Initiating medications

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Page posted: 3/6/24

This page provides tips and guidance to support a person when they start taking a psychotropic medication or another type of medication.

Informed consent

The 245D-licensed service provider must get written authorization from the person or their legal representative (as defined in Minn. Stat. §245D.02, subd. 12) before they administer medication or treatment. This requirement is included in Minn. Stat. §245D.05, subd. 2. To gather written authorization, the provider should use Medication Administration and Emergency Medical Authorization (.doc) or a similar document.

If the person or their representative has questions about a medication, DHS recommends that the 245D service provider help the person have that conversation with the licensed practitioner who is best qualified to explain the risk and benefits of the medication. The communication between the provider and the person or their representative should be done in a way the person can understand.

Tips to promote understanding

To help the person or their representative understand information about a medication, the 245D service provider should:

· Use simple oral, written or visual communication and plain language.

· Use culturally appropriate language in materials.

· Provide illustrations when possible and helpful for the person.

· Use audiovisual aids when available.

· Provide individual sessions designed specifically for the person.

· Try various ways to explain the information based on what works best for the person.

Refusal of medications

The 245D service provider cannot administer a medication if the person or their legal representative refuses to authorize it or if the person refuses to take a dose of it. The provider must report the refusal to the licensed practitioner as soon as possible.

Plan for when the person refuses or unintentionally misses a medication

When appropriate, the 245D service provider should work with the licensed practitioner or others (e.g., therapists, work supervisors who manage employee schedules) to plan for situations when the person might consent to the medication initially but later refuse or be absent for administration. For example:

· The person might experience barriers to learning about medications and/or treatments (e.g., understanding medical terminology, not having access to updated information). They might interpret information one way and then later refuse administration when things do not go the way they expect.

· The person might experience cultural barriers (e.g., consenting initially but then later fasting during certain times of the day for a religious holiday). The provider should create a plan to ensure the person can take their medication with food at a different time.

· Work environments or other community activities might expose the person to stigma or misinformation.

· Scheduling conflicts might make it difficult for the person to take medications at specific times.

· Emotional health, lack of self-esteem or personal biases might prevent the person from taking medication as prescribed.

Find out the reason for refusal

When a person refuses to start a medication or receive a dose of a medication, it is important for the 245D service provider to find out what the person thinks and feels about using the medication. For example:

· Has the person taken other medications in the past that haven’t helped them?

· Is the medication difficult to swallow?

· Does the medication taste bad?

· Is the person experiencing unwanted side effects?

· Is the person facing ridicule from others or stigma against taking medications or mental illness?

· Is the person unhappy about not being able to “have a beer with their friends” at the end of the week because of the new medication?

· Does the timing of the medication interfere with other activities such as work, resting time or dinner?

It is important for the 245D service provider to understand why the person does not want to take their medications so they can support the person’s right and beliefs. The provider should work with the person in a supportive way to identify changes to make the situation work for the person.

Example: Joe just moved into a home with a new licensed residential provider, and he is refusing to take some of his medications. He had been prescribed two psychotropic medications for several years before. Joe’s family, whose input Joe values, told the new provider that Joe had difficulty swallowing those particular medications. One of the psychotropic medications was a large, round pill that kept sticking in his throat when he tried to swallow it. Staff used to crush the medication to help Joe swallow it, but Joe really did not like the taste of the medication when it was prepared that way. Once the new staff understood why Joe had protested so much about taking his medications, they contacted the licensed practitioner. The licensed practitioner changed the dosage of the medication so Joe could take several smaller pills that were easier to swallow and still receive the same dosage determined optimal by the team.

Additional strategies to support the person when initiating medication

To support the person, the 245D service provider also can:

· Learn about the recommended treatment by using information on Psychotropic Medication Manual – Attending appointments.

· Consider technology that might support the person by using information on Psychotropic Medication Manual – Using technology to support people with medications and other health-related needs.

· Determine supports the person needs to help them manage their medication in a way that ensures they have power and control.

Additional resources

DHS created the following forms to help 245D service providers comply with Minn. Stat. Ch. 245D requirements:

· Sample form: Health Needs Record (.doc).

· Sample form: Intensive Support Self-Management Assessment (.doc).

· Sample form: Medication and Treatment Administration Packet (.doc).

For more information, refer to:

Psychotropic Medication Manual
Psychotropic Medication Manual – Medications
Psychotropic Medication Manual – Optimizing medications