1. Accident Investigation Long Term Care Massachusetts Care Self-Insurance Group, Inc. S afety A wareness F or E veryone from Cove Risk Services

2. What is an Accident? An unintended happening, mishap Most often an accident is any unplanned event that results in personal injury or in property damage The failure of people, equipment, supplies or surroundings to behave or react as expected

3. Accident Investigation Will determine the “how” and “why” of failures Examine possible corrective action Aid in the accident prevention and elimination of a clearly identified hazard Most important – Investigation is not intended to place blame

4. Be Prepared Designate an investigator (or a team) –This should be one of this persons key responsibilities –Should have a good working knowledge of operating procedures Be equipped with the right tools to do the job thoroughly

5. Record the Facts Interview witnesses as soon as possible Record all necessary information at the accident scene before any changes are made –Take photos (camera or camera phone) –Record measurements Gather support documents such as maintenance records, employee records, production schedules, training documents and records, or process diagrams

6. Record the Facts Keep all notes and remarks in a bound notebook or three ring binder Record: –Pre-accident conditions –Accident sequence –Post-accident conditions Document victim location, witnesses, equipment, machinery, energy sources and other contributing factors

7. Record the Facts Even the most insignificant detail may be useful Document and then document some more The investigator should be concentrating solely on the investigation at hand

8. Interviewing Excellent source of first hand knowledge May present pitfalls in the form of: –Bias –Perspective –Embellishment It is important to maintain a clear thought process and control of the interview

9. Interviewing Get preliminary statements as soon as possible from all witnesses Locate the position of each witness on a master chart (including the direction of view) Explain the purpose of the investigation (accident prevention) and put each witness at ease.

10. Interviewing Let each witness speak freely and take notes without distracting the witness (use a tape recorder only with consent of the witness) Use sketches and diagrams to help the witness Emphasize areas of direct observation and label hearsay accordingly Record the exact words used by the witness to describe each observation

11. Interviewing Word each question carefully and be sure the witness understands Identify the qualifications of each witness (name, address, occupation, years of experience, etc.) If they wish, supply each witness with a copy of their statements (signed statements are desirable)

12. Problem Solving Techniques This technique emphasizes change to correct the problem Examine the differences between the norm and what actually happened Consider all problems to result from some unanticipated change Analyze the changes to determine its cause

13. Use the following steps in this method: –Define the problem (What happened?) –Establish the norm (What should have happened?) –Identify, locate, and describe the change (what, where, when, to what extent) –Specify what was affected –Identify the distinctive features of the change –List the possible causes –Select the most likely causes Problem Solving Techniques Change Analysis

14. Problem Solving Techniques Job Hazard Analysis Job Hazard Analysis (JHA) is part of many existing accident prevention programs In general, JHA breaks a job into basic steps, and identifies the hazards associated with each step as well as prescribing controls for each hazard A JHA is a chart listing these steps, hazards, and controls Review the JHA during the investigation if a JHA has been conducted for the job involved in an accident Perform a JHA if one is not available to determine the events and conditions that led to the accident

15. Investigation Report An accident investigation is not complete until a report is prepared and submitted to the proper managers

16. Investigation Report Background Information –Where and when the accident occurred –Who and what were involved –Personnel and other witnesses Account of the Accident (What happened?) –Sequence of events –Extent of injury –Accident type –Source

17. Investigation Report Discussion (Analysis of the Accident – HOW & WHY) –Direct causes (energy sources; hazardous materials) –Indirect causes (unsafe acts and conditions) –Basic causes (management policies; personal or environmental factors)

18. Investigation Report Recommendations (to prevent a recurrence) for immediate and long-term corrective actions –Engineering Controls –Administrative Controls –PPE

19. Accident Scenario Jane, a C.N.A., strained her back while team transferring a fully dependent resident from a wheelchair to bed with another C.N.A. She (and the other C.N.A.) was in a hurry, but used good body mechanics while lifting the 90 lb. resident. What questions need answering?

20. Some Questions Where did this happen? Which resident? What time/shift? What does the Care Plan call for? Does this current plan make sense? Was she trained? If yes, when? Is the training effective? Why or why not? When did the employee last complete competency on this safe procedure? Who is the supervisor? Are there any prior disciplinary action in place for a similar infraction? If not…why not? Do we have the necessary tools to do this job safely? Is disciplinary action necessary? Are new procedures necessary?

21. Potential Corrective Actions Develop policy requiring use of mechanical floor lift for all dependent residents/patients no matter what they weigh. Re-train staff on all transfer techniques, specifying when they will be required, and how they will be able to recognize it on the Care Plan. Develop periodic observation program as an internal competency measurement system. Inform employees on the disciplinary policy for safety infractions related to these expectations and explain the benefits of high level competency. Inform all staff via posters, mailers, handouts, etc. as to what these new procedures are. Counsel employees with low level competency, using disciplinary policy as outlined in writing. Document this action. Praise employees for following expected procedure as trained. Document this action. Inform Supervisors and Managers that incidents that occur as a result of low competence will effect their performance review.

22. Accident Scenario THE ACCIDENT: Jen the C.N.A. is walking from the main corridor in to a resident’s room. She slips and falls on water, twisting her knee and hurting her wrists while trying to stop herself. THE INVESTIGATION: Mary, the Nurse Manager for the unit, sees that she receives immediate care, and calls for an ambulance. Jen signs the medical authorization on the Incident Report. Mary secures the area where Jen was injured. Mary notes the puddle of water near the entrance to the room. Mary begins the accident investigation. Mary grabs the camera (or camera phone) and takes pictures from a few different angles. These might be of use during the review phase. Mary obtains information from witnesses by interviewing them individually. One witness states that the leak is from a food cart that “seems to always be wet” when coming from the kitchen. Mary, also on the safety committee, reviews her copies of the minutes to see if this has been discussed before. There is no evidence that this has ever been discussed. No action was requested, nor taken.

23. Accident Scenario (CONTINUED) THE INVESTIGATION: Mary, asks the Dietary Manager if this has ever been brought to his attention, or if he has ever noticed this issue. He says it has not. Mary asks other nursing staff if this has been an issue. They confirm that it has been brought to housekeeping’s attention. Housekeeping confirms this and says they have increased floor cleaning practices after meals. Mary calls Jen to see how she is doing. She will be returning to work with restrictions the next day. Mary arranges for some modified duty work in varying departments to allow her to get her normal 8 hours. Mary interviews Jen when she comes back in. She says she was not paying attention to the floor, because she was in a rush. She was wearing older-than- average sneakers. Mary completes the investigation report. What new controls and improved safety procedures might Mary suggest as a result of this incident?

24. Any Questions ?? Massachusetts Care Self-Insurance Group, Inc. S afety A wareness F or E veryone from Cove Risk Services