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Massachusetts Rehabilitation Commission (MRC) Department of Developmental Services (DDS)
HCSIS Incident Management Business Process Training March 2014
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Training Overview
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Incident Management Trainings
This training is one of three learning opportunities: HCSIS/ IM Training Provides an opportunity to learn the Incident Management module and how it supports the policies and procedures. Audience includes: MRC staff DDS ABI/MFP staff Shared DDS/MRC providers MRC-only providers Business Process Training Provides an overview of the Incident Management policies and processes. User Acceptance Testing Provides an opportunity to test the system to ensure it meets business requirements. Overview
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What is my role here today?
Agenda Incident Reporting at DDS and MRC Incident Report Review Process Incident Categorization Incident Categories Questions? What is my role here today? As we are using a train-the-trainer model, we hope that all attendees: Learn as much as you can today Bring back your insight to your office Train any staff who may need to know this information but were unable to attend
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Supporting Training Documents
PowerPoint Incident Categories Significant Behavioral Incident Decision Tree Paper Incident Report Incident Management Fact Sheet Incident Scenarios Incident Management Guidelines
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Incident Reporting at DDS and MRC
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What makes a good incident management system?
Incident Reporting An incident report must be completed for any incident that can compromise the safety and well-being of an individual We have moved from incident reporting to incident management What makes a good incident management system? Identifies adverse events, potential jeopardy and factors related to risk Notifies key people Triggers response to protect individual and minimize risk Closes loop with agreeded upon action steps Has the ability to collect and analyze information Has the capacity to identify patterns and trends to guide service improvement Has thresholds for what is important Reports important events to key people Includes levels of review dependent on the severity of the incident
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HCSIS for Incident Reporting
As of April 14, 2014, MRC staff and select providers will begin using HCSIS for Incident Reporting MRC providers were selected to use HCSIS based on the number of individuals served and the number of incidents reported All shared MRC/ DDS providers will begin using HCSIS to report incidents for individuals enrolled to the ABI/MFP waivers There will be minor differences between the current MRC and DDS incident report and the revised incident report The incident report form will now be the same for DDS individuals and MRC individuals enrolled to the ABI/MFP waivers HCSIS will indicate whether or not an individual is supported by MRC or DDS – this is not information the provider or staff will need to input on either the paper or electronic incident report
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Differences in reporting for ABI/MFP individuals
The Incident Reporting process is very similar to what is currently in practice at MRC for individuals on the ABI and MFP waivers, but there are a few key differences: Reporting Unwitnessed Events Currently, MRC policies state only to report incidents that have been witnessed Moving forward, all incidents in an individuals’ life will be reported if they meet the criteria for a reportable incident Use of Categories MRC providers will begin reporting incidents using the current DDS categories, which have been adjusted to include actions that are relevant to the ABI/MFP population Note that restraints are not allowed under ABI/MFP and would be reported as Suspected Mistreatment
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Why HCSIS? HCSIS, the Home and Community Services Information System, supports incident management for DDS and MRC in the following areas: Promotes consistent collection of data Provides an integrated system for state agencies and providers Expedites communications Automates collection and storage of information Assists in the identification and remediation of individual events Allows for analysis of patterns and trends Helps to identify service improvement activities MRC will begin to use HCSIS for incident management for individuals enrolled to the ABI and MFP waivers on April 14, 2014.
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Paper Incident Reports and Electronic Incident Reports
The paper incident reports and the electronic incident reports have the same questions and information Both reports have two sections: The initial incident report The final incident report Initial Incident Report The initial incident report is completed immediately after the incident is discovered and can be submitted without all of the event details. There are 7 sections of the intial report: Individual Information Filing Agency Information Incident Classification Incident Description Actions Taken Involved Parties Notifications Final Incident Report The final incident report is completed within a week of the initial incident report and fills in any gaps and builds upon the initial incident report. There are 4 sections of the final report: Additional Information Action Steps Verifitcation of Time and Categorization
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Initial Incident Report Components
Individual Information Individual’s basic information Name Address Service Coordinator/ Case Manager Filing Agency Information Filing Agency’s basic information Agency name Name of staff who filled out the incident report Name of staff responsible for follow-up Incident Classification Incident overview Date and time of incident Who was responsible for supervision at the time of the incident Incident categories Description of any injury Incident Description Describe the incident in detail All relevant details Incident location The latest status of the individual Actions Taken Actions taken to protect the health, safety and rights of the individual What actions were taken Who took these actions Involved Parties People involved with the incident Who completed the incident report Eyewitneses Who discovered the report Notifications Who has been informed of the incident DPPC DCF Family/ Guardian Law enforcement
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New Prompts on the Incident Report for DDS Providers
Incident Classification new prompts: Did the incident involve the unauthorized use of drugs or alcohol? Did the incident involve suicidal threat/ideation? Did the incident involve non-compliance with a medical directive? Did the incident involve non-compliance with medications? Note: these last two prompts existed on the report previously, but have now been split into two questions Notification prompts: Was the Executive Office of Elder Affairs Notified? Note: this prompt is only mandatory for individuals who are over age 55 Was the agency on-call notified? If “yes,” who was the on-call person notified? Note: #3 is conditionally mandatory if “Yes” is selected for #2 There are new prompts on the Incident Classification and Notifications screens within the Incident Report. As of April 14, these prompts will need to be addressed for all incident reports completed for individuals on both DDS and ABI/MFP waivers.
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Final Incident Report Components
Additional Information Any updated or corrected information Expand upon the previous Incident Description section Action Steps Additional action steps assocaited with the incident Action step details Target completion date Responsible party Involved Parties Any updates or additions to the involved parties Eyewitnesses Relationship to the individual Contact information Verification of Time and Categorization Verify whether or not the initial report information is accurate and make updates as needed
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Incident Reporting Steps
An event meets the threshold for a reportable incident – now what? Incident Discovered Provider Submits Initial Report Provider Submits Final Report DDS or MRC Conducts First Level Review DDS or MRC Conducts Second Level Review Minor Review ≤ 3 days ≤ 1 day ≤ 7 days Approve OR Not Approve Major Review
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Events Requiring a Minor versus Major Level of Review
Definition An incident that can compromise the safety and well being of an individual. An incident that can compromise the safety and well being of an individual and meets at least one of the following criteria: Suspected mistreatment where there is a life threatening result Where staff action or failure to act exposes the individual to series personal or public safety risk Has the potential for broad, negative publicity in the media Law enforcement is involved in any capacity Example Primary category: Theft Secondary category: Alleged Victim Secondary category: Alleged Perpetrator Review Process There is only one level of review, conducted by the Case Manager or Service Coordinator. There are two levels of review The first review is conducted by the Case Manager or Service Coordinator The second review is conducted by the Case Manager Supervisor or Service Coordinator Supervisor
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Incident Report Review Process
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First Level Review State agency performs first level review
Review incident Change category, if needed (except for an unexpected hospital visit) Approve or reject the incident Escalate the incident for major level review for incidents that had been classified as minor Incident Discovered Provider Submits Initial Report Provider Submits Final Report DDS or MRC Conducts First Level Review DDS or MRC Conducts Second Level Review ≤ 1 day Major Review ≤ 7 days Approve OR Not Approve
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Second Level Review State agency performs second level review
Required for all incidents that are designated as major incidents Applies to incidents of suspected mistreatment with injury or life threatening condition or where staff action exposes individual(s) to serious harm Applies to all incidents involving law enforcement Applies to all incidents with potential for negative publicity Incident Discovered Provider Submits Initial Report Provider Submits Final Report DDS or MRC Conducts First Level Review DDS or MRC Conducts Second Level Review ≤ 1 day Major Review ≤ 7 days Approve OR Not Approve
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Incident Categorization
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Incident Categorization
Incident categories provide criteria and a threshold for reporting Primary category Bullets that define overall category Secondary category Expanded information for a specific category Examples Certain combinations of primary and secondary categories will require a minor level of review whereas others will require a major level of review Major and minor describe the level of review, not the incident itself Major/Minor level of review by State Agency Primary Category Identifies reportable events Secondary Category Identifies specific types of events within a primary category
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Choosing a Category When choosing a category, there are a few tips to keep in mind: Choose only one primary and one secondary category Review the facts of event carefully and choose category that best fits the predominant component of the event The incident categories are hierarchical, with the more concerning categories listed first If you are ever deciding between two categories, opt for the one that appears first in the incident categories document
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Types of Incidents There are two types of incidents:
Individual Incidents Incident written for one individual Must be completed for any event that results in an injury to the individual If multiple individuals are involved in the event, individual incidents must be created if the event affects all those involved differently Site Based Incidents Time saver for providers Multiple individuals are involved Impact of the event and the action steps are the same for all individuals involved Cannot involve injury or illness to individuals involved in the event
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Incident Categories
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Site Based Incident Categories
Transportation accident Suspected mistreatment Failure to provide needed supports e.g. staff does not repair the fire alarm equipment Failure to provide needed supervision e.g. staff leaves individuals unattended although no one is harmed Fire However, if individuals sets fire purposely or accidentally, that individual needs an individual incident report as well Emergency relocation Theft/ alleged victim Other
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Individual Incident Categories
Review the “Incident Category” document for full definitions # Primary Incident Categories 1 Unexpected/ suspicious death 2 Suicide attempt 3 Unexpected hospital visit 4 Inappropriate Sexual Behavior 5 Victim of Physical Altercation 6 Significant Behavioral Incident 7 Missing Person 8 Medical or Psychiatric Intervention Not Requiring a Hospital Visit 9 Fire 10 Suspected Mistreatment 11 Property Damage 12 Theft 13 Other Criminal Activity 14 Transportation Incident 15 Emergency Relocation 16 Unplanned Transportation Restraint 17 Other
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Individual Incident: Unexpected/ Suspicious Death
Description Expected deaths such as someone on Hospice would not be reported through as an incident Secondary Categories Accidental Suicide Unusual circumstances Other unexpected/suspicious death Level of Review All unexpected/suspicious death incidents require a major level of review
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Individual Incident: Suicide Attempt
Description Serious, intentional and voluntary attempt to take one’s life Secondary Categories First known attempt Repeat attempt Level of Review All suicide attempt incidents require a major level of review
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Individual Incident: Unexpected Hospital Visit
Description Always used for any unexpected, unplanned visit to the E.R. or emergency psychiatric/drug/alcohol evaluation Does not include planned hospitalizations Does not include urgent care visits Need to carefully identify the reason for the hospital visit: all incident categories can be applied, as well as: Near drowning Illness Injury Other Unknown Requires additional information: Length of time in emergency room Admission date and name of hospital What occurred during the visit Discharge information Remains open until the individual is discharged
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Individual Incident: Unexpected Hospital Visit (cont’d)
Secondary Categories ER Visit: for medical evaluations without hospitalization Psychiatric Evaluation: for psychiatric/drug/alcohol evaluations when person is not admitted Medical Hospitalization: used if an individual is actually admitted to the hospital for a medical need Psychiatric Hospitalization: used if an individual is actually admitted to a psychiatric hospital, psychiatric unit or detoxification center Level of Review Unexpected hospital visits sometimes require a major or minor level of review depending on the reason for the visit.
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Individual Incident: Inappropriate Sexual Behavior
Description Includes unwanted advance, contact or activity Includes credible threats of rape or violent sexual activity Secondary Categories Aggressive Sexual Behavior (Alleged Victim and/or Alleged Perpetrator): Used when the victim is a member of the community, includes threats of violent sexual behavior, involves the police, includes actual violent acts (e.g. rape, attempted rape, or use of physical force) Sexual Misbehavior (Alleged Victim and/or Alleged Perpetrator): Nonconsensual sexual touching towards another individual and behavior stops immediately when asked or consensual sexual behavior in an inappropriate place Level of Review Aggressive sexual behavior incidents require a major level of review and sexual misbehavior incidents require a minor level of review
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Individual Incident: Victim of Physical Altercation
Description Victim of attack from another individual receiving services Event may be minor but very upsetting to the victim Victim has an additional behavior incident as a result Victim displays signs of distress that continue for an extended period of time (e.g. crying, screaming, refusing the leave the room) Secondary Categories None Level of Review All victim of physical altercation incidents require a minor level of review
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Individual Incident: Significant Behavioral Incident
Description Behavioral episodes that could result in serious harm Behavior that can cause public disturbance or a scene Behavior that involves the police This can be a difficult category to determine whether or not the incident should be reported, so review the “Decision Tree for Significant Behavioral Incidents” Questions to help in determination Chart with guidance for reportable/not reportable events Secondary Categories Does not include physical altercation Includes physical altercation Note: there are additional questions regarding the identity of the involved parties Level of Review All significant behavior incidents require a minor level of review
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Individual Incident: Missing Person
Description Covers any individual who is missing and considered at risk Secondary Categories Law enforcement contacted Law enforcement not contacted Level of Review If law enforcement is contacted, the incident requires a major level of review If law enforcement is NOT contacted, the incident requires a minor level of review
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Individual Incident: Medical or Psychiatric Intervention Not Requiring a Hospital Visit
Description Treatment beyond first aid but not involving a hospital visit Includes urgent care visits Includes ingestion of non-food items Includes medication refusals without a plan already in place Includes suicidal threats, gestures and/or attempts Secondary Categories Medical Psychiatric Level of Review All medical or psychiatric intervention incidents that do not require a hospital visit require a minor level of review
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Individual Incident: Fire
Description Fire started by the individual always needs an individual incident report for that individual An event is reportable if the smoke detectors go off because of smoke or malfunctioning fire or carbon monoxide detectors and the fire department comes even if there is no fire If the incident meets certain criteria related to the secondary incident categories, it could be classified as a site-based incident Secondary Categories Alleged started by individual Includes purposeful and accidental fires Not started by individual – fire of known origin Fire of unknown origin Level of Review All fire incidents require a minor level of review
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Individual Incident: Suspected Mistreatment
Description Includes intentional or negligent action or omission that causes or exposes an individual to a serious risk of physical or emotional harm Secondary Categories Alleged victim of psychological abuse Alleged victim of verbal abuse Alleged victim of physical abuse For individuals enrolled to the ABI and MFP waivers, this incident category should be used for any restraints Alleged omission of needed supports Could also be a site based incident Alleged omission of needed supervision Level of Review All suspected mistreatment incidents require a minor level of review
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Individual Incident: Property Damage
Description Charges are not being filed for the property damage Value of the damage exceeds $200 or has significant intrinsic value to the owner, such as a family heirloom, causing significant distress Destruction needs to be deliberate If another individual is the owner of the property that is damaged, there needs to be 2 incident reports – one for the perpetrator and one for the victim Secondary Categories Alleged victim Alleged perpetrator Level of Review All property damage incidents require a minor level of review
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Individual Incident: Theft
Description Individual is the victim or perpetrator of the unlawful taking of money, other financial assets and/or personal property Incident is reported to DPPC and/or law enforcement Secondary Categories Alleged victim Alleged perpetrator Level of Review If the individual is the perpetrator, the incident requires a major level of review If the individual is the victim, the incident requires a minor level of review
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Individual Incident: Other Criminal Activity
Description Any criminal activity reported to law enforcement and is not covered under the incident category of “theft.” Secondary Categories Alleged victim (e.g. an individual being harassed, threatened and/or physical assaulted by someone other than an caregiver) Alleged perpetrator (e.g. an individual that is arrested for drug possession, stalking or property destruction) Level of Review All incidents involving other criminal activity require a major level of review
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Individual Incident: Transportation Accident
Description Covers traffic accidents involving individuals receiving supports when the police are involved Does not cover minor fender benders with no police involvement Incident could be a site based incident when the incident affects all individuals involved the same, such as an accident when the police are called and the effect on all involved individuals is the same Secondary Categories Pedestrian Motor vehicle accident Other Level of Review All transportation accident incidents require a minor level of review
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Individual Incident: Emergency Relocation
Description Individual(s) need to be relocated on an emergency basis for more than 24 hours Relocation can be for any emergency such as fire, weather conditions, local disaster Incident could be a site based incident when the incident affects all individuals involved the same, such as an accident when the police are called and the effect on all involved individuals is the same Secondary Categories N/A Level of Review All emergency relocation incidents require a minor level of review
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Individual Incident: Unplanned Transportation Restraint
Description Individual requires the use of physical holding or a mechanical device to keep him or her safe during transportation that has not been planned for in the individual’s ISP A restraint form is not required in these circumstances but an incident report is required if the intervention is not written into an individual’s ISP Examples include a staff needing to hold down an individual to fasten his or her seatbelt so s/he does not grab the steering wheel Secondary Categories N/A Level of Review All unplanned transportation restraint incidents require a minor level of review
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Individual Incident: Other
Description Event does not fit into an existing category but meets the threshold for a reportable event: Event puts the individual at risk Key people need to be notified in a timely manner Response needed for protection and to minimize risk Should RARELY be used! Secondary Categories None Level of Review All “other” incidents require a minor level of review
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Conclusion
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Incident Reporting Summary
The incident reporting guidelines we have covered in this training apply to both the paper incident report and to incident reporting within HCSIS. Using HCSIS for incident reporting provides several benefits for DDS, MRC and provider agencies: Gives ability to sort data for planning and analysis Individual Site Agency Area/Region/State Class Please continue to use your current incident reporting process for all incidents that occur prior to April 14, After April 14, please use the updated incident report and HCSIS to record incidents for individuals enrolled to the ABI and MFP waivers.
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Questions? Further information on Incident Management can be found on the DDS website under “Home and Community Services Information System (HCSIS)” and “Incident Management”
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Conclusion Today we have covered: Incident Reporting at DDS and MRC
The Incident Report Review Process Purpose of Incident Categorizations Review of Incident Categories
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