SECTION 340:100-5-29. Monitoring for dyskinesia

(a)   Scope and applicability. Developmental Disabilities Services Division (DDSD) provides a standardized system to regularly and systematically assess, evaluate, and inform service recipients who are at risk for dyskinesia, including tardive dyskinesia (TD). Monitoring for dyskinesia applies to all service recipients who receive classes of medication per OAC 340:100-5-29(a)(1). Providers of residential services funded by Oklahoma Department of Human Services (OKDHS) DDSD or Oklahoma Health Care Authority (OHCA) have primary responsibility for implementation of OAC 340:100-5-29. Providers of other types of supports inform service recipients and encourage the implementation of OAC 340:100-5-29. Providers are required to meet standards per OAC 340:100-3-27. Service recipients:

(1)   prescribed amoxapine, metoclopromide, or neuroleptic or other medications known to cause side effects that include dyskinesia are regularly and systematically assessed and evaluated for dyskinesia. The service recipient who is prescribed such medications, parent(s) of a minor service recipient, or, if applicable, service recipient's legal guardian is regularly informed about the risk of TD;

(2)   identified with signs or symptoms of dyskinesia are referred for further evaluation to diagnose the type of dyskinesia;

(3)   properly diagnosed by a physician with dyskinesia, parent(s) of a minor service recipient, or, if applicable, legal guardian are informed of the presence of dyskinesia, including TD; or

(4)   with dyskinesia are regularly and systematically assessed and evaluated regarding the status of dyskinesia.

(b)   Assessment requirements. Assessments are completed by a trained rater or licensed professional. The Dyskinesia Identification System: Condensed User Scale (DISCUS) is the preferred assessment scale. In the absence of trained raters for DISCUS, the Abnormal Involuntary Movement Scale (AIMS) may be used. DDSD trains staff identified by agency providers to be raters on the use of DISCUS at no charge to the provider agency. Identified staff may be contract staff or employees of the provider agency. When DDSD is needed to train raters, the provider agency notifies the DDSD area manager in a timely manner.

(1)   The rater obtains prerequisite information about neuroleptic medication, amoxapine, or metoclopromide exposure.

(2)   The applicable assessment scale is filed in the service recipient's record per OAC 340:100-3-40.

(c)   Service recipients requiring assessments. Service recipients:

(1)   whose history of medication exposure is unknown or uncertain receive an initial rating.

When the initial rating is:

(A)   negative, total score less than five on DISCUS, further assessments are not needed; or

(B)   positive, total score of five or more on DISCUS, items in (i) and (ii) must be performed.

(i)   A physician's evaluation and, if indicated, further referral is made to confirm the type of dyskinesia.

(ii)   The assessment is repeated every six months until the assessment is negative. The assessment is repeated one month after a negative assessment, and if negative again, further assessments are not needed;

(2)   who are prescribed medication or receive medication that may cause dyskinesia are assessed before medication is started or within 30 days of the treatment being identified.

(A)   Service recipients are routinely assessed every six months while on medication.

(B)   Assessments may be done quarterly or more frequently if medications are changed or side effects are suspected or identified;

(3)   who receive medication that may cause dyskinesia are assessed within 30 days of the treatment being identified.

(A)   Service recipients are routinely assessed every six months while on medication.

(B)   Assessments may be done quarterly or more frequently if medications are changed or side effects are suspected or identified;

(4)   who had medications discontinued that may cause dyskinesia are assessed as described in (A) through (C).

(A)   After four months of positive ratings, monthly assessments are stopped, and assessments are repeated every six months.

(B)   If a negative rating occurs, reassess monthly until two negative ratings occur.

(C)   After two negative ratings, DISCUS screening is discontinued; and

(5)   who have medications introduced again that may cause dyskinesia, OAC 340:100-5-29(d) is followed.

(d)    TD diagnosis. The diagnosis of TD is conveyed in writing by the physician to the service recipient, parent(s) of a minor service recipient, or, if applicable, legal guardian.

[Source: Added at 10 Ok Reg 2505, eff 5-24-93 (emergency); Added at 11 Ok Reg 2303, eff 5-26-94; Amended at 23 Ok Reg 1026, eff 5-11-06; Amended at 25 Ok Reg 986, eff 5-15-08]