Emergency Situations

(1) Psychotropic Medication (a) Without regard to whether the patient has or lacks capacity to give informed consent for psychotropic medication, in an emergency situation as defined in Rule 0940-01-02-.03, emergency psychotropic medication may be ordered and administered to the patient without informed consent or TRC authorization for up to twenty-four (24) hours and may be renewed for up to an additional twenty-four (24) hours, if the emergency situation continues. 1. The initial order for emergency psychotropic medication shall be valid for no longer than twenty-four (24) hours. If the initial order for emergency psychotropic medication was authorized without personal observation of the patient by the member of the RMHI Medical Staff who ordered the emergency psychotropic medication, a member of the RMHI Medical Staff shall personally evaluate the patient’s condition within one (1) hour of the order. 2. If the emergency continues beyond twenty-four (24) hours, the emergency order for psychotropic medication may be renewed once for up to an additional twenty- four (24) hours, but only after a face-to-face assessment of the patient by a member of the RMHI Medical Staff. (b) After forty-eight (48) hours from the initial order for emergency psychotropic medication, the patient shall not receive psychotropic medication without informed consent or authorization by the TRC under Rules 0940-01-02-.08, 0940-01-02-.09, 0940-01-02-.10, or 0940-01-02-.11. (c) The effective duration of emergency psychotropic medication prescribed shall be appropriate to the emergency situation. Depot forms of neuroleptics, which are PROCEDURES FOR PRESCRIPTION AND ADMINISTRATION OF CHAPTER 0940-01-02 PSYCHOTROPIC MEDICATIONS AT MENTAL HEALTH INSTITUTES psychotropic drugs characterized by a slow rate of absorption and a long duration of action, shall not be ordered or administered as emergency psychotropic medication. (2) Physical Treatment (a) Without regard to whether the patient has or lacks capacity to give informed consent for physical treatment, in an emergency situation as defined in Rule 0940-01-02-.03, emergency physical treatment may be provided to the patient without informed consent or TRC authorization for up to twenty-four (24) hours and may be renewed for up to an additional twenty-four (24) hours, if the emergency situation continues. 1. The initial order for emergency physical treatment shall be valid for no longer than twenty-four (24) hours. If the initial order for emergency physical treatment was authorized without personal observation of the patient by the member of the RMHI Medical Staff who ordered the emergency physical treatment, a member of the RMHI Medical Staff shall personally evaluate the patient’s condition within one (1) hour of the order. 2. If the emergency continues beyond twenty-four (24) hours, the emergency order for physical treatment may be renewed once for up to an additional twenty-four (24) hours, but only after a face-to-face assessment of the patient by a member of the RMHI Medical Staff. (b) After forty-eight (48) hours from the initial order for emergency physical treatment, the patient shall not receive physical treatment without informed consent or authorization by the TRC under Rules 0940-01-02-.08, 0940-01-02-.09, 0940-01-02-.10, or 0940-01- 02-.11. (3) Release of Information Emergency releases of information shall be managed in accordance with applicable state and federal statutes and regulations. (4) The authorization for emergency psychotropic medication and/or emergency physical treatment, including a description of the emergency situation, shall be documented on a state-approved form and maintained in the patient’s medical record. Documentation shall include: (a) A description of the emergency situation detailing how the criteria specified in Rule 0940-01-02.03 were met, including the observations of the member of the RMHI Medical Staff ordering the emergency psychotropic medication and/or emergency physical treatment, and (b) The rationale for ordering the emergency psychotropic medication and/or emergency physical treatment, including any alternate measures that were considered. (5) By the end of the next regular working day following the initial order for emergency psychotropic medication and/or emergency physical treatment, the PRA shall be informed of the use of emergency psychotropic medication and/or emergency physical treatment. (6) Within twenty-four (24) hours of being informed of the use of emergency psychotropic medication and/or physical treatment, or, if such period expires on a weekend or a legal holiday, by the end of the next regular working day, the PRA shall: (a) Review the documentation relating to the emergency situation and the actions taken; (b) Interview the patient (unless the patient declines to be interviewed); and PROCEDURES FOR PRESCRIPTION AND ADMINISTRATION OF CHAPTER 0940-01-02 PSYCHOTROPIC MEDICATIONS AT MENTAL HEALTH INSTITUTES (c) Document comments and/or recommendations in the patient’s medical record. (7) TRC Process (a) The patient, the PRA, a member of the RMHI Medical Staff, or a member of the patient’s treatment team may request TRC review of the emergency psychotropic medication and/or emergency physical treatment. (b) By the end of the next regular working day following receipt of a request for review of emergency psychotropic medication and/or emergency physical treatment, the TRC shall meet and: 1. Review the documentation relating to the emergency situation and the actions taken; 2. Interview the patient (unless the patient declines to participate in the TRC meeting); and 3. Document its review on a state-approved form in the patient’s medical record. (c) The TRC may request an assessment of the patient’s capacity to give informed consent to determine if TRC approval under Rules 0940-01-02-.08, 0940-01-02-.09, 0940-01-02-.10, or 0940-01-02-.11 is needed.