One time administration of psychiatric medications are permitted for an anticipated event that may cause agitation or safety issues. For example, medical procedures, dental appointments or transportation by airplane. To request a one-time medication administration for a future event, a psychotropic medication request should be submitted prior to administration of the medication.

To request the one-time medication, please submit the request as a “New” medication type and report the name of the medication and its formulation (i.e. tablet, liquid, sublingual film, etc.).

To ensure a one-time med is submitted correctly please indicate that the consent period should last for 1 day, and for medication start date please indicate what date the appointment or event will take place in the future.

Please indicate the approximate time the medication will be administered and enter “0” in the other fields. The maximum daily range should be set at the dose that will be given.

Please list the symptoms targeted by the medication (i.e. anxiety, agitation, etc.) in the current symptoms field, making sure to indicate that the symptoms are current.

Finally, in the additional Rationale section please indicate the reason for the one-time administration by specifying the event. An example would be: “One time administration of lorazepam to treat agitation and anxiety related to dental appointment.”

Proceed through the remaining steps in the online portal to submit the one-time medication request. The submission is successfully received when a confirmation email is received by the email associated with the request.

Illinois Statute 20 ILCS 535: the Administration of Psychotropic Medications to Children Act, establishes guidelines for the administration of psychotropic medications to children, emphasizing the importance of careful and appropriate use, and delineates the responsibilities of the Department of Children and Family Services in ensuring compliance with the act.  To implement the law, DCFS was charged with the responsibility of proposing rules.  These rules, Title 89: Chapter III, subchapter b, Part 325: Administration of Psychotropic Medications to Children and Adolescents for Whom the Department of Children and Family Services is Legally

Responsible, often referred to as DCFS Rule 325, were reviewed and approved by the Illinois Joint Commission on Administrative Rules. In Rule 325, PRN medications are defined as: "standing medication orders to administer a psychotropic medication for the emergency management of aggression, psychotic agitation, insomnia and other troublesome symptoms without a physician assessment or specific approval according to parameters set by the licensed prescriber."

Rule 325 prohibits the use of PRN medications. As detailed in Rule 325.  "PRN medications for the purpose of behavioral management, inducing sleep, or treating other emotional, behavioral or psychiatric illnesses are prohibited...

The Rule allows for the use of one-time emergency medications to aid in the management of behaviors that pose an immediate threat of serious harm to self or others and one-time non-emergency medications to manage symptoms of insomnia or other non-emergent symptoms that may adversely affect a child's or youth's sense of well-being. Administration of an emergency medication or a one-time, non-emergency medication is time sensitive.  Consequently, one-time emergency medications and one-time non-emergency medication administrations prescribers are required to notify the Department's Division of Guardian and Advocacy, in writing, of the administration of an emergency psychotropic medication or a one-time, non-emergency medication using the online consent portal or faxing DCFS form 431A.to the Consent Unit (312-814-7015).

References

1. Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Suhler, J. R., & Rockhill, C. (2020). Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124. https://doi.org/10.1016/j.jaac.2020.05.005

2. Patel, D. R., Feucht, C., Brown, K., & Ramsay, J. (2018). Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners. Translational Pediatrics, 7(1), 23–35. https://doi.org/10.21037/tp.2017.08.05

3. Ballard, R., Romba, C., & Walkup, J. T. (2024). Psychopharmacology for Pediatric Anxiety Disorders. 307–345. https://doi.org/10.1007/978-3-031-57472-6_14

4. Gober, H. J., Li, K. H., Yan, K., Bailey, A. J., & Carleton, B. C. (2022). Hydroxyzine Use in Preschool Children and Its Effect on Neurodevelopment: A Population-Based Longitudinal Study. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.721875

To find out more visit the DCFS Guardian Consent Portal: guardianconsent.dcfs.illinois.gov

Questions? Please email: DCFS.IllinoisConnect@Illinois.gov