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Critical Incident Reporting System (CIRS). Linda Metzger Colorado Department of Health Care, Policy & Financing. Any actual or alleged event or situation that creates a significant risk of substantial or serious harm to the health or welfare of a client. - PowerPoint PPT Presentation
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Crit
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m Critical Incident Reporting System
(CIRS)
Linda MetzgerColorado Department of Health Care, Policy & Financing
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mWhat Is a Critical Incident?
• Any actual or alleged event or situation that creates a significant risk of substantial or serious harm to the health or welfare of a client.
• Could have or had a negative impact on the mental and/or physical well being of a client in the short or long term.
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mApplicable Waiver Programs
• Persons with Brain Injury (BI)• Persons with Mental Illness (MI)• Persons Living with AIDS (PLWA)• Elderly, Blind & Disabled (EBD)• Persons with Spinal Cord Injury (SCI)• Children with Life Limiting Illness
(CLLI) • Children’s HCBS (CHCBS) • Children with Autism (CWA)
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m Why does the State need to track
Critical Incidents?• To assure that necessary safeguards
have been taken to protect the health and welfare of the individuals receiving 1915c waiver services
• To identify, address and seek to prevent the occurrence of abuse, neglect and exploitation on a continuous basis
• To comply with key regulatory requirements from CMS regarding monitoring
• To insure remediation (follow up) actions are initiated when appropriate
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m Critical Incidents and the Department’s Quality Improvement Strategy
Monitoring Critical Incidents is a part of the Department’s Global Quality Improvement Strategy encompassing three functions:
• Discovery
• Remediation (Follow-Up)
• Continuous Improvement
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mProviders of Waiver Services
• Waiver services are furnished at widely dispersed sites throughout the community
• Typically include: large and small private-sector provider organizations, assisted living facilities, adult day care facilities, case managers, individual personal assistants and attendants, clinicians, neighbors and other community members who support individuals
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mNumber of Critical Incidents
Reported per Month
There was a significant increase in reporting over the past 3 years.
• 2009 100/month
• 2010 150/month
• Jan.-June 2011 200/month
• July-Dec. 2011 300/month
• Jan.- July 2012 500/month
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mReporting Issues
• Some providers are very diligent about reporting critical incidents to SEP/CMAs
• Some agencies understand the CIR reporting process and expectations well and others do not
• Some agencies are over-reporting incidents, e.g. reporting unnecessary events
• Some SEP/CMA regions have a high frequency of critical incidents while others have a low frequency
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9
Timely Reporting Requirements
HCBS Waiver Service Provider Case Manager
( within 24 hours or one business day)
Case Manager HCPF (BUS) ( within 24 hours or one
business day)
Follow-up and investigation Case Manager
responsibility? Provider responsibility? Other entity
Responsibility?
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mProvider Reporting
Forms
www.colorado.gov/hcpf Provider Services>provider
services>forms>Critical Incident reporting systems forms
1.HCBS Provider Critical Incident Information Form
2. Provider Critical Incident Follow-Up Form
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Crit
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mTypes of Critical Incidents to
Report
• Death• Suspected
Abuse/Neglect/Exploitation• Serious Illness• Injury to Client• Damage to Client’s Property or
Theft• Medication Management• Other High Risk Issues
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mDeath Types
• Ongoing Medical Condition/Illness/Disease
• New Medical Condition/Illness• Unexpected/Unknown Cause• Completed Suicide• Homicide• Accidental Death• Other
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mSuspected Abuse, Neglect or
Exploitation
• Abuse includes actions which result in bodily harm, pain or mental distress.
• Neglect is a failure to provide care and service when a waiver client is unable to care for him or herself.
• Exploitation is the deliberate misplacement, exploitation, or wrongful temporary or permanent use of a client’s belongings or money without the client’s consent.
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mSerious Illness/Medical
Crisis
• Recurring Illness
• Heart attack (MI)
• Stroke (CVA)
• Pneumonia
• Respiratory failure
• Seizure
• Infection (UTI)
• Dehydration
• Cancer
• Diabetic Crisis
• Mental Illness symptoms
• Medical crisis
• Other illness
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m
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Cause of Serious Illness
•New medical condition•Existing medical condition•Treatment error•Medication•Poor care•Undetermined•Other
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mSerious Injury
• Fracture/Dislocation
• Laceration• Serious Burn• Head Injury• Multiple injuries
• Unknown injury from fall requiring medical attention
• Unknown injury• Other injury
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mCause of Serious Injury
• Fall• Accident• Seizure• Assault
• Choking/Aspiration
• Physical Restraint
• Undetermined• Other
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Crit
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mDamage to Client’s
Property/Theft
Deliberate damage, destruction, theft, misplacement or use of a client’s belongings or money without the client’s consent, including the deliberate diversion of medications
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mMedication Management
• Problems with medication dosage, scheduling, timing, set-up, compliance, administration or monitoring which can result in documented harm or an adverse effect which necessitates medical care.
• Event Type
• Cause for event
• Administered by
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mOther High Risk Issues
Serious issues that do not yet rise to the level of a critical incident, but have the potential to do so in the future, including such events such as environmental hazards, suicide threats, self-injurious behaviors, arrest or detention, etc.
• This type of critical incident always requires follow-up.
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mTypes of High Risk Issues
•Lost/missing person•Loss of Home/Eviction•Client fraud•Provider fraud•Serious criminal offense (offense by client)•Client abuse toward others•Unusual aggressive behavior
•Suicide ideation•Suicide attempt•Substance abuse•Media involvement•Environmental hazard•Restraints used
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1. Hospitalizations2. ER Visits3. Dr. Visits4. Law Enforcement Involvement
Common Reporting Items
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mUnnecessary or Inappropriate
Reporting Examples
•Lifeline Activation not related to a specific incident type
•Reports about non-HCBS persons•Due to weakness in his legs, client fell in the
dining room, no ER visit•Client said she tripped over her dog and fell
again•Client complained of having severe neck
pain•Client was scratched on left forearm by dog
paw
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mRecording a Critical Incident
Report
When reporting a critical incident, be prepared to provide enough information so the reviewer knows:
• Who was involved in the incident
• What were the circumstances of the incident - details
• Where the incident happened
• When the incident took place, Date & Time
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mMandatory Reporting
Responsibilities
Reporting Critical Incidents in the BUS does not relieve the provider, provider agency or SEP/CMA of other forms of mandated reporting, including reports to law enforcement, Child or Adult Protective Services, or Occurrence Reports to the Colorado Department of Public Health and Environment
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mAfter a Critical Incident is
Reported
HCPF Waiver Program Staff will review CIRS reports on daily basis checking for completeness of reports to determine if the report:• Provides enough detail to understand the
circumstances of the incident• Documents the steps taken to respond to
incident• Identifies how client’s safety has been
addressed and the follow-up measures taken and/or planned
• Documents whether mandatory reporting has occurred
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mAfter a Critical Incident is
Reported
There will be instances when additional follow-up by the SEP/CMA will be required:
• when reports lack sufficient information for the reviewer to understand the nature of the incident
• how a client or situation has been stabilized
• what safety measures have been taken to investigate and remedy the circumstances
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mEntering a CIR in the BUS
After you login to the BUS, identify
the client for report entry
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mCIRS – Entering a Critical Incident
After you verified you have the
correct client, click on “Critical Incident Reports”
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mCIRS – Entering a CIR
You can click on “Add New CIRS” or “Add Critical
Incident” to start the entry process
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mCIRS – Entering the incident info
Make sure all
elements are
completed
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mCIRS – Incident Specific
Descriptors
Complete a thorough
description of the
incident circumstanc
esComplete
the incident specific
descriptors
Definition of what types of events
are appropria
te for each
incident type
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mCIRS – Persons Involved
After completing the incident descriptors,
click “Persons Involved”
Complete the sections for
name, relationship to client, and
role
Click “Add” to enter additional persons
involved
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mCIR – Mandatory Reports Made
Make sure all sections
are complete
After completing
Persons Involved, click on
Mandatory Reporting
Steps
Click “Add” to enter additional mandatory
reports made
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mCIRS – Follow Up Actions
After completing Mandatory Reporting
Steps, click on Follow-up
Actions Taken
Make sure follow-up
actions are complete. This
section describes the
actions take to remedy the
situation and/or secure
the client’s health and
welfareClick “Add” to enter additional follow up
actions
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mCIRS – Referrals Made
After Follow-up Actions, click on
Referrals Made
Complete a referral screen
for each referral
completed in relationship to
the incident that occurred.
Please be descriptive of actions take
and reason for referral
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mCIRS – Persons Notified
Click “Add” to enter additional persons
notified
After completing
Referral Steps, click on Persons
Notified
Complete all sections of the person
notified
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mCIRS – Post Report Follow-up
Provide narrative descriptio
n of additional informatio
n
Select Post Report
Follow-up to document additional incident related
information
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mHCBS Provider Reports to
SEP/CMA
• The Department does not require any specific method of communication between HCBS Provider Agencies and SEP/CMAs
• A form entitled “PROVIDER CRITICAL INCIDENT REPORTING FORM” has been provided as a means of capturing the detail necessary for reporting incidents; but, it is not a required by the Department.
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