Section
3.15 Psychotropic Medication: Prescribing and Monitoring
3.15.1
Introduction
3.15.2 References
3.15.3 Scope
3.15.4 Did you know…?
3.15.5 Definitions
3.15.6 Objectives
3.15.7 Procedures
3.15.7-A. Basic requirements
3.15.7-B. Assessments
3.15.7-C. Informed consent
3.15.7-D. High-risk medications
3.15.7-E. Polypharmacy
3.15.7-F. Reporting requirements
3.15.1
Introduction
The use of psychotropic medications is often an integral part of
treatment for persons receiving care for behavioral health conditions.
As such, the use of psychotropic medications must be monitored closely
to help ensure that persons are treated safely and effectively.
ADHS/DBHS has developed guidelines and minimum requirements designed
to:
- Ensure the
safety of persons taking psychotropic medications;
- Reduce or
prevent the occurrence of adverse side effects; and
- Help persons
who are taking psychotropic medications restore and maintain optimal
levels of functioning and achieve positive clinical outcomes.
3.15.2
References
The following citations can serve as additional resources for this
content area:
Go
to top
3.15.3
Scope
To whom does this apply?
All T/RBHA and
subcontracted providers utilizing Behavioral Health medical
Practitioners to prescribe psychotropic
medications to the following populations:
- All Title
XIX and Title XXI eligible persons;
- All non-Title
XIX/XXI persons determined to have a serious mental illness; and
- All other
persons, based on available funding.
3.15.4
Did you know?
- A person’s
target symptoms and clinical responses to treatment must be identified
for each medication prescribed and documented in the person’s
comprehensive clinical record. Also, the use of psychotropic medication
must always be referenced and incorporated into the person’s
individual treatment plan.
- Education
regarding all prescribed medications must be routinely provided
to persons, family members, guardians, or designated representatives
in a culturally competent, language appropriate manner.
- Psychotropic
medications that are not clinically effective after reasonable
trials should be discontinued, unless the rationale for continuation
can be supported and is documented in the person’s comprehensive
clinical record.
- The prescription
of psychotropic medications by Behavioral Health medical
Practitioners must be coordinated
with primary care providers (PCPs) and Medicare providers or other health care providers to minimize the potential for adverse clinical outcomes. See Section
4.3, Coordination of Care with AHCCCS Health Plans and Primary
Care Providers regarding expectations for
coordination of care with PCPs and other health care providers.
Go
to top
3.15.5
Definitions
Adverse
Drug Reaction
Behavioral Health Medical Practitioner
Cross-tapering
Medication
Error
3.15.6
Objectives
To ensure that psychotropic medications prescribed for persons are
prescribed and monitored in a manner that provides for safe and
effective use.
3.15.7
Procedures
3.15.7-A.
Basic requirements
Medications may only be prescribed by T/RBHA credentialed
and licensed physicians, physician assistants, or nurse practitioners.
See Section 3.20, Credentialing and Privileging for more information
regarding credentialing requirements.
Go
to top
3.15.7-B:
Assessments
Reasonable clinical judgment, supported by available assessment
information, must guide the prescription of psychotropic medications.
To the extent possible, candidates for psychotropic medications
must be assessed prior to prescribing and providing psychotropic
medications. Psychotropic medication assessments must be documented
in the person’s comprehensive clinical record and must be
scheduled in a timely manner consistent with Section 3.2, Appointment
Standards and Timeliness of Service. Behavioral Health medical
Practitioners can use assessment
information that has already been collected by other sources and
are not required to document existing assessment information that
is part of the person’s comprehensive clinical record. At
a minimum, assessments for psychotropic medications must include:
- An adequately
detailed medical and behavioral health history;
- A mental
status examination;
- A diagnosis;
- Target Symptoms;
- A review
of possible medication allergies; and
- A review
of previously and currently prescribed medications including any
noted side effects and/or potential drug interactions.
Reassessments
must be completed on an ongoing basis to ensure medication compliance
and to substantiate that the prescribed psychotropic medication(s)
are the most effective treatment for the person.
Go
to top
3.15.7-C:
Informed consent
Informed consent must be obtained from the person and/or
legal guardian for each psychotropic medication prescribed. In obtaining
informed consent, Behavioral Health medical Practitioners must communicate in a manner that
the person and/or legal guardian can understand and comprehend.
The comprehensive clinical record must include documentation of
the essential elements for obtaining informed consent. Essential
elements for obtaining informed consent for medication are contained
within
PM
Form 3.15.1, Informed Consent for Psychotropic Medication Treatment.
The use of PM
Form 3.15.1 is recommended as a tool to review and document informed
consent for psychotropic medications. If PM Form 3.15.1 is not used
to document informed consent, the essential elements for obtaining
informed consent must be documented in the person’s individual
comprehensive clinical record in an alternative fashion.
For more information
regarding informed consent, please see Section 3.11, General and
Informed Consent to Treatment.
Go
to top
3.15.7-D:
High-risk medications
Psychotropic
medications must be monitored adequately to avoid, diminish, or
relieve side effects and adverse outcomes. Behavioral Health
medical Practitioners must develop
and implement safe and effective prescribing and monitoring practices
to ensure that high-risk medications are adequately monitored to
promote safe and effective use. At a minimum, this must include:
| Type
of Medication |
Monitoring
Action |
| Antipsychotic
Medications |
Administer
the Abnormal Involuntary Movement Scale (AIMS) and document
results. At a minimum, the AIMS must be completed and recorded
upon the initiation of a new anti-psychotic medication, at least
annually, or more frequently as indicated on an individual basis,
or according to additional timeframes established by the T/RBHA
Medical Director. Weight, fasting blood glucose and lipid levels
must be monitored at least annually, or more frequently as indicated
on an individual basis, or according to additional timeframes
established by the T/RBHA Medical Director. Gila River RBHA
Policy 1.1.1 Assessment of Movement Disorders requires that
the AIMS be completed and documented upon initiation of a new
anti-psychotic medication and every 6 months throughout treatment. |
| Lithium
Carbonate |
For each
person who is prescribed Lithium Carbonate or any related formulations
of Lithium, obtain Lithium levels, thyroid function tests, and
renal function test at least annually or more frequently as
indicated on an individual basis, or according to additional
timeframes established by the T/RBHA Medical Director. |
| Anticonvulsant
medications used for mood stabilization |
For each
person who is prescribed anti-convulsant medications for mood
stabilization or related treatment purposes, as indicated, obtain
blood levels and liver function tests, CBC or other lab tests
at least annually, or more frequently as indicated on an individual
basis, or according to additional timeframes established by
the T/RBHA Medical Director. |
| For persons
on medications that are known to affect health parameters |
For persons
on medications that are known to affect health parameters, such
as height, weight, heart rate, and blood pressure, assessments
will be made of the person’s height, weight, heart rate,
and blood pressure as indicated on an individual basis, or according
to timeframes established by the T/RBHA Medical Director. The
Gila River RBHA requires that network Behavioral Health
medical Practitioners document a
baseline weight prior to the initiation of any psychiatric medication. |
3.15.7-E:
Polypharmacy
ADHS/DBHS recognizes two types of polypharmacy; intra-class
polypharmacy and inter-class polypharmacy. Below are ADHS/DBHS expectations
regarding prescribing multiple psychotropic medications to a person
being treated for a behavioral health condition:
Intra-class
Polypharmacy: Defined as more than two medications regularly prescribed
at the same time within the same class, other than for cross-tapering
purposes. The person’s medical record must contain documentation
specifically describing the rationale and justification for the
combined use.
Inter-class
Polypharmacy: Defined as more than three medications regularly prescribed
at the same time from different classes of medications for the overall
treatment of behavioral health disorders. The medical record must
contain documentation specifically describing the rationale and
justification for the combined use.
3.15.7-F.
Reporting requirements
ADHS/DBHS requires that T/RBHAs establish a system for monitoring
the following:
- Adverse
drug reactions
- Medication
errors
The above referenced
events must be identified, reported, tracked, reviewed and analyzed
by the T/RBHA. Providers within the Gila River RBHA must report
adverse drug reactions and medication errors to the RBHA within
7 days of each occurrence. The Gila River RBHA reviews, tracks and
trends data at least quarterly with findings reported to the Gila
River RBHA Quality Management Committee.
An incident
report must be completed for any medication errors and/or adverse
drug reactions that result in emergency medical intervention. See
Section 7.4, Reporting of Incidents, Accidents and Deaths for more
information.
Go
to top
3.15
Psychotropic Medication: Prescribing and Monitoring
Last Revised: 05/17/2007
Effective Date: 08/15/2007 |
