HCSIS INCIDENT REPORTING

1. HCSIS INCIDENT REPORTING Changes and Updates

2. GOALS FOR TODAY • Review incident: • Category changes • Definition changes • Clarifications

3. CHANGES TAKE AFFECT • Friday evening, June 21, 2013

4. HANDOUTS FOR TODAY • Revised incident categories • Revised incident guidelines • SBI decision tree • Change document • Fact sheet • Power Point

5. YOUR ROLE • Take back information provided here and training staff at your agency or area office

6. HISTORY • System begun in 2005 • Last updated content training in 2008 • Changes made but no content training since 2008 • Ongoing system use training provided

7. HISTORY, cont. • Continued review on how we can improve the system • IR “look behind” of key categories • Standards Group

8. DOCUMENTS ON WEB • All documents handed out today • In addition: • Revised incident report - individual & site based 2013 • Revised incident report instructions – individual & site based 2013 • Incident Management Category Changes Summary, 2008

9. WHY MAKE CHANGES? CONSISTENT INFORMATION IMPORTANT IN ORDER TO: • identify events in people’s lives • Collect and analyze information about • Individuals • Services • Providers • Overall system • Identify patterns and trends for service improvement

10. WHY MAKE CHANGES? cont. • Concern about consistent categorization • Concern about which incidents were being escalated for broader review

11. REVIEW OF DATA • Statewide “look behind” review of incident categories for: • Significant Behavioral Incidents • Physical Altercation • Mistreatment • Inappropriate Sexual Behavior • Other • Site Based Incidents • Psychiatric Evaluation/Hospitalization • Major incidents

12. PURPOSE OF REVIEW • Is categorization correct? • Are incidents escalated when required? • Determine incidents to be forwarded to Commissioner and Senior Management

13. RESULTS OF REVIEW • Lack of consistency in categorization of: • Significant Behavioral Incidents • Physical Altercation • Hospital Visits

14. ISSUES IN REPORTING • Escalation from minor to major • Use of site based incidents • Use of “other” category • Mistreatment and caretaker role

15. MAKING DECISIONS FOR CHANGES • Proposed changes reviewed by HCSIS Standards Group comprised of DDS and provider representatives • Reviewed by key people within DDS

16. CHOOSING A CATEGORY • Eliminating category hierarchy • Category definitions refined • Choose category that fits most serious component of event.

17. SIGNIFICANT BEHAVIORAL INCIDENTS VS. PHYSICAL ALTERCATION • Categories often difficult to distinguish • Examples: • AB ran out of program with staff following. Attempted to strike staff and community witness called police. Police arrested AB and held him for bail. Category: Physical Altercation

18. SIGNIFICANT BEHAVIORAL INCIDENTS VS. PHYSICAL ALTERCATION Cont. • AB became angry at his housemate, punched him in the face causing a bloody nose Category: Significant Behavioral Incident

19. SIGNIFICANT BEHAVIORAL INCIDENTS VS. PHYSICAL ALTERCATION Cont. • SOLUTION: • ELIMINATE PHYSICAL ALTERCATION, PERPETRATOR, CATEGORY • EXPAND SIGNIFICANT BEHAVIORAL INCIDENT TO INCLUDE THE PERPETRATOR OF PHYSICAL ALTERCATION

20. SIGNIFICANT BEHAVIORAL INCIDENTS • SECONDARY CATEGORIES OF “INCLUDES PHYSICAL ALTERCATION” AND “DOES NOT INCLUDE PHYSICAL ALTERCATION.” • ADDED QUESTIONS FOR PHYSICAL ALTERCATION OF WHO THIS INVOLVED AND IF THERE IS AN INJURY

21. PHYSICAL ALTERCATION • Limited physical altercation category only for victim when the victim and perpetrator are both individuals receiving DDS services • Threshold is different for “victim of physical altercation” and “significant behavioral incident”

22. SIGNIFICANT BEHAVIORAL INCIDENT • Victim of Physical Altercation incident will not always have corresponding significant behavioral incident incident report for perpetrator when: • Incident occurs at program site • Police are not involved

23. SIGNIFICANT BEHAVIORAL INCIDENTS, cont. • No corresponding incident report, cont. • No injury requiring medical intervention • Does not otherwise meet threshold for significant behavioral incident

24. HOSPITAL VISITS • Hospital visit category “trumps” all other categories (except suicide attempt and death) if the individual goes to the hospital • Reporter must answer question for reason for hospital visit.

25. HOSPITAL VISITS – cont. • Choices for the reason for hospital visit include all incident categories except suicide attempt and death. • Choices also include near drowning, injury, illness, other, and unknown

26. HOSPITAL VISITS – cont. • Importance of Reason for Visit • Allows for identification of precipitating incident category • Automatically escalates to “major” specific reasons for visit • Incident categories automatically escalated • Physical Altercation • Significant behavioral incident

27. HOSPITAL VISITS – cont. • Identification of reason for visit • Use existing incident category, if appropriate • Use injury or illness for potential injury/illness (ingestion of non-food item) • Use other only after fully exploring other existing options

28. MEDICAL INTERVENTION NOT REQUIRING A HOSPITAL VISIT • Definition expanded to include ingestion of non-food item not requiring hospital visit • Ingestion should be discussed with Poison Control and/or medical personnel

29. ESCALATION MINOR TO MAJOR • Suspected mistreatment with life threatening injury or medical condition • Suspected mistreatment with serious personal or public safety risk • Potential for negative community impact • System generated escalation

30. ESCALATION MINOR TO MAJOR Cont. Change in Expectation Any incident with police involvement in any capacity – escalation by AO Any incident involving ingestion of a non-food item – escalation by AO

31. SITE BASED INCIDENTS • Appropriate when: • Involves more than one individual • Impact for all individuals involved identical

32. SITE BASED INCIDENTS, cont. • Appropriate when, cont. • Falls within categories of: • Fire (must be separate incident if individual started fire) • Suspected mistreatment alleged omission • Transportation accident • Emergency relocation • Other

33. SITE BASED INCIDENTS, cont. • Inappropriate when: • Involves only one individual • Impact for all individuals is not identical • Incident involves actual or potential injury or illness

34. SITE BASED INCIDENTS, cont. • Examples of site based incidents received • Individual ingests a non-edible item. Is monitored by provider but not seen at a hospital. Categorized as site based “other” incident.

35. SITE BASED INCIDENTS, cont. • Examples, cont. • While cooking, individual leaves plastic plate in oven which begins to smoke. When removed from oven, plate catches fire. Fire department is contacted and individuals are escorted from the house. Categorized as site based, “fire, not started by individual.”

36. SITE BASED INCIDENTS, cont. • EXAMPLES, cont. • Individual exhibits aggressive behavior towards staff and peers, requiring restraint. Categorized as site based “other.”

37. FIRE • Expansion of definition • Current definition only includes presence of fire • Definition now expanded to include unexpected sounding of smoke or carbon monoxide detectors, requiring emergency evacuation.

38. MISTREATMENT • Mistreatment and Caretaker Role • Category is only used if perpetrator is a caretaker of the individual • Category is not appropriate if abuse is by a stranger or by someone other than a caretaker (boyfriend/girlfriend). • Appropriate category in this situation would typically be victim of “other criminal activity” or “theft”

39. OTHER • Category of “other” • Count of incidents for calendar year 2012 • Unexpected Hospital Visits 9961 • Physical Altercations 2716 • Significant Behavioral Incidents 1593 • Other 1309

40. OTHER, cont. • Findings in review of “other” category • Some do not rise to level of incident • Some fit into another category • Some indicated the need to revise category definitions

41. OTHER, cont. • A few are reportable and fit in “other” • Example: • Staff comes to work intoxicated and is immediately relieved of duty. Staffing numbers are maintained. • Neighbor complains to police that individuals in the home are too noisy

42. NEW DOCUMENTS/TOOLS • Decision Tree for determining whether an event rises to the level of a significant behavioral incident. • Fact Sheet which clarifies areas of confusion and changes

43. NEW DOCUMENTS/TOOLS, cont. • Revised and reformatted document of incident categories and definitions • Revised guidelines • Revised incident report and instructions • Chart for current changes

44. COMING ATTRACTIONS • Development of Power Point to train all new incident reporters and incident reviewers in incident reporting content • Interested in helping to develop, contact connie.lehr@state.ma.us • Power Point will be on the DDS Website

45. QUESTIONS?