OTIS Abuse/Neglect Reporting

1. OTISAbuse/Neglect Reporting

2. OTIS Incident Report • OTIS (Online Tracking Incident System) is a web based application created by DHH. • Reports submitted via the internet to meet State and Federal reporting requirements; mandatory use since 5/1/09

3. DEFINITIONS • Abuse means the willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. (CMS) • Includes sexual abuse, sexual harassment, sexual coercion or sexual assault

4. DEFINITIONS • Abuse is the infliction of physical or mental injury or the causing of deterioration of a consumer by means including but not limited to sexual abuse, or exploitation of funds or other things of value to such an extent that his health or mental or emotional well-being is endangered. (Minimum Licensure)

5. DEFINITIONS • Physical abuse including hitting, slapping, pinching and kicking • Controlling behavior though corporal punishment • Mental abuse, including humiliation, harassment, threats of punishment or deprivation

6. DEFINITIONS • Verbal-use of oral, written or gestured language that willfully includes disparaging and derogatory terms to Residents or families, or within hearing distance, regardless of their age, ability to comprehend or disability (CMS)

7. DEFINITIONS • Involuntary seclusion is separation of a Resident from other Residents or from her/his room or confinement to her/his room (with or without roommates) against the Resident’s will, or the will of the Resident’s legal representative (CMS)

8. DEFINITIONS • Emergency or short term monitored separation from other Residents will not be considered involuntary seclusion and may be permitted if used for a limited period of time as a therapeutic intervention to reduce agitation until professional staff can develop a plan of care to meet the Resident’s needs.

9. DEFINITIONS • Willful means that the individual intended the action itself that he/she knew or should have known could cause physical harm, pain or mental anguish.

10. DEFINITIONS • Even though a Resident may have a cognitive impairment, he/she could still commit a willful act • There may still be instances when a Resident’s willful intent cannot be determined

11. DEFINITIONS • Neglect is the failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness. (CMS) • Neglect is the failure to provide the proper or necessary medical care, nutrition or other care necessary for a consumer’s well-being. (Minimum Licensure)

12. DEFINITIONS • Facilities should investigate Allegationsof Caregiver Neglect when altercations occur between Residents who are incapable of willful abuse • It is important that a facility take reasonable precautions, including providing adequate supervision when the risk of Resident-to-Resident altercations is identified

13. DEFINITIONS • Misappropriation of Resident Property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a Resident’s belongings or money without the Resident’s consent. (CMS)

14. Injury of Unknown Origin • Injuries of Unknown Origin must meet the following two criteria: • The source of the injury was not observed by any person or the source of the injury could not be explained by the Resident • The injury is suspicious because of the extent of the injury or the location of the injury (e.g.: the injury is located in an area not generally vulnerable to trauma) or the number of injuries observed at one particular point in time or the incidence of injuries over time

15. Injury of Unknown Origin • Major injuries of unknown origin (fractures, burns, suspicious contusions, head injuries, etc.) for which the facility is unable to determine the cause and could possibly be the result of abuse or neglect shall be reported (Minimum Licensure)

16. Injury of Unknown Origin • All other injuries not meeting the two conditions listed should be investigated by the facility and documentation of the investigation retained by the facility.

17. DEFINITIONS • Reporter is name of person who completed the incident report • Witness – person(s) who witnessed the incident • Discovered – date and time incident discovered by any facility staff or reported to any facility staff

18. DEFINITIONS • Substantiated – facility investigation established proof that Abuse, Neglect or Exploitation occurred • An incident should not be considered substantiated because you proved it really happened, but because your investigation provedthat Abuse, Neglect or Exploitation occurred

19. OTIS Reminder • If you substantiate Abuse or Neglect, you must show outcome to the Resident. • Outcomes include harm, pain or mental anguish • This should be included in the Summary.

20. DEFINITIONS • Unsubstantiated – facility investigation determined no Abuse/Neglect/Exploitation occurred • Unable to verify – facility investigation unable to determine Abuse/Neglect/Misappropriation occurred due to lack of information or evidence

21. What is Reportable in OTIS ? • Incidents that meet the definition of Abuse, Neglect, Misappropriation or Injury of Unknown Origin • Incidents must have been “willful and/or deliberate” andhave caused harm to be considered Abuse or Neglect

22. What Is Not Reportable in OTIS • Resident to staff incidents • Local authorities • Internal investigation and documentation

23. Reporting Requirements • Initial report must be input in the OTIS system within 24 hours. 24 hours means 24 hours, not 1 business day • Report must be complete within 5 business days • Automatic email notifications of incomplete reports being sent

24. OTIS Reminders • The 24 hour reporting requirement is not met by accessing the system and creating a “placeholder” with little or no information; this may result in surveyors citing a tag • Minimum information required: • Victim • Accused/Allegation/Incident Category • Statement describing allegation/s in Description • Date discovered in facility

25. OTIS Reminders • Reporter • Name of the person who completed the facility incident report. • May be different than the person who is actually entering the data in the OTIS system. • Witness • Person or persons who witnessed the incident. Can be a staff member, a Resident, a family member, etc. • Other Contacts • May be entered as desired

26. OTIS Reminders • Verbal abuse = Abuse: Emotional • Description = brief statement describing the incident

27. OTIS Reminders • Summary • Include details about your investigation and findings • Investigation findings should logically show how you made the decision whether the Allegations were substantiated, unsubstantiated or unable to verify.

28. OTIS Reminders • Summary • Must show what measures have been put in place to ensure this incident doesn’t reoccur • Include information about inservice or other trainings, new policies and procedures, etc. • Include information about what is being done facility-wide to protect Residents • Include information about what you did to resolve the incident, such as reimburse Resident • Include information about the final disposition of the Victim and the Accused; ex: moved Victim, trained or terminated Accused, etc.

29. OTIS Reminders • When typing in Description or Summary, do not use all caps • If facility substantiates Abuse/Neglect/Financial Exploitation by a CNA, this should be included on the NAT-7 Employment/Termination form and mailed to the CNA Registry within 5 working days. This and the OTIS report meet the facility’s reporting requirements

30. OTIS Reminders • Date and time format • 1/5/2010; 3:51pm (no “0” in front of time) • Incident Category used only in cases of: (otherwise should be left blank) • Death w/restraints/seclusion • Injury of unknown origin • Remove Injury of Unknown Origin when Accused is discovered or Abuse is suspected/investigated

31. OTIS Reminders • Correct DOB, SSN for Accused • Last known address of Accused staff, not facility address • First name of Accused and Victim in correct box

32. OTIS Reminders • Protective Actions • Be sure to give yourself credit for everything you did to protect the Resident. Include all Protective Actions, whether they be for the Resident Victim or the Accused. • Resident Accused – “moved out of client care” is not an appropriate protective action. If the Resident has to be moved, you would choose “relocated”

33. OTIS Reminders • Complete “Protective Action” box with final disposition of Accused and Victim • Unknown Accused = unknown, unknown • Relationship = other, client or staff • Staff = facility address, title, SSN

34. OTIS Reminders • Input of “facility/CEO finding” locks report so always input that data last • Report unlocked by Program Manager at State Office; fax request on letterhead, signed by Administrator

35. OTIS Reminders • “Facility/CEO finding” should be the same as the Allegation findings • If one or more Allegations are substantiated, the “Facility/CEO finding” is substantiated

36. OTIS Reminders • Printing the Complete Report • Click on the print button in any screen except the Case Notes screen • Click “Select a format” and highlight “Acrobat (PDF) file” • Click Export • Click Open • Click printer picture at top left under File • Click OK at bottom right

37. OTIS Reminders • Many blank reports are being created • To Create A New OTIS Report: • Click “New Incident” • Left click “Save new incident” • These 2 actions will result in the creation of a new incident number • To Open a Previously Created OTIS Report • Log into system • Enter previously created number into empty box • Click on “GO”

38. PM OTIS Responsibilities • Review all OTIS reports • Determination is made after reviewing OTIS reports whether an on-site investigation is warranted • Referral may be made to local Sheriff’s Office, CNA Registry, Professional Board or Nursing Home Complaint Desk

39. Clinical/Forensic Markers • Most common nonaccidental injuries are the face and neck, chest wall, abdomen and buttocks • Injuries suggestive of defensive maneuvering: • Back of arms and hands • Injuries related to grasping, squeezing or forcible restraint • Color is helpful in dating bruises

40. Fractures • 50% of nursing home Residents fall • Spontaneous fractures • Vertebral fractures in osteoporotic women • Hip fractures • Prolonged bed rest, chronic limb paralysis, non-weight bearing status increase risk for spontaneous fractures (Kane and Goodwin, 1991)

41. Fractures • Fractures of the head, spine and trunk are more likely to be assault injuries than limb fractures, sprains or musculoskeletal injuries (Fanslow et al, 1998) • Spiral fractures of large bones with no history of gross injury diagnostic of abuse • Fractures with rotational component diagnostic of abuse (Medical Tribune, 1995)

42. Trauma • Accidental trauma is usually distal: knees, chins, fingers, toes • Abusive trauma usually midline and proximal • Sexual trauma: face, neck, arm, chest, breast, back and buttocks (Daniel J. Sheridan, PhD, RN)

43. Medications • Aspirin, Warfarin, Ibuprofen, Celebrex, Ketorolac, Heparin, Depakote, Valproic Acid, Prednisone, Plavix • Supplements: Bilberry, Garlic, Ginger, Ginko, Vitamin E and Fish Oil

44. Dementia • Dementia present in 15% over age 65, 50% over age 80 (Abrams et al, 1995) • Dementia noted in 51% of abused/neglected patients • Dementia noted in 30% of patients referred for other reasons

45. Depression • Affects from 15-50% of elderly • Institutionalized elders and those with medical illness have highest incidences of depression, which can be as high as 70% following a stroke • 62% of neglected or abused patients had depressions compared with 12% referred for other reasons

46. Psychosis • Elderly with depression more prone to psychosis (Abrams et al, 1995) • 4-5% of elderly experience psychosis (Abrams etal, 1995)

47. Alcohol Abuse • Present in up to 5% of older persons • More common in men than in women

48. Sexual Abuse • 75-77% of Sexual Abuse victims have cognitive impairment and 67-92% have functional limitations • 72% of elder abuse victims did not complain of the abuse at the time of presentation to an emergency center

49. OTIS User Guide OTIS User Guide can be downloaded at: http://www.dhh.louisiana.gov/offices/publications.asp?ID=112&Detail=171

50. Contact Information • Denise Traylor, BSN, RN • LTC Abuse/Neglect Program Manager • DHH/Health Standards Section • 500 Laurel St., Suite 100 • Baton Rouge, La.  70801-1811 • 225-342-7715 phone • 225-342-0453 fax • Denise.Traylor@LA.GOV • http://www.dhh.louisiana.gov/offices/?ID=112