1. 24-Hour Access to Care and Crisis Services 1-866-875-1757 Customer Services 1-855-250-1539 Insider’s Guide to IRIS

2. Purpose of Incident Reporting: Ensure incidents are addressed in a thorough and timely manner Track and trend information to identify patterns of concern Analyze ways to prevent future incidents Identify ways to improve the service system Assess for Health & Safety

3. Understanding Report Submission * “Under Your Care” 90 day rule * Saving an incident report Submitting one * An IRIS incident number DOES NOT necessarily mean the incident report has been successfully completed Submitted Report = * The Supervisors Action tab MUST be completed in order for the incident report to be fully submitted

4. Resubmitting Incident Reports Providers will know additional information is requested for an incident report by email or phone notification. * Information should be completed within 2 business days * Once the information has been updated in the report, the Incident Submission section under the Supervisor Actions tab must be completed for successful resubmission. Once providers obtain a death certificate, medical examiner’s report and/or an investigative summary letter related to an incident, the document should be attached to the IRIS report and resubmitted.

5. Common Incidents That May Be Downgraded Consumer Injury: This section is completed when a consumer is injured and requires more than First-Aid (example: x-rays show a broken bone and cast is applied) Illness of a Consumer: Per Incident Manual Section C, page 8; Medical Illness is not reportable unless it results in injury or death, or is believed to be caused by abuse/neglect or medication error. Restrictive Interventions: With approved behavior plans (10 A NCAC 27E.0104)

6. QM 11’s (Quarterly Provider Incident Report) All Level 1 incidents, including incidents downgraded to a Level 1 will need to be reported on QM 11’s QM 11’s are reviewed to assess incidents, and the steps and strategies taken to ensure quality of care Level 2 and Level 3 incidents reported on the QM 11 are verified with IRIS Feedback may be given to providers if additional information is requested

7. IRIS Pitfalls: RED STARS Email address/incident numbers Host/Home LME/MCO 72-hour report list Double check DOB Not identifying Incident Type Google Chrome and Restrictive Interventions Completing boxes Supervisor Action Tab

8. Human Right’s Committee Human Right’s Committee is comprised of CoastalCare Staff and Board Members/CFAC Members/Community Members who possess experience with the MH/DD/SUD population. Committee meets monthly to review all Tier 2 Grievances, Level 3 Incidents, Deaths and Restrictive Interventions Follow up on specific incidents may be requested by the Committee

9. Scenario 1: DEATH 54 year old female (Mary Tarheel DOB:9/15/1959) Diagnosis: Major Depressive Disorder, COPD Medications: Symbicort, Celexa, Elavil Location of Death: Consumer’s Home What we know: *Found by family member unresponsive. *Consumer was linked with provider, but was only seen 2 times in the past 90 days. Received: Medication Management and Individual Therapy Resided in New Hanover County

10. Death Incident Key Points: ▪ Verbal Notification is required for all Level 3 incidents, including Deaths within 24 hours of learning of incident. If on the weekend, provider’s should still leave a message. ▪Internal death forms and timeframes ▪Know how/where to request death certificate ▪Death incidents will remain open until a death certificate/ME report is received. Documents should be attached to the IRIS incident and Manner of Death tab should be adjusted based on findings. ▪DHHS pays close attention to last date of discharge from a state facility/hospital. ▪All deaths are sent to CoastalCare’s Chief Medical Officer for review. Additional questions may come from this review. ▪Deaths are presented to CoastalCare’s Human Right’s Committee

11. Scenario 2: Restrictive Intervention 8 year old male (John Smith DOB: 1/25/2006) Diagnosis: ADHD, ODD Medications: Melatonin, Intuniv Location: Service Facility Receives: Day Treatment Services Services: Onslow Lives: New Hanover Consumer did not want to participate in group activity, but rather talk to his mother. Staff told consumer he wasn’t allowed to use the phone at this time. Consumer became agitated and started throwing chairs. Staff provided redirection and prompting. After numerous attempts, consumer had to be put in a Standing Restraint for 1 minute and Isolation Time/Out for 5 minutes. No behavior plan

12. Restrictive Intervention Key Points: ▪If ‘yes’ is checked to the Restrictive Intervention being part of the consumer’s behavior plan, the plan must be attached to the IRIS report for confirmation. ▪Make sure all the tabs are completed under Restrictive Intervention tab. IMPORTANT: Time, type and duration. ▪Restrictive Interventions are presented to Human Right’s Committee and additional information may be requested. ▪CoastalCare tracks and trends Restrictive Interventions in order to identify patterns of concern. ▪Face down is not an option. Situation will have to be assessed and report will need to be amended if this is selected.

13. Scenario 3: Consumer Behavior (Destructive/Illegal Act) 22 year old female (Kimmy Nelson DOB 6/15/1991) Diagnosis: Cannabis Abuse, Alcohol Dependence, Depression, Opioid Dependence Medications: Prozac, Suboxone Location: Community Receives: SACOT Services: Brunswick Lives: New Hanover Consumer became intoxicated. She took a moped, and crashed into the side of the providers office. No other people involved in accident, and consumer only required first aid for minor injuries. When police arrived on the scene, they found there was a warrant out for her arrest. Consumer was taken into custody. Incident was reported in the Media.

14. Miscellaneous Key Points: ▪ If the Consumer Behavior (as shown in previous scenario) results in permanent physical or psychological impairment or is in the media, then the incident will be classified as a Level 3. ▪ If an incident involves the media, then the provider will need to attach the media source to the IRIS report. ▪ DHHS pays close attention to the last date of discharge from a state facility/hospital when the media is involved.

15. Process with late incidents: Providers are required to submit incident reports within 72 hours of learning of the incident. *Even if all the information is not readily available, it is better to get the report in and go back and amend it, then submit it late!* If an incident report is submitted late, providers will receive the following correspondence: 1 st offense email = notification incident report is late, incident reporting manual attached and offer for technical assistance 2 nd offense email = notification incident report is late, Network liaison is included in communication and notice that with a 3 rd offense a plan of correction (POC) is possible 3 rd offense email = notification incident report is late, liaison will contact provider regarding plan of correction (POC) steps.

16. RESOURCES IRIS Website: http://iris.dhhs.state.nc.us/http://iris.dhhs.state.nc.us/ IRIS INCIDENT MANUAL: http://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/incidentmanu al2-25-11pdf *Please refer to “The Criteria for Determining the Level of Response to Incidents” on pages 20-25 for guidance in determining the level of response to Level I, Level II and Level III incidents IRIS TECHNICAL MANUAL: http://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/iris6-4-10dhhsmanual.pdf Medical Examiner’s Report, Autopsy Report or Toxicology Report: http://www.ocme.unc.edu/docrequest.shtml IRIS “PRACTICE” website- DO NOT Enter Real Incidents Here https://irisuat.dhhs.state.nc.us/

17. 24-Hour Access to Care and Crisis Services 1-866-875-1757 Customer Services 1-855-250-1539 Questions? Please feel free to Contact: Tricia Pike: 910-550-2577 Chrissy Gonthier: 910-550-2748