1. INCIDENT REPORTING

2. INCIDENT REPORTING What is an Incident?
An “Incident” is an unexpected event that causes an adverse or potentially adverse outcome.
Examples:
Vehicle accidents, injuries, property damage, break ins, medication reactions, clients going AWOL/LACA, unknown substance, fire, violence, self harm, clients sexually acting out, etc.
Vehicle Accidents
Client Injuries
Illness or injury of a person requiring hospitalization
Illness or injury of staff related to or occurring at work
Staff member or visitor death on agency property
Property Damage
Collateral Injuries (visitors, volunteers)
Security Breaches
System Failures
Adverse Medication Reactions
Suicidal attempt/gesture
Client self-harm
Assault of a client
Any act of violence
Clients leaving treatment against clinical advice
Need for interpretation services that are not readily available
Evacuations
Fires or natural disasters
Hazardous materials events
Potential media events involving persons related to the agency
Sexual intercourse/oral sex/penetrative sexual acts
Abuse of a person receiving services
Neglect of a person receiving services
Unknown Substance in Facility
Client Illicit Substance Use During Treatment
Trained staff use of Safety Hug physical restraint on a child

3. INCIDENT PROCEDURE Who Initiates? What do I do?
Anyone Involved or Witnessing
What do I do?
Protect Health & Safety (Emergency response 911 if necessary)
IMMEDIATELY contact supervisor and start phone tree!
IMMEDIATELY fill out incident report
Where is the incident report?
Red Binder
Staff Office
Network Drive (L & N Forms, Desktop)
Then What?
GIVE TO SUPERVISOR IMMEDIATELY!
Supervisor Responsibilities
Oversee notification of relevant parties, review completed report and forward to Admin within one business day.
Supervisor Responsibility
Following notification, immediately notify next level of call tree based on severity.
Oversee notification of other relevant parties within the required timeframes, such as family members, guardians, caseworkers, legal contacts, Office of Licensing, etc.
Review incident report to ensure required components are present and thorough.
Review actions taken and debrief with staff member as necessary.
Forward report to Administration within one business day.
Ensure original complete, signed report is placed in client file.
Participate in Performance Improvement activities as indicated.
Complete follow-up report to document Performance Improvement activities.

4. INCIDENT REPORT FORM New & Improved!! Who fills one out?
EVERY PERSON involved or witnessing
How do I find one?
Network drive or red binder
When?
Immediately
Where does it go?
Staff: To immediate supervisor
Supervisors: To Admin

5. ASSESSING RISK SECTION
POTENTIAL FUTURE RISK
Potential (P) 3
Consequence (C) 2
Risk (PxC)= 6
Potential
Consequence
Grading 5
Almost Certain to reoccur
Extreme (death, closure, media attention, huge financial loss)
15-25
Extreme Risk: Urgent action 4
Likely to reoccur
Very high (permanent injury, closure, major financial loss)
8-12
High Risk: Action planned and implemented within 1 month.
Might reoccur
Medium (injury, illness, service disruption, financial loss)
4-6
Medium Risk: Action planned and implemented within 3 months.
Slightly likely to reoccur
Low (minor injury, little disruption, little financial loss)
1-3
Low Risk: Action planned in 3 mo. Reviewed in 1 yr. 1
Not likely to reoccur
Negligible (very minor injury, no disruption, slight financial loss)
Assess potential risk (P) in yellow field and assign a number to the yellow box.
Assess consequence (C) in blue field and assign a number to the blue box.
Multiply both P and C numbers together and put in green box.

6. SENTINEL EVENTS What is a Sentinel Event? Examples
A “Sentinel Event” is an unexpected occurrence involving client death or serious physical or psychological injury, or the risk thereof.
Signal the need for immediate investigation and response
Examples
Unanticipated client death, loss of limb, or major loss of function, sexual assault, client abduction, medication error, suicide, etc.
Sentinel Event Examples:
An event is reportable as a sentinel event under the following conditions:
Unanticipated death, including suicide.
Loss of limb.
Major permanent loss of use of limb function or other function.
Sexual Assault of a client by another client, staff member, or other perpetrator.
Any client death, paralysis, coma or other major permanent loss of function associated with a medication error.
Any death, suicide, or major loss of function of any patient receiving care, treatment and services in a staffed around-the-clock care setting or within 72 hours of discharge.
Abduction of any client receiving care, treatment, and services.
Any elopement, i.e., unauthorized departure, of a client from an around- the-clock care setting resulting in a temporally related death (suicide or homicide) or major permanent loss of function within 72 hours of elopement.
Assault, homicide or other crime resulting in client death or major permanent loss of use of limb function or other function.
Adverse outcomes that are directly related to the natural course of the client’s illness or underlying condition are exempt from the reporting requirement.

7. SENTINEL EVENT PROCEDURE
Who Initiates?
Everyone Involved or Witnessing
What do I do?
Immediately ensure client is receiving proper medical care
Remove all clients from area
IMMEDIATELY contact supervisor and start phone tree!
IMMEDIATELY fill out incident report
Give completed report to supervisor
Supervisor Responsibilities
Oversee notification of relevant parties, review completed report and forward to Admin immediately.
Supervisor Responsibility
Review incident report.
Discuss actions with staff as necessary.
Remind staff of the confidentiality surrounding the event and the clients involved.
Make any additional notifications necessary.
Distribution of Report
Copy to Program Director Immediately
Program Director will forward form to Director of Operations immediately.
If a client is involved
Copy to Clinical Director
Original form to Clients folder
A copy to client’s assigned workers (P.O., Caseworker, Juvenile Court, etc.)

8. RISK REPORTING What is Risk? What is Risk Management? Examples
“Risk” is the potential for future suffering from harm, loss, or danger.
What is Risk Management?
Procedures and practices involved in the identification, analysis, control, and minimization of risks.
Examples
Anything you believe is a risk to client and staff safety.

10. RISK REPORTING PROCEDURE
Who Initiates?
Anyone Involved or Witnessing
What do I do?
Fill out risk report form before end of shift if you are unable to fix risk yourself.
Where?
Red Binder
Staff Office
Network Drives L, K, & N in form folders.
Then What?
Give to Supervisor within one business day
Supervisor Responsibility
Review form and actions taken, forward to Admin within one business day.
Supervisor Responsibility
Following notification, immediately notify next level of call tree based on severity.
Review risk report to ensure required components are present and thorough.
Review actions taken and debrief with staff member as necessary.
Forward report to Administration Office Manager within one business day.
Participate in Performance Improvement activities as indicated.
Complete follow-up report to document Performance Improvement activities.

12. RISK REPORT EXAMPLES