoring depends on individual circumstances and can vary from person to person. The frequency of monitoring needs to be identified in the person's ISP.
• If a psychotropic medication is used that has the potential of causing tardive dyskinesia (TD), a monitoring system should be in place on a regular and systematic basis. If the drug is discontinued, monitoring needs to continue to check for withdrawal TD for approximately two months after the drug is stopped. This monitoring may be completed by the physician, the nurse, or house manager, etc. as specified in the person's ISP, (See samples of MOSES and AIMS).
• All psychotropic drugs must be reviewed regularly and systematically by the prescriber to determine the need for continued use at the lowest possible dose. The review schedule should be outlined in the ISP and will vary from person to person. An annual review should involve all ISP team members.
• Advocate for keeping drugs regimes as simple as possible in order to enhance desired outcomes and minimize side effects. Avoid frequent drug and dose changes, as drugs can take varying lengths of time to work. Avoid drug changes in a reactive manner to short term behavior fluctuations and caregiver's frustrations.