Incident Reporting When, What, Why, How Incident Reporting 12/2/2018

Introduction Incident Reports are a vital part of protecting Residents as well as Providers. When, What, Why, How: to file an Incident Report. Incident-When an action or change places someone at increased risk of injury/death, illness, loss of property, or behavior that is outside of the norm. Incident Reporting 12/2/2018

Incident Reports Overview When: Time-Limits for different Types of Incidents. Regular IR – once per week. Critical IR – by end of shift it happened. Incident in Progress – Immediately ie: call 911 or the Call Center and say that you “have an incident in progress.” Why: Documentation, Protection, Prevention. How: Handwritten or Template Forms Critical Incidents / Investigations Tracking Trends with Data Incident Reporting 12/2/2018

Overview Monitoring Residential Safety Protection of Residents Protection of Providers Prevention: Addressing small problems. Addressing larger problems: Critical Incidents and Adult Protective Services. Protect Residents Protect Providers Monitor APS Investigation CIR Incident Reporting 12/2/2018

Terms and Categories IR : Incident Report Medication Incidents Behavioral Incidents Exploitation Incidents Facility Incidents Unknown Incident Report form: When in doubt, fill one out. County provided forms or Template, or you may use one of your own, but it should have the same categories of Incidents, Was Anyone Injured box, a Description of the incident, Action Taken by Staff, and Administrator Comments or Follow-up. Incident Reporting 12/2/2018

Types of Incidents: Definitions of Categories Medication Categories Wrong Drug Wrong Dose Wrong Time Med Refusal Missed Med MAR Error Med County Discrepancy Adverse Reaction Other Med Error Incident Reporting 12/2/2018

Definitions: Behavioral/Health Incidents Assault Drug/Alcohol Contraband Elopement Fall Personal Injury Self-Harm Threats/Intimidation Incident Reporting 12/2/2018

Definitions: Behavioral/Health Incidents Inappropriate Behavior Medical Change Medical Emergency Clinical/Behavioral Change Property Harm/Theft/Loss Incident Reporting 12/2/2018

Definitions: Exploitation Sexual Financial Incident Reporting 12/2/2018

Definitions: Facility Unlocked doors/windows Unsecured equipment / supplies Other Incidents (Please explain) Incident Reporting 12/2/2018

Filling in the Information Facility, Resident Involved, Date & Time. Peers: do not give other resident’s names Check Category / Type of Incident Was anyone Injured? Was this a Critical Incident? Describe Incident Action Taken Administrator’s Comments / Follow-up Second and Third involved residents IR s. Incident Reporting 12/2/2018

When & How often send in IR s? Regular IR s can be sent in once a week. Critical Incidents must be sent in by the end of the shift that it occurred on. Fax to your Residential Specialist at 503-988-3335 and also call leaving a message for the RS. Batching: Can send in once a week for Non-Critical Incidents. Missed Meds for Elopements. Missed Meds for Hospitalization. Incident Reporting 12/2/2018

Do’s and Don’ts For regular IR s: you may hold for up to a week, but send in even without Administrator’s Comments, if it may take longer than a week for their comments. For Critical Incidents: Must be sent by the end of the shift that it occurred in. DO NOT hold for Administrator’s comments, if can’t be completed before end of the shift. Always send follow-up copies when the Administrator does fill-out their portion. Administrators should ALWAYs review each IR. Incident Reporting 12/2/2018

CRITICAL INCIDENTS The death of any consumer who is living in a licensed residential facility (hereafter called resident). The serious injury (requiring emergency department treatment or hospitalization) of any resident determined by the agency to be related to mental health issues. The death or serious injury to another individual caused by a resident. Incident Reporting 12/2/2018

CRITICAL INCIDENTS Any other incident deemed necessary by the contractor provider and/or MHASD staff. Any resident charged (new charges only) with an assault involving a weapon or serious bodily harm, sexually-related charges, such as, sexual assault, sexual abuse, rape, sodomy, etc. Any resident charged with an act of arson, or reasonable suspicion that a resident set fire/s that caused significant property damage or injury to self/others. Incident Reporting 12/2/2018

CRITICAL INCIDENTS Any stalking behavior by a resident.   Abuse allegations against agency personnel providing mental health services to residents living in a licensed residential facility. A suicide attempt or self-injury with significant intent to cause self-harm or death. In particular, those events that without medical/psychiatric care would result in impairment or death.  Incident Reporting 12/2/2018

CRITICAL INCIDENTS A medication error, which may result in a resident death, serious injury, or hospitalization. Police Intervention: Involvement by law enforcement personnel who enter a licensed mental health residential facility in response to a crisis call from the provider to control disruptive resident behavior. Incident Reporting 12/2/2018

Do’s And Don’ts For Incidents where the police are involved, for example; Director’s Custody, please note if they are being used for secure transportation and if the resident was cooperative. If the Police enter the facility to control disruptive resident behavior, please note this in your report, and check the “Yes” for the Critical Incident box. Incident Reporting 12/2/2018

Incident Reports Summary When in Doubt, fill one out. Always fill-out identifying information completely: not just first names, or part of facility names. Please include West, East, North, South, etc. Don’t delay submissions for Administrator’s comments past a week for regular IR and past the shift of the occurrence of Critical Incidents. Be sure to know what defines a Critical Incident. If using the County’s Template, Fax it in, DO NOT E-MAIL it in. Incident Reporting 12/2/2018

What does the County do with your Incident Reports? Residential Specialist Review Critical or Non-Critical? Problem Solving Quality Management Review If Critical; QM sets-up a Critical Incident Review (CIR) Data Entry Incident Reporting 12/2/2018

IR Database Analysis County Database Re-licensure May be used to focus on areas during inspection. Requests for data by Administrators Investigations Identification of trends Med Refusals vs Increase Behaviors Med Refusals vs Time of the year Incident Reporting 12/2/2018

County Data Analysis: Med Refusals vs Behaviors Incident Reporting 12/2/2018

Future Incident Reporting On-line, Secure Form currently being considered through Raintree. Wish list: Eventually, On-line IR and Administrator access to data regarding their facility to get immediate information regarding trends. Immediate data at the finger tips of Administrators and the County. Automated notification of the Residential Specialist and Quality Management Residential Licensing Specialist. Flexible Report Generation to identify specific trends. Incident Reporting 12/2/2018

Multnomah County – Residential Services Incident Report Incident:   Multnomah County – Residential Services Incident Report Incident: Any occurrence in or out of the residential facility that causes or could potentially cause harm to persons or property or violates rules/policies. Facility Name:_____________________________ Date of Incident: Time: ______AM / PM Resident Involved:_______________________ Age: _____ Staff: ______________________ Peers: Peer 1 Peer 2 Peer 3 Peer 4 (Attach peer IRs) ______________________ Persons Type of Incident Involved: Medication Incident Behavior/Health Incident Resident to Staff Wrong Drug Assault Clinical/Behavioral Change Resident to Resident Wrong Dose Drug/Alcohol Inappropriate Behavior Staff to Resident Wrong Time Contraband Medical Emergency Single Resident Med Refusal Elopement Property Harm/Theft/Loss Not Applicable Missed Med Fall Exploitation: Sexual Financial Other (Please explain) MAR Error Personal Injury Facility Incident / Other Incidents Med Count Discrepancy Self-Harm Unlocked doors/windows Adverse Reaction Threats/Intimidation Unsecured equipment/ supplies Other Med Error Medical Change Other Incident (Please explain below) Was anyone injured: yes no Who: ___________________________________ Describe incident:________________________________________________________________ ________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________ Action taken:___________________________________________________________________ ________________________ Who was notified: Administrator Case Manager Call Center County Residential Specialist Physician Family/Guardian 911 Non-Emergency Police County Adult Protective Services Other Staff Other (Name) __________________________________________________________________________________ Reporting Staff Signature: Date: ___________ Administrator Comments/Follow-up:_________________________________________________ _______________________ _________________________________________________________________________________________________________________________________________________________ __________________________________________________________ Administrator Signature: Date___________________ Sent to: ________________________________________________, RS at Mult. Co. on ___________________________________ Phone: (503) 988-5464 x ____________ Fax: (503) 988-3335 421 SW Oak, Suite 520, Portland, OR 97204 (ECMU Residents Only) Sent to: ___________________________________, ECMU contact at State on ______________________ Phone: (503) 945-9719 Fax: (503) 947-5546 500 Summer St NE E86, Salem, OR 97301 (PSRB Residents Only) Sent to: Mary Claire Buckley, PSRB contact at State on Phone: (503) 229-5596 Fax: (503) 229-5085 620 SW 5th Avenue, Suite 907, Portland OR 97204 Original: Facility File Copy: Consumer Chart Copy: Residential Specialist / ECMU / PSRB

The End Questions Hand-Out IR Examples Incident Reporting 12/2/2018