Lucrecia Johnson MSW, LSW Mary Bartlett MSW, LISW-S Protection From Harm (PFH) Prevention Planning Expectations & Review Criteria January 14, 2016 Lucrecia Johnson MSW, LSW Mary Bartlett MSW, LISW-S

Overview Purpose What is a prevention plan When are prevention plans expected Prevention Plan expectations Prevention Plan Review Criteria Prevention Planning Tips Conclusion/Questions

Purpose This presentation should be the foundation at which the case management agencies and provider oversight contractor train staff in developing and reviewing prevention plans.

Purpose Continue The purpose of this presentation is to communicate the ODM expectations and standards for developing prevention plans. In addition, the Protection form Harm Program will identify the criteria for which prevention plans will be evaluated when reviewed by the Protection from Harm Managers.

The Life Cycle of an Incident Immediate Actions Conduct an Investigation Identify Cause and Contributing Factors Develop the Prevention Plan Integrate Prevention Plan Close Investigation

What is a Prevention Plan? Prevention Plan as defined by OAC-5160-45-05 section I (4) (c) A prevention plan for the individual identifies the steps necessary to mitigate the effects of a substantiated incident, eliminate the causes and contributing factors that resulted in risk to the health and welfare of the individual and any other persons impacted by the incident and prevent future incidents.

Prevention Plan Prevention plans should be person-centered and individualized based on the strengths and needs of the individual while specifically addressing the causes and contributing factors identified through the investigation process or case management assessment.

Individual’s Perspective It is more important to integrate the person-centered planning principles when developing the prevention plan rather than using specific words. Simply writing that the “individual will….” doesn't make the prevention plan person-centered. The prevention plan can include actions taken by any member of the individual’s person-centered planning team.

Causes and Contributing Factors The investigation will identify cause and contributing factors of the incident. Causal Factors: are any behavior, omission, or deficiency that if corrected, eliminated, or avoided probably would have prevented the incident. Contributing Factors: are any behavior, omission, or deficiency that sets the stage for an incident, or increases the severity of injuries.

Cause and Contributing Factors Categories Cause and contributing factors categories may include but are not limited to: Progression of individual’s existing disease process New diagnosis or medical finding Human Factors Environmental Equipment More than one cause and/or contributing factor can be identified. When identifying a category there also must be details provided based on the investigation findings of the incident. The categories are simply to provide structure in reporting for further data analysis. Progression of individual’s existing disease process and New diagnosis of medical finding provide details

Cause and Contributing Factors Categories Progression of individual’s existing disease process New diagnosis or medical finding Human Factors: Incidents that include concerns that someone’s action or inaction lead to the incident or contributed to the incident Environmental: Incidents that include concerns with the area at which the incident occurred Equipment: Incidents that include concerns with equipment malfunctioning, lack of equipment or the use of equipment. This can include assisted devices or other medical devices

Expectation of Identifying Causes & Contributing Factors The analysis of the evidence found as a result of the investigation will identify the causes and contributing factors of the incident. The causes and contributing factors identify Why the incident happened. Example #1: A reported incident of an ER visit for a swollen ankle due to a fall from tripping over a step. The investigation may find that the discharge paperwork from the hospital included the ex-ray of the foot as well as documentation of an untreated infection and the individual reported being dizzy. The causes and contributing factors may include both a review of the environmental factors (the step) as well as a new diagnosis's or medical finding (the infection). Example #2: A reported incident of a Hospitalization due to a ventilator malfunction. The investigation may find through the review of the nursing notes, that the nurse was not completing the maintenance checks for the ventilator. The causes and contributing factors may include both a review of the equipment (ventilator) as well as Human factors (nurse) not completing the maintenance check of the equipment.

When is a Prevent Plan Expected At the conclusion of the investigation the provider oversight contractor shall Include a prevention plan for the individual that identifies the steps necessary to mitigate the effects of a substantiated incident, eliminate the causes and contributing factors that resulted in the risk to the health and welfare of the individual and any other persons impacted by the incident and prevent further incidents. All provider occurrence violations and unsubstantiated incidents do not require a prevention plan. The requirement of the prevention plan will be left to the discretion of the investigator based on the outcome of the investigation, the causes and contributing factors and the risk to health and welfare. All prevention plans should be added to the Person-centered Services Plan in order to be integrated in the individual’s plan.

Prevention Plan Content Expectations A prevention plan should include at minimum: Interventions or actions that address all causes and contributing factors The interventions should be measurable and include a time frame for implementation Identify who is responsible for a specific activity in the prevention plan (i.e. individual, provider or case manager) Identify if re-assessments, care plan revisions, staff training, equipment and/or possible home modification are needed to assure individual’s health and safety

Prevention Plan Review Criteria The review of the prevention plans will include the following criteria: Are there identified interventions/actions Are the interventions and actions related to the causes and contributing factors for the incident or significant change of condition (i.e. the reason the individual was hospitalized, the reason the individual fell) Were all of the causes and contributing factors addressed Are the interventions measureable Is there indication when the intervention will be implemented and/or monitored If needed, was individual education addressed Is the person(s) to execute or monitor interventions identified

Prevention Planning TIPS Consider these questions when developing the prevention plan: What happened? Why did it happen? What does the team need to do to reduce the risk of reoccurrence? What can the individual do to prevent the incident from reoccurring? What can the case manager do to prevent the incident from reoccurring? What can the provider(s) do to prevent the incident from recurring? How will you measure that risk is reduced? All prevention plans must be integrated in the Person-Centered Services Plan following the criteria specified in the Case Management Guide Start with the least intrusive intervention first based on the individual’s strengths and needs when developing a prevention plan Prevention plans need to be person centered but don’t always need to state “Individual will……”

The Goal of the Prevention Plan The goal is the desired outcome to mitigate the reoccurrence of the incident. The prevention plan should contain the steps or actions the team members (including the individual) take in order to reach the desired outcome. The goal doesn’t equal the prevention plan New slide that was not included prior to the rough draft “The goal of services is the destination”

The Goal of the Prevention Plan (continue) Below are examples of statements that have previously been placed in prevention plans that represent desired outcomes. “Individual will always take medications as prescribed” “Family will anticipate all needs” “Individual will not drink” “Individual will have all needs met” “Individual will follow all physician’s orders” “Individual will avoid bleeding” “Individual will be as safe as possible both in his home and outside of his home” When writing prevention plans use the desired outcome to develop the steps/actions/interventions to include in the prevention plan. The desired outcome is NOT the prevention plan.

Prevention Plan Tips Current Prevention Plan Updated Prevention Plans This example is just to demonstrate ways to incorporate the prevention plan criteria. The updated prevention plan is only meant to illustrate the contrast between what currently is being provided and what should be included in future prevention plans. The interventions listed in the updated prevention plan are examples only. Current Prevention Plan Updated Prevention Plans Individual will follow all medications and treatment recommendations. Individual will work with all physicians and psychiatrist for treatment. Case managers will increase individual’s nursing services to included weekly education and monitoring of mediations and treatment recommendations. Individual’s family will take individual to weekly physician and psychiatrist appointments.

Prevention Plan Tips (continue) Current Prevention Plan Updated Prevention Plans Individual will follow all safety plans. The current safety plan will be amended to include removal of all chemicals that could be drank and cause health issues. Individual will always be in eye contact with a grandparent or other responsible adult to assure her safety. Case manager will be provide family with information from the Poison Control Center on ways to safely store or dispose of harmful chemicals within the next week. Case manager and individual/family will update the safety plan to included individual’s supervision requirements and review monthly with individual/family.

Requesting a Prevention Plan The investigator will identify the causes and contributing factors to the CM and request prevention plan The CM will have three business days to complete the prevention plan and submit to the Provider Oversight Contractor for approval. If the prevention plan is not completed timely, the investigator will escalate to the clinical manager. The clinical manager will then have two days to complete the prevention plan and submit it to the investigator for approval. In the event the prevention plan is not submitted within these two days, then the Provider Oversight Contractor will escalate to the ODM contract manager.

Questions?

Thanks. Mary. Bartlett@medicaid. ohio. gov Lucrecia. Johnson@mediciad Thanks! Mary.Bartlett@medicaid.ohio.gov Lucrecia.Johnson@mediciad.ohio.gov