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Critical Incident Reporting System Critical Incident Reporting System (CIRS) Linda Metzger Colorado Department of Health Care, Policy & Financing.

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Presentation on theme: "Critical Incident Reporting System Critical Incident Reporting System (CIRS) Linda Metzger Colorado Department of Health Care, Policy & Financing."— Presentation transcript:

1 Critical Incident Reporting System Critical Incident Reporting System (CIRS) Linda Metzger Colorado Department of Health Care, Policy & Financing

2 Critical Incident Reporting System What Is a Critical Incident? Any actual or alleged event or situation that creates a significant risk of substantial or serious harm to the health or welfare of a client. Could have or had a negative impact on the mental and/or physical well being of a client in the short or long term.

3 Critical Incident Reporting System Applicable Waiver Programs Persons with Brain Injury (BI) Persons with Mental Illness (MI) Persons Living with AIDS (PLWA) Elderly, Blind & Disabled (EBD) Persons with Spinal Cord Injury (SCI) Children with Life Limiting Illness (CLLI) Children’s HCBS (CHCBS) Children with Autism (CWA)

4 Critical Incident Reporting System Why does the State need to track Critical Incidents? To assure that necessary safeguards have been taken to protect the health and welfare of the individuals receiving 1915c waiver services To identify, address and seek to prevent the occurrence of abuse, neglect and exploitation on a continuous basis To comply with key regulatory requirements from CMS regarding monitoring To insure remediation (follow up) actions are initiated when appropriate

5 Critical Incident Reporting System Critical Incidents and the Department’s Quality Improvement Strategy Monitoring Critical Incidents is a part of the Department’s Global Quality Improvement Strategy encompassing three functions: Discovery Remediation (Follow-Up) Continuous Improvement

6 Critical Incident Reporting System Providers of Waiver Services Waiver services are furnished at widely dispersed sites throughout the community Typically include: large and small private-sector provider organizations, assisted living facilities, adult day care facilities, case managers, individual personal assistants and attendants, clinicians, neighbors and other community members who support individuals

7 Critical Incident Reporting System Number of Critical Incidents Reported per Month There was a significant increase in reporting over the past 3 years /month /month Jan.-June /month July-Dec /month Jan.- July /month

8 Critical Incident Reporting System Reporting Issues Some providers are very diligent about reporting critical incidents to SEP/CMAs Some agencies understand the CIR reporting process and expectations well and others do not Some agencies are over-reporting incidents, e.g. reporting unnecessary events Some SEP/CMA regions have a high frequency of critical incidents while others have a low frequency

9 Critical Incident Reporting System 9 Timely Reporting Requirements HCBS Waiver Service Provider Case Manager ( within 24 hours or one business day) Case Manager HCPF (BUS) ( within 24 hours or one business day) Follow-up and investigation  Case Manager responsibility?  Provider responsibility?  Other entity Responsibility?

10 Critical Incident Reporting System Provider Reporting Forms Provider Services>provider services>forms>Critical Incident reporting systems forms 1.HCBS Provider Critical Incident Information Form 2. Provider Critical Incident Follow-Up Form 10

11 Critical Incident Reporting System Types of Critical Incidents to Report Death Suspected Abuse/Neglect/Exploitation Serious Illness Injury to Client Damage to Client’s Property or Theft Medication Management Other High Risk Issues

12 Critical Incident Reporting System Death Types Ongoing Medical Condition/Illness/Disease New Medical Condition/Illness Unexpected/Unknown Cause Completed Suicide Homicide Accidental Death Other

13 Critical Incident Reporting System Suspected Abuse, Neglect or Exploitation Abuse includes actions which result in bodily harm, pain or mental distress. Neglect is a failure to provide care and service when a waiver client is unable to care for him or herself. Exploitation is the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a client’s belongings or money without the client’s consent.

14 Critical Incident Reporting System Serious Illness/Medical Crisis Recurring Illness Heart attack (MI) Stroke (CVA) Pneumonia Respiratory failure Seizure Infection (UTI) Dehydration Cancer Diabetic Crisis Mental Illness symptoms Medical crisis Other illness

15 Critical Incident Reporting System 15 Cause of Serious Illness New medical condition Existing medical condition Treatment error Medication Poor care Undetermined Other

16 Critical Incident Reporting System Serious Injury Fracture/Dislocation Laceration Serious Burn Head Injury Multiple injuries Unknown injury from fall requiring medical attention Unknown injury Other injury 16

17 Critical Incident Reporting System Cause of Serious Injury Fall Accident Seizure Assault Choking/Aspiration Physical Restraint Undetermined Other 17

18 Critical Incident Reporting System Damage to Client’s Property/Theft Deliberate damage, destruction, theft, misplacement or use of a client’s belongings or money without the client’s consent, including the deliberate diversion of medications

19 Critical Incident Reporting System Medication Management Problems with medication dosage, scheduling, timing, set-up, compliance, administration or monitoring which can result in documented harm or an adverse effect which necessitates medical care. Event Type Cause for event Administered by

20 Critical Incident Reporting System Other High Risk Issues Serious issues that do not yet rise to the level of a critical incident, but have the potential to do so in the future, including such events such as environmental hazards, suicide threats, self- injurious behaviors, arrest or detention, etc. This type of critical incident always requires follow-up.

21 Critical Incident Reporting System Types of High Risk Issues Lost/missing person Loss of Home/Eviction Client fraud Provider fraud Serious criminal offense (offense by client) Client abuse toward others Unusual aggressive behavior Suicide ideation Suicide attempt Substance abuse Media involvement Environmental hazard Restraints used

22 Critical Incident Reporting System 1. Hospitalizations 2. ER Visits 3. Dr. Visits 4. Law Enforcement Involvement Common Reporting Items 22

23 Critical Incident Reporting System Unnecessary or Inappropriate Reporting Examples Lifeline Activation not related to a specific incident type Reports about non-HCBS persons Due to weakness in his legs, client fell in the dining room, no ER visit Client said she tripped over her dog and fell again Client complained of having severe neck pain Client was scratched on left forearm by dog paw

24 Critical Incident Reporting System Recording a Critical Incident Report When reporting a critical incident, be prepared to provide enough information so the reviewer knows: Who was involved in the incident What were the circumstances of the incident - details Where the incident happened When the incident took place, Date & Time

25 Critical Incident Reporting System Mandatory Reporting Responsibilities Reporting Critical Incidents in the BUS does not relieve the provider, provider agency or SEP/CMA of other forms of mandated reporting, including reports to law enforcement, Child or Adult Protective Services, or Occurrence Reports to the Colorado Department of Public Health and Environment

26 Critical Incident Reporting System After a Critical Incident is Reported HCPF Waiver Program Staff will review CIRS reports on daily basis checking for completeness of reports to determine if the report: Provides enough detail to understand the circumstances of the incident Documents the steps taken to respond to incident Identifies how client’s safety has been addressed and the follow-up measures taken and/or planned Documents whether mandatory reporting has occurred

27 Critical Incident Reporting System After a Critical Incident is Reported There will be instances when additional follow-up by the SEP/CMA will be required: when reports lack sufficient information for the reviewer to understand the nature of the incident how a client or situation has been stabilized what safety measures have been taken to investigate and remedy the circumstances

28 Critical Incident Reporting System Entering a CIR in the BUS After you login to the BUS, identify the client for report entry

29 Critical Incident Reporting System CIRS – Entering a Critical Incident After you verified you have the correct client, click on “Critical Incident Reports”

30 Critical Incident Reporting System CIRS – Entering a CIR You can click on “Add New CIRS” or “Add Critical Incident” to start the entry process

31 Critical Incident Reporting System CIRS – Entering the incident info Make sure all elements are completed

32 Critical Incident Reporting System CIRS – Incident Specific Descriptors Complete a thorough description of the incident circumstances Complete the incident specific descriptors Definition of what types of events are appropriate for each incident type

33 Critical Incident Reporting System CIRS – Persons Involved After completing the incident descriptors, click “Persons Involved” Complete the sections for name, relationship to client, and role Click “Add” to enter additional persons involved

34 Critical Incident Reporting System CIR – Mandatory Reports Made Make sure all sections are complete After completing Persons Involved, click on Mandatory Reporting Steps Click “Add” to enter additional mandatory reports made

35 Critical Incident Reporting System CIRS – Follow Up Actions After completing Mandatory Reporting Steps, click on Follow-up Actions Taken Make sure follow- up actions are complete. This section describes the actions take to remedy the situation and/or secure the client’s health and welfare Click “Add” to enter additional follow up actions

36 Critical Incident Reporting System CIRS – Referrals Made After Follow- up Actions, click on Referrals Made Complete a referral screen for each referral completed in relationship to the incident that occurred. Please be descriptive of actions take and reason for referral

37 Critical Incident Reporting System CIRS – Persons Notified Click “Add” to enter additional persons notified After completing Referral Steps, click on Persons Notified Complete all sections of the person notified

38 Critical Incident Reporting System CIRS – Post Report Follow-up Provide narrative description of additional information Select Post Report Follow- up to document additional incident related information

39 Critical Incident Reporting System HCBS Provider Reports to SEP/CMA The Department does not require any specific method of communication between HCBS Provider Agencies and SEP/CMAs A form entitled “PROVIDER CRITICAL INCIDENT REPORTING FORM” has been provided as a means of capturing the detail necessary for reporting incidents; but, it is not a required by the Department.

40 Critical Incident Reporting System QUESTIONS???


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