INCIDENT REPORTING

1. INCIDENT REPORTING Updated 8-24-2018

2. BEGINNING OF THE PRESENTATION • The Incident Reporting Training will be easier to follow if you have a copy of the Agency Incident, Death and GA DCA/HCFR (used in DD & SA) Reports in front of you.

3. INCIDENT REPORTING FORMS • Agency Incident Report • Death Report Form • GA DCA/HCFR Incident • Medication Error Report (see Policy 8052 for form) sent to the Director of Nursing, at the Behavioral Health Crisis Center

4. HIGH PRIORITY • All incident forms written in the Agency, must have all areas, lines, check boxes and questions filled out completely. Please make sure the site and your title are included.

5. REPORTING OF INCIDENTS • Steps It is the responsibility of the staff that is involved in, informed of, or who witnesses an incident to do the following:

6. REPORTING OF INCIDENTS • Complete the password protected incident report and email the report to Incidentreports@cobbcsb.com, copying your supervisor on the email, within 2hours. All reports, Agency Incident Report, Death Report and the Safety Plan, must be received within 2 hours, especially the Death Report. NO EXCEPTIONS!!!!Notify the Client Rights Representative (CRR) of all deaths by phone, immediately, when notified of the death.

7. REPORTING OF AGENCY INCIDENTS • Report incidents within 15 minutes, or as soon as safely possible, by phone, to the Site Supervisor if the incident falls into Sections 1, 2, or 3 on page 2 of the Agency Incident Report. • If the incident involves individuals we are serving, record the event in the Clinical Record.

8. REPORTING OF AGENCY INCIDENTS • If the incident involves a CSB staff injury, the Site Supervisor MUST place a call to DOAS at 1-877-656-7475 reporting the incident within 4 hours for Workers’ Compensation processing. • Incident reports are confidential regardless if it involves an individual or an employee.

9. INVOLVED PERSONS • The Individual’s information is located in CareLogic (CL) on the program history page (Client, ECR, Program History) for the Agency services the client is enrolled in along with the admission dates. Page 1 of Agency Incident Report

10. INVOLVED PERSONS • Be sure to include the actual client’s identification number (CID#), not the CareLogic (CL) ID # after the client’s name. • Be sure all the witnesses/staff/other names are written on the Agency Incident Report. Page 1 of Agency Incident Report

11. TYPES OF INCIDENTS Behaviors: Such incidents would be verbal altercations, fighting, using drugs or alcohol, threatening remarks, etc. Page 2 of Agency Incident Report

12. TYPES OF INCIDENTS Damage: Property - Incidents involving damage to walls, doors, windows, furniture, computers, and other agency items. Page 2 of Agency Incident Report

13. TYPES OF INCIDENTS Damage: Vehicle - This includes all state vehicles and personal vehicles used to transport clients during working hours. Page 2 of Agency Incident Report

14. TYPES OF INCIDENTS Infection /Contagious Disease: Illnesses including potential communicable disease, food borne illness, positive Tuberculin skin tests. Reportable diseases required by state law will be reported to the public health department by the program nurses. Page 2 of Agency Incident Report

15. TYPES OF INCIDENTS Injury – Be sure to describe and give size of any cuts, scratches, marks or bruises, relating to the incident/accident. AMA: Discharge against medical advice. AWOL: Absent without leave. more than one can be recorded on a the incident report. Page 2 of Agency Incident Report

16. TYPES OF INCIDENTS Seclusion and Restraint - BHCC is the only program that is authorized to do Seclusion and Restraints and onsite staff is specially trained. Any injury requiring medical care during the time a client is in seclusion also requires a Incident Report. Page 2 of Agency Incident Report

17. NON-VIOLENT PRACTICES Non-Violent Practices (CPI). An Incident Report is required for any CPI techniques used, other than verbal de-escalation. Page 2 of Agency Incident Report

18. TYPES OF INCIDENTS Property Loss: Loss of Agency property anywhere, personal losses of clients, staff and visitors while at program sites, in state vehicles and/or in personal vehicles during transportation. Page 2 of Agency Incident Report

19. DESCRIPTION OF INCIDENT • Write only what happened or what was reported to you. This can be written in one to two descriptive sentences. • What actions you took can be written as first step, second step, etc. • NO OPINIONS! Page 3 of Agency Incident Report

20. DEBRIEFING • Only fill out the debriefing area if you had to discuss feelings with a client or clients due to the sensitivity of the incident involved. Page 3 of Agency Incident Report

21. SIGNATURE • In the signature area be sure you have written your name, title and a working phone number. Page 3 of Agency Incident Report

22. SUMMARY PAGE cont’d • The Client Rights Representative will make note if the IR was submitted on time, completed correctly or incomplete. If corrections are needed the CRR will request specific changes to be made within 24 hrs. Page 3 of Agency Incident Report

23. WORKERS COMPENSATION If the incident involves a CSB staff injury that requires more than first aid, the Site Supervisor MUST place a call to DOAS 1-877-656-7475 reporting the incident within 24 hours for Workers’ Compensation processing. Copy Bridget Tolbert btolbert@cobbcsb.com when emailing the form to incidentreports@cobbcsb.com

24. CONFIDENTIALITY All Incident Reports are confidential. When sending incident reports make sure you are using the password protected form located on the Agency’s website under documents. The password is Cobbcsb3830. Also make sure to include your full name, title and Agency location in the email.

25. Critical Incidents Reported to DBHDD • See Attachment A to the policy for the DBHDD Critical Incident definitions.

26. Safety Plan Form • Agency Incident, pg. 4 and Death Report, pg. 3, require a Safety Plan form to be completed. A Safety Plan MUST be completed for all incidents, NO EXCEPTIONS! • Remember, this Safety Plan does not replace the Client’s Safety/Crisis plan entered into CareLogic. • Safety/Crisis Plans in CareLogic should be updated as needed!

27. DBHDD DEATH REPORT FORM – page 1 1. Date of Death 2. Date of Discovery of Death 2. Time of Death 3. Provider reporting death (our agency) 4. Region # - The agencies are in located in Region 1

28. DBHDD DEATH REPORT FORM – page 1 5. Person completing report 6. Contact person and contact person’s number 7. Name of site where the death occured (Hospital, PCH etc). 8. Check program type

29. DBHDD DEATH REPORT FORM Page 1Individual (Client) Information • Name, DOB , Age at time of death, Sex • Address • Medicaid Waiver, ClD/MHID #, SSN, Race

30. DBHDD DEATH REPORT FORM Page 1Individual (Client) Information • Admission Date, Disability, check box • Agency services in which client was enrolled. (Go to Program History in EMR) • How was death discovered • Date of last contact (any staff), reason for contact.

31. DBHDD DEATH REPORT FORM Page 1Medical History • Only check history [cancer, hypertension, diabetes, etc.] if it is verified in the client’s record by a physician. • Or if the client reported any of the medical factors - then document on form “as reported by client”. • Never check anything that can not be verified in the chart.

32. DBHDD DEATH REPORT FORM –Page 1 • Autopsy- ordered yes or no? Many times it is unknown if there will be an autopsy. If there is going to be an autopsy please ask the family to send a report of the findings to the Agency. • If not ordered, state reason. • Cause of death, when known. • Unusual circumstances?

33. DBHDD DEATH REPORT FORM– Page 2 • Any medication that the client has been given one week prior to the death and up to the death should be recorded on the CIR. • If dose, route and frequency is known please fill in that information.

34. DBHDD DEATH REPORT FORM– Page 2 • Category of Death. • Brief description. What is needed in the brief description: • What - what happened • Who - persons involved • Where - place and location • When - date and time • How - what factors caused the death.

35. DBHDD DEATH REPORT FORM– Page 2 • Notifications - This area is decided by the site supervisor or site director. Several programs must follow regulations and standards from other regulatory organizations and it will be the duty of the Supervisor or Director to follow up.

36. Safety Plan Form • A Safety plan must be completed for all Death Reports. • Remember, this does not replace the Client’s Safety/Crisis plan entered into CareLogic. • Plans in CareLogic should be updated as needed!

37. GA DCA/HCF Incident Report For clients enrolled in the Developmental Disability and/or any Substance Abuse residential programs the following incidents must be reported to the GA Dept. of Community Health, Healthcare Facility Regulation Division using their form: • Death • Accident or injury requiring medical treatment and/or hospitalization

38. GA DCA/HCF Incident • Emergency safety intervention resulting in injuring of patient requiring medical treatment beyond first aid • Incident that resulted in any federal, state or private legal action by or against the facility which affects any child or the conduct of the facility.

39. GA DCA/HCF Incident Form – page 1 • Facility Information – Make sure all information is completed. The facilities that are licensed by Healthcare Facilities Regulation will have their licenses posted and the License number can be found there • Incident Reporting - Make sure all information is completed.

40. GA DCA/HCF Incident Form – page 1 Type of Incident – check those that apply Brief description should include: • What - what happened • Who - persons involved • Where - place and location • When - date and time • How - what factors caused the incident. • NO OPINIONS!

41. GA DCA/HCF Incident Report- page 2 • Immediate corrective or safety/prevention plan – again be brief • Name of staff/or clients involved or witnesses • Who else was notified? • Acknowledgment of Information reported: DO NOT SIGN! The Client Rights representative will complete and sign the formal report.

42. DEATHS/HCFR Form • Deaths Reports and HCFR reports must be reported to the Client Rights Representative within 2 hours of the staff’s notification of the death. • The Client Rights Representative must be called immediately by staff on notification of death.

43. REMEMBER • ALL incidents that are outside of the ordinary must have an Agency Incident Report completed. • ALL incident reports should be done immediately after the incident. • Supervisors, when changes/corrections are needed and/or the staff is not available it is your responsibility to make the needed changes/corrections and re-submit the report by the close of business on the day the changes/corrections were requested.