Incident Reporting: Getting It Right

Incident Reporting: Getting It Right

Author: Mark Parkinson BsPharm:  President  AFC-CE

Credit Hours 1- Approximate time required: 60 min.

Educational Goal

Show how incident reports are a caregiving tool that leads to easier caregiving.

Educational Objectives

Explain about profession and amateur attitudes about towards incident reports.

Quote state regulations

Show how to effectively fill out and utilize incident reports

Procedure:

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Disclaimer

   The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.

 

 

Incident Reporting: Getting It Right

When I first became an adult foster care provider back in the ‘80s, there were few, if any, regulations governing the industry. As I look back, the freedom of less regulation was a mixed blessing. Yes, I enjoyed not being told what to do, but it also left me wide open for conflict. Without regulation, any incident or harmful occurrence would lead to disputes and tension with the county. They became the enemy and I thought it was best to keep them in the dark as much as possible. It was not a very professional attitude, I admit. It closed the door on any help that the county could have given me. It also created a climate where erroneous methods never got addressed. With such an attitude, improvement and innovation got very stifled. How can you improve if you hide and deny every problem that comes along?

Today, regulations are a fact of the industry, but I have learned that is not necessarily a bad thing. Take, for instance, incident reporting. At first glance it appears that you are telling on yourself. Why would you want to send out a report on any problem that you’re having? Won’t that just get you in trouble? That is the common reaction of amateurs and the inexperienced. Professionals, however, view incident reports as just another caregiver tool that helps them identify the root cause of problems. Once identified, practices and systems can be improved, which eliminates the root cause of the problem. In doing so, this will naturally prevent the error from reoccurring in the future. If utilized correctly, incident reports may actually keep you from getting in trouble in the future. It’s a blessing, not a curse.

Whether you love them or hate them, incident reports are required to be filled out by government mandate. If you want to be licensed (and thus make a living) you have to agree to fill them out. If you ignore them or do them incorrectly, you may lose your license.

 

DHS Administrative Rules Chapter 411 Division 360

Since you are agreeing to follow the administrative rules you might as well know what they say.

 

411-360-0180 General Practices (15):

  (15) Complete an incident report as described in section:

 

(A)

1. TYPES OF INCIDENTS. A foster care provider must complete an incident report for all of the following:
   1. Any allegation of abuse as defined in OAR 411-317-0000.
   2. Death or serious illness, injury, or accident, requiring inpatient or emergency hospitalization.
   3. An individual is away from the home without support beyond the time frames established by their ISP team.
   4. Use of an emergency physical restraint.
   5. Use of a safeguarding intervention or safeguarding equipment.
   6. Unusual incident as defined in OAR 411-317-000
2. INCIDENT REPORT REQUIREMENTS. An incident report must include all of the following information:
   1. Name of the individual who is the subject of the incident.
   2. Date, time, duration, type, and location of the incident.
   3. Conditions prior to, or leading to, the incident.
   4. Detailed description of the incident, including staff response.
   5. Description of injury, if injury occurred.
   6. Name of staff, including their position title, and witnesses to the incident.
   7. Follow-up to be taken to prevent a recurrence of the incident. The use of any emergency physical restraint must be reviewed by the licensee within two hours of application.
3. INCIDENT REPORTING TIMELINES.
   1. A foster care provider must place an incident report in the individual's record and provide a copy to the individual's case manager, and as applicable by their legal representative, in accordance with the following timelines:
      1. ABUSE. An incident report documenting abuse must be provided within five business days from the date of the incident.
      2. DEATH, SERIOUS ILLNESS, INJURY, OR ACCIDENT. An incident report documenting a death or a serious illness, injury, or accident, must be provided within five business days from the date of the incident. 
      3. UNAUTHORIZED ABSENCE. An incident report documenting an individual's unauthorized absence must be provided within five business days from the date of the incident. 
      4. EMERGENCY PHYSICAL RESTRAINT. An incident report documenting the use of an emergency physical restraint must be provided within one business day from the date of the incident. 
      5. SAFEGUARDING INTERVENTION AND SAFEGUARDING EQUIPMENT. 
         1. TEMPORARY EMERGENCY SAFETY PLANS. If an individual has a Temporary Emergency Safety Plan, an incident report documenting the use of a safeguarding intervention or safeguarding equipment must be completed in accordance with the requirements outlined in the individual's Temporary Emergency Safety Plan. 
         2. INJURY. An incident report documenting the use of a safeguarding intervention or safeguarding equipment, resulting in an injury, must be provided within one business day from the date of the incident. 
         3. NO INJURY. An incident report documenting the use of a safeguarding intervention or safeguarding equipment, not resulting in an injury, must be provided within five business days from the date of the incident. 
         4. UNUSUAL INCIDENT. An incident report documenting an unusual incident must be provided within five business days.

(B) An individual's case manager or a Department designee (when applicable) must receive complete copies of all incident reports.

(C) A copy of an incident report provided to an individual's legal representative or other service providers must have confidential information about other individuals removed or redacted as required by federal and state privacy laws.

 (D) A copy of an incident report may not be provided to an individual's legal representative when the report is part of an abuse investigation.

 

Some Notes from the Battle Trenches

It may seem that the rules are cut-and-dried because of the precise language used, but that is not the case. There is a lot of wiggle room on what is applied and how the terms are interpreted. There is even a lot of difference of application between different government officials. It would be wise not to get angry about it. This leads to an “us against them” environment that is not conducive to running a successful business. I’ve always found that establishing a good relationship with those in authority always leads to a greater latitude in permissions to act. It’s all about developing trust. If they don’t trust you, a stricter application of the rules is applied. It’s just that simple and is part of a normal human reaction; try to use that reaction to your advantage. Develop trust with those in authority and your job gets much easier. If you still are having trouble letting go of the “us versus them” mentality, ask yourself this question: Who gets the bigger traffic fine? The jerk who yells at the traffic cop and judge? Or the cooperative, humble, and grateful offender?

 

How to Effectively Fill Out an Incident Report

 

Start with the Right Frame of Mind

Perception influences reality. A negative fearful frame of mind compared to a positive and cooperative frame of thought affects how much benefit is derived from an incident report. A more effective way to fill out the form is to realize that incident reports are not a weapon that leads to destruction. It is a management tool that leads to improvement. Negative minds don’t look for benefit, positive minds do. If you are business owner with employees, you have to work hard at this so your people will cooperate. Nothing turns off cooperation faster than chewing someone out after an incident report is filed. (That’s a lesson that county officials need to be reminded of now and then.)

 

“Just the Facts, Ma’am”

That is a line made famous by Jack Webb’s character Joe Friday from the TV show Dragnet. He used it to filter out assumption, speculation, and guesses from witness statements. Similarly, incident reports are a simple statement of the facts. It is a nonjudgmental summary of events as you witnessed them. Do not write down any conclusions or assign any blame.

What does that look like?

Monday at 11:30 Mary Smith left the house unattended and was gone for three hours.  After a search of the neighborhood, Jane Jones found and escorted the resident back home. No injuries or other incidents were observed.

Not – Mary Smith got agitated because her son brought his kids and they were too noisy. She took off because the son left the door open and was more concerned about his own kids and not his mom’s welfare.

If you didn’t see it, don’t write it as if you did. If there were witnesses, put their comments in quotation marks and reference their name. Remember, don’t draw any conclusions from the remarks.

Henry Kaplan, a fellow resident, reported, “I heard Mary’s son yell at her when she got upset about the kids misbehaving.” He witnessed the incident just before she left the home.

Not – The kids got her upset and that made the son angry. He was abusive to her which made her want to run away.

The benefit of “just the facts” is that you get to tell exactly what happened up front, before any conclusions are jumped to. You can get to what actually happened much faster and draw the correct conclusions after properly studying the facts. You will spend less time trying to correct an issue that may not have even occurred.

In his book The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change, Stephen Covey states, “For every thousand hacking at the leaves of evil, there is one striking at the root.” A correctly filled-out, factual, non-judgmental report can help you get to the root of the problem faster.

 

Timeliness Counts

Incident reports must be written while memories are fresh. The human  mind is easily distracted. We forget things easily as new thoughts push out the old. Not every fact makes it to our long-term memory. This leaves holes in the story. Often, our brain subconsciously knows that there are holes and fills them in with substituted facts. These false facts are filled in because that is what the subconscious mind wants us to believe. It’s what makes sense at the time. Our conscious mind is not aware that a substitution of facts took place. All it knows is that the flow of thoughts seems to fit together. 

Also, a timely presentation of the facts prevents wrong conclusions from being formed. If you wait until later to file a report, assumptions will have already been made and it will be harder to see past an incorrect conclusion. That is true for your part, the witness, the boss, the family, and everyone else concerned. In the absence of timely facts people will make up their own story.

Finally, late reports make you look like you’re trying to hide something. You don’t want to go there. On the other hand, timely reports make it look like you’re on top of things. So, take care of immediate safety concerns and then write your report and get it to the right people quickly.

 

Follow Up

Now that you’ve filed the report, what are you going to do — nothing? Are you hoping that the incident won’t happen again? Are you going to let it sit there and wait to see what happens? Are you hoping that nobody will notice? That’s what amateur caregivers do. Doing nothing is a missed business opportunity. Professionals view incident reports as vital feedback on their caregiving practices. Successful businesses view incident reports as critical operational feedback that is used to improve their product. Successful business owners know that no improvements means that they will eventually fall behind the competition. You can bet that your competition is using this important data to try to out-compete you.

 

 

More Notes From the Business Trenches

 Here is what I suggest that you do to get the full benefit out of incident reports: Treat an incident just as you would if it were a report on the appearance of symptoms in one of your residents. This time, the business is the patient and you’re the doctor. Ask questions to find out what is really going on. Is it serious? What are the contributing factors? What are the circumstances that will make it happen again? Do you see any hidden patterns? Once you’ve got a good handle on it, you’re going to want to conduct a therapeutic experiment to see if you can cure the patient. Find something to measure, implement a change, and record and review the results.

What does that look like?

After sending your report about Mary Smith, you start to look at the circumstances. Mary wandered off because she got agitated. She got agitated when her son yelled, because the kids were making her nervous. The son yelled because it was hard for him to control the kids. The kids got out of control because they got bored.

The therapeutic experiment: supply visiting children with entertaining distractions, or supply a plate of cookies, or keep staff around during family visits. Measure the agitation level during and after the visit, or the kid’s annoyance factor.

 

Conclusion

Over the years, I have changed my opinion about incident reports. Today, I see them as a valuable caregiving tool. I view their use by others as proof of their professionalism. No one will ever be perfect all the time; incidents are going to happen. Are you going to fearfully hide, or are you going to take advantage of incident reports? I hope that I have supplied you with enough reasoning to look on incident reports more favorably. Because the fact is, a properly filled-out incident report submitted in a timely manner will give you valuable insights that will drive improvement. Improperly filled-out or late reports will only land you in trouble with licensors, families, and the courts. Just view them as another professional caregiving tool, not as something that leads to punishment.

As always, good luck in your caregiving efforts.

Mark Parkinson, BSPharm

 

References:

Adult Foster Homes for Individuals with Intellectual or Developmental Disability. Oregon Administrative Rules, Chapter 411, Division 360. https://www.dhs.state.or.us/policy/spd/rules/411_360.pdf

Incident Reports. The Climate Change and Public Health Law Site. 2019.  https://biotech.law.lsu.edu/Books/aspen/Aspen-INCIDENT.html

Hynes, JoElla MSN. Charting Checkup Don't Be Intimidated by Incident Reports. LPN2009. March/April 2009, Volume :5 Number 2, page 4 – 5. https://www.nursingcenter.com/journalarticle?Article_ID=843476&Journal_ID=522928&Issue_ID=843475

When to Report an Incident in an Assisted Living Facility. Highland Risk. 2019. https://www.highlandrisk.com/when-to-report-an-incident-in-an-assisted-living-facility/

Should I be reporting this to someone? Making sense of the Incident Reporting Requirements. Elliott Frost Leadingage Procare. ADHCC Annual Conference Apr. 2013  https://www.leadingageny.org/home/assets/File/Incident%20Reporting%20Requirements.pdf

 

 

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