Incident Management Bulletin: Recognizing Incidents

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Incident Management Bulletin: Recognizing Incidents

Part 7: Primary Categories: Serious Illness, Serious Injury, Death, and Suicide

Course #: ID-2021-10

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Course #: ID‐2021‐10 1

Incident Management Bulletin: Recognizing Incidents Part 7: Serious Illness, Serious Injury, Death, and Suicide


Hello, my name is Dave Maloney with The Columbus Organization. Welcome to this webcast on Recognizing Incidents, Primary Categories: Serious Illness, Serious Injury, Death, and Suicide.

This webcast series is about our responsibility to recognize incidents that have occurred, are alleged or suspected, respond to the individual’s immediate needs, and elevate the information to others in the incident management process.

As you learn more about Incident Management, stay focused on what matters most. Something bad has happened or may have happened in a person’s life. It’s our responsibility to help the people we support to be healthy and safe.

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Initial Reporter Responsibilities

Notice the details when an incident occurs, is alleged, or suspected.

Recognize

Respond

Elevate

Point Person

Reports the incident.

Initial Reporter

Recognizes an incident or suspected incident, responds, and elevates the information.

Remember that the Incident Management process doesn’t begin until an incident is recognized. When individuals are hurt or harmed, we need to respond with empathy to support health and safety and then quickly elevate the information to the Point Person, who creates the incident report.

All of us are responsible to be the Initial Reporter and notice details if we see an incident, hear an allegation, or recognize the signs that an incident may have occurred and elevate the information to the Point Person.

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Incident Management Bulletin

Primary Category

Secondary Category

Timeframes for entering incidents

Enterprise Incident ManagementEnterprise Incident Management

The Incident Management Bulletin is the source for information in this webcast series. The Bulletin includes Incident Management Primary and Secondary Categories. Secondary Categories always relate to the Primary Category under which they fall. Keep in mind that the Bulletin includes timeframes for incident reports to be entered by the Point Person and others in the Enterprise Incident Management System (EIM).

In this webcast series, you’ll see the 24 and 72‐hour symbols depending on the reporting timeline the Point Person is required to meet. As the Initial Reporter, you must keep in mind that quickly elevating information will help the Point Person to meet the reporting timelines in the Bulletin in order to keep an individual healthy and safe.

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• Serious Illness

• Serious Injury

• Death

• Suicide Attempt

Objectives

By watching this webcast, you will understand the Incident Categories listed below and your responsibilities as the Initial Reporter when they occur:

By watching this webcast, you will understand the Incident Categories listed on this slide and your responsibilities as the Initial Reporter when they occur.

As you read the list, notice one difference between these incidents and the ones discussed in Parts 2 and 3. Most of these incidents are observable and do not involve suspicion or allegation. Many of these incidents will, by definition, require the intervention of others such as police, medical professionals, or behavioral health workers who have their own obligation to respond and report what happened.

However, your responsibilities as an Initial Reporter remain the same. If you notice something, you must say something, even if others are involved and report their actions. Remember what we said earlier, it’s better to err on the side of speaking up when something happens than to later regret not having said something.

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A physical illness, disease, or period of sickness that requires a hospitalization. This includes an elective surgery that requires a hospitalization.

Serious Illness

A physical illness, disease, or period of sickness that requires a hospitalization. This includes an elective surgery that requires a hospitalization.

We’ll begin with the Category Serious Illness.

Serious Illness is a recognized and reportable incident when it requires hospitalization for physical illness, disease, or sickness, including hospitalizations for elective surgery. This incident category does not require reporting of emergency room visits when they do not result in hospital admission. For example, Karla can’t get in to see her primary care doctor for fever and severe intestinal symptoms, and instead, she goes to the emergency room. There, she’s evaluated and diagnosed with an intestinal virus, given a prescription, and sent home. Even though she is quite ill, you would not recognize and elevate this as a Serious Illness incident because Karla was not admitted to the hospital.

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Chronic/Recurring

An illness, condition or disease that is persistent or otherwise long-lasting in its effects for which an individual has had previous treatment and/or diagnosis.

New

An acute illness, condition or disease for which an individual has not previously received treatment. This includes acute illnesses, conditions

or diseases that may become chronic in the future.

Serious Illness – Secondary Categories

Chronic/Recurring

An illness, condition or disease that is persistent or otherwise long-lasting in its effects for which an individual has had previous treatment and/or diagnosis.

New

An acute illness, condition or disease for which an individual has not previously received treatment. This includes acute illnesses, conditions

or diseases that may become chronic in the future.

Serious Illness is reported with one of two Secondary Categories. When an illness is chronic and requires intermittent hospitalizations for treatment, or when a new illness requires treatment in the hospital, both are required to be recognized and reported as serious illnesses. As the Initial Reporter, you would elevate the information to the Point Person as soon as you become aware that an admission is in process.

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Serious Injury

Any injury that requires treatment beyond first aid. This includes injuries that receive an assessment or treatment at an emergency room, urgent care center, primary care physician office, etc., or that require hospitalization.Assessment by emergency medical services that did not require a visit to one of the locations listed above for treatment is not reportable. Serious injuries that are treated by a medical professional (i.e. doctor, nurse, etc. that is used by the organization) on-site are reportable.

Any injury that requires treatment beyond first aid. This includes injuries that receive an assessment or treatment at an emergency room, urgent care center, primary care physician office, etc., or that require hospitalization. Assessment by emergency medical services that did not require a visit to one of the locations listed above for treatment is not reportable. Serious injuries that are treated by a medical professional (i.e. doctor, nurse, etc. that is used by the organization) on-site are reportable.

A Serious Injury, to be reportable in ODP’s Incident Management system, requires treatment beyond first aid, including assessment and/or treatment in an Emergency Room, Urgent Care, Primary Care Physician Office, or an injury that requires hospitalization. If a medical professional, such as the provider’s nurse, comes to the place where an individual lives or works to assess or treat an injury, the injury is also reportable. However, if Emergency Medical Services assess an injury but the injury does not require a visit to one of the sites I mentioned, the injury is not reportable.

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• Any injury with loss of consciousness

• Medical equipment malfunction and/or damage that requires immediate intervention

• Lacerations requiring stitches, staples or sutures to close

Serious Injury - Examples

• Fractures

• Dislocations

• Burns

• Electric shock

• Loss or tearing of body parts

• Eye emergencies

• Ingestion of toxic substance

• Head injuries from accidents, falls, or blows to the head

Examples include (but are not limited to):

These are examples of the kinds of injuries that, if they require treatment beyond first aid, are to be recognized as serious injuries and elevated to the Point Person. Remember that, as the Initial Reporter, your responsibilities include not only recognizing and elevating serious injuries but responding to an individual’s immediate needs for health and safety. This includes helping him or her reduce the potential for further harm – for example, moving away from a stove that caused a burn – and providing emotional support.

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Injury Accidental

Injury (other than self-inflicted) with a known cause at the time of the report.

Injury Accidental

Injury (other than self-inflicted) with a known cause at the time of the report.

ChokingWhen food or other items become lodged in the back of the throat and the cause is not attributed to neglect. Choking incidents are only reportable when they require interventions such as back blows, abdominal thrusts or the Heimlich maneuver.

ChokingWhen food or other items become lodged in the back of the throat and the cause is not attributed to neglect. Choking incidents are only reportable when they require interventions such as back blows, abdominal thrusts or the Heimlich maneuver.

Serious Injury – Secondary Categories

Choking incidents must be followed up by having a person medically assessed.

Choking events or injuries resulting from failure to implement protocols and precautions are reported as Neglect.

A choking incident that requires intervention to dislodge the cause of choking is required to be recognized and elevated. For example, if an individual were to choke while eating but the food was dislodged when someone used the Heimlich maneuver, this incident requiring assistance to stop the choking is elevated to the Point Person. Provider staff are required to provide basic first aid, and the provider and team are required to follow up with medical assessment, examination, or treatment by a qualified medical professional.

Choking events or injuries that result from failure to implement existing established protocols and precautions must be recognized and reported as Neglect.

When an accidental injury occurs, the immediate priority is to act to protect the individual’s health and safety, and then elevating the information to the Point Person. Remember the example we discussed in a previous webcast. If I severely cut my hand when we were in the kitchen, you would first help me to slow the bleeding by applying pressure and then immediately call for help.

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Injury Unexplained

An injury with no known cause at the time of the report.

Medical Equipment Failure/Malfunction

Any medical equipment failure or malfunction that requires intervention by a medical professional. This does not include routine maintenance or care of medical equipment.

Pressure Injury (decubiti, pressure ulcer, pressure sore, bedsore)

Injuries to skin and underlying tissue resulting from prolonged pressure on the skin, regardless of stage and including an injury that is unstageable. This includes initial diagnoses, newly affected areas of the body as well as a diagnosis that becomes worse over time.


Injury Unexplained

An injury with no known cause at the time of the report.

Medical Equipment Failure/Malfunction

Any medical equipment failure or malfunction that requires intervention by a medical professional. This does not include routine maintenance or care of medical equipment.

Pressure Injury (decubiti, pressure ulcer, pressure sore, bedsore)

Injuries to skin and underlying tissue resulting from prolonged pressure on the skin, regardless of stage and including an injury that is unstageable. This includes initial diagnoses, newly affected areas of the body as well as a diagnosis that becomes worse over time.

When an injury is discovered but the cause is not known, Initial Reporters are to respond to the individual’s immediate needs and elevate the information to the Point Person.

If a medical professional must intervene for medical equipment failure or malfunction, this must also be recognized and elevated to the Point Person.

Prolonged pressure to one area of the body, whatever the cause, can result in pressure sores and ulcers which can, in turn, have serious effects on overall health and wellness due to pain and infection. When an Initial Reporter discovers new injuries to the skin, including decubiti (or pressure sores), ulcers, or bedsores – or worsening of known skin breakdown, the injury is immediately to be elevated to the Point Person.

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Injury Self-Inflicted

Injury with a known cause at the time of the report that can be attributed to an intentional action of an individual to cause harm upon himself or herself.

Self-inflicted injury must be indisputable and not an accident or an attempt at suicide.

Remember that serious injuries, including those that are self-inflicted, are recognized as incidents when they requiretreatment beyond first aid.


Injury Self-Inflicted

Injury with a known cause at the time of the report that can be attributed to an intentional action of an individual to cause harm upon himself or herself.

If you see or learn that an individual has inflicted injury on himself or herself with the intent to cause harm, elevate the information to the Point Person. At the time you recognize a Self‐inflicted Injury, whether you see it happen or have cause to believe an injury was self‐inflicted, err on the side of caution and tell someone. More information may come to light later about the injury and the individual’s intention, but in the moment, respond to immediate needs to reduce risks to health and safety.

For example, you discover a large bruise on Bernie’s leg and believe that it might be because he tends to rock and swing his legs while sitting, so you assume the injury was self‐inflicted. The priority at the time you see the bruise is to check that Bernie is okay and then elevate the information to the Point Person. There will be time later to look into what happened once Bernie’s immediate needs are taken care of and the Point Person has the information.

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The causes of injuries and illnesses may not be fully known at the time the incident is recognized and elevated.

Serious Illness and Injury - Reminders

Make sure to pay attention to details surrounding an injury or illness. They will be needed later in the process.

Immediate needs for health and safety are a priority when an incident occurs.

The causes of illnesses and injuries, including the intent of someone who self‐harms or the action or inaction of others that may have contributed to an illness or injury, are not always fully known at the time of an injury or the start of the illness. As we’ve said, at the point of recognition of a Serious Illness or Serious Injury, the priority of an Initial Reporter is to the individual’s immediate needs for health and safety. But what you notice will be important later when an organization reviews serious illnesses and injuries, or an injury is investigated by a Certified Investigator (or CI).

Therefore, I’ll reinforce a point we’ve made throughout this series. When you recognize, discover, or suspect a Serious Illness or Serious Injury and act for health and safety, make note of the details: what happened before, during, and after, who was present, and anything that may have contributed to the illness or injury. This information will be important for those who review information to prevent future illnesses and injuries.

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While helping Eleanor get ready for bed, you notice an open sore on her right buttock. Eleanor is favoring her right side and her forehead feels slightly warm.

Submit Clear

A) Get Eleanor ready to go to the emergency room.

B) Reassure Eleanor, quickly contact a Point Person, and followdirections for next steps.

C) Check Eleanor’s record to find out if the injury is new or hasalready been noticed.

Check Point: Serious Injury

Which action would you immediately take?

Hi, this is Robin. It’s time for a Check Point. This is an opportunity for you to think through what to do when you see an injury.

While helping Eleanor get ready for bed, you notice an open sore on her right buttock. Eleanor is favoring her right side and her forehead feels slightly warm. Which action would you immediately take? Choose one response and then click submit.

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Robin

Stamp


While it may be necessary to have Eleanor checked in an emergency room and learn information about whether the injury is new or existing, your first priority as the Initial Reporter is to respond to Eleanor’s immediate needs for reassurance and then elevate the situation to a Point Person.

Now let’s go back to Dave.


Course #: ID‐2021‐10 15


Death

All deaths are reportable. Deaths attributed to or suspected to have been the result of abuse or neglect require additional reporting in the appropriate corresponding category. In addition, any critical incidents that are discovered during an investigation into a death require additional reporting in the appropriate corresponding category.

All deaths are reportable. Deaths attributed to or suspected to have been the result of abuse or neglect require additional reporting in the appropriate corresponding category. In addition, any critical incidents that are discovered during an investigation into a death require additional reporting in the appropriate corresponding category.

When we began this webcast series, I mentioned that many of the topics are difficult to talk about. It can be traumatic and stressful to learn that an individual you care about has died. When you learn of a Death, take a moment to breathe and work through the shock and sadness.

ODP requires that all deaths are reported in the Incident Management system. If you are the first person to discover an individual has died, notice details as they may be important later. When a Death occurs, you are not the person responsible for classifying it in the Incident Management system, but you are responsible to recognize that an incident has occurred and provide information about what happened.

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Natural Causes – Services Provided

Primarily attributed to a terminal illness or an internal malfunction of the body not directly influenced by external forces. For example, a personwho has been diagnosed with cancer and is receiving hospice services or when a Do Not Resuscitate (DNR) order is in place.

Unexpected – Services Provided

An unexpected death is primarily attributed to an external unexpectedforce acting upon the individual. Deaths attributed to events such as car accidents, falls, homicide, choking and suicides would be consideredunexpected.

Death – Secondary Categories

Death should be reported in these categories if it occurs while an individual is enrolled in a Waiver program or ACAP or is receiving services in a provider operated setting.

Natural Causes – Services Provided

Primarily attributed to a terminal illness or an internal malfunction of the body not directly influenced by external forces. For example, a personwho has been diagnosed with cancer and is receiving hospice services or when a Do Not Resuscitate (DNR) order is in place.

Unexpected – Services Provided

An unexpected death is primarily attributed to an external unexpectedforce acting upon the individual. Deaths attributed to events such as car accidents, falls, homicide, choking and suicides would be consideredunexpected.

Deaths are reported according to whether the person was receiving services or was not receiving services at the time of death. ODP uses the word service to describe individuals enrolled in and receiving paid services from an Intellectual Disability/Autism waiver, the Adult Community Autism Program (or ACAP), or provider‐operated settings.

If an individual receiving services passes away, the Secondary Category is either Natural Causes or Unexpected. Death is attributed to natural causes when it is due to illnesses such as cancer, or a malfunction of the body, such as a heart attack. When the death of an individual receiving services is due to, for example, an accident, fall, or choking, this is considered an Unexpected Death.

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Unexpected – Only Supports Provided

An unexpected death is primarily attributed to an external unexpected force acting upon the individual. Deaths attributed to events such as car accidents, falls, homicide, choking and suicides would be considered unexpected.

Natural Causes – Only Supports Provided

Primarily attributed to a terminal illness or an internal malfunction of the body not directly influenced by external forces. For example, a person who has been diagnosed with cancer and is receiving hospice services or when a Do Not Resuscitate (DNR) order is in place.

Unexpected – Only Supports Provided

An unexpected death is primarily attributed to an external unexpected force acting upon the individual. Deaths attributed to events such as car accidents, falls, homicide, choking and suicides would be considered unexpected.

Death – Secondary Categories

Natural Causes – Only Supports Provided

Primarily attributed to a terminal illness or an internal malfunction of the body not directly influenced by external forces. For example, a person who has been diagnosed with cancer and is receiving hospice services or when a Do Not Resuscitate (DNR) order is in place.

The Secondary Categories for Deaths of individuals who only receive supports (no waiver or ACAP services) are the same as for the Services Provided Secondary Categories. Deaths may be the result of Natural Causes or Unexpected.

When an individual receiving services dies, the death will be investigated. Even when an individual is receiving only supports, it’s important to take note of the details. Deaths may become associated with other incident categories such as Abuse or Neglect as more is learned. Recall also that the Inspector General’s report discussed in the first webcast found that information surrounding deaths needs to be consistently reported to authorities. Details are very important following a death.

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Suicide Attempt

The intentional and voluntary attempt to take one’s own life. A suicide attempt is limited to the actual occurrence of an act and does not include suicidal threats or ideation. If medical treatment was sought after a suicide attempt, it should be reported under suicide attempt as a Primary Category in all cases, and not as serious injury, or illness.

The intentional and voluntary attempt to take one’s own life. A suicide attempt is limited to the actual occurrence of an act and does not include suicidal threats or ideation. If medical treatment was sought after a suicide attempt, it should be reported under suicide attempt as a Primary Category in all cases, and not as serious injury, or illness.

When a Suicide Attempt is discovered, the immediate priority is for medical and/or emergency support to provide safety for the individual. If you are the Initial Reporter with the person at the time of a suicide attempt, it may cause you to experience shock or fear for the person. It’s important that you do your best to respond calmly and with empathy and compassion.

The person who recognizes a Suicide Attempt may not know the individual’s motivation or state of mind at the time the attempt is discovered and the information is elevated. Suicide Attempts may reveal other incidents in the person’s life, such as ill health, emotional problems, abuse, or neglect, that will need to be pursued after recognition and elevation of the incident. Therefore, it’s especially important to make note of details around the event, including the person’s actions, words, or mood, and the actions of others before the event (including staff and other people in the individual’s life) so that this information can be used to understand what happened and provide support to prevent a recurrence.

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Injury/Illness that Requires Medical Intervention

An individual sustained an injury or became ill due to a suicide attempt and it required medical treatment beyond basic first aid.

No Injury/Illness that Requires Medical Intervention

An individual has not sustained an injury or become ill due to a suicide attempt that required medical treatment beyond first aid.

Suicide Attempt – Secondary Categories

Injury/Illness that Requires Medical Intervention

An individual sustained an injury or became ill due to a suicide attempt and it required medical treatment beyond basic first aid.

No Injury/Illness that Requires Medical Intervention

An individual has not sustained an injury or become ill due to a suicide attempt that required medical treatment beyond first aid.

The Secondary Categories for a Suicide Attempt focus on whether or not medical treatment beyond first aid was required (for example, stitches for a wound) or if the attempt did not result in an injury or illness that required treatment beyond first aid.

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Conclusion

As a reminder, the focus of this webcast series is on the recognition of potential incidents in

order to protect the health and safety of the individuals we support. We have a

responsibility to Respect, Listen, Ask, Believe, and Respond to what the individual is telling

us and recognize when things that occur in the individual’s life may cause hurt or harm and

may be a reportable incident. We all have a responsibility to quickly bring those concerns

to the table and elevate the concern, so that those responsible for further actions,

including reporting, can quickly take the necessary actions.

In Part 8 of this series, we will explore the Primary Categories: Public Health Emergency

and Other Categories.

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Incident Management Bulletin Training

Recognizing Incidents

Part 2: The Initial Reporter’s Responsibility to Recognize and Elevate Incidents

Part 7: Primary Categories: Serious Illness, Serious Injury, Death, and Suicide

Part 1: The Incident Management Process

Part 5: Primary Categories: Abuse and Sexual Abuse

Part 4: Primary Category: Exploitation

Part 3: Primary Categories: Neglect, Passive Neglect, and Self-Neglect

Getting Started

Part 6: Primary Category: Rights Violation

Part 8: Primary Categories: Public Health Emergency and Other Categories

This concludes the webcast on Primary Categories: Serious Illness, Serious Injury, Death, and Suicide. Please be sure to watch all nine webcasts and complete all the course requirements in order to obtain your Certificate of Achievement and training credit.

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Developed and produced by

Pennsylvania Department of Human ServicesOffice of Developmental Programs

in partnership with

Music courtesy of www.essasmusic.com

This webcast has been developed and produced by the Pennsylvania Department of Human Services, Office of Developmental Programs in partnership with The Columbus Organization.

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Documents

Incident Management Bulletin: Recognizing Incidents