1. Report, Record, Respond

2. Adult Guardianship Legislation Representation Agreement Act Health Care (Consent) and Care Facility (Admission) Act Adult Guardianship Act –Part 3 (2000) –Part 2 Public Guardian and Trustee Act CHANGES NEW

3. Getting your Acts together Mental Health Act Patients Property Act Power of Attorney Licensing Criminal Code Hospital Act Marriage Act Community Care and Assisted Living Act FOIAPP Act

4. Adult Guardianship Act (Part 3) Abused, neglected & self-neglected and unable to seek support and assistance due to: –Physical restraint –A physical handicap that limits their ability to seek help –An illness, disease, injury or other condition that affects their ability to make decisions about the abuse and neglect

5. Designated Agencies 5 Regional Health Authorities and PHC Community Living BC (Ministry of Children and Family Development)

6. Vancouver Coastal Health Provides all levels of acute, primary and public health, mental health & addiction services Richmond, Vancouver, Coastal Communities including Whistler, Sunshine Coast, Powell River, Bella Bella and Bella Coola Approximately 27,000 staff Over 500 sites, 15 hospitals

7. Every employee has a responsibility to act in situations of abuse, neglect and self-neglect of vulnerable adults

8. Health Authorities did not receive any additional resources to implement their new “Adult Protection” role – it was added to existing duties of health staff

9. What the D.A. Must Do Receive reports of abuse & neglect Conduct investigations to determine needs Involve the adult as much as possible Report criminal offences Keep the name of the person making the report confidential Use the tools in the legislation (possible court orders etc.)

10. AGL (Part 3) Tools Mandate Power to investigate (Section 48) Right of DA to information and duty to ensure confidentiality (Sec. 62) Access order (Sec.49) Warrant to enter for purpose of interview (Sec. 49) Interim restraining order – 30 days (Sec.51) Emergency provisions (Sec. 59) Support and assistance order – 6 months (Sec. 56)

11. VCH Designated Responders Acute Care –Social Workers –Clinical Practice Coordinators/Leaders –Patient Service Coordinators Mental Health Teams Long Term Care Case Managers Licensing Officers Managers of Assisted Living

12. Who Else is Involved? Substitute Decision Maker (Committee, Guardian, Trustee, TSDM, Representative, PoA) Physician/Health Care Team Another Designated Agency Police (Elder Abuse Unit) Public Guardian & Trustee

13. Process for Designated Responder Document at each step Interview the adult Assess the urgency of the situation Coordinate the collection of collateral Coordinate the assessment of abuse, neglect or self-neglect

14. Process for D.R. (cont’d) Coordinate the assessment of ability to seek/refuse support and assistance Determine if the adult has a Representative, Committee, or Power of Attorney Coordinate the development of a care plan to provide support and assistance

15. Process for D.R. (cont’d) Advise the most responsible physician of the situation and actions taken Make reports as necessary to the PGT Report crimes to police Keep the identity of the person who made the report confidential Use the tools in the legislation as a last resort if the S & A is refused

16. Data & Communication Challenges Documentation who? where? what? Retrieval Confidentiality Security/Privacy Communication Tracking Quantifying Evaluation

17. Patient Safety Learning System Province wide “safety event” reporting system Captures, stores, summarizes events and promotes timely investigations of: –Patient Incidents –Employee Incidents –Claims, Complaints –Safety Hazards etc Meanwhile…

19. PSLS Re:Act - SLS $20,000 grant from BC Solicitor General Leverage the existing PSLS to meet requirements for statutory obligations of AGA Stakeholder agreement throughout BC Developed a specific Adult Abuse and Neglect Report Form & Follow-Up Form Pilot in 5 sites within VCH

20. Abuse and Neglect Event Reporting Process 20 Reviews Feedback Supports Investigation Reports Abuse/Neglect Event SLS-Abuse and Neglect via VCHA Intranet Reports Abuse/Neglect Event SLS-Abuse and Neglect via Re:act Resource Reviews SLS-A&N Event Reporter Designated Responder Frontline Staff Handler Designated Responder Coordinators Practice Leader Participant Manager Re:act Resource Other Designated Responder Coordinator Final Approve Event Collects Additional Info as Required Added as Participant on Event by Handler Reviews SLS Event Provide Feedback

21. SLS-Abuse and Neglect Form Benefits Easy to use, intuitive interface –8 mins: typical time for an end-user to log an incident –Focus on simplicity and key data capture Auto-notification of abuse and neglect reports to relevant groups: –Designated Responder Coordinator Supports investigation & analysis of safety events Feedback on progress of the event

22. SLS-Abuse and Neglect Access and Homepage Click here to access SLS Abuse and Neglect report form

23. What Do You Want To Report?

24. Provide a few more details

25. Is it an Adult Guardianship Case?

26. Details of the Vulnerable Adult

28. Details of the Suspected Abuser

29. Confidential Details of Reporter

30. Details about the SLS Reporter

31. Choose the Follow Up Person

32. Follow Up (Investigation)

33. Ability to see who is involved

34. Record Investigation Details

35. Risk Assessment

36. Include others & send emails

37. Close the file when A&N issues are resolved

38. Dashboard & Accountability Overdue Items! Still Investigating Closed & Approved

39. Audit Trail Example Show DIF1 values

40. Data Reports

41. Pilot Results 5 Sites in VCH (2 Community Health Centers, 1 Mental Health Team, 1 Acute Hospital, 1 Re:Act) 58 Reports & Investigations over 3 months Feedback from users through bi-weekly teleconferences lead to revisions to forms New Pilot Phase beginning October 2009

42. Contact info Anne Beer, Project Manager, VCH, 604- 875-4111 Ext 69504 Amanda Brown, Director, Re:Act, 604.984.5957 BC Patient Safety Learning System http://www.bcpsqc.ca/initiatives-we- support/learning-system.htm http://www.bcpsqc.ca/initiatives-we- support/learning-system.htm