624 Regulations

Incident Reporting & Abuse

What is an Incident?

OPWDD (Office of People With Developmental Disabilities)" Significant events or situations endangering a persons well-being.”

All Incidents are required to be recorded on a standardized form and are subject to OPWDD’s approval.

Objective:

To familiarize employees with Heaven’s Hands Community Service policy and procedures regarding incident management.

Training Areas:

Incident and their classifications Distinguishing between reportable, serious

reportable, sensitive situations, minor occurrence.

Define abuse, discuss prevention of abuse Outline notification procedures and

timeframes

Why do we report incidents?

To enhance the quality of care for our consumers. To ensure that consumers enjoy a safe environment. To identify possible trends and implement

preventative strategies. To increase agency-wide awareness of incidents in

order to implement corrective measures.

Reporting Responsibilities

All staff, regardless of status are responsible for the health, safety, and welfare of those individual we serve. All staff are therefore responsible to report all incidents.

What constitutes an Incident?

Injury Missing Person Death Restraint Medication Error Possible Criminal Act Sensitive Situations Abuse/Neglect/Mistreatment

Minor Occurrence:

An incident/injury which requires no more than First Aid.

Even if it is being provided by a nurse, physician or other health care professional.

Even if the person goes to the emergency room.

Reportable Incident:

Any suspected or confirmed harm, hurt or damage to a person receiving services, caused by an act of that person or another, whether or not by accident and whether or not the cause can be identified, which results in a persons requiring medical or dental treatment by a physician , dentist, physician’s assistant or nurse practitioner, as such treatment is more than first aid. Furthermore the treatment must revile something. i.e a break, chip, deep cut

Illness is not an injury

Serious Reportable:

Any injury which results in the admission of a person to a hospital or 24 hour infirmary for treatment or observation because of the injury.

A serious reportable incident is a reportable incident which because of the severity or sensitivity of the situation, it must be immediately reported to OPWDD.

Injury resulting in a hospital admission.

Illnesses are NOT reportable, including psychiatric illnesses.

What classification does the following incident fall under:

While walking towards the kitchen John fell hitting his left knee. Carlos the staff member, helped John onto a chair and applied ice to his knee.

a) Reportable

b) Minor Occurrence

c) Serious Reportable

d) None of the above

What classification does the following incident fall under:

While walking towards the kitchen John fell hitting his left knee. Carlos the staff member, helped John onto a chair and applied ice to his knee. After monitoring John for approximately 30 minutes, Carlos sees John knee is still swollen. Carlos escorts John to the emergency room where the doctor orders x-rays. The x-rays revile John has a chipped knee cap.

a) Minor Occurrence

b) Sensitive Situation

c) Serious Reportable

d) Reportable

What classification does the following incident fall under:

While walking towards the kitchen John fell hitting his left knee. Carlos the staff member, helped John onto a chair and applied ice to his knee. After monitoring John for approximately 30 minutes, Carlos sees John knee is still swollen. Carlos escorts John to the emergency room where the doctor orders x-rays. After reviewing the x-rays the doctor decides John should remain in the hospital for observation….

a) Minor Occurrence

b) Sensitive Situation

c) Serious Reportable

d) Reportable

Missing Person

Unauthorized/Unexpected Absence After Normal Search Procedures (911) Initiated.

Formal search must be initiated after 4 hour, reasonable judgment, considering clients habits, deficits, capabilities, health status, determines when a search procedure should be implemented. When client is in danger to themselves or others, A FORMAL SEARCH MUST START IMMEDIATELY.

Any situation that meets the definition of Missing Person will always be considered a Serious Reportable Incident.

Death

All Deaths are SERIOUS REPORTABLES INCIDENTS. Whether the death is Natural and/or Unnatural or Unexpected. When unrelated to known illness or disease, homicide, suicide, unexplained or accidental.

Restraint

Any device which prevents the free movement of both arms and/or both legs.

Physical, Mechanical or Medicinal aimed at controlling BEHAVIORS.

Immobilization of fractures, intravenous drips or other medical application are allowed as long as they are being applied/monitored in a hospital setting.

Whenever a restraint is used it is to be reported as a Serious Reportable Incident.

Medication Errors

Marked, Adverse Side Effects which jeopardizes the health and welfare of the consumer.

This can be identified as a result from: Wrong dosage Wrong form Wrong application Wrong patient Wrong medication Failing to administer medication

This is classified as a Reportable incident.

Medication Errors

If the consumer is admitted into the hospital resulting from any of the previously mentioned infractions, the classification of the incident MUST change from a Reportable Incident to Serious Reportable Incident.

Medication Errors

Medication Errors which do not result in advise effects are not reportable but must be documented in a persons record.

Possible Criminal Act

Actions by a person receiving services which are or appear to be a crime.

A crime is defined as “an act that is forbidden by law that makes the offender liable to punishment pursuant to the law. In New York State, the Penal Law defines a crime as a Misdemeanor or a Felony, but does not include a traffic infraction.”

This falls under the classification of Serious Reportable Incidents.

Sensitive Situations

A Reportable Sensitive Situation Incident are situations involving a person receiving services which are not described previously, which may be of a delicate nature to the agency, and which are reported to the administration to ensure awareness.

Sensitive Situations

A Serious Reportable Sensitive Situation Incident are those situations which in the judgment of the chief executive officer, needs to be brought to the attention of OPWDD, through the DDSO as expeditiously as possible.

ABUSE The definition of ABUSE under 624 Regulations is as

follows: The maltreatment or mishandling of a person

receiving services which would endanger the physical or emotional well being of the person through the action or inaction on the part of anyone, including an employee, intern, volunteer, consultant, contractor, visitor, or others, whether or not the person is or appears to be injured or harmed.

ABUSE Failure to exercise one’s duty to intercede on behalf

of a person receiving services also constitutes abuse.

Employees must realize that, should they fail to intervene in a situation in which they consider a consumer is being abused, they may be considered as contributing to the abuse. This includes failing to interrupt an actual act of abuse or failing to report such abuse.

Mishandling/Maltreatment

Mishandling: is to manage wrongly or ignorantly.

Maltreatment: is cruel or rough treatment (or handling) of a consumer.

WHO REPORTS ABUSE?

Everyone and anyone who observes abuse, discovers signs of abuse or who hears an allegation.

Allegation: a claim that somebody has done something illegal, wrong, or undesirable.

WHEN SHOULD YOU REPORT ABUSE?

Immediately. Even if you are not sure it is abuse, report what you observed, heard, etc. so that it can be investigated. It is not up to the reporter to judge whether it was abuse or not.

What Should be Reported?

Report the facts. (i.e. what you saw and/or heard).

Do not draw your own conclusions.

How Should I Report the Abuse?

Verbally, to your supervisor.

DO NOT leave a message.

How Can We Prevent Abuse?

Identifying the signs of stress and burnout. Learning coping solutions and how to

reframe situations. Seeking support when needed. Know your consumer. Recognizing

antecedents, early warning signs. Be flexible, avoid power struggles.

CATEGORIES OF ABUSE

Physical Sexual Psychological Seclusion Violation of Civil Rights Mistreatment Neglect

CATEGORIES OF ABUSE

UNAUTHORIZED OR INAPPROPIATE USE OF:

Restraints Aversive Conditioning Time Out

PHYSCIAL ABUSE

Physical contact which may include, but not limited to such obvious physical actions as hitting, slapping, pinching, kicking, hurling, strangling, shoving, unauthorized or unnecessary use of personal intervention.

Physical contact which is not necessary for the safety of the person and/or causes discomfort to the person may also be considered to be physical abuse.

PHYSICAL ABUSE

Any intentional hitting, slapping, pinching, kicking, hurling, strangling or shoving of an individual receiving services by a staff member, intern, contractor, consultant or volunteer of a DDSO or provider entity, except for those instances in which the action was taken to prevent injury to the individual receiving services or any other person, whether or not such action causes injury, may be a crime and must be reported to law enforcement.

PHYSICAL ABUSE

Any intentional hitting, slapping, pinching, kicking, hurling, strangling or shoving of an individual receiving services by another individual receiving services, where the individual who performs the abusive action intends to cause physical injury to the other individual and causes such physical injury, may be a crime and must be reported to law enforcement. Physical injury is defined as impairment of physical condition or substantial pain.

PHYSICAL ABUSE

Any unauthorized or unnecessary use of restrictive personal intervention techniques, including the use of more physical force than is necessary for the safety of the individual receiving services, by a staff member, intern, contractor, consultant or volunteer, where the staff member, intern, contractor, consultant or volunteer knowingly acts in a manner likely to cause injury to the physical or mental welfare of the person receiving services, may be a crime and must be reported to law enforcement

PHYSICAL ABUSE

Physically forcing a person, who refuses to take a medication would be considered physical abuse.

Any unauthorized or unnecessary use of restrictive personal intervention techniques, including the use of more physical force than is necessary for the safety of the individual receiving services, by a staff member, intern, contractor, consultant or volunteer, where the staff member, intern, contractor, consultant or volunteer knowingly acts in a manner likely to cause injury to the physical or mental welfare of the person receiving services, may be a crime and must be reported to law enforcement.

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PHYSICAL ABUSE

Any unauthorized or inappropriate use of restraint where the staff member, intern, contractor, consultant or volunteer knowingly acts in a manner likely to cause injury to the physical or mental welfare of the person receiving services may be a crime and must be reported to law enforcement. This includes the use of mechanical restraining devices or medication to control a person’s behavior without the necessary permissions

SEXUAL ABUSE

Any sexual abuse, as defined by 14 NYCRR Part 624.4(c)(2), between a person receiving services and an employee, intern, consultant, contractor or volunteer of an agency may be a crime and must be reported to law enforcement.

Sexual contact is defined as the touching or fondling of the sexual or other intimate parts of a persons for the purpose of gratifying the sexual desire of either party, whether directly or through clothing.

Any sexual contact between two persons receiving services in which one person receiving services uses force or coercion may be a crime and must be reported to law enforcement.

PSYCHOLOGICAL ABUSE

The use of verbal or non-verbal expression, or other actions in the presence of one or more persons receiving services that subjects the person (s) to ridicule, humiliation, or scorn, contempt or dehumanization. In addition to the language and/or gestures, the tone of voice, such as that used in screaming or shouting at the presence of persons receiving services, may in certain circumstances, constitute psychological abuse.

SECLUSION

The placement of a person in a secured room or area from which he or she cannot leave at will.

Note: This does not include TIME OUT as part of a behavior management plan.

UNAUTHORIZED OR INAPPROPRIATE USE OF RESTRAINTS

Use of mechanical restraining devices without the written prior physicians authorization without it being specified in a plan of service, or used for medical purposes without a physician's order.

The intentional use of a medication to control a persons behavior that has not been prescribed by a physician.

UNAUTHORIZED OR INAPPROPRIATE USE OF Aversive Conditioning

The use of adverse conditioning without appropriate permission is the unauthorized use of aversive conditioning. Inappropriate use of aversive conditioning shall include, but not limited to, the use of the technique for convenience, as a substitute for programming, or for disciplinary (punishment) purpose.

UNAUTHORIZED OR INAPPROPRIATE USE OF TIME OUT

The use of Time Out without appropriate permission is the unauthorized use of Time Out. Inappropriate use of Time Out shall include, but not limited to, the use of the technique for convenience, as a substitute for programming, or for disciplinary (punishment) purpose.

Time out should not be confused with seclusion.

VIOLATION OF A PERSONS CIVIL RIGHTS

Any action or inaction which deprives a person of the ability to exercise his or her legal rights.

Civil rights are those rights stipulated in State or Federal law for all persons in the United States, as such but not limited to the right to be free from discrimination, the right to vote, the right of children to education, and the right of disabled person to access public buildings.

MISTREATMENT

The deliberate and willful determination of an agency or staff to follow treatment practices contraindicated a person’s plan of service, which violates a person’s human rights or does not follow accepted treatment practices and standards in the field of developmental disabilities.

The denial of programming, socialization, recreation, etc. might be categorized as abuse in the form of mistreatment.

NEGLECT

A condition of deprivation in which persons receiving insufficient, inconsistent or inappropriate services, treatment, or care to meet their needs.

Failure to provide appropriate and/or safe environments for persons receiving services.

Failure to provide appropriate services, treatment, or care by gross error in judgment, inattention, or ignoring may be considered a form of neglect.

IS THIS ABUSE?

It’s 9:00 pm and Maria, DCC assist her consumers with their showers and puts two residents to bed in the room they share and shuts the door. The consumers keep getting up from their beds and opening the door. Maria decides to put a chair in front of the door and holds the door shut to prevent the consumers from leaving their room.

Is this abuse, and if so what kind?

Thirty five year old Janet has been trying to make her own sandwich for months. One afternoon she successfully completes the task and proudly approaches a staff who says “Big deal” and throws the sandwich in the garbage and walks away.

Is this abuse, and if so what kind?

IS THIS ABUSE?

While Roseanne, a twelve year old consumer is watching T.V., Tom, the DCC begins to tickle her. Roseanne doesn't like it and repeatedly asks Tom to stop. Tom says “ You’ve been so quiet today”, and continues to tickle Roseanne.

Is this abuse, and if so what kind?

Tom is a consumer who enjoys going to church every Sunday. This particular Sunday it is raining outside and staff tells Tom he would not be going to church today because it is raining.

Is this abuse, and if so what kind?

REPORTING AN INCIDENT CHAIN OF COMMAND

Carmella McDonald, Dir. of Clinical Services 646-919-8890

Kimberlyn James, Program Manager 917-682-9819

Daniel Rodriguez, Dir. Of Day Hab Services 347-756-8851

Marie Saintelmy Dir. Of QA & Corp Comp. 718-809-0721

Arlene Rado, Deputy. Ex Dir. of Pro Oper. 718-864-0228

Child Abuse Hotline 800-635-1522

CHILD ABUSE & NEGLECT

Mental Health Professional is one of the many professions recognized by the New York State Social Services Law Section 413 to be specially equipped to hold the important role of Mandated Reporter of child abuse or maltreatment.

Mandated Reporters are required to report instances of suspected child abuse or maltreatment only when they are presented with reasonable cause to suspect child abuse or maltreatment in their professional roles. Therefore, if the Doctor is examining a child in her practice and has a reasonable suspicion of abuse she must report it. However, the doctor who witnesses’ child abuse when riding her bike on the weekend is not mandated to report that abuse. (Of course, anyone may report any suspected abuse at any time, and is encouraged to do so.)

CHILD ABUSE & NEGLECT continue…

As a staff member of Heaven’s Hands Community Services. you are a mandated reporter.

RECOGNIZING CHILD ABUSE & NEGLECT

Signs and Symptoms of Child Abuse and Neglect

Child abuse and neglect occurs in all segments of our society, but the risk factors are greater in families where parents:

Seem to be having economic, housing or personal problems. Are isolated from the community. Have difficultly controlling anger or stress. Are dealing with physical or mental health issues. Abuse alcohol or drugs. Appear uninterested in care, nourishment or safety of their

children.

RECOGNIZING CHILD ABUSE & NEGLECT

The behavior of children may signal abuse or neglect long before any change in physical appearance. Some of the signs may include:

Nervousness around adults. Aggression towards adults or other children Inability to stay awake or concentrate for an extend period of

time. Sudden dramatic changes in personality or activities. Unnatural interest in sex. Frequent or unexplained bruises or injuries. Low self esteem. Poor Hygiene.

CHILD ABUSE & NEGLECT continues…

Procedures When a staff member makes report in their capacity

as members of the staff of a medical or other public or private institution, school, facility or agency, they are required to report the abuse to the Statewide Central Register Child Abuse and Maltreatment THEMSELVES DIRECTLY.

The law requires that only one report from the institution, school or agency be made.

HHCS reporting procedures on CHILD ABUSE & NEGLECT

Staff who witness the abuse must report the abuse directly to Statewide Central Resister for Child Abuse and Maltreatment.

After which they should contact their supervisor.. Oral report by Mandated Reporter is to be made to

the State Central Register at 1-800-635-1522. A signed, written report OMR 147 must be filed

within 24 hours of an oral report.

CHILD ABUSE & NEGLECT continues…

Penalties for Failure to Report (apply to mandated reporters only) or False Allegation

Criminal Sanction: It is a Class A Misdemeanor for a mandated reporter to willfully fail to report a case of suspected child abuse or maltreatment. The maximum penalty for a Class A Misdemeanor is 1 year in jail and a $1,000 fine.

Civil Sanction: A mandated reporter who knowingly and willfully fails to make a report of suspected child abuse or maltreatment is civilly liable for damages caused by such failure.

Immunity from Liability for Good Faith Reporting When a report is made in good faith, the reporter is immune

from civil or criminal liability.

INJURY OF UNKNOWN ORIGIN

The purpose of this outline is to address: The purpose for conducting an investigation

into Injuries of Unknown Origin. When do we complete an inquiry into an

injury of unknown origin report? What does it take to complete a thorough

inquiry?

INJURY OF UNKNOWN ORIGIN

Simply stated, inquires into injuries of unknown origin are completed because we don’t know how the injury occurred. As specified under 624 regulations , all reportable incidents, classified as injuries of unknown origin must be thoroughly investigated by the program.

We need to attempt to find out how the injury happened because we may be able to prevent it from reoccurring to either the same consumer or to someone else.

Having knowledge enables us to be proactive and as we all know being proactive is always better than being reactive.

There have been plenty of examples where a complete and thorough inquiry has shown the cause of an injury and prevented many others.

Many experiences, even negative, can be used as a learning experience. Remember, the consumer’s safety is your primary concern.

INJURY OF UNKNOWN ORIGIN

When do we do an injury of unknown origin?

We need to complete an inquiry injury of unknown origin for all. injuries classified under 624 regulations as “Reportable Injury-Unknown Origin. As you know we file a “147-I” report for someone whose injury requires attention “ above and beyond first aid” It is our responsibility to thoroughly investigate the injury.

INJURY OF UNKNOWN ORIGIN

We may encounter a bruise, mark, scrape on someone’s body that only requires first aid, but needs to be looked into. In this instance, we need to train staff to notify their supervisor immediately so that as assessment of the situation can be made and a determination whether an inquiry must be initiated.

Think about the times that you have noticed a mark on your body and though how did this happen and tried to determine the cause of it! That is what we must do for our consumers who are unable to recall and/or express the cause of an injury.

INJURY OF UNKNOWN ORIGIN

What does it take to complete the report thoroughly?

The key is to remember that you need to speak with any and everyone who could possibly know what may have caused the injury.

Always err on the side of caution, because it is always better to have interviewed too many people than not enough. It is important to remember that you don’t know when the incident could have happened.

INJURY OF UNKNOWN ORIGIN

WHO SHOULD I INTERVIEW?

Talk to the consumer Talk to all staff on duty at the time the injury was discovered. Depending on how old the injury is, talk to people who worked

on different shifts the same day and maybe even the day prior. Talk to people who transport the individual(s). If applicable, talk to day program, OPTS/ In home behavioral

personal. Talk to parents/siblings

INJURY OF UNKNOWN ORIGIN

The purpose of speaking with people is to gather information about what could have happened to cause this injury. You want to learn from staff whatever relevant information they possess about the incident and eventually you’ll need them to write it down for you.

Written statements are VERY important. The person conducting the inquiry should start by asking all staff on shift at the time of discovery to write a statement, date and SIGN it. These statements will be kept on file with the complete injury report.

After you’ve compiled all the information, read it through and begin completing the report. The person completing the inquiry into the unknown origin form should transcribe a summary of each person’s statement. Meets with your supervisor/ Coordinator of QA to discuss corrective action or whether additional follow-up is necessary. Your report is not complete until a supervisor and the Coordinator of QA has reviewed it.