Understanding Critical Incident Reporting in Behavioral Health Services

Slide Note

Behavioral health services providers like KBH are required to report and track critical incidents and sentinel events in order to ensure client safety and program integrity. This involves identifying trends, reporting abuse, and following specific reporting processes set by accrediting bodies. The NEO Critical Incident Report is a tool used for tracking and reporting purposes to help improve service quality and ensure timely notification in critical situations.

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KBH Updated Critical Incident KBH Updated Critical Incident Reporting Reporting Completing an incident report in NEO August 24, 2023 Georgana Prudhomme, LCSW

Why Do We Report and Track Critical Incidents & Sentinel Events KBH is licensed by DHHS, Office of Behavioral Health, and the Office of Child & Family Services and accredited by CARF which requires KBH to report incidents that fall into the categories of a Level I or Level II incident for adults which we will review in upcoming slides. OCFS has different reporting processes. In tracking Critical Incidents and Sentinel Events, the KBH Quality team is able to create reports to assist with identifying any trends or concerned areas of services. As mandated reporters, KBH staff are required to report alleged abuse: physical/sexual, emotional abuse to CPS and financial exploitation of a client. This includes

Changes Made by The Office of Behavioral Health The Office of Behavioral Health created changes for the Level I and Level II reporting categories which we will review in more detail later in the slide presentation. These changes went into effect 7/1/22. Some categories have been altered, added or deleted. This presentation will review the types of event updated in the NEO Incident reporting form. You will see the changes and definitions provided as well.

What are Sentinel Events & Critical Incidents KBH is accredited by CARF and as one component of our accreditation is KBH tracks and follows Sentinel Events. Sentinel event is defined by CARF as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Death occurring from natural causes are not reported to CARF by the Quality Team. The Office of Behavioral Health (OBH) defines a critical incident as a serious event that creates significant risk of harm to clients, jeopardizes public safety or program integrity, and includes errors or undesirable events. For OBH, ALL client deaths must be reported including medical or death due to natural causes.

The NEO Critical Incident Report is used for tracking and reporting purposes The NEO Critical Incident Report is used for tracking and reporting purposes and not intended to replace real time notifications that may be required in and not intended to replace real time notifications that may be required in a critical situation. a critical situation. The NEO report is to be completed as soon as possible. Reporting incidents to your Supervisor, Administrator, Clinical Director, or Human Resources, for staff and/or client related injuries is required as well. If you are unsure if an incident requires reporting in NEO, you may consult with any of the above named persons. You may also contact the Clinical Training & Quality Manager for clarification of an incident.

KBH Reporting Timelines to Office of Behavioral Health OBH for KBH Reporting Timelines to Office of Behavioral Health OBH for Level I incidents Level I incidents Level 1 Incidents for OBH: Reported with 4 hours from when KBH staff learn about the event: Suicide Homicide Other Death may be unknown at the time of the report. Clinical or Medication error resulting in emergency medical care for the client Lost, missing client or client that left the facility AMA in a residential/CSU placement which would rise to the level of Silver Alert and/or under the guardianship, in the Care and Custody of the Commissioner, and/or in violation to conditions of release/court order * Alleged abuse: physical/sexual, emotional abuse, neglect and financial exploitation of client by a staff. New category.

Level I incidents, continued Level I incidents, continued Alleged Serious Crime (e.g., arson, assault, hostage) by client with extreme risk of harm to client, staff, or public Other serious events (fire, flood, motor vehicle accident in company vehicle with clients that requires medical attention for staff and/or client(s). Natural Disaster, building becomes uninhabitable, incidents that require client evacuation from the building * Medical Outbreak- is a new category. This relates to a medical outbreak that may close a program or office or, if the majority of staff are out due to a medical outbreak in the same program and area.

What to do when you learn about a Client Death? Please send Sally Giddings an email noting the client ID number, initials, and if known, state how you were notified of the death and cause if known. This includes front desk staff as well as staff with direct service for the client. All deaths, either medical or undetermined, are reported to the appropriate DHHS department, such as OBH or OCFS. Complete a NEO CIR as soon as possible as a death needs to be reported within 4 hours of KBH learning about the death to OBH. Please provide as much detail as known in the NEO CIR. The Clinical Training and Quality Manager will complete the reporting process. When a NEO CIR is entered, the Clinical Director, Clinical Training & Quality Manager & the Clinical Quality & Training Coordinator receive a NEO alert.

Level II Incidents Level II Incidents Reported within 24 Hours from when KBH staff learn about the incident Reported within 24 Hours from when KBH staff learn about the incident: : *New - Alleged Physical/Sexual, emotional abuse, and financial exploitation of client by someone other than a provider staff Suicide attempt that requires medical intervention Self-harm that requires medical attention Lost or missing client or client left the facility AMA in facility )PNMI residential/CSU Placement client (for more than 24 hours) Medication/Drug Diversion * New - Wellness Check Major Physical Plant Disaster

Level II Continued Level II Continued This is a new Category OBH has added to the CIR reports * Neglect is a pattern of conduct, engaged in without the patient s informed consent, resulting in deprivation of food, water, medication, medical services, shelter, cooling heating or other services necessary to maintain minimum physical or mental health. Examples : Malnutrition, Dehydration, Pressure sores, Unsafe or Unsanitary living conditions, Untreated medical problems or refusal of medical care, shelter, cooling or heating or other services to maintain minimum physical or mental health.

Childrens Critical Incidents If a report is made to Child Protective Services, we do not need to complete a NEO CIR form. Generally speaking Clinical Quality reports a child s death, serious suicide attempt, or dangerous situation using the EIS system. If a client injury or other situation arises, if the incident occurred outside of KBH services at the time of the incident, we do not need to report these situations to OCFS. For example, if a client runs away and steals a car, it is not reportable to OCFS unless a KBH staff person was present providing services at the time of the incident.

In the next slides we will review how to complete an Incident Report in NEO. Please complete the form as soon as possible. In the event of an injury or EMS involvement, please report after everyone is safe. Please share this information with your staffs in order to assist them in knowing what and how to report an Incident in NEO. After this presentation, if you would like training for your staff at a team meeting, this can be arranged.

In the Search: Client screen In the Search: Client screen click on the Incident Reports tab. click on the Incident Reports tab. This will open the Search Incident Reports screen. Enter the client This will open the Search Incident Reports screen. Enter the client ID by clicking on the client tab. ID by clicking on the client tab.

Search Incident Reports Screen: Click on the Add button which will open the Incident Report window.

U U U U U U U U U U U U U U U U U U U U U U U U U 10/04/202 12:00 AM U After selecting the type of event, note the date of the incident and not the date you are After selecting the type of event, note the date of the incident and not the date you are entering the incident. If you know the time of the incident enter it in the box shown below. entering the incident. If you know the time of the incident enter it in the box shown below. Otherwise click the Unknown button. Note the Incidents are now listed in alphabetical order. Otherwise click the Unknown button. Note the Incidents are now listed in alphabetical order.

If you are a staff person, and are unsure which category to select, use the Incident Types Descriptions tab by click directly on the tab. This will bring up the Incident Type and Description text box to assist in determining what category to select. If you are still unsure which category to select, enter a category and the Clinical Quality team will make any needed corrections to a category selected.

The following are definitions provided in the Incident Type Description. Please note The following are definitions provided in the Incident Type Description. Please note Medical has changed to Medical Event Emergent and Non Medical has changed to Medical Event Emergent and Non- -Emergent. Emergent. Client is aggressive or threatening violence towards a staff or other client/person Client is aggressive or threatening violence towards a staff or other client/person while on KBH property. while on KBH property. Aggression/Violence Aggression/Violence Alleged Abuse/Physical/Sexual/Emotional/ Alleged Abuse/Physical/Sexual/Emotional/Financial Exploitation of a Client (This is a new addition to the Exploitation of a Client (This is a new addition to the category) category) Financial Client, guardian or elder reports to staff there has been an incident of alleged Client, guardian or elder reports to staff there has been an incident of alleged sexual, physical abuse of a client or financial exploitation (adult focused). For sexual, physical abuse of a client or financial exploitation (adult focused). For children if event is reported to CPS it is not reportable in NEO. children if event is reported to CPS it is not reportable in NEO. Death of a client as Suicide, Homicide or Unknown reasons. Report all client Death of a client as Suicide, Homicide or Unknown reasons. Report all client deaths. deaths. Death Death Document staff and/or client who are exposed to infectious diseases such as viral Document staff and/or client who are exposed to infectious diseases such as viral hepatitis hepatitis- -B, HIV, tuberculosis, etc. or if there is a Medical Outbreak in a KBH B, HIV, tuberculosis, etc. or if there is a Medical Outbreak in a KBH location or team. location or team. Exposure to Communicable Disease Exposure to Communicable Disease Client and/or staff experience a needlestick or have non Client and/or staff experience a needlestick or have non- -intact skin or mucous membrane, exposed to blood, bodily fluid or other potentially infectious materia membrane, exposed to blood, bodily fluid or other potentially infectious materia intact skin or mucous Exposure to Potentially Biohazardous/Infectious Material Exposure to Potentially Biohazardous/Infectious Material A Client or Staff slips, trips or falls on KBH property. Report even if injuries are A Client or Staff slips, trips or falls on KBH property. Report even if injuries are unknown. unknown. Injury including slips, trips and falls Injury including slips, trips and falls Emergent would be client or staff person experiences a life threatening Emergent would be client or staff person experiences a life threatening emergency that requires immediate attention. emergency that requires immediate attention. Medical Event Medical Event Emergent Emergent Non Emergent would be a Medical Condition that does not require emergency Non Emergent would be a Medical Condition that does not require emergency services but does require medical attention. services but does require medical attention. Medical Event Medical Event - - Non Emergent Non Emergent

Definitions Continued. Please note Neglect is a separate Category; Psychiatric Event Definitions Continued. Please note Neglect is a separate Category; Psychiatric Event also has Emergent and Non also has Emergent and Non- -Emergent; and Self Emergent; and Self- -Harm has been changed to include requires medical attention. requires medical attention. Harm has been changed to include A pattern of conduct, engaged without the patient's informed consent resulting A pattern of conduct, engaged without the patient's informed consent resulting in deprivation of food, water, medication, medical services, shelter, in deprivation of food, water, medication, medical services, shelter, cooling/heating or other services necessary to maintain minimum physical or cooling/heating or other services necessary to maintain minimum physical or mental health. mental health. This box is used when the staff person is unsure which box to check. This box is used when the staff person is unsure which box to check. Used when an incident does not fit into one of the other categories Used when an incident does not fit into one of the other categories - - but is believed to be a serious event. believed to be a serious event. Fires, floods, natural disasters, long term power outage, or uninhabitable for Fires, floods, natural disasters, long term power outage, or uninhabitable for KBH or client. Client or staff damages KBH property. Or a client of a KBH building KBH or client. Client or staff damages KBH property. Or a client of a KBH building is unhabitual. is unhabitual. Neglect Neglect Other Other but is Other Serious Events Other Serious Events Property Damage Property Damage Emergent would be a client or staff person experiences a serious mental health Emergent would be a client or staff person experiences a serious mental health crisis that requires immediate intervention including Emergency Services. crisis that requires immediate intervention including Emergency Services. Psychiatric Event Psychiatric Event Emergent Emergent Non Emergent would be a serious mental health crisis that requires attention Non Emergent would be a serious mental health crisis that requires attention but is not require emergency services. but is not require emergency services. Used when a client harms him/herself to the point that medical attention is Used when a client harms him/herself to the point that medical attention is needed. needed. Psychiatric Event Psychiatric Event - - Non Emergent Non Emergent Self Self- -Harm Harm that requires medical attention that requires medical attention Serious Crime (arson, assault, hostage) by client with extreme risk of harm to Serious Crime (arson, assault, hostage) by client with extreme risk of harm to client, staff, or public. client, staff, or public. Serious Crime Serious Crime

Please note that Sexual Assault is a separate stand alone category. Wellness Check is a new additional category. This is a separate category from alleged abuse as Sexual Assault is used when a This is a separate category from alleged abuse as Sexual Assault is used when a client reports any form of sexual assault. client reports any form of sexual assault. When a client makes a Suicide Attempt that requires medical attention. When a client makes a Suicide Attempt that requires medical attention. No longer report suicide plans. report suicide plans. Used for client and/or staff who have illegal substance on KBH premises or are Used for client and/or staff who have illegal substance on KBH premises or are under the influence of substances. under the influence of substances. Sexual Assault Sexual Assault Suicide Plan/Attempt Suicide Plan/Attempt that requires medical that requires medical attention attention Unauthorized Use or Posession of Legal or Illegal Unauthorized Use or Posession of Legal or Illegal Substances Substances No longer Used when a client or a staff person brings a weapon onto KBH property which Used when a client or a staff person brings a weapon onto KBH property which may include a gun, machete, bomb or other items deemed as a weapon. may include a gun, machete, bomb or other items deemed as a weapon. Use and Unauthorized Posession of Weapons Use and Unauthorized Posession of Weapons Use of Seclusion/Restraint Use of Seclusion/Restraint Used when a staff member holds or places a client in seclusion or a restraint. Used when a staff member holds or places a client in seclusion or a restraint. MVA in company vehicle with clients that requires medical attention for staff or MVA in company vehicle with clients that requires medical attention for staff or client(s). client(s). When a client leaves a KBH facility AMA When a client leaves a KBH facility AMA - - PNMI, residential/CSU placement for client for more than 24 hours. Or if the client is under Guardianship, in the Care & client for more than 24 hours. Or if the client is under Guardianship, in the Care & custody of the Commissioner, and/or in violation of conditions of release/court custody of the Commissioner, and/or in violation of conditions of release/court order, OR, Lost or Missing client or client left the facility AMA order, OR, Lost or Missing client or client left the facility AMA - - PNMI, residential/CSU placement for client for more than 24 hours residential/CSU placement for client for more than 24 hours Vehicular Accident Vehicular Accident PNMI, residential/CSU placement for Wandering/Elopement Wandering/Elopement PNMI, Used anytime KBH staff requests a Wellness Check by local authorities to check on Used anytime KBH staff requests a Wellness Check by local authorities to check on the well being of the client(s). the well being of the client(s). Wellness Check Wellness Check

Enter the Client ID or the Staff member name in the areas noted below. Enter the Client ID or the Staff member name in the areas noted below. When you enter a client ID or staff name the next box will appear. If there When you enter a client ID or staff name the next box will appear. If there was a witness to the event, enter their name in that section. was a witness to the event, enter their name in that section.

Add the Client ID & the Information will Auto Fill. Enter the Provider in the box Add the Client ID & the Information will Auto Fill. Enter the Provider in the box designated below. If the incident involves additional staff use the Add New Provider box designated below. If the incident involves additional staff use the Add New Provider box marked below. marked below.

When you select a provider if the box did not pre When you select a provider if the box did not pre- -populate, you will select a provider or enter the provider type; agency, even if KBH; Clinician/Staff; Program; provider or enter the provider type; agency, even if KBH; Clinician/Staff; Program; and Save. If you have notified other staff please click the box for Informed. and Save. If you have notified other staff please click the box for Informed. populate, you will select a

Summary Section Summary Section In this section you will enter what occurred. Please add enough information in the Summary text box to make it clear as to what occurred, who was involved, and any other relevant information, in order to assist the Clinical Training & Quality Manager or Administrators, in reporting the incident. Providing clarity here is important in capturing a picture or understanding of what the incident involved when we report the incident. For example, Client s sister called Jane at the Med Clinic to report the client passed away last night. If this is a staff incident, state what occurred. (Please note all staff injuries are handled by Human Resources) For example, Jane Doe twisted her ankle coming down the stairs, missing the last step and is limping with a swollen ankle.

Outcomes Text Box Outcomes Text Box In the Outcomes text box please document what you know happened after the incident Summary has been completed, if known. In an incident Summary section, an example may be: a client reports he took 50 Tylenol in a suicide attempt and then told his partner. The Outcome may be that his partner called 911; EMS arrived; and took him to the MGMC ER for treatment. His partner met him in the ER and stayed until he was admitted to the unit. In the staff injury, you may document if the person left for medical care; or consulted with HR; and if it was recommended the staff person go to Employee Health. No details about the injury are documented here.

The The Admin Admin Response Text Box Response Text Box The Admin Response text field should be left blank by the staff person entering the incident report. The Clinical Quality & Training Manager, Supervisor, Director, or Administrator can use this field to note any actions taken, if necessary. In this text field the Clinical Training & Quality Manger documents actions taken re: reporting the incident to OBH or the Office of Child an Family Services (OCFS). Once the Incident is submitted you will no longer be able to see the incident.

The Incident Management Section is completed by Clinical Quality for The Incident Management Section is completed by Clinical Quality for tracking the incident and outcomes. You do not need to do anything in this tracking the incident and outcomes. You do not need to do anything in this section of the form. section of the form.

Submitting the Form Submitting the Form Once you have entered the Client ID; client s providers; documented what occurred in the Summary; and, if you have information to document re: outcomes; next, you will select your supervisor in the drop down menu and Send the form. Then you select your supervisor and click Submit. Clinical Quality receives a notification when an incident is submitted. The incident is reviewed and actions taken appropriate for the information presented. The Incident will be sent to the supervisor or Administrator, who will submit the form after reviewing the case.

That is how you successfully submit a NEO Critical Incident Form. Questions If you have any questions re: using this form, please speak with your Supervisor, Director, or Administrator? For back-up, you may contact Georgana Prudhomme, LCSW, at gprudhomme@kbhmaine.org When Georgana is out of the office, Jody Bucknam is the back up contact at jbucknam@kbhmaine.org