Accident Incident Policy

Changes to Policy

September 2007

Policy Purpose

• To protect residents by– Assuring appropriate action taken when

accidents or incidents occur– Including prevention planning– Providing accurate documentation of

accidents/incidents and action plans

Definition of Terms

• Accident- event leading to injury or potential injury

• Incident- event which appears out of ordinary routine of resident in question

• LAWN- leaving area without notification- resident’s whereabouts are not known thus creating dangerous situation for resident

Definitions Continued

• Significant Injury- – Any injury, witnessed or not witnessed in

which nature, cause or severity warrants need for closer examination

– May include (not limited to) multiple bruising, injuries on or about head or vital organ, injuries of sexual nature or otherwise suspicious nature

– Careful attention to Atypical or Unusual injuries

Definitions Continued

• Witnessed- you saw the

• accident happen

• Not witnessed- you did not see the accident happen

Classifications Accidents and Incidents

• Class 1- accident or incident no injury

• Class 2- injury with no treatment or first aid treatment

• Class 3-injury requiring examination, consultation or treatment from physician

Person Finding injury or witnessing accident should:

• Protect the resident, get medical attention

• Complete top part of accident/incident form

• Contact nurse, advocate and supervisor as required by policy

• Make note in record and logbook

Tips A/I form

• Complete all sections

• Account of accident/incident– If resident can tell you what happened- indicate

“resident says or states ____ happened.”– If you witnessed-indicate what you saw– If not witnessed-indicate what you found

Nurse responsibility

• Assess injury and provide treatment (contact physician if needed)

• Complete classification section of A/I form• Document injury and treatment in Nurses’ Notes• Assist supervisor or OD as needed with

statements, review A/I, preventative measures, notification, etc. may request additional statements

Nurse: Pictures

• Photograph all observable injuries– Electronically download pictures to PPS prior

to end of shift; leave picture on camera (30 days)

– Review clarity and quality of picture– Note picture number on A/I formUse body chart for injuries to sensitive areas

(genitalia, female breasts)– Attach body chart to A/I form

Medication Variances

• Notify physician

• Implement prescribed treatment

• Follow Nursing Policy 6.14 for additional responsibilities

Nurse: Guardian Notifications

• Notify guardians as soon as possible for all class 3 accidents/incidents

• Document family/guardian notification in Nurses’ Notes, on A/I form, and in Family/Guardian contact log- include date, time and nurse’s name

• Guardians will be notified of other injuries as indicated on Family/Guardian contact log

• Nurse works with QDDP and SW to address guardian’s requests

Guardian Notifications Continued

• If guardian was not notified, Nurse should provide clear documentation of why notification was not completed.

Other Nursing Responsibilities

• Check A/I form for completeness and for statements

• Enter A/I information in PPS by end of shift

• Leave A/I form with all attached documents for QDDP

• Assist supervisor or Officer of the day as needed- (letter e page 3 policy)

On-site Supervisors

• Assess the situation– Look at injury– Has medical care been provided– Is resident calm?– Are additional supports needed?– Look at environment where A/I occurred- are

there ongoing safety issues present?

On site supervisor continued

• Completing A/I Form– Gather information from staff regarding

• Circumstances or • Cause

– Talk to staff in private area

Statements

• Secure written statements for:• any not witnessed A/I, • all class 3 A/I, and • all significant class 2 and • any atypical or unusual

accident/incident (witnessed or not witnessed)

A/I Statement Form: Witnessed

– Describe what happened – include details including any event immediately A/I• What happened• Where did it happen• Where were you when it happened• Who else was around• When• How

A/I Statement Form: Not Witnessed-knowledge person prior to A/I discovery

• When did you 1st see resident on this date• Who else was around• Did resident have any behavioral or health

issues• Were other residents in area• What type of activities involved in• Describe anything that might help determine

what happened

Statements: Other Shifts

• Attach post-it note to A/I indicating need

• Leave A/I in designated box for next shift

• Statements should be secured by end of 2nd working day (from A/I initiation)

Statements Continued

• Be sure person completes form including:– Print name; Position; Signature; Date

• Supervisor reviews, signs, dates

• QDDP reviews, signs, and dates

• Advocate reviews, signs and dates

Other Responsibilities

• Prior to end of shift you should:– Check statements for content and

completeness– Sign and date each statement form as

having been reviewed- attach to A/I form– Complete A/I review on bottom of form– Communicate and implement prevention

plan

Notifications

• For all Class 3 A/I, all Significant Class 2 A/I, any Atypical or Unusual accident/incident (witnessed/not witnessed)– Notify QDDP immediately– After 5 p.m., weekends/holidays- notify Ad

Watch– Notify Area Director– Insure Advocacy notified according to policy– Notify Officer of the Day

Ad Watch Responsibilities

• Check status of resident and advise/assist as needed

• Review with staff member to see that policies and documentation have been followed

• Check to ensure notifications made according to policy

Accident/Incident Review

• Reviews are required for any not witnessed A/I, all class 3, significant class 2 and any atypical or unusual accident/incident (witnessed or not witnessed)

• Review completed by On Site Supervisor, Officer of the Day, or Nursing staff and must occur before end of shift

QDDP Responsibilities

• Review entire A/I document (including photograph in PPS) by end of following working day

QDDP Responsibilities Continued

• Provide feedback as indicated regarding:– Policy implementation; Resident safety; A/I

assessment;preventative measures and notifications

• Develop and implement additional immediate safety measures and share plans with appropriate staff

Suspected Abuse/Neglect

• Additional immediate review is required of any accident/incident (regardless of class) suspected to be result of abuse and/or neglect as defined in JIRDC policy 2.3.3

• Should abuse and/or neglect be suspected implement Policy 2.3.3 immediately

Area Director Responsibilities

• All not witnessed Class 3 and not witnessed significant Class 2 accidents/incidents will be reviewed/investigated by Area Director and others as appropriate

Advocacy

• All accident/incidents will be reviewed by Advocacy– Accident/incidents resulting in significant

impact to resident will be reported to Facility Director and Human Rights Advocacy Committee

A/I Monitoring: QDDP

• Daily– Review all A/I reports to review/determine

circumstances of each A/I and seek means of prevention

– Check A/I forms for completeness and sign by end of shift or by end of next working day

– Document and communicate preventative measures

A/I Monitoring Core Team

• A/I will be reviewed at least monthly in core teams

• RN or QDDP presents information-emphasis on A/I trends

• Core team will develop action plans-individual and group; documented in minutes

• Individual plans documented in resident’s chart

QDDP Will

Discuss A/I in monthly progress notesReview and analyze all A/I in report to Director of

Program Services, Director of Residential Services, Area Director, Human Development Research and Training Director and Advocate (monthly)

Annually Assess each resident using Injury Risk Assessment

Review safety plans on high risk people quarterly

A/I Form: Changes

• LAWN- Leaving area without notification-

• Not Witnessed-Suspected Cause– If resident can tell you what happened indicate

the “Resident says or states”– Not witnessed nature - place is not witnessed

• Notifications- added times for supervisor and Nurse

A/I Form: Changes

• Review of A/I by on-site supervisor– Includes list of things supervisor may do to

address situation– Check all that apply– Write in other actions on lines provided

• Form prompts statements for required situations

• Notifications prompted