(Also see Section 5, URGENT EVENTS AND EMERGENCIES, Chemical Restraint)
1. Policy
Hillcrest does not perform Chemical Restraints. As stated by the Massachusetts Department of Early Education and Care (DEEC) in policy statement number P-OCCS_R&P-02 (revised 1/05/04): “Chemical restraint is defined as the administration of medication for the purpose of restraint. Medication administered according to requirements and procedures for treatment authorized by a court (a Rogers order) is not a chemical restraint. …a PRN …taken voluntarily is not a chemical restraint. A psychotropic medication administered involuntarily in an emergency to prevent immediate, substantial and irreversible deterioration of serious mental illness is not a chemical restraint.”
According to DEEC a program may request a variance to use chemical or mechanical restraint.
1. Notification
The Supervisor or Nurse will contact the on call Administrator to inform him/her of the situation which constitutes an immediate danger presented by a student, and to describe interventions which have been attempted to deal with the danger. If the on call Administrator determines that the situation constitutes an immediate danger of serious harm to the student and/or others, and that other interventions have been properly employed but have not been successful, he/she will instruct the onsite or on call Nurse to consult an agency physician.
Final notification routes for each occurrence will depend on the urgency of the situation and other current conditions.
2. Determination of Need for involuntary anti-psychotic medication
Through first hand, on site assessment, or through telephone consultation with a physician or nurse who is present at the site of the emergency, the agency physician will determine whether involuntary psychotropic medication administration is the least intrusive intervention necessary to prevent further deterioration of a student’s emotional/psychological well-being.
3. Administration
Only a physician, or a nurse acting on an order from a licensed physician, will administer the medication. He/she will monitor the student in person immediately afterward for negative effects, and will reassess the student’s condition 15 minutes after the administration. The student receiving the medication will continually remain in the presence of an assigned staff member trained in assessing for distress. The practitioner who administered the medication will inform the assigned staff member of any possible negative effects of the medication and the amount of time necessary for the student to remain in close supervision.
4. Documentation
The time and date of the order for involuntary anti-psychotic medication administration must be documented on the doctor’s order sheet by the physician, or documented by a licensed nurse as a telephone order from the physician. The use of medication will be documented in the student’s case record with at least the following information:
a) A description of the precipitating incident or series of incidents, the alternative interventions attempted including all efforts to prevent the use of chemical restraint, and the reasons the medication was necessary.
b) The fact that involuntary medication was the least restrictive alternative and why.
c) The time and from whom the order for administration was obtained, and the names and titles of all other persons notified and/or involved in the decision.
5. Incident Review/Treatment Planning:
At all Hillcrest sites except for the Intensive Treatment Unit (ITU), the use of an involuntary PRN requires a Special Team Meeting to discuss the circumstances of the event and revise the student’s crisis intervention plan accordingly. A second involuntary PRN for the same student requires an Emergency Team Meeting to determine the student’s appropriateness of placement.
The ITU may request a waiver by D.E.S.E. to allow involuntary PRN’s as a part of a student’s intervention plan for severe cases. In such cases, a monitoring plan must be incorporated into the student’s Comprehensive Treatment Plan to assure frequent and proper assessment of the intervention’s benefit. Without such a waiver in place, the ITU must follow the general protocol described above.