Reporting Critical Incidents

It is impossible to prevent errors but it is possible to put in place barriers that will help reduce the number of occurrences.   However, if no-one knows what kind of problems are occurring, and how often, it is impossible to put into place procedures that will help make home care safer for clients.  It follows, therefore, that the first, vital, step in reducing preventable incidents is to ensure the open system of reporting all adverse and near miss incidents are communicated in a timely manner to the Human Resources Department for evaluation and identifying solutions by the management team.

At the end of this module, you will be able to determine when a critical incident has occurred, – who is responsible to report a critical incident, – when a critical incident situation needs to involve Protective Services, – and how to report it all.

PREVENTABLE INCIDENTS

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Reporting Critical Incidents

The Office of Long Term Living (OLTL) has the following assurances in each client's waiver:

  • Health and Welfare

  • Financial Accountability

  • Level of Care

  • Qualified Provider

  • Service Plan

  • Administrative Authority

 

• Definitions:

  •  Abuse – an act or omission that willfully deprives a client of rights or human dignity, or which may cause or causes actual physical injury or emotional harm to a participant including a critical incident and any of the following:​

    • Sexual harassment of a client.

    • Sexual contact between a staff member and a client.

    • Using restraints on a client.

    • Financial exploitation of a client.

    • Humiliating a client.

    • Withholding regularly scheduled meals from a client.

  • Exploitation – an act of depriving, defrauding, or otherwise obtaining the personal property of a client in an unjust or cruel manner, against one’s will, or without one’s consent or knowledge for the benefit of self or others.

  • Investigation – to take the steps necessary to determine if a critical incident has occurred, to determine if suspected abuse, neglect, abandonment or exploitation requiring the involvement of protective services is involved, what actions are needed to protect the health and welfare of participants and what actions are needed to mitigate future incidents?

  • Neglect – the failure to provide an individual the reasonable care that he or she requires, including but not limited to food, clothing, shelter, medical care, personal hygiene, and protection from harm. Seclusion, which is the involuntary confinement of an individual alone in a room or an area from which the individual is physically prevented from having contact with others or leaving, is a form of neglect.

  • Restraint – any physical, chemical or mechanical intervention that is used to control acute, episodic behavior that restricts the movement or function of the individual or a portion of the individual’s body. Use of restraints and seclusions are both restrictive interventions, which are actions and procedures that limit an individual’s movement, a person’s access to other individuals, locations or activities, or restricts participant rights.

  • Service Interruption – any event that results in the client's inability to receive services that places his or her health, and or safety at risk. This includes involuntary termination by the provider agency and failure of the client's back-up plan. If these events occur, the provider agency must have a plan for temporary stabilization.

  • Critical Incident – An occurrence of an event that jeopardizes the client's health or welfare including:

  • Death, serious injury or hospitalization of a participant.

  • Provider and staff member misconduct including deliberate, willful, unlawful or dishonest activities.

  • Abuse, including the infliction of injury, unreasonable confinement, intimidation, punishment or mental anguish, of the participant. Abuse includes the following:

  • Physical abuse

  • Psychological abuse

  • Sexual abuse

  • Verbal abuse

  •  Neglect

  • Exploitation

  • Service interruption, which is an event that results in the participant’s inability to receive services and that places the participant’s health or welfare at risk.

  • Medication errors that result in hospitalization, an emergency room visit or other medical intervention.

  • Complaints are different from critical incidents, and should not be reported as critical incidents.

  • Program fraud and financial abuse should not be reported as critical incidents, but should be reported in accordance with the OLTL Fraud & Financial Abuse bulletin 05-11-04, 51-11- 04, 52-11-04, 54-11-04, 59-11-04 issued on August 8, 2011.

  •  Pre-scheduled hospitalizations, or hospitalizations for routine illnesses should not be reported as critical incidents.

  •  A death due to natural causes should not be reported as a critical incident.

  • Before a critical incident is reported, measures must be taken immediately to safeguard the client. This may include calling 911, contacting Adult Protective Services if the situation meets the definition (participants aged 18-59) or Older Adult Protective Services (participants aged 60 and above), law enforcement, the fire department, or other authorities as appropriate.

  • After the health and welfare of a client has been safeguarded, it needs to be determined if a critical incident is reportable or not. The health and welfare of the participant must be ensured at all times.

  • The entity who first discovers or learns of the critical incident (if they were not present when it occurs) is responsible to report it.

  • The Service Coordination or provider agency that discovers or has independent knowledge of the critical incident must submit the critical incident report within 48 hours to OLTL.

    •  If the critical incident occurs over the weekend, a written report must be entered the first business day after the incident occurred.

  • Each critical incident report should show:

    • what steps were taken immediately to ensure the client's health and welfare.

    • what fact-finding steps were taken, and what information was found.

    • what corrective steps were taken.

    • how the critical incident will be prevented from happening in the future.

    • any changes to the service plan because of the critical incident.

  • Remember that state entities are viewing your report, so each critical incident report needs to account for background information relative to the critical incident, and explanations of who is involved/what happened. If you read the critical incident report in court, would it paint an accurate picture of the situation and the participant’s life?

  • Direct Service Providers must inform the participant’s Service Coordinator of the critical incident within 24 hours of an incident occurring. While a critical incident report must be submitted within 48 hours, communication with the Service Coordinator about the issue must happen within 24 hours of critical incident discovery.

  • All initial critical incident reports must include:

    • Reporter information

    • Participant demographics

    • OLTL program information

    • Event details and type

    • Description of the incident

    • Actions taken to immediately secure the participant’s health and welfare.

  • All critical incident reports should show what steps were taken to address the issue that occurred, and what steps will be taken to prevent the issue from happening in the future.

  • When a critical incident occurs, any information relating to the critical incident or the client should be kept confidential, and only necessary information should be released to essential personnel such as police, medical personnel, Adult Protective Services/Older Adult Protective Services, crisis intervention, etc. in order to ensure the participant’s health and welfare, and/or complete the critical incident report.

  • Who is a mandated reporter?

    •  Anyone who is part of an organization of people that uses public funds (including waiver funds) and is paid, in part, to provide care and support to adults in a licensed or unlicensed setting is a mandated reporter. This includes all OLTL Service Coordination Entity staff and direct service provider staff.

    • A mandated reporter is responsible to contact protective services for anyone, including individuals not on the waiver, with a physical or mental impairment that substantially limits one or more major life activities.

    • When faced with suspected abuse and neglect, the first thing anyone should do is make sure the victim is safe. This may mean calling the police….it definitely means making a report to protective services.

    • How to involve protective services:

      • If anyone suspects that a participant is in imminent danger of abuse, neglect, exploitation or abandonment, they are responsible to make an immediate oral report to the statewide Protective Services Hotline at 1-800-490-8505. This goes to the local Area Agency on Aging, who will create a Report of Need (RON) that will be sent to Liberty Healthcare (the contracted Adult Protective Services agency) or Older Adult Protective Services within the Area Agency on Aging to investigate.

  • What happens after calling the Protective Services Hotline?

If a case involves sexual abuse, serious injury, serious bodily injury, or suspicious death, you must also take the following steps:​

  • Make an immediate oral report to law enforcement

  • Make an immediate oral report to Department of Human Services (for participants under 60) or Department of Aging (for participants over 60)

  • Within 48 hours of making the oral report, submit a written report to law enforcement.

  • ​Once Protective Services is involved, the Protective Services agency is responsible for investigating Reports of Need.

  • If Protective Services becomes involved, the Service Coordinator should still make a contact with the participant to ensure the participant is safe.

  • Client involvement in critical incident reporting:

    • A client has the right to not report incidents.

    • A client has the right to decline further interventions.

    • A client has the right to refuse to be involved in the critical incident investigation.

    • A client has the right to have an advocate present during any interviews or fact finding activities.

 

If a client chooses not to report an incident, or declines further intervention, the critical incident must still be reported, and the Service Coordinator must still perform fact-finding activities relating to the incident. Documentation must be kept indicating that the participant did not wish to report the critical incident or declined interventions. The Service Coordinator should also inform the participant that their services may be in jeopardy if they are putting themselves or others at risk.

 

  • The agency staff who first reported the critical incident must notify the participant (and possibly their representative) of filing a critical incident report within 24 hours of filing the report. This notice must be provided in a format that is easily understood by the participant and/or their representative.

  • If the client's representative is suspected of being involved with the critical incident, the representative should not be informed.

  • Within 48 hours of the conclusion of the critical incident fact finding, the Service Coordinator must inform the client of the resolution and measures taken to prevent recurrence. This must be documented in the critical incident report.

  • A critical incident may entail suspending an employee or removing the employee from all OLTL Home and Community Based Services programs. If this happens, the employee should not have contact with the client during incident fact finding. Agencies should follow their own policies about whether the suspension is with or without pay until critical incident fact finding activities are complete.

  • If the critical incident involves a client-directed employee, the suspension must be without pay, and the client's back-up plan should be enacted, or an alternate paid employee should be used.

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© 2018 by An Answered Prayer, LLC