Critical Incident Reporting

1. Critical Incident Reporting Western Highlands Network June 2007

2. Incidents • Know when an event is considered an “incident” • Know agency policy/procedure to deal with incidents and follow up • Know what types of incidents require reports to the LME and/or State agencies • Know timelines for reporting to LME and to State • Know how to access current forms for reporting and who to send them to

3. Stuff HappensWhat’s considered an Incident? • Incident: Defined in 10A NCAC 27G .0103(b)(32) as “any happening which is not consistent with the routine care of a consumer and that is likely to lead to adverse effects upon a consumer.”

4. Incidents in Context • Rules 10A NCAC 27G.0600 went into effect July 1, 2004 • Created the three levels of incidents • Modified forms to meet the rules • Reporting, tracking and agency peer review requirements are expected elements of LME and provider agency QI processes

5. Level III Level II State Incident Levels • Level I: incidents that the provider must respond to and document internally • Level II: incidents that the provider must respond to and report within 72 hrs to the LME • Level III: incidents that the provider must respond to and report within 72 hrs to the LME, DMH/DD/SAS Quality Management Team and if licensed under G.S. 122-C to the DFS Complaint Intake Unit Level I

6. Determining Level of Response

7. LEVEL • Recommend providers have internal process for documenting Level I incidents. • LEVEL I : “Events that in isolated numbers do not significantly threaten the health or safety of an individual, but could indicate systematic problems if they occur frequently. May signal need for provider to review clinical care and practices.” • Eg. Minor injury not needing med care, client behavior not leading to police involvement

8. Level • …”involves threat to consumer’s health or safety or threat to others due to consumer behavior.” • May signal need for the LME to review the provider’s clinical care and practices and the LME’s service management processes • Eg. Natural cause deaths, restraints without injury, AWOL, aggression leading to medical care

9. Level • …results in 1) death or permanent physical or psychological impairment to consumer… • …2) a death or permanent physical or psychological impairment caused by a consumer, or • …3)a threat to public safety caused by a consumer. • Signals need for DHHS and LME to review the local and state service provision and management system. • Requires formal peer review process by the provider w/in 24 hrs

10. When and How to file a report Note: If death occurs w/in 7 days of restraint or seclusion must notify LME/DMH immediately

11. Quarterly Reporting to LME- QM11 Complete separate report for each facility your agency operates and complete name and facility in box at top. Section 1 on form includes only selected Level I incidents so does not showall Level I occurrences for your facility. Restrictive interventions, Med errors, other incidents of search/seizure only. Section 2 includes summary counts of Level 2 and 3 incidents for the quarter. Section 3 provides QI analysis of trends and patterns found in incidents. Submit Form QM 11 Provider Quarterly Incidents Report by 10th month following end of quarter (e.g. due by July 10 for quarter ending June 30th). Send via e-mail (lynn@westernhighlands.org or kristeen@westernhighlands.org) or fax to 828-225-2784

12. Provider Quarterly Incidents Report

13. Quarterly Report Totals How do I know if this is right? Total Unduplicated count cannot be smaller than single categories below (Seclusion, Isolation, Restraint) Unduplicated count of consumers cannot be larger than total number of restrictive intervention incident reports in this section. Highest number of incidents for one consumer cannot exceed the total number of reports Example Total Unduplicated Count = 25 Seclusion = 2 Isolated Time out = 5 Restraint = 30 cannot be true Unduplicated counts: If 12 clients had total of 12 incidents, the highest # for one client would be 1 The highest number for a single client cannot exceed the total unduplicated count Resist urge to add other items and counts

14. DHHS Incident and Death Report LME Record Number Confidentiality: Use only initials of other consumers involved Description of Incident- what happened that makes this reportable?

15. DHHS Incident and Death Report Indicate type of death at time of report Restrictive Interventions: Include Detail Report Form Select most appropriate type of incident- data is aggregated for the State Include printed name and signature

16. DHHS Incident and Death Report Facility information and County important for determining Host/Home reporting issues Determination of Level important for meeting reporting requirements. See Guidelines slide for assistance in deciding upon II or III Provider Response: Gives indication of internal processes and notes for upcoming investigations. Supports provider QI processes Note all others reported to here. Include WHN especially if sending to DFS / DHHS

17. For agency use per QI/peer review

18. Reporting Restrictive Interventions – Level II Form QM04 Use LME Id number NOT SSN If planned include date of latest plan

19. Reporting Restrictive Interventions – Level II Form QM04 Use LME Id number NOT SSN Include printed names and signatures

20. Reporting Restrictive Interventions – Level II Form QM04 Use LME Id number NOT SSN Important to note plans and approvals Include printed names and signatures

21. Reporting Restrictive Interventions – Level II Form QM04 Use LME Id number NOT SSN Important page for provider QI/peer review process

22. Where do I send my reports? Those coming to WHN LME as Host (consumers being served within our 8 county area) or Home (consumers from our 8 county area) • Level II and III • (do not need to send detail reports of Level I) • Fax to 828-225-2784 • c/o Lynn Trotter • Number to call if informing LME of incident • 828-225-2800 ext 2912, Lynn Trotter

23. Does anybody even look at these? • WHN has an extensive review process to assure incident data is in, accurate and timely. We want to assure that clinical care questions are answered to everyone’s satisfaction • Reports are screened for accuracy and completeness • An Incident Review Workgroup examines Level III, and Level II cases with health/safety issues more closely • A monthly Critical Incident Review Committee determines if any further action/information is needed.

24. Following up on reports • Provider network specialists and other LME staff may • Ask for supplemental information regarding client care • Request copies of other reviews/investigations being done • Carry out a focused chart review • Request autopsy, toxicology reports • Clinical review samples include consumers with incidents • Division staff will call the LME to ask for details regarding an incident of interest • Human Rights Committee reviews aggregated information and looks for patterns of reporting

25. Who you may hear from… • Lynn Trotter, Community and Consumer Relations Coordinator • Heidi Sears, Support Staff for Provider and Consumer Relations • Dick Graham, Provider Specialist • Kathy Rubendall, Monitoring and Care Management Coordinator • Leslie Kingsbury, Quality Management Assistant • Kris Booker, Quality Management Director

26. Questions