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

2. 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

3. 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

4. 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

5. 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

6. 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

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

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

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

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

11. 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

12. 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 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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 it in.
Incident Reporting
12/2/2018

20. 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

21. 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

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

23. 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

24. 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 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) x ____________ Fax: (503) SW Oak, Suite 520, Portland, OR 97204
(ECMU Residents Only) Sent to: ___________________________________, ECMU contact at State on ______________________
Phone: (503) Fax: (503) Summer St NE E86, Salem, OR 97301
(PSRB Residents Only) Sent to: Mary Claire Buckley, PSRB contact at State on
Phone: (503) Fax: (503) SW 5th Avenue, Suite 907, Portland OR 97204
Original: Facility File Copy: Consumer Chart Copy: Residential Specialist / ECMU / PSRB

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