Okla. Stat. tit. 63, § 63-1-881

facility residents – Written consent – Denial of admission.

A. As used in this section:

1. "Antipsychotic drug" means a drug, sometimes called a major

tranquilizer, used to treat symptoms of severe psychiatric

disorders, including, but not limited to, schizophrenia and bipolar

disorder;

2. "Long-term care facility" means:

a. a nursing facility as defined by Section 1-1902 of

this title,

b. the nursing facility component of a continuum of care

facility as defined under the Continuum of Care and

Assisted Living Act, or

c. the nursing care component of a life care community as

defined by the Long-term Care Insurance Act;

3. "Resident" means a resident as defined by Section 1-1902 of

this title;

4. "Representative of a resident" means a representative of a

resident as defined by Section 1-1902 of this title; and

5. "Prescribing clinician" means:

a. an allopathic or osteopathic physician licensed by and

in good standing with the State Board of Medical

Licensure and Supervision or the State Board of

Osteopathic Examiners, as appropriate,

b. a physician assistant licensed by and in good standing

with the State Board of Medical Licensure and

Supervision, or

c. an Advanced Practice Registered Nurse licensed by and

in good standing with the Oklahoma Board of Nursing.

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B. Except in case of an emergency in which the resident poses

harm to the resident or others, no long-term care facility resident

shall be prescribed or administered an antipsychotic drug that was

not already prescribed to the resident prior to admission to the

facility unless each of the following conditions has been satisfied:

1. The resident has been examined by the prescribing clinician

and diagnosed with a psychiatric condition and the prescribed drug

is approved by the United States Food and Drug Administration for

that condition or prescribed in accordance with generally accepted

clinical practices;

2. The prescribing clinician, or a previous prescribing

clinician, has unsuccessfully attempted to accomplish the drug's

intended effect using contemporary and generally accepted

nonpharmacological care options, and has documented those attempts

and their results in the resident's medical record or has deemed

that those attempts would not be medically appropriate based upon a

physical examination by the prescribing clinician and documented the

rationale in the resident's medical record;

3. The facility has provided to the resident or representative

of the resident a written explanation of applicable informed consent

laws. The explanation shall be written in language that the

resident or representative of a resident can be reasonably expected

to understand;

4. The prescribing clinician has confirmed with the nursing

facility verbally or otherwise that written, informed consent has

been obtained from the resident or representative of the resident

that meets the requirements of subsection C of this section; and

5. In the event a long-term care facility resident is

prescribed an antipsychotic medication in the case of an emergency,

the prescribing physician shall prescribe the minimum dosage and

duration that is prudent for the resident's condition and shall

examine the patient in person within thirty (30) days.

C. Except in the case of an emergency as provided for in

subsection B of this section, the prescribing clinician shall

confirm that written, voluntary informed consent to authorize the

administration of an antipsychotic drug to a facility resident has

been obtained from the resident or the representative of the

resident prior to the initial administration of the antipsychotic

drug. Voluntary informed consent shall, at minimum, consist of the

following:

1. The prescribing clinician has confirmed that a signed,

written affirmation has been obtained from the resident or the
administration of an antipsychotic drug to a facility resident has

been obtained from the resident or the representative of the

resident prior to the initial administration of the antipsychotic

drug. Voluntary informed consent shall, at minimum, consist of the

following:

1. The prescribing clinician has confirmed that a signed,

written affirmation has been obtained from the resident or the

representative of the resident that the resident has been informed

of all pertinent information concerning the administration of an

antipsychotic drug in language that the signer can reasonably be

expected to understand. Pertinent information shall include, but

not be limited to:

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a. the reason for the drug's prescription and the

intended effect of the drug on the resident's

condition,

b. the nature of the drug and the procedure for its

administration, including dosage, administration

schedule, method of delivery and expected duration for

the drug to be administered,

c. risks, common side effects and potential severe

adverse reactions associated with the administration

of the drug,

d. the right of the resident or representative of the

resident to refuse the administration of the

antipsychotic drug and the medical consequences of

such refusal, and

e. an explanation of pharmacological and

nonpharmacological alternatives to the administration

of antipsychotic drugs and the resident's right to

choose such alternatives; and

2. Except in the case of an emergency as provided for in

subsection B of this section, the prescribing clinician shall inform

the resident or the representative of the resident of the existence

of the long-term care facility's policies and procedures for

compliance with informed consent requirements. The facility shall

make these available to the resident or representative of the

resident prior to administering any antipsychotic drug upon request.

D. 1. Antipsychotic drug prescriptions and administration

shall be consistent with standards for dosage, duration and

frequency of administration that are generally accepted for the

resident's condition.

2. Throughout the duration of the administration of an

antipsychotic drug and at generally accepted intervals approved for

the resident's condition, the prescribing clinician or designee

shall monitor the resident's condition and evaluate drug performance

with respect to the condition for which the drug was prescribed.

The prescribing clinician shall provide documentation of the status

of the resident's condition to the resident or the representative of

the resident upon request and without unreasonable delay.

3. Any change in dosage or duration of the administration of an

antipsychotic drug shall be justified by the prescribing clinician

with documentation on the resident's record of the clinical

observations that warranted the change.

E. 1. No long-term care facility shall deny admission or

continued residency to a person on the basis of the person's or his

or her representative's refusal to the administration of

antipsychotic drugs, unless the prescribing clinician or care

facility can demonstrate that the resident's refusal would place the

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health and safety of the resident, the facility staff, other

residents or visitors at risk.

2. Any care facility that alleges that the resident's refusal

to consent to the administration of antipsychotic drugs will place

the health and safety of the resident, the facility staff, other

residents or visitors at risk shall document the alleged risk in

detail and shall present this documentation to the resident or the

representative of the resident, to the State Department of Health

and to the Long-Term Care Ombudsman, and shall inform the resident

or the representative of the resident of the resident's right to
the health and safety of the resident, the facility staff, other

residents or visitors at risk shall document the alleged risk in

detail and shall present this documentation to the resident or the

representative of the resident, to the State Department of Health

and to the Long-Term Care Ombudsman, and shall inform the resident

or the representative of the resident of the resident's right to

appeal to the State Department of Health. The documentation of the

alleged risk shall include a description of all nonpharmacological

or alternative care options attempted and why they were unsuccessful

or why the prescribing clinician determined alternative treatments

were not medically appropriate for the condition following a

physical examination.

F. The provisions of this section shall not apply to a hospice

patient as defined in Section 1-860.2 of this title.