Human Rights Training Addendum

Course Introduction This course will provide you with additional Human Rights information specific to NRVCS. In addition, this course will expand upon and clarify some of the areas discussed in the first course, “Human Rights, Rules and Regulations to Assure Individual Rights”. Please Note: You should complete course one before completing this course.

Course Objectives After completion of this course, you should be able to: Define a serious injury. Identify which types of medication errors are reportable. Determine which types of Peer to Peer conflict are reportable. Identify which types of restriction are never used at NRVCS. Explain when a restraint may be used at NRVCS. Explain when the service records of a minor may be accessed. Melissa Jackson, Client Advocate

Serious Injuries Any injury resulting in bodily damage, harm, or loss that requires medical attention by a licensed physician, doctor of osteopathic medicine, physician assistant, or nurse practitioner while the individual is supervised by or involved in services.

Serious Injuries - Examples Seizure (single episode that requires immediate medical attention) Multiple/increasing seizures (that require medical evaluation) Abrasions/cuts/scratches/lacerations Adverse reactions Aspiration pneumonia Bite Burn Choking Constipation/Bowel Obstruction Contusion/Hematoma Decubitus ulcer Dislocation/fracture Falls Ingestion of substance Medication administration error Overdose Redness/swelling Convulsion Sprain Suicidal Attempt If medical attention is required, complete the NRVCS Critical Incident Report!

Serious Injuries - Clarification NRVCS is required to report all serious injuries, for all active clients, regardless of whether the client was in the act of receiving services at the time of the injury. How can we manage all that information? You are not required to solicit information regarding injuries experienced by clients in their personal settings If a client shares such information with you voluntarily, REPORT If there is reference to an injury in your electronic documentation, REPORT If there is an obvious injury (a client comes to an appointment wearing a cast), REPORT

Serious Injuries - Exclusions NOT reported as Serious Injuries: An individual with a laceration is given first aid treatment by an NRVCS Registered Nurse: reportable injuries are those that require care by a licensed physician, doctor of osteopathic medicine, physician assistant, or nurse practitioner only An individual receives medical clearance at a hospital during a TDO event: there was no bodily damage, harm or loss An individual sustains a burn, but does not seek medical attention: injuries are not considered “serious” unless medical attention is required When in doubt, ask your supervisor!

Medication Errors If NRVCS is responsible for administering medication to any individual, errors are potentially reportable.

Medication Errors Sometimes reported as a serious injury Sometimes reported as founded neglect Sometimes reported as BOTH Over the counter meds are included if there is a Doctor’s order in place.

Medication Errors Reported as serious injuries: All med errors that result in a need for medical attention Reported as founded neglect: Wrong dose given Wrong med given Med given to wrong person Discontinued meds given Multiple doses missed Was medical attention required? If so: Reported as both

Peer to Peer Aggression Any physical act, verbal threat or demeaning expression by an individual against or to another individual that causes physical or emotional harm to that individual.

Peer to Peer Reporting P2P Aggression must be reported as potential neglect when NRVCS is responsible for supervision of the individuals at the time of the incident. An investigation will be conducted to determine: Was there an adequate number of staff members on duty? Were staff members actively supervising the individuals? Did staff take action to prevent harm? Did staff act immediately to prevent further harm? Is corrective action needed to prevent future incidents? If any individual required medical attention, the incident is also reported as a serious injury.

Peer to Peer Reporting Reportable: Hitting Kicking Scratching Threats Not Reportable: Voluntary Horseplay Accidental Contact No Harmful Intent

Seclusion, Time Out, and Physical Restraint Do you know which is never allowed? How does NRVCS policy address these issues?

Seclusion and/or “forced time out” is not permitted at NRVCS. Seclusion and Time Out Seclusion: means the involuntary placement of an individual alone in an area secured by a door that is locked or held shut by a staff person, by physically blocking the door, or by any other physical or verbal means, so that that individual cannot leave it. Time Out: the involuntary removal of an individual by a staff person from a source of reinforcement to a different, open location for a specified period of time or until the problem behavior has subsided to discontinue or reduce the frequency of problematic behavior. The NRVCS Behavior Management Policy states: Seclusion and/or “forced time out” is not permitted at NRVCS.

Physical Restraint Physical restraint (also referred to as manual hold) means the use of a physical intervention or hands-on hold to prevent an individual from moving his body when that individual’s behavior places him or others at imminent risk. The NRVCS Behavior Management Policy states: Physical restraint is only used in an emergency where there is threat of imminent danger. Physical restraint is only performed by staff trained in the proper use of emergency restraint. Incidents of emergency physical restraint must be reported internally at NRVCS the same business day of the restraint. Complete the NRVCS Emergency Use of Physical Restraint Reporting Form same business day!

Service Records of Minors When can a minor access their own records without parental consent? Is a parent ever denied access to a minor child’s records?

Service Records – Access by Minors In the case of a minor, the authorization of the custodial parent or other person authorized to consent to the minor's treatment under § 54.1-2969 is required, except as provided below: Section 54.1-2969 E of the Code of Virginia permits a minor to authorize the disclosure of information related to medical or health services for a sexually transmitted or contagious disease, family planning or pregnancy, and outpatient care, treatment or rehabilitation for substance use disorders, mental illness, or emotional disturbance. The concurrent authorization of the minor and custodial parent is required to disclose inpatient substance abuse records. The minor and the custodial parent shall authorize the disclosure of identifying information related to the minor's inpatient psychiatric hospitalization when the minor is 14 years of age or older and has consented to the admission. Before allowing a minor access to records, you should consult with your supervisor, medical records, or the agency attorney to ensure compliance!

Service Records – Parental Access A parent may access his minor child’s services record unless parental rights have been terminated, a court order provides otherwise, or the minor’s treating physician or clinical psychologist has determined, in the exercise of professional judgment, that the disclosure to the parent would be reasonable likely to cause substantial harm to the minor or another person. Access to service records is an important right – guaranteed to all the individuals served by NRVCS. Before denying a parent access to records of a minor child, you should consult with your supervisor, medical records, or the agency attorney to ensure compliance!

Summary No training course on Human Rights can address the circumstances of every situation. The details of any scenario will vary from individual to individual. Seek guidance anytime you have questions!