1. Adverse Incident Reporting Presented by: Susanne Ohama October 5, 2010 Magellan Health Services, Inc. 1

2. Magellan Health Services, Inc. 2 Adverse Incident Reporting Many of you may be familiar with Adverse Incident reporting.  Magellan adopted the OMHSAS incident definitions in 2007 based on revised requirements for the reporting of Adverse Incidents for HealthChoices individuals. These requirements are consistent with the reporting definitions set forth in the OMHSAS Community Incident Management & Report System Bulletin of 2006 (OMHSAS-06-04).

3. Adverse Incident Reporting Our objectives today are:  Review adverse incident reporting  Explain the types of incidents  Explain how to complete and submit a Provider Adverse Incident Reporting Form. Magellan Health Services, Inc. 3

4. When should I report?  The incident takes place during the span of time (tenure) the individual is receiving MBH funded services through your organization, or  The individual was in treatment with your organization within six (6) months of the incident and completes a suicide or homicide or engages in another type of serious incident.  Incident reporting for County-funded services will continue to be submitted to the County office. Magellan Health Services, Inc. 4

5. When should I report?  For the following types of events, submit a report if the event occurs while in your care: Significant medication error, Need for emergency services, Serious injury or illness, Missing person, Seclusion or Restraint.  For the following types of events, submit a report regardless of where it occurs: Death, Suicide Attempt, Abuse, or Neglect. Magellan Health Services, Inc. 5

6. Adverse Incident Types  Death  Suicide Attempt  Significant Medication Error  Need for Emergency Services  Abuse  Neglect  Injury or Illness  Missing Person  Seclusion  Restraint Magellan Health Services, Inc. 6

7. Adverse Incident Reporting Definitions  Death - all deaths regardless of cause  These are reported whether seen as a medically related death such as the result of illness, a possible suicide, or an apparent homicide. An accidental overdose resulting in death is also reported. Magellan Health Services, Inc. 7

8. Adverse Incident Reporting Definitions  Suicide Attempt - The intentional and voluntary attempt to take one's own life. A suicide attempt is limited to the actual occurrence of an attempt which requires medical treatment and/or where the individual suffers or could have suffered significant injury or death.  Non-reportable events include:  Threats of suicide which do not result in an actual attempt.  Gestures which clearly do not place the individual at risk for serious injury or death.  Actions which may place the individual at risk but where the individual is not attempting harm to himself/herself Magellan Health Services, Inc. 8

9. Adverse Incident Reporting Definitions  Significant Medication Error - A significant medication error includes a missed medication, incorrect medication or incorrect dosage, where an individual suffers an adverse consequence that is either short or long term in duration or receives treatment to offset the effects of the error.  Non-reportable events include: Refusal by the consumer to take prescribed medication. Magellan Health Services, Inc. 9

10. Adverse Incident Reporting Definitions  Any event requiring the emergency services of the fire department, or a law enforcement agency – This includes events such as fires; an individual charged with a crime; an individual who is a victim of a crime; acts of violence; vandalism, or misappropriation of individual property.  Non-reportable events include:  Non-emergency services of the fire department or police.  Police presence related to commitment procedures or rescue squad activities.  Testing of alarm systems/false alarms, or 911 calls by individuals that are unrelated to criminal activity or emergencies.  Presence of law enforcement personnel during any activity governed by the Mental Health Procedures Act. Magellan Health Services, Inc. 10

11. Adverse Incident Reporting Definitions  Abuse – Allegations of abuse are to be reported. Abuse is occurrence of the infliction of injury, unreasonable confinement, intimidation, punishment, mental anguish, or sexual abuse. For the purposes of the Bulletin, abuse includes abuse of individuals by staff or abuse of individuals by others. Depending on the nature of the abuse, it may also constitute a crime reportable to police. If Childline was called, a report is submitted. Magellan Health Services, Inc. 11

12. Adverse Incident Reporting Definitions  Abuse includes:  Physical Abuse - An intentional physical act by staff or other person which causes or may cause physical injury to an individual.  Psychological abuse - An act including verbalizations, which may inflict emotional harm, invoke fear and/or humiliate, intimidate, degrade or demean an individual. Magellan Health Services, Inc. 12

13. Adverse Incident Reporting Definitions  Sexual abuse - An act or attempted act such as rape, sexual molestation, sexual harassment and inappropriate or unwanted touching of a sexual nature of an individual by another person. Any sexual contact between a staff person and an individual is abuse.  Exploitation - The practice by a caregiver or other person of taking unfair advantage of an individual for the purpose of personal gain, including actions taken without the informed consent of the individual or with consent obtained through misrepresentation, coercion or threats of force. This could include inappropriate access to or use of an individual’s finances, property, and personal services. Magellan Health Services, Inc. 13

14. Adverse Incident Reporting Definitions  Non-reportable events include:  Altercations among residents that may result in physical contact but do not cause serious injury and which do not reflect a pattern of physical intimidation or coercion of a resident.  Discord, arguments or emotional distress resulting from normal activities and disagreements that can be found in typical congregate living situations. Magellan Health Services, Inc. 14

15. Adverse Incident Reporting Definitions  Neglect - Neglect is the failure to obtain or provide the needed services and supports defined as necessary or otherwise required by law, contract or regulation. This can include the failure to provide for needed care such as shelter, food, clothing, personal hygiene, medical care, and protection from health and safety hazards. As with abuse, if Childline was called, a report is submitted. Magellan Health Services, Inc. 15

16. Adverse Incident Reporting Definitions  Injury or illness of an individual –  Reportable injury includes those where the individual requires medical treatment more intensive than first aid.  Reportable illness includes any life threatening illness, any involuntary emergency psychiatric admission that occurs as the result of a non-inpatient provider 302 petition, or any illness that appears on the Department of Health’s List of Reportable Diseases at http://www.health.state.pa.us. Magellan Health Services, Inc. 16

17. Adverse Incident Reporting Definitions  Non-reportable events include:  Scheduled treatment of medical conditions, on an outpatient or inpatient basis.  Any voluntary inpatient admission to a psychiatric facility, or service at a crisis facility or psychiatric department of acute care hospitals for the purpose of evaluation and/or treatment.  ER visits or inpatient admissions that result from a patient’s previously diagnosed, chronic physical illness, where such episodes are part of the normal course of the illness.  ER visits where the visit is necessitated because of the unavailability of the individual’s primary care physician. Magellan Health Services, Inc. 17

18. Adverse Incident Reporting Definitions  Missing person – Providers are to report an individual who is out of contact with staff without prior arrangement for more than 24 hours. A person may be considered to be in "immediate jeopardy" based on his/her personal history and may be considered "missing" before 24 hours elapse.  Additionally, it is considered a reportable incident whenever the police are contacted about a missing person or the police independently find and return the individual, regardless of the amount of time he or she was missing.  Ask yourself- Is there "immediate jeopardy“?? Magellan Health Services, Inc. 18

19. Adverse Incident Reporting Definitions  Seclusion or Restraint – As defined in the 2006 OMHSAS Bulletin, Providers are to report any use of seclusion or restraint (chemical, mechanical, and manual).  Recommended practices for the use of such can be found in the "OMHSAS Bulletin of 2002, “The Use of Seclusion and Restraint in Mental Health Facilities and Programs” (OMHSAS -02-01). Magellan Health Services, Inc. 19

20. Adverse Incident Reporting Form  Located on www.MagellanofPa.comwww.MagellanofPa.com  Reports should be faxed to Magellan within 24 hours of learning of the incident. Please ensure each of your programs has the forms accessible. Magellan Health Services, Inc. 20

21. AI Reporting Form Provider Instructions  Please check the county of residence of the individual, not the program location.  Please write your phone number, not the individual’s home phone number. Facility/Provider NameDate of Report: Reporter Name/Position:Reporter Phone Number: Member Name:Member SSN: Provider Level of Care/Service:Member Date of Birth: Location of Incident:Date and Time of Incident: Magellan Health Services, Inc. 21

22. AI Reporting Form Provider Instructions  The second section asks the provider to identify the type of Adverse Incident. Please check all that apply. DeathAbuse/Childline reportSeclusion Attempted SuicideNeglectRestraint Significant Medication Error Injury/illness (Beyond First Aid) Other (please explain) Need for Emergency Services Missing person Magellan Health Services, Inc. 22

23. AI Reporting Form Provider Instructions  The third section asks for a concise narrative of the event. The facts of the case (where, what, when, how) should be provided. This may include immediate precursors to the incident, and/or what was done to avoid the situation if applicable.  The fourth section asks about any actions taken by the provider to ensure the safety of the persons involved in the incident, debriefing activities, and steps you implemented to avoid similar events in the future. Magellan Health Services, Inc. 23

24. AI Reporting Form Provider Instructions  The final section asks about parental/guardian notification for minors and medical interventions as a result of the incident; did a nurse, psychiatrist or other physician see the individual following the event? If so, what treatment was provided? Yes No Parent/Guardian notified?Date/Person notified: Yes No Member seen by psychiatrist after incident? If yes, treatment: Yes No Member seen by physician/nurse after incident? If yes, treatment: Magellan Health Services, Inc. 24

25. AI Reporting Form Provider Instructions  Each restraint needs documentation on the form that the individual was assessed by a medical personnel, whether medical treatment was needed, family/guardian notification, and that the incident was processed with the individual.  Please sign and date the form then fax it to the Magellan QI Department within 24 hours of learning of the incident. 866-667-7744 for Bucks, Delaware and Montgomery County members 866-382-1258 for Lehigh and Northampton County members Magellan Health Services, Inc. 25

26. As a provider, what are my responsibilities? Providers are expected to have a Quality Management process in place.  This should include review of Adverse Incident information at the individual and aggregate level.  Ensure applicable staff at all levels are trained in both internal and external incident reporting procedures.  The purpose of such quality improvement activities is to identify potential quality and/or safety issues that may impact future members served, and to assist in development of improved practices where needed.  A structured problem solving approach, such as a Root Cause Analysis, can be helpful in discerning areas of strength and opportunities for change. Magellan Health Services, Inc. 26

27. What is the responsibility of Magellan and the Counties?  Review the incident report and available information  Work with Providers to obtain further information as needed, which may include a review of records for more serious events  Collaborate with the Medical Director related to serious incidents  Complete monthly and quarterly Trending Reports  Use the information to improve services and quality of care as well as identify areas for improvement across the system. Magellan Health Services, Inc. 27

28. Questions?  Please submit procedural reporting questions electronically. For questions that require sharing of Protected Health Information (PHI) please call directly. 215-504-3900 for Bucks, Delaware and Montgomery County members NewtQICG@magellanhealth.comNewtQICG@magellanhealth.com 610-814-8045 for Lehigh and Northampton County members SVMilonas@magellanhealth.com SVMilonas@magellanhealth.com  A document with sample scenarios entitled, Incident Type Examples, which is useful for training, is also located on this website. Magellan Health Services, Inc. 28