1. Beaver County System of Care
Incident Reporting

2. Overview Reasons for Reporting – why it’s important
Two different reporting systems
Managed Care Organization – MCO
Adverse
Critical
BC Critical Incident system – all residents
Early Warning
Frequently asked questions
Helpful hints
Communication

3. Reason for Reporting: Why it’s important
Continuous Quality Improvement
Identification of trends and/or improvement opportunities
prevent future incidents
Improve system functioning
Monitoring to ensure member safety and high quality services
increase opportunities for intervention
Because it is required.

4. Reporting Systems: MCO
Staff serving MCO Members only:
When do I report?
Within the next business day from the incident date.
Where can I find the reporting form?
Critical Incident Log is located under Quality Management Forms at
How do I report?
Risk Management Fax:
Risk Management (encrypted only):
Contact Quality Management Staff:
Nicole Brown

5. Critical Incident/Quality of Care Log
Reporting Form: MCO
Critical Incident/Quality of Care Log
VBH Risk Management Fax Encrypted
Critical Incident Provider Preventable Condition Quality of Care
Date Received:
     
Date of Incident:
Date of Log:
Reporter Information: Incident Reported By: Provider VBH-PA Staff Other
Reporting Staff Name:
Provider Name:
Provider Phone:
Provider Address:
Member Information
MAID #:
First Name
Last Name
Date of Birth
Age
County:
MH Diagnosis:
D&A Diagnosis:
Medical Conditions:
Provider and Level of Care at time of incident: (if same as reporting provider, please note as “same”)
Incident Code:      
Please provide a brief description of incident:
Name of VBH-PA staff person accepting incident report: *****
Risk Management Information
Faxed ( ):     
Entered:     
Comments:

6. MCO Reportable Incidents:
Suicide/attempted suicide
Homicide/attempted homicide
Death
Allegations of sexual/physical abuse
Assault
Absent w/out leave with or w/out risk to self/others
Undesirable events inconsistent with routine patient care
Breach of confidentiality
Parent/guardian taking child AMA – Against Medical Advice
Accidental injury
Medication/Treatment errors
Adverse reaction to medication/treatment
Fire setting/property damage
Temporary closure of a facility
Possession of a deadly weapon
Outbreak of a serious communicable disease
Other
Administrative Discharge
Any real or threatened litigation in a case

7. Reporting Systems: Beaver County
Staff serving all Beaver County residents:
When do I report?
Within the next business day of the incident date.
Where can I find the reporting form?
BC Critical Incident Reporting form is located at
How do I report?
Send all incidents to BCBH on the BC Reporting Form via fax:
To: Elisia Majors & Stephanie Santoro
Fax:

8. Beaver County Behavioral Health Reportable Incidents:
Critical Incidents:
CRIT - Abuse - Physical/Sexual CRIT - Outbreak of Contagious Disease
CRIT - Apparent Homicide By Client CRIT – Overdose
CRIT – Arrest CRIT - Serious Assault
CRIT - Attempted Suicide CRIT - Suicide
CRIT - Client Injury - Accident/Intentional
CRIT - Client Injury - Restraint/Seclusion
CRIT - Community Hosp - Involuntary (302)
CRIT - Community Hosp - Voluntary (201)
CRIT – Death
CRIT - Failure to Follow Duty to Warn
CRIT – Fire
CRIT - Hospitalization – SMH*
CRIT - Medical Hospitalization
CRIT - Medical Tx Error
CRIT - Missing Person
CRIT - Misuse of Client Funds
CRIT - Other Incident-Serious Nature
*admission to a state hospital

9. Beaver County Behavioral Health Reportable Incidents:
Early Warning Incidents:
EW – AMA – Against Medical Advice
EW - Attempts At Elopement
EW - Atypical Behavior - Change From Baseline
EW - Complaints - Property Destruction/Eviction
EW - Consumer Not Responding to Contact
EW - E/R Visit - Behavioral/Physical Health
EW - Inability to Locate Consumer
EW - Indications For Increased Service/Supports
EW - Police Involvement
EW - Refusal to Take Medications Posing Risk
EW - Sleep Pattern Change From Baseline
EW - Unexcused Missed Appts - Provider

10. BC Incident Reporting Form

11. Frequently Asked Questions:
When should I report?
Within the next business day of an incident. Follow up later if more information is available.
Who should report?
All providers serving Beaver County residents.
Do I have to complete all the fields?
Yes. This helps us identify the person in the system.
Should a supervisor review the incident report before sending it to the county?
Yes. This will ensure it is complete, legible and tells what happened.
Who can I contact with questions or to get forms?
Elisia Majors or Stephanie Santoro

12. Helpful Hints: Type or print legibly.
The date of the incident is the date the incident started.
An incident might cover several dates. Use the start date but include the details and additional dates in the body of the report.
Choosing a category:
What take highest priority? - use your best judgement*
Not sure, talk to your supervisor - Call Elisia or Stephanie
Include the symptoms that lead to an ER visit and/or inpatient behavioral health admission
What happened? Don’t leave the reader wondering.
Hospital is not a type of housing
Use relationships not names. (other than the member’s name)
*Phone number is the number of the provider/program where supervisor/staff can be reached to answer any questions.

13. Communication: Why is communication so important? Continuity
Many people are served by multiple systems and levels of care.
Talk to each other about the individual, incidents and reporting requirements.
Can’t report on time?
Talk to the county. Make them aware of the incident and obstacles to reporting. They will work with you.

14. THANK YOU You have completed the Incident Reporting protocol.
Please take the test!
You will get a certificate once you have completed all the competencies and passed with 90% or better.
The certificate will generate on its own.
Print it.
Give it to your supervisor