CMS SOM App. J, Tag W312

directed specifically towards the reduction of and eventual elimination of the behaviors for

which the drugs are employed.

Guidance §483.450(e)(2)

All medications to manage behavior must be integrated into the IPP and the IPP must specify

how the specific target behavior for which the medication is prescribed will be reduced or

eliminated. This includes medications which are typically used for medical conditions that may

be used to manage behavior (e.g. 1. propranolol (Inderal), an antihypertensive used for self-injurious behavior, and 2. carbamazepine (Tegretol), an anticonvulsant, used for aggression).

Drugs for behavior management must not be ordered on a PRN basis for a client. The facility

staff must contact the physician to obtain a one-time order if the situation necessities the use of

medication. The facility policy must address the maximum number of times a medication can be

used as an emergency prior to being incorporated in the IPP, side effects of such medications,

and the frequency of re-evaluation of ongoing behavior and its treatment.

Clients or their legal guardian have the right to choose sedation for medical and dental

procedures. However, the facility cannot do routine administration of medication for sedation

for medical and dental procedures without the agreement/consent of the client or their

parent/legal guardian and they must follow the specific orders of the healthcare practitioner

who will be providing services to the client. Decisions to order medications prior to medical and

dental procedures must be made on an individual basis. Clients who demonstrate severe

anxiety around these procedures should be considered for desensitization programs.