IRIS- Incident Response Improvement System Training

October 9, 2013

Presented byPresented by: Ashley Armstrong

Contact Information for QuestionsContact Information for Questions: providermonitoring@eastpointe.net

What is IRIS?The DHHS IRIS is a web based incident reporting system for reporting and documenting Level II and III incidents that involve consumers who receive MH/DD/SA funds

Who must submit Incident Reports?

Providers of publicly funded services licensed under NC General Statutes 122C, except hospitals, (Category A providers) and providers of publicly funded non-licensed periodic or community-based MH/DD/SA services (Category B providers).

LME/ MCO Role In IRIS Verify incidents and review the 72 hour listing with providers daily. Review for any Safety Concerns and request Safety Plan, if needed Review for data completeness and request any additional information needed Review to assure all appropriate guardian/ agencies have been notified- refer if needed Discuss additional information/ reports needed such as police reports, Medical examiner reports,

hospital discharge, etc. Send incident number to providers Assess (or refer to applicable team within LME/MCO) if Provider Monitoring is needed Review Quarterly Provider Report for any concerns or need for Provider Monitoring Contact DMH/DD/SAS within 24 hours (business days) on Level IIIs – unless any media

involvement If incident is reported or likely to be reported in media, contact DMH/DD/SAS as soon as possible-

on the same day. Review provider handling to ensure safety of consumers, certified copy of record and provider’s

review committee convened. Monitor and provide technical assistance as warranted to ensure that problems are corrected. Analyze and respond to patterns of incidents as part of review of QI monitoring processes Review of monthly Unknown Death Report

DMH/DD/ SAS Role in IRIS

Weekly contact with LME/MCO for follow-up on reports Review of monthly Unknown Death Report Review to assure all appropriate guardian/ agencies have been

notified- refer if needed Inform all appropriate DMH/DD/SAS staff Discuss/ provide technical assistance to LMEs/ MCOs with plans or

strategies for complex cases Analyze and respond to statewide patterns of incidents as part of

review of QI monitoring and LME/MCO oversight of response processes

What is an Incident?

An incident is “any happening which is not consistent with the routineroutine care of a consumer and that is likely to lead to adverse effects upon a consumer” as defined in 10A NCAC 27G .0103(b)(32).

There are 3 levels of response to incidents, based on the potential or active severity of the event. Levels are Level I, Level II, & Level III.

Confidentiality

All incident reports are confidential quality assurance documents.

Do not file incident reports in the individual’s service record.

Use this form according to confidentiality requirements in NC General Statutes and

Administrative Code and in the Code of Federal Regulations.

Reporting Guidelines

Documentation of All Incidents – All incidents should be documented and

analyzed as part of agencies QA/QI process. Complete all required sections for level II & III

incidents Give as much information that is known.

Reporting Guidelines (continued) Level I incidents are documented on

agency’s internal forms. Level I incidents are not submitted in IRIS.

Level II & III incidents must be submitted in IRIS.

NEVER file incidents reports in individual’s service record.

Under Provider Care

“a consumer under the care of a provider” refers to a consumer who has received any service in the 90 days prior to the incident.

Individuals who receive Residential or ACTT services are considered under the provider’s care 24 hours a day.

Individuals receiving day services or periodic services are considered under the provider’s care while a staff person is providing services or if the consumer received any services from the provider in the 90 days prior to the incident.

Under Provider Care (continued) Providers of crisis, day, and periodic services

should report all deaths and errors in self-administration of medication upon learning of the incident, even if it did not happen while under the provider’s care.

For additional Information, please refer to Implementation Update # 55.

What staff submits?

The staff person most knowledgeable about the incident should complete the information on the report as soon as possible after learning of the incident.

The staff person should obtain the incident number and notify their supervisor to complete the supervisor section of the report.

Timeframe for Submission

Level II Reports IRIS report must be

appropriately submitted within with in 72 hours

Level III Reports Verbal report immediately to Eastpointe Monitoring

IRIS report must be appropriately submitted within with in 72 hours

IRIS report must be submitted within 72 hours to DMH/DD/SAS

What if IRIS is unavailable?

Any time IRIS is unavailable for use, providers must still meet the required timeframe for submission of an incident.

Reports may be faxed to Eastpointe at 910-298-7165.

Provider must enter into IRIS as soon as possible after IRIS back available.

This is the only time paper reports will be accepted. IRIS replaced the DHHS Incident and Death Report

(DMH/DD/SAS form QM02)

Don’t Forget to:

Print a copy for your records and maintain the incident report number.

Providers are required to complete mandatory items based on the type of incident that occurred. Mandatory items are indicated by red stars beside the item. If you can answer questions without stars, please provide this information.

It is essential to save information at the end of each information tab. It may take several seconds before data saves. Click on each Save icon only 1 time.

Incident Report Number

IRIS provides an Incident Report number for each report in two ways:1. Save the entire report after completing Provider

Incident Information, Incident Information, Consumer Services and Consumer Treatment section. Click “Finish” and the incident number appears on the screen.

Incident Report Number (continued)

2. Once you have completed the entire report, to include Supervisor Actions Tab.

Example of Incident Number

Important Facts about Incident Number Print a copy of the incident number for your

record. There is only 1 number for each incident

report. The Incident Number will not contain the

letter “O”. All letters are lower case. Any “0” will be a numerical zero.

Comment Sections

Comment boxes are located on many tabs for the user to provide brief, specific information on a topic.

Enter Incident Comments

To enter specific comments, click on the pencil and paper icon. Type your information

and use spell check Click “Save” After you save the

information, the paper and pencil will change to a check mark

IRIS Home Page

To Report An Incident

Choices include: Enter a new incident: Click to enter a new Level II

or III incident. View/Edit: For an existing report, enter the

Incident Number and Consumer’s last name.

Please note: If you do not print the Incident Number, please call Eastpointe Provider Monitoring Department to request the number be sent to you.

Provider Information Tab Enter Corporation Name Name and Title of Person completing form Local facility/Unit/Group Home Physical Address Mailing Address, City, Zip Code Phone Number Fax Number Email Address – If the provider agency does not have

an email address, provider will need to determine the email address to which the agency will get information regarding the incident. Please make sure the email address is accurate.

Provider Information Tab (continued) Counties

County where services are provided/Host LME: Where the consumer receives services

County of Residence/Home LME: The county in which the consumer legally resides.

IRIS will notify the Host and Home LME of the Incident Report.

Incident Information

There are 2 tabs that have to be completed in this section

A. Date and Location Tab

If there is an allegation against the facility, check YES. The supervisor will have to complete the HCPR Facility Allegation section of the incident report.

B. Services Type Provided Tab

Consumer Information/TreatmentThere are 2 tabs that have to be completed in

this section

A. Consumer Information Tab

B. Consumer Information-Treatment Tab

Consumer Information Tab

Consumer Name Address Where

Incident Occurred LME Client Record

Number – If there is not a LME number, use your provider identification number.

Consumer Date of Birth, Gender, Height, and Weight

Date of Last 2 Medical Exams

Diagnosis – select up to 5 different diagnosis, starting with the primary diagnosis. Include ALL as applicable. This helps to aid

oversight staff in determining the appropriate response needed.

Consumer Information Tab (continued)

Medications: Click on the pencil icon to enter. Include Name, Dosage, Frequency of the medication and the reason the consumer is taking the medication.

Adjudicated incompetent?

TBI recipient? Receives CAP-MR/DD

funding? MFP program? Receive ICF-MR/DD?

Consumer Information-Treatment Tab Did this incident result in or is it likely to result

in permanent physical or psychological impairment? If reporting a death, select “No”.

Has this incident resulted in or is it likely to result in a danger to or concern to the community or a report in a newspaper, television or other media?

Consumer Information-Treatment Tab (continued) Was the consumer treated by a licensed

health care professional for the incident?Do not include visits to a hospital ER if

the person received no treatment. Refer to the definition of more than just First Aid found in the Incident Response Manual.

If hospitalized, was it for a medical condition? Was if for a MH/DD/SA issue?

Opioid – Questions relate only for consumers receiving Opioid Treatment.

Consumer Information/Services TabThere are 6 tabs in this section: MH/DD and/or SA Tab (3 separate tabs) Hospital Discharge Tab Last Appointment Tab Associated Incidents Tab

Type of Incident

Type of Incident Choose which type you are

reporting Choices are:

Death Restrictive Intervention Injury Medication Error Allegation of Abuse,

Neglect, or Exploitation Consumer Behavior Suspension, Expulsion Fire Other

You must have at least 1 type of incident

You must include pertinent details in the “Incident Comment Tab” relevant to the incident.

Death Tab

Manner of Death Choose one:

Terminal Illness/Natural Cause Accident Homicide/Violence Suicide – indicate method from drop down box Unknown

Consumer Deaths

Report ALL consumer deaths whenever you become aware, even if it did not occur while the individual was under your care.

Cause of Death by Natural Cause or Terminal Illness should be documented by a physician, Medical Examiner or Death Certificate.

Level III Deaths

Will include: Accident Homicide/Violence Suicide Unknown Cause of Death

Requirements of All Level III Deaths are to obtain a copy of the Medical Examiner’s (ME) report and/or autopsy report.

This is in accordance with 10A NCAC 26C .0303 (f) (3).

NOTE:The web address for requesting a free copy of ME report is:http://www.ocme.unc.edu/docrequest.shtml

Make sure to complete all information on the request and request all 3 documents.

NC OCME Document Request (only for NC Deaths Since 1975)We are accepting on-line document requests, but cannot currently return all documents in an electronic format. Therefore, we must have a US mail address. Please also provide an email address in case we need to contact you about your request. If you do not have an email address, call us at (919) 445-4410 to request a document.

Your Name and Address

  First              Last

Name *                   * Required

Agency /Address Line 1 *

Address Line 2

City *   State *    Zip *

Telephone

Email Address

If you provide an email address, it ill be used for all of the documents that we can currently send electronically. You may need to add documents@ocme.unc.edu to your address book to allow the documents to get past your spam filter.

The Decedent

Name of Decedent*  

County of Death*  

Date of Death*  

Documents Requested *

Investigative Report

Autopsy Report (May not exist on every case)

Toxicology Report

SUBMIT RESET

Consumer Death

Providers must update the incident report, even if the level does not change.

Updated information should be entered in IRIS, documenting the reason for Re-Submission (in Supervisor Action Tab).

Attach copies of reports, Death Certificate and/or other documents.

Level III Process

For Level III incidents that did not occur while the consumer was receiving a service or was on the provider’s premises, the responsible LME’s may continue to request detailed information regarding services if this information is not already provided in the incident report. (See Attachment B: Suggested Questions for Level III

Incidents.)

Manner of Death Tab

If manner of death is unknown, check “unknown cause”. Once the death is verified via ME report and/or death certificate, the cause of death has to be updated and the report re-submitted.

Restrictive Intervention

Report any restrictive intervention when: Use of unplanned, emergency situation. Planned, but administered improperly or without

proper authorization, staff use without proper training, or for longer than the authorized time.

Planned, but resulting in discomfort, complaint, death or injury requiring treatment by a licensed health care professional.

Restrictive InterventionThere are 9 Tabs in this section if IRIS requires based on your responses.

General 1 Tab General 2 Tab Status Check Tab Staff Involved in

Restrictive Intervention Debriefing Tab

Person Centered Planning 1 Tab

Person Centered Planning 2 Tab

Person Centered Planning 3 Tab

Follow-up Plans Tab

Injury

There are 3 Tabs in this section

Must complete for injuries when the injury requires more than First Aid treatment.

The definition of First Aid is listed in the Incident Response and Reporting Manual February 2011, Appendix XI (page 29).

3 Tabs include: Injury Description Tab Injured Body Parts Tab Injury Due to Tab

Medication Error

Report all medication errors. In cases of medication errors, the consumer’s

physician or pharmacist should be notified immediately of any error, as required by 10A NCAC 27G. 0209(h).

If the physician or pharmacist does not believe the error is a threat of health or safety, document the error as a level I.

Level I Medication Error

Level I documentation should indicate the following: The type of error, Name of the physician or pharmacist consulted, The statement made by the physician or

pharmacist about the error, Date and time of the contact, and Name of the person making the contact.

Level II Medication Error

If the physician or pharmacist does believe the error is a threat of health or safety, document the error as a level II or III.

Ensure medical attention is provided as necessary and recommended.

If after the medication error the consumer shows any side effects or distress, seek immediate medical attention.

Report all Level II and III errors in self administration of medications within 72 hours of learning of the incident, even if it did not happen while actively engaged in providing services.

Medication ErrorsReport the following:

Missed dose Wrong dosage Dose preparation error Wrong time Wrong Administrative

technique

Dose given to wrong consumer

Wrong medication Loss or spillage Refusal Other

Alleged Abuse, Neglect or Exploitation Complete this section for any allegationallegation or suspicionsuspicion

that a consumer has been abused, neglected or exploited.

Report all suspected or alleged cases of abuse, neglect or exploitation of a child or disabled adult to DSS pursuant to GS 108A Article 6, GS 7B Article 3 and 10A NCAC 27G .0610

IRIS reports must be submitted. IRIS does not submit reports to DSS. The provider

is responsible for contacting DSS to make the report.

Reports made to DSS

Always ask DSS to follow up with provider agency in writing of the status of the report and findings of the report is accepted

Attach DSS letter(s) in IRIS

Allegations against staff

Reports must be sent to DHSR Health Care Personnel Registry regarding an allegation against an unlicensed staff in a licensed or unlicensed facility should be submitted within 24 hours or the agency becoming aware of the incident.

If the allegation is against a staff, the Supervisor must complete the HCPR Facility Allegation section of the Incident Report.

Consumer Behavior

Types of consumer behavior: Any sexual, aggressive or destructive behavior

that involves a report to law enforcement, a complaint to an oversight agency, including LME, DSS, DHSR or DMH/DD/SAS

A potentially serious threat to the health or safety of self or others

Consumer Behavior (continued) Report to the LME any acts that are reported

to law enforcements for: Incidents occurring while actively engaged in

providing services Incidents related to individual’s treatment When you learn of legal involvement of the

individual

Consumer Behavior (continued) Consumer Absence

Any absence over the time specified in the PCP Any absence that may or may not require police

contact If an Amber or Silver Alert is issued, report as a

Level III. Alert appropriate agencies ASAP

Suspension or Expulsion

When a consumer is suspended or expelled from servicesfrom services

Indicate the length of the suspension

Fire Information

Report as Level II or Level III when: there is any injury, Consumer faces a threat to health or safety, or Fire has an impact on public confidence

Authorities Contacted

Check the box beside any individuals or agencies that you have notified of the incident, such as DSS, Law Enforcement, Parent Guardian, etc.

Include the Contact Name, Phone Number and Date of Notification

Provider Incident Comments

These comments are public comments for IRIS users ONLY

Comment Title – for example, Provider Detail of Incident

Text – Include all information you want to document about the incident. Be very clear and concise. Paint a picture of what happened with the incident.

Check Spelling Save by clicking “Save” button

Supervisor Actions There are 4 Tabs in this section

Level of Incident Tab Cause of Incident Tab Incident Prevention Tab Incident Submission Tab

Level of Incident

IRIS will determine the level based on the information entered. This screen will automatically show the level of II or III.

Cause of Incident Tab

Describe what steps you have taken to determine why the incident occurred and what you have discovered.

Describe why the incident occurred – not why the incident occurred – not what happenedwhat happened. That should have been described in the Provider Comment Section.

Incident Prevention Tab

Provide a short description of actions that you have taken or plan to take to prevent future incidents of a similar nature.

Don’t just refer to “Agency Policy and Procedure”.

Incident Submission Tab

Upon submission, IRIS will notify Host/Home LME, DMH/DD/SAS will be notified of Level III incidents.

IRIS will notify Division of Health Service Regulation (DHSR) of any level III deaths that occur in a 122C licensed facility.

IRIS will notify DHSR Health Care Personnel Registry (HCPR) of any level II or III allegation of abuse, neglect, or exploitation against an unlicensed staff member.

Incident Submission Tab (continued) Name, Title, Phone Number and email address of

Supervisor. This needs to include the working title, not degrees and/or licenses

IRIS Agency Notification – Iris will provide a listing of agencies notified based on the details provided.

Resubmission of Incident – When resubmitting the report, enter explanation.

Attestation – By checking the box, you are affirming the information is true and an accurate account of the incident.

Do not click on Submit Incident box a second time…be patient.

Attached Documents

Attach documents that have been uploaded from a computer into IRIS

Examples may include Medical Examiners Report, Death Certificate, DSS Letters, etc.

When Attaching

Follow All HIPPAA and Confidentiality Rules Choose a Title Click Browse and open the document you

want to attach. This will place the name of the file into the Locate Attachment box

Click “Add Attachment(s)” and the documents will be added to the report under “Attach Documents” box

To View Attachment

Click on Attach Documents Menu Button In the list of documents click on the title and

click “Select” Click on “Display Attachment”

Printing Incident

Check items that you would like to print. You may “Select All” To print, click on the printer icon

An error occurred in IRIS

What do I do?Copy the error message that you receive

Paste it in an email

Send to providermonitoring@eastpointe.net

Quarterly Reports

Form must be submitted by the 10th of the month following the end of the quarter

Providers required to submit aggregate data on Level I incidents quarterly that involve: Restrictive Interventions Medication Errors Search and Seizure

What/Where to report

Report to host LME Total number of incidents Unduplicated count of consumers involved Highest number of incident for any one consumer Brief narrative summarizing patterns or trends

(should be documented thru QA/QI process) Brief narrative summary of QA/QI efforts to address

improvements identified.

Reporting Requirements

Agencies are required to submit per Rule Requirement (10A NCAC 27G .0604)

Tied to monitoring of agency

Submitting Quarterly Reports Submit Quarterly Report through the Forms

Desk at

https://fd10.formdesk.com/eastpointe/Provider_Quarterly_Incident

Or by visiting Eastpointe website at www.eastpointe.net click on “For Provider Community”, “Web Submission Form” and “Quarterly Incident Report (QM11)

Other ways to submit

Quarterly Incident Reports may also be faxed to 910-298-7165 Attention - Susan Bryan

mail to: Eastpointe

500 Nash Medical Arts MallAttention Provider Monitoring

Rocky Mount, NC 27804 or emailed to providermonitoring@eastpointe.net

Back-Up Staffing (NC Innovations Waiver) To meet the needs of the participant to

ensure health and safety Failure to provide back-up staff is considered

a Level I Incident per the NC Innovations Waiver

The incident report is completed even if the participant/family declines the back-up staff offered

Back-Up Staffing (NC Innovations Waiver) (Continued) Level I form can be located in the NC

Innovations Waiver Manual (Appendix S) http://www.ncdhhs.gov/dma/lme/Final_NC_Innovations_Manual_06252012.pdf

Incident report includes: Description of Incident How the pariticpant was affected How time was covered Follow up Provided

Back-Up Staffing (NC Innovations Waiver) (Continued) Follow-up provided should be accompanied

by documentation that supports intervention and its effectiveness

Follow-up documentation should be submitted with the incident report

Back-Up Staffing (NC Innovations Waiver) (Continued) The Level I report must be submitted within

72 hours Reports can be faxed to 910-298-7165 Back-Up Staffing Incident Reports are not to

be included in the Quarterly Incident Report Summary.

Helpful Websites

IRIS Website:https://iris.dhhs.state.nc.us/

IRIS Practice Site

https://irisuat.dhhs.state.nc.us/

IRIS Manual

http://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/iris6-4-10dhhsmanual.pdf

Helpful Websites (continued)

Incident Response Manual

http://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/incidentmanual2-25-11.pdf

Quarterly Incident Report

http://www.ncdhhs.gov/mhddsas/providers/NCincidentresponse/

qm11formproviderreport10-8-10.doc

Helpful Websites (continued)

Medical Examiner’s Report, Autopsy Report or Toxicology Reports can be obtained at:

http://www.ocme.unc.edu/docrequest.shtml Restrictive Interventionshttp://www.ncdhhs.gov/mhddsas/

statspublications/manualsforms/aps/apsm95-2clrights7-03.pdf

Helpful Questions Document

MH/DD/SAS website has generated a FAQ document that may be helpful with questions

http://www.ncdhhs.gov/mhddsas/providers/NCincidentresponse/iris-faq-condensed.pdf

One frequently asked question is, do providers have to have a user ID and password? The answer is No.

Email: providermonitoring@eastpointe.net

All questions and comments will be posted and sent out on the Eastpointe listserv as a Q & A document.