Young House Family Services

Young House Family Services

Incident Reporting Procedure

Reference: PQI 4.03(b), RPM 2.02 (b) & RPM 2.03 (a-f)

Iowa Code 232.69, Iowa Code 235B.3 & Iowa Code 441.77

Policy Location: Policy and Procedure Manual

Purpose: Document and review client, staff and property minor and critical incidents and accidents to minimize future occurrence and reduce risk.

Policy: During the course of conducting business and providing services to clients, incidents can arise that have the potential to impact the safety and well-being of clients, staff members, and/or property. Young House Family Services conducts supervisory and administrative review of all Critical and Minor incidents in order to mitigate future risk while improving upon the quality of services being provided. A standard system of reporting incidents makes the review process more efficient, enhances quality service provision, and minimizes the risk of harm to clients, staff, visitors and property of Young House Family Services.

Approved by Young House Family Services Board of Directors on:
Date: / October 22, 2008
Revision approved by Young House Family Services Board of Directors on:
Date: / September 28, 2011
Policies “Client Incident and Accident Policy” and “Employee Incident and Accident Policy” were merged into one policy, “Incident Reporting Policy.”
Revision approved by Young House Family Services Board of Directors on:
Date: November 26, 2013
Revision approved by Young House Family Services Board of Directors on:
Date: / November 30th, 2016
Revision approved by Young House Family Services Board of Directors on:
Date: / September 28, 2011
Revision approved by Young House Family Services Board of Directors on:
Date: / August 30th 2016
Revision approved by Young House Family Services Board of Directors on:
Date: / June 28th 2017

Definitions:

“Major incident” or “Critical Incident” means an occurrence within a Young House Family Services facility or during service delivery that involves staff, clients, vehicles and/or agency property that;

·  Results in a physical injury to or by a consumer or staff that requires a physician’s treatment or admission to a hospital;

·  Results in the death of any person;

·  Situations involving crisis management: (Including but not limited to; Emergency hospitalizations for a suicidal client; assisting a client to seek emergency domestic abuse shelter; or a circumstance where there was an immediate threat of harm or risk to employee or client.)

·  Requires emergency mental health treatment for the client;

·  Requires intervention by law enforcement;

·  Requires a report of child abuse pursuant to Iowa Code section 232.69 or a report of dependent adult abuse pursuant to Iowa Code section 235B.3;

·  Constitutes a prescription medication error or a pattern of medication errors.

·  Involves a consumer’s location being unknown by provider staff who are assigned protective oversight.

“Minor incident” means an occurrence within a Young House Family Services facility or during service delivery that involves staff, clients, vehicles and/or agency property that is not a major incident and that:

·  Results in the application of basic first aid;

·  Results in bruising;

·  Results in seizure activity;

·  Results in injury to self, to others, or to property; or

·  Constitutes a prescription medication error. (Including but not limited to; missed prescription time or wrong dosage.)

Client Minor Incidents

Notification and reporting procedures for client minor incidents

·  Within 24 hours of a minor incident staff are required to notify their supervisor or the Human Resource Director if the supervisor is unavailable.

·  Within 72 hours of a minor incident occurring or a staff member becoming aware of a minor incident the staff member involved is required to submit the completed Minor Incident Report Form.

o  The Young House Family Services Minor Incident Report Form located in Vision Works is used to document all Minor incidents.

·  YHFS is required to keep records of all minor incidents, but do not have to report minor incidents to the MCO’s.

Administrative review of minor incidents

·  Supervisory Staff review and approve all completed Minor Incident Report Forms.

·  Supervisory Staff will notify the Chief Financial Officer within 48 hours of all incidents resulting in damage to agency vehicles or property.

Client Major/Critical Incidents

Notification procedure for client major incidents

When a major incident occurs or a staff member becomes aware of a major incident, the staff member involved is required to notify the supervisor on staff immediately following the incident. The supervisor on staff has the duty to notify the executive director immediately of all critical incidents. By the end of the next calendar day after the incident to the following are required to be notified of the incident:

·  The consumer or the consumer’s legal guardian.

o  EXCEPTION: Notification to the consumer is required only if the incident took place outside of the provider’s service provision. Notification to the guardian, if any, is always required.

·  The consumer’s case manager.

Reporting procedure for client major incidents

Within 24 hours after a major incident, the staff member who observed or first became aware of the incident shall also report as much information as is known about the incident to the member’s managed care organization in the format defined by the managed care organization. If the member is not enrolled with a managed care organization, the staff member shall report the information to the department’s bureau of long-term care either:

·  By direct data entry into the Iowa Medicaid Provider Access System, or

·  By faxing or mailing Form 470-4698, Critical Incident Report, according to the directions on the form.

The following information shall be reported about a major incident:

·  The name of the consumer involved.

·  The date and time the incident occurred.

·  A description of the incident.

·  The names of all provider staff and others who were present at the time of the incident or who responded after becoming aware of the incident. The confidentiality of other waiver-eligible or non-waiver-eligible consumers who were present must be maintained by the use of initials or other means. The action that the provider staff took to manage the incident.

·  The resolution of or follow-up to the incident.

·  The date the report is made and the handwritten or electronic signature of the person making the report.

Employee Incident Notification and Reporting

Any accidents or injuries arising out of or in the course of employment must be reported within 24 hours by the employee to his/her immediate supervisor and the Human Resource Director by submitting a completed Young House Family Services Employee Injury Form. This form is required even if medical attention is not needed. All employees are covered by Worker's Compensation in accordance with Iowa law, and at the expense of the agency. Any other staff members who observed or first became aware of the incident shall also report as much information as is known about the incident to the HR Director within 24 hours of the incident.

Should medical attention be required during business hours, the HR Director will contact the Great River Business Health office (319) 768-4199 to make an appointment for the employee to be examined. After business hours the employee should be treated at the nearest medical center. Follow-up treatment will be with the agency’s designated physician.

For a serious injury needing immediate medical attention the employee should visit their local emergency room department for treatment. Follow-up appointments will be scheduled with Great River Business Health by the HR Director.

As with all personnel information, injuries are kept confidential and information only shared with those who may need to know. The Executive Director will be made aware of serious employee injuries.

When an incident involves an agency vehicle the staff member driving the vehicle at the time of the accident is responsible for filling out the insurance incident form located in the glove box of the agency vehicle. The police must also be called to report the incident for insurance purposes.

Investigation and disposition of client and employee incidents

a)  The Investigation

Young House Family Services will conduct a prompt, thorough and impartial investigation of all serious incidents as necessary and appropriate. All applicable documentation (as necessary) will be reviewed by the Management Personnel Committee, which includes: the Human Resources Director, Executive Director, and Supervisor or other designated party. Young House Family Services will complete a review of a serious injury or death to a client or employee within 24 hours.

The investigation will include an interview with the victim. It also may include interviews with the person who made the initial report, the alleged offender and/or any other person who may have information regarding the incident, each of whom is encouraged to cooperate with any investigation. The investigation process is strictly internal to Young House Family Services.

b)  Findings and Recommendations

The committee will report his or her findings to the person who made the initial report, the victim, the offender, and relevant managers and supervisors.

Where the investigator concludes that a violation of this policy has occurred, Young House Family Services Human Resource Director, Executive Director and offender’s Program Director will take prompt and appropriate remedial action, including disciplinary action.

c)  The Investigatory File

Every serious incident will trigger the creation of an investigatory file. The investigatory file will consist of the initial complaint, the final investigative report, including a record of the remedial action to be taken, if any, and any documents created or used during the investigation.

d)  Responsibilities of Managers and Supervisors

In cases where an investigation confirms a violation of this policy, the Program Directors must ensure that the prescribed remedial action, including disciplinary action, is implemented. Program Directors must provide confirmation to their Human Resources Officer within 14 days that the recommended action has occurred. Program Directors are responsible for regular monitoring to ensure that all remedial and/or disciplinary steps are completed and no further incidents occurs in the work environment.

Supplemental Documentation

Based on contract requirements, additional documentation may be required. When additional documentation is required, it will be completed by Supervisory Staff and submitted with Iowa Medicaid Critical Incident Report Form # 470-4698 within 24 hours. Additional required documentation includes but is not limited to the following:

·  Group Care Online Reporting

o  Residential Programs will ensure compliance with requirements for entry into the online DHS Group Care Reporting System.

o  The Iowa Department of Human Services requires all online reporting to be submitted within 24 hours of the incident.

o  Iowa Department of Human Services requires the following categories or incidents be entered into the online DHS Group Care Reporting System:

§  Behavior resulting in injury requiring medical attention

§  Behavior resulting in self-harm

§  Property damage

§  AWOL

§  Police assistance

§  Placement in detention

§  Restraint

§  Control Room

·  Report of Suspected Child Abuse

o  The Report of Suspected Child Abuse Form will be completed and submitted to the Iowa Department of Human Services for all reports of suspected child abuse.

o  Iowa law requires all mandatory reporters to complete and submit this form within 24 hours of making an oral report of suspected child abuse to the DHS Centralized Intake Unit.

·  Reporting to Managed Care Organizations

o  The Young House Family Services Iowa Medicaid Critical Incident Report Form will be completed and submitted by Supervisory Staff within 24 hours to client’s MCO for all incidents that involve a client receiving MCO-paid services and is in one of the following categories:

§  Death

§  Suicide attempt

§  Self-mutilation/self-assault

§  Assault on others

§  Other dangerous behavior

§  Sexual abuse or allegation thereof (while in treatment setting)

§  Use of illicit drugs/alcohol while in an inpatient, residential, or halfway facility

§  Leaving a 24-hour facility against medical advice (AMA/ASA)

§  Escape from a locked facility

§  Unauthorized departure from a 24-hour facility pursuant to a court order

§  Adverse incidents related to seclusion and/or restraint

o  Managed Care Organizations of Iowa requires that Critical Incident reporting forms are submitted within 24 hours of the incident.

Managed Care Organizations (MCO) contact information:

Submission Instructions: If this is a completed investigation and an initial report was submitted please send final documentation and note that you are closing the case. The form may be submitted to the appropriate MCO shown below. This form will be printed from Vision Works.

o  Amerigroup Iowa

o  Fax: 844-400-3465

o  Provider Call Center: 1-800-454-3730

o  Web: https://providers.amerigroup.com/IA/Pages/welcome.aspx

o  Email:

o  AmeriHealth Caritas Iowa

o  Provider Telephone Services: 1-844-411-0579

o  Web: http://www.amerihealthcaritasia.com/provider/manual-forms/index.aspx

o  Non-Provider Telephone Services: 1-855-332-2440

o  TTY: 1-844-214-2471 | 24 hours a day, 7 days a week

o  Email:

o  UnitedHealthcare Community Plan

o  Submit completed form by fax to 1-855-371-7638 or email to

o  Provider Services Call Center: 1-888-650-3462

o  Web: http://www.uhccommunityplan.com/health-professionals/ia.html

o  Iowa Medicaid Enterprise

o  Submit via the Iowa Medicaid Provider Access (IMPA) system

o  Email:

Managed Care Organizations of Iowa requires that Critical Incident reporting forms are submitted within 24 hours of the incident.

Incident tracking and analysis

The agency tracks and reviews incident data and analyzes trends to assess the health and safety of employees and clients served and determine if changes need to be made for service implementation or if staff training is needed to reduce the number or severity of incidents. All incidents (client and employee) are reported in the Young House Family Services Quarterly Report Card and reviewed to identify any existing or potential risks.

The PQI committee reviews this Incident Reporting Policy and Procedure on an annual basis for continued efficiency, effectiveness and compliance with all applicable state and federal laws including compliance with the standards set by the Council on Accreditation.

Form 470-4698, Critical Incident Report FAQ