1. Accident Incident Policy Changes to Policy September 2007

2. Policy Purpose To protect residents by –Assuring appropriate action taken when accidents or incidents occur –Including prevention planning –Providing accurate documentation of accidents/incidents and action plans

3. Definition of Terms Accident- event leading to injury or potential injury Incident- event which appears out of ordinary routine of resident in question LAWN- leaving area without notification- resident’s whereabouts are not known thus creating dangerous situation for resident

4. Definitions Continued Significant Injury- –Any injury, witnessed or not witnessed in which nature, cause or severity warrants need for closer examination –May include (not limited to) multiple bruising, injuries on or about head or vital organ, injuries of sexual nature or otherwise suspicious nature –Careful attention to Atypical or Unusual injuries

5. Definitions Continued Witnessed- you saw the accident happen Not witnessed- you did not see the accident happen

7. Classifications Accidents and Incidents Class 1- accident or incident no injury Class 2- injury with no treatment or first aid treatment Class 3-injury requiring examination, consultation or treatment from physician

8. Person Finding injury or witnessing accident should: Protect the resident, get medical attention Complete top part of accident/incident form Contact nurse, advocate and supervisor as required by policy Make note in record and logbook

9. Tips A/I form Complete all sections Account of accident/incident –If resident can tell you what happened- indicate “resident says or states ____ happened.” –If you witnessed-indicate what you saw –If not witnessed-indicate what you found

10. Nurse responsibility Assess injury and provide treatment (contact physician if needed) Complete classification section of A/I form Document injury and treatment in Nurses’ Notes Assist supervisor or OD as needed with statements, review A/I, preventative measures, notification, etc. may request additional statements

11. Nurse: Pictures Photograph all observable injuries –Electronically download pictures to PPS prior to end of shift; leave picture on camera (30 days) –Review clarity and quality of picture –Note picture number on A/I form Use body chart for injuries to sensitive areas (genitalia, female breasts) –Attach body chart to A/I form

12. Medication Variances Notify physician Implement prescribed treatment Follow Nursing Policy 6.14 for additional responsibilities

13. Nurse: Guardian Notifications Notify guardians as soon as possible for all class 3 accidents/incidents Document family/guardian notification in Nurses’ Notes, on A/I form, and in Family/Guardian contact log- include date, time and nurse’s name Guardians will be notified of other injuries as indicated on Family/Guardian contact log Nurse works with QDDP and SW to address guardian’s requests

14. Guardian Notifications Continued If guardian was not notified, Nurse should provide clear documentation of why notification was not completed.

15. Other Nursing Responsibilities Check A/I form for completeness and for statements Enter A/I information in PPS by end of shift Leave A/I form with all attached documents for QDDP Assist supervisor or Officer of the day as needed- (letter e page 3 policy)

16. On-site Supervisors Assess the situation –Look at injury –Has medical care been provided –Is resident calm? –Are additional supports needed? –Look at environment where A/I occurred- are there ongoing safety issues present?

17. On site supervisor continued Completing A/I Form –Gather information from staff regarding Circumstances or Cause –Talk to staff in private area

18. Statements Secure written statements for: any not witnessed A/I, all class 3 A/I, and all significant class 2 and any atypical or unusual accident/incident (witnessed or not witnessed)

19. A/I Statement Form: Witnessed –Describe what happened – include details including any event immediately A/I What happened Where did it happen Where were you when it happened Who else was around When How

20. A/I Statement Form: Not Witnessed- knowledge person prior to A/I discovery When did you 1 st see resident on this date Who else was around Did resident have any behavioral or health issues Were other residents in area What type of activities involved in Describe anything that might help determine what happened

21. Statements: Other Shifts Attach post-it note to A/I indicating need Leave A/I in designated box for next shift Statements should be secured by end of 2 nd working day (from A/I initiation)

22. Statements Continued Be sure person completes form including: –Print name; Position; Signature; Date Supervisor reviews, signs, dates QDDP reviews, signs, and dates Advocate reviews, signs and dates

23. Other Responsibilities Prior to end of shift you should: –Check statements for content and completeness –Sign and date each statement form as having been reviewed- attach to A/I form –Complete A/I review on bottom of form –Communicate and implement prevention plan

24. Notifications For all Class 3 A/I, all Significant Class 2 A/I, any Atypical or Unusual accident/incident (witnessed/not witnessed) –Notify QDDP immediately –After 5 p.m., weekends/holidays- notify Ad Watch –Notify Area Director –Insure Advocacy notified according to policy –Notify Officer of the Day

25. Ad Watch Responsibilities Check status of resident and advise/assist as needed Review with staff member to see that policies and documentation have been followed Check to ensure notifications made according to policy

26. Accident/Incident Review Reviews are required for any not witnessed A/I, all class 3, significant class 2 and any atypical or unusual accident/incident (witnessed or not witnessed) Review completed by On Site Supervisor, Officer of the Day, or Nursing staff and must occur before end of shift

27. QDDP Responsibilities Review entire A/I document (including photograph in PPS) by end of following working day

28. QDDP Responsibilities Continued Provide feedback as indicated regarding: –Policy implementation; Resident safety; A/I assessment;preventative measures and notifications Develop and implement additional immediate safety measures and share plans with appropriate staff

29. Suspected Abuse/Neglect Additional immediate review is required of any accident/incident (regardless of class) suspected to be result of abuse and/or neglect as defined in JIRDC policy 2.3.3 Should abuse and/or neglect be suspected implement Policy 2.3.3 immediately

30. Area Director Responsibilities All not witnessed Class 3 and not witnessed significant Class 2 accidents/incidents will be reviewed/investigated by Area Director and others as appropriate

31. Advocacy All accident/incidents will be reviewed by Advocacy –Accident/incidents resulting in significant impact to resident will be reported to Facility Director and Human Rights Advocacy Committee

32. A/I Monitoring: QDDP Daily –Review all A/I reports to review/determine circumstances of each A/I and seek means of prevention –Check A/I forms for completeness and sign by end of shift or by end of next working day –Document and communicate preventative measures

33. A/I Monitoring Core Team A/I will be reviewed at least monthly in core teams RN or QDDP presents information-emphasis on A/I trends Core team will develop action plans-individual and group; documented in minutes Individual plans documented in resident’s chart

34. QDDP Will Discuss A/I in monthly progress notes Review and analyze all A/I in report to Director of Program Services, Director of Residential Services, Area Director, Human Development Research and Training Director and Advocate (monthly) Annually Assess each resident using Injury Risk Assessment Review safety plans on high risk people quarterly

35. A/I Form: Changes LAWN- Leaving area without notification- Not Witnessed-Suspected Cause –If resident can tell you what happened indicate the “Resident says or states” –Not witnessed nature - place is not witnessed Notifications- added times for supervisor and Nurse

36. A/I Form: Changes Review of A/I by on-site supervisor –Includes list of things supervisor may do to address situation –Check all that apply –Write in other actions on lines provided Form prompts statements for required situations Notifications prompted