26 Tex. Admin. Code § 568.42

Current through Reg. 50, No. 1; January 3, 2025

Section 568.42 - Responding to a Psychiatric Emergency

(a) The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise.

(1) Emergency psychoactive medication--A psychoactive medication administered to a patient in a psychiatric emergency that is used to exercise an immediate effect on the central nervous system.

(2) Psychiatric emergency--A situation in which it is immediately necessary to administer medication to a patient to prevent:

(A) imminent probable death or substantial bodily harm to the patient because the patient:

(i) overtly or continually is threatening or attempting to commit suicide or serious bodily harm; or

(ii) is behaving in a manner that indicates that the patient is unable to satisfy the patient's need for nourishment, essential medical care, or self-protection; or

(B) imminent physical or emotional harm to another because of threats, attempts, or other acts the patient overtly or continually makes or commits.

(3) Psychoactive medication--A medication prescribed for the treatment of symptoms of psychosis or other severe mental or emotional disorders and that is used to exercise an effect on the central nervous system to influence and modify behavior, cognition, or affective state when treating the symptoms of mental illness. "Psychoactive medication" includes the following categories when used as described in this section:

(A) antipsychotics or neuroleptics;

(B) antidepressants;

(C) agents for control of mania or depression;

(D) antianxiety agents;

(E) sedatives, hypnotics, or other sleep-promoting drugs; and

(F) psychomotor stimulants.

(b) In accordance with 25 TAC § 414.410 (relating to Psychiatric Emergencies), only a treating physician may issue an order to administer emergency psychoactive medication without a patient's consent.

(c) A treating physician may only issue an order to administer emergency psychoactive medication without a patient's consent when less restrictive interventions are determined ineffective to protect the patient or others from harm.

(d) A hospital shall adopt, implement, and enforce written policies and procedures to ensure safe and appropriate administration and monitoring of an emergency psychoactive medication. These policies and procedures shall:

(1) identify the staff members authorized to administer an emergency psychoactive medication;

(2) identify the psychoactive medications permitted and approved by the hospital for administration in a psychiatric emergency;

(3) prescribe how and with what frequency and duration a staff member shall monitor a patient who has received an emergency psychoactive medication to ensure the health and safety of the patient, in addition to the in-person evaluation conducted as required by subsection (f) of this section;

(4) identify the licensed practitioners authorized to examine the patient as required by subsection (f) of this section; and

(5) ensure staff members follow all monitoring and evaluation requirements under this section and all hospital policies and procedures regarding administration of an emergency psychoactive medication each time a patient receives a separate dose of an emergency psychoactive medication.

(e) Staff members authorized by the hospital's policies and procedures to administer an emergency psychoactive medication shall receive training on and demonstrate competency in the following:

(1) knowledge of the psychoactive medications permitted and approved by the hospital for administration in a psychiatric emergency;

(2) safe and appropriate administration and monitoring of an emergency psychoactive medication per hospital policies and procedures as required by subsection (d) of this section; and

(3) management of emergency medical conditions in accordance with the hospital's policies and procedures and other applicable requirements for:

(A) obtaining emergency medical assistance; and

(B) obtaining training in and using techniques for cardiopulmonary respiration and airway obstruction removal.

(f) When a staff member administers a psychoactive medication to a patient experiencing a psychiatric emergency, a physician, other licensed practitioner, or registered nurse trained in accordance with the requirements specified in subsection (g) of this section shall examine the patient in person within one hour after the administration of the psychoactive medication to evaluate and document in the patient's clinical record:

(1) the patient's immediate situation;

(2) the patient's reaction to the medication;

(3) the patient's medical and behavioral condition; and

(4) whether to return to or modify the patient's plan of care.

(g) A physician, other licensed practitioner, or registered nurse who conducts the in-person evaluation specified in subsection (f) of this section shall receive training and demonstrate competency in the following:

(1) techniques identifying staff member and patient behaviors, events, and environmental factors that may trigger a psychiatric emergency;

(2) use of nonphysical intervention skills;

(3) choosing the least restrictive intervention based on an individualized assessment of the patient's medical or behavioral status or condition;

(4) safe administration of emergency psychoactive medications and how to recognize and respond to signs of physical and psychological distress;

(5) clinical identification of specific behavioral changes indicating the psychiatric emergency's conclusion;

(6) monitoring the physical and psychological well-being of the patient who has received an emergency psychoactive medication, including the patient's respiratory and circulatory status, vital signs, and any special requirements specified by hospital policy associated with conducting the in-person evaluation; and

(7) the use of first aid techniques and certification in the use of cardiopulmonary resuscitation, including required periodic recertification.

(h) If a trained registered nurse conducts the in-person evaluation specified in subsection (f) of this section, the trained registered nurse shall consult the attending physician or other licensed practitioner responsible for the patient's care as soon as possible after completing the evaluation.

(i) The physician or other licensed practitioner responsible for the patient's care shall document in the patient's clinical record in specific medical and behavioral terms:

(1) the information required by 25 TAC § 414.410(b) (relating to Psychiatric Emergencies);

(2) the evaluation findings specified in subsection (f)(1) - (4) of this section;

(3) a description of the patient's behavior and the emergency psychoactive medication used;

(4) alternatives or other less restrictive interventions attempted, as applicable;

(5) the patient's condition or symptoms warranting the emergency psychoactive medication; and

(6) the patient's response to the emergency psychoactive medication, including the rationale for continued use of the medication.

26 Tex. Admin. Code § 568.42

Adopted by Texas Register, Volume 50, Number 01, January 3, 2025, TexReg 0155, eff. 1/6/2025