Incident Report Training

What is an incident?

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This document was updated April 2016

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What is an Incident?

What is an incident?

An incident is any unusual or unexpected event involving a consumer or consumers that is inconsistent with the desired outcome or routine operation

Examples

Examples of When to File an Incident Report• Death• Elopement• Suspected Abuse (physical, verbal or sexual)• Neglect• Exploitation• Any explained or unexplained injury of consumer• Any accident or illness resulting in ER visit or

hospital admission• Displays of serious hostility• Attempts at self-inflicted harm or harm to others

Examples

Examples of When to File an Incident Report• Consumer seizure-like activity and/or highly unusual

behavior episode• Any problem behavior not addressed in the IPOS• Unusual medical problems• Medication errors, refusals or missed dosage• Significant/serious destruction of property• Environmental incidents that could place the

consumer at risk (i.e. bed bugs, power outage, etc.)• Suspected criminal offenses committed by or

against consumer• Recipient arrest or conviction• High blood pressure or sugar levels noted/monitored

Death

Death All deaths are required to be reported to required parties including:

• Expected deaths – those occurring as the natural conclusion of an illness

• Unexpected – suicide, homicide, accidental, other

• Unknown – cause of death is currently unknown and pending determination by a medical examiner

Elopement

Elopement (Also known as an Unauthorized Leave of Absence)

• If a consumer leaves the home without prior approval or does not return at designated time: – Submit Incident Report immediately when consumer

does not return at appropriate time– File a police report if gone for 24 or more hours– Submit 2nd Incident Report indicating police report filed

and that consumer gone for more than 24 hours– Submit final Incident Report when, if consumer returns

Abuse/Neglect/Exploitation

Abuse/Neglect/ExploitationIf you suspect or witness abuse, neglect or exploitation, you MUST report it immediately to Adult/Child Protective Services and all other required parties!

• This may also require you to call the Police!

*Please note, consumers often require medical or psychological help after they have been a victim of abuse or neglect! Please seek medical and/or mental health counseling for the consumer immediately after reporting incident

APS/Child Protective Services Hotline (855) 444-3911

Medication

MedicationIncident Reports are required for the following:• Missed dose(s)• Incorrect dose given • Incorrect medication given• Consumer’s refusal of medication

*Please note, consumers require medical consultation when any of the above happen!

Hospitalizations

HospitalizationsFor physical symptoms/illness:

• Be sure to state the symptoms and/or cause for hospitalization

• Note if symptoms are new or part of an existing illness

• Document if the consumer was discharged or admitted

For psychiatric hospitalizations: • Be sure to state the symptoms and/or cause for

hospitalization• Is the behavior/problem new to the consumer or is it

a known behavior/problem • Does the consumer have a Behavioral Treatment

Plan? If so, what interventions did staff use to de-escalate the behavior?

Responsibility

Who is Required to File an Incident Report?

YOU ARE!

Responsibility

Who is Required to File an Incident Report?All staff who are involved in, or witness the incident is required to file an Incident Report. This includes:

• Direct Care Worker’s • MCPN• CMH • Subcontractor (Skill Building, Clubhouse, etc.)• Paid Employee’s• Volunteer’s

Incident Report Standards

Incident Report Standards

• All Incident Reports must be completed fully and legibly with the consumers MH WIN ID # – (This is not the CMH case number)

• A separate report must be completed for each consumer involved in incident

• A separate report shall be completed by each employee who witnessed the incident

• Staff shall describe in detail, in their own words, what they actually saw

Incident Report Standards

Incident Report Standards

• Staff shall describe in detail how they handled the incident

• If the consumer was taken to the hospital, staff must document whether the consumer was admitted– A separate incident report should follow when the

consumer is discharged

• If consumer has an injury, staff must describe in detail when and how injury occurred. – Staff must also indicate how they assisted the

consumer with medical attention – If consumer refuses medical attention, staff shall

document the refusal on the Incident Report

Key Points

Key Points for Incident Reports

• Incident Reports should be sent directly from the home or agency where the incident occurred. – Reports should NOT be sent to the Provider’s office or a

alternative location first!

• If a staff member, manager or provider decides they would like to add additional information to the Incident Report, they must resend the report with the word “REVISED” appearing in capitol letters at the top of the page.

• Incident Reports shall identify the full name and telephone number of a contact person who can provide additional information, if needed

Key Points

Completing Incident Reports

• When writing an Incident Report, staff should always answer the questions Who, What, When, Where, How and Why! This format will help capture the information needed in the report

• Staff should write the Incident Report so that others who were not involved, have a clear understanding what has happened

How to Fill Out an Incident Report

How to Fill Out an Incident Report• Make sure all text boxes are filled out completely with

correct information!– Name, address, phone number, license number, facility,

consumer’s Date Of Birth (DOB), MH WIN #, etc.

How to Fill Out an Incident Report

How to Fill Out an Incident Report

Please indicate the date and time of incident clearly. Be sure to designate AM or PM!

How to Fill Out an Incident Report

How to Fill Out an Incident ReportSign and Date!!! (Please remember to sign your name legibly!)

Next Steps

Once you complete the Incident Report, what should

you do?

Next Steps

• Read it! Make sure you didn’t forget anything and that all the information is correct!

• FAX the Incident Report to all required parties described in this presentation by the end of your shift!

When Should Incident Reports be Sent?

All Incidents Reports are required to be completed by the end of the employee’s shift,

but no more than 24 hours after unusual incident occurs.

• NOTE: Urgent and emergent situations should always be reported to the Network immediately by phone via the Quality Assurance Department (313-656-0000).

Where to Send Incident Reports

All Incident Reports are required to be faxed within 24 hours of incident occurring to the following required parties:

• BHPI on behalf of CareLink or ConsumerLink– FAX (313) 656-2593

• Office of Recipient Rights – FAX (313) 833-2043

• CMH (case manager or supports coordinator)• Licensing• Guardian, if applicable

Why Complete Incident Reports?

Why Do We Complete Incident Reports?

• They help ensure appropriate treatment for the consumer• Identify various patterns/trends of behavior• Identify agency-wide or program specific issues• Assists in identifying areas for improvement, staff training

and development.

Why Complete Incident Reports?

Why Do We Complete Incident Reports?

• Incident Reports are used to monitor a consumer’s progress. If an incident occurs frequently, the consumer’s IPOS may need to be modified or the consumer may need a Behavioral Treatment Plan to specifically address the undesired behavior

• If you feel the consumer needs a modified IPOS or Behavioral Treatment Plan, please talk to the consumers Case Manager/ Supports Coordinator and the Guardian, if applicable, about the issues to determine further action steps

Tracking and Trending IRs

While all providers are encouraged to review incident reports for trending and continuous quality improvement, Unaccredited Providers are REQUIRED to document their analysis of the trends and any changes made as a result to improve overall quality

– See Unaccredited Providers CARF Standards for more information

Critical and Sentinel Events

Monitoring and Reporting

Critical/Sentinel Events

Critical/Sentinel Events

• Critical/Sentinel Events are determined by the Care Coordinating Agency, the MCPN and/or DWMHA after they review an Incident Report.

• Care Coordinating Agencies are responsible for filing a Critical or Sentinel Event Report, not an AFC or downstream provider site such as a workshop, etc.

• Critical/ Sentinel Events are required to be completed within 48 hours of learning about the incident

Critical/Sentinel Events

Critical/Sentinel Events

What is a Critical Incident?

• A serious type of incident that involves:– Suicide or suspected suicide– Unexpected death– Emergency medical treatment due to injury or

medication error– Hospitalization due to injury or medical care– Arrest– Environmental emergencies (i.e. bed bugs, power

outage, etc.)– Elopement– Anything that can be alerted to the Media

Critical/Sentinel Events

What is a Sentinel Event?

• A type of Critical Incident/Event that occurred with a consumer who meets one or more of the following criteria:

– Living in a 24 hour specialized residential facility or a child caring institution (Funded by the Network)

– Living in own home but receiving Community Living Support services

– Receiving Targeted Case Management, Habilitation Waiver services (HAB), Children’s Waiver, Home-based services, Assertive Community Treatment (ACT) and Wraparound services

Critical/Sentinel Events

Critical/Sentinel Events

– Residing in a residential substance abuse treatment program

– Discharged from a State facility

– Caused by staff action or inaction

Incidents

Critical Incident/Event

Deaths

Sentinel Event

INCIDENTSAny unusual or unexpected event involving a consumer or consumers that is inconsistent with the desired outcome or routine operation. CRITICAL INCIDENT/EVENT

(CI/CE)Serious type of incident that involves:•Suicide or suspected suicide•Unexpected deaths•Emergency medical treatment due to injury or medication error•Hospitalization due to injury or medication error•Arrest•Environmental emergencies •Elopement•Media Item

SENTINEL EVENT (SE)Type of Critical Incident/Event that occurred with a consumer who meets one or more of the following criteria:•Living in 24 hour specialized residential facility or a child caring institution (funded by Network)•Living in own home but receiving community living support services•Receiving targeted case management, habilitation support waiver (HAB), children’s waiver, home based services, assertive community treatment (ACT), wraparound services•Residing in a residential substance abuse treatment program•Discharged from a State facility•Caused by staff action or inaction*

UNDERSTANDING INCIDENTSFigure 1

DEATHSSerious type of incident that may be an Incident, Critical Incident or a Sentinel Event:•Natural Cause/Expected – Incident only•Suicide, Homicide or other Unexpected Death – Critical Incident/Event•CI/CE Death that meets criteria – Sentinel Event

Completing a Critical/Sentinel Event

How to Complete a Critical/Sentinel Event• Care Coordinating Agencies must complete

a Critical/Sentinel Event training sponsored by DWMHA – Individuals who will be entering Criticals

and/or Sentinels will each need to attend a training

• Once you received training, the Critical/Sentinel Event Module will be added to your MH WIN profile allowing you to electronically enter the information

Critical/ Sentinel Event Training

How to Register for the Critical/ Sentinel Event Training

• Staff who are interested in attending the Critical/ Sentinel Event training at DWMHA must contact:

– Gail Parker at (313) 833-4556 or gparker@dwmha.com

Additional Information

For Additional Information on Incident Reports• Consult the Quality Assurance Section of the Provider

Manual– Found on the Provider Portal of our website

Questions?

Writing Exercises

Exercise 1

A consumer was sitting in the living room with a staff member. The staff got up to get something to drink for the consumer. While the staff was in the kitchen, their cell phone rang. The consumer picked up the phone and attempted to answer it. When staff returned, they saw the consumer with their phone so they hit the consumer across the face and told them to never touch their belongings again. The second staff on duty, who walked into the living room at the same time, witnessed the event.

Exercise 2

While eating dinner, a consumer becomes ill and passes out at the table. EMS is notified and the consumer was transported to the hospital. Later the home manager is told that the consumer died upon arrival at the hospital.

Exercise 3

A consumer is prescribed Seroquel. They are to take their prescription once in the morning and once in the evening. During the evening when you are passing meds, the consumer refused to take the Seroquel, stating that they didn’t need it.