The SC s Role in Incident Management 1 The Supports Coordinator s Role in Incident Management Title Slide (music playing) This webcast is one in a series about incident management and risk management in Pennsylvania. This webcast, The Supports Coordinator s Role in Incident Management, provides information about incident management procedures and roles as they pertain to Supports Coordinators or SCs. It was decided that this course should also be available to other interested parties who would like to learn about the SC s role in incident management. The reason for this is two-fold. One, as it is a course in the series about incident management and risk management in Pennsylvania, it has value to all interested parties. Two, the role of SCs in incident management is impacted by and also impacts other roles. Therefore, it is believed that it could be helpful for other roles in the incident management process to view this course as well. Webcast Tips There are a few things that will assist you in navigating through this webcast. At the bottom of the viewing pane are the play and pause buttons as well as buttons to go back and forward. There are also buttons to adjust the volume and view the closed captioning. On the left is a table of contents that you can use to navigate to a specific area of the webcast. There are also times when other buttons may appear on the screen. They will typically appear at the bottom of the screen. The webcast may pause until you click the button. To continue, click the [Continue] button that appeared in the lower right hand corner of the slide. Certificates of Achievement will be available after completing all course requirements. For SCs and SC Supervisors, course requirements include successful completion of the pre-test and post-test. Please view and then save or print your certificate in order to receive credit for this course. Pre-requisites If you have not viewed the Foundation of Incident Management and Understanding Incident Management courses, you should do so before proceeding. This course builds upon concepts presented in those webcasts which provide requirements contained in the Incident Management Bulletin, a sense of overall purpose of incident management and risk management, and how those two related, but distinct processes work together.
The SC s Role in Incident Management 2 You should also read the Incident Management Bulletin 6000-04-01 and Annex A prior to viewing this webcast. Annex A defines what incidents are and provides the rules for responding to and reporting incidents. Click on the picture of the IM Bulletin or Annex A to view either document. When you are finished, click [Continue]. Presenter Hello and thank you for viewing this webcast about the Supports Coordinator s role in incident management. My name is Dalila Byrd and I work for the Office of Developmental Programs, or ODP, as the Western Region Risk Management Specialist. I will be your narrator for this webcast. Webcast Focus At the end of this webcast, you will be able to describe the SC s role in the various components of the incident management process. You will also be able to explain how to monitor for incidents using the two incident management questions in the SC Individual Monitoring Tool. At the end of this webcast, you will be able to explain how incident information can guide the Individual Support Plan, or ISP, and team. You will also be able to recognize the alerts related to incident management, and state what incident management activities are billable for SCs. SC s Role in IM Supports Coordinators have a vital role in the developmental disability system in Pennsylvania. Through monitorings and team meetings, SCs gain an in-depth view of the individuals they support and can provide a clear picture of their lives in the community. One of the ways SCs gain an in-depth view of individuals lives is through the incident management process in which they have a number of responsibilities. It s important for SCs to have a clear picture of the incident management process because SCs have the role of recognizing incidents, making sure that an individual s provider agency reports and investigates incidents when necessary, and assuring that the provider agency plans and takes necessary corrective actions to ensure the individual s health and safety as well as to ensure that the incident doesn t happen again. Many of these tasks are accomplished through the SC Individual Monitoring Tool. These tasks are ways in which SCs contribute to the incident management process by making sure the system is functioning correctly in relation to specific incidents. However, SCs also help ensure that systematic changes happen so that the incident doesn t happen again. Because SCs work with numerous individuals, they can take what they learn from one incident that happens to one person and help providers recognize potential risks to other individuals for the same type of incident. Incident Management Process - Introduction When an incident occurs, various roles exist to complete components of the incident management process. Each component is meant to ensure the individual s health and safety. Some components also help to prevent the incident from occurring again for that individual or others. As we look at each component, we will focus on the role of the SC. Incident Management Process Recognize Incident
The SC s Role in Incident Management 3 As you know from reading Annex A of the Incident Management Bulletin and completing the Understanding Incident Management course, there are specific incidents that must be reported. The Consolidated and Person/Family Directed Support Waivers and the Adult Protective Services Law, Act 70, require the reporting of exploitation in addition to abuse, neglect, or death. Incident categories associated with the exploitation of an individual, as defined in the waivers, are Rights violation and Misuse of funds. As an SC, there are certain instances when you may be the initial reporter. These instances are described in the Incident Management Clarification for SCOs Informational Memo. To view this informational memo, click on the picture of it. When you are ready, click [Continue]. SCs are initial reporters of incidents when they witness an incident or are informed of an incident. In circumstances where the alleged incident is associated with a provider delivered service, the SC should contact the provider agency and inform them of the incident. The provider agency is then responsible for filing the incident report. As supports coordination organizations are considered provider agencies, the statement in Annex A, Chapter 6000.911, letter b number 3 states that After taking all appropriate actions following an incident to protect the individual, the provider is to report all categories of incidents and complete an investigation as necessary whenever services or supports are provided in [the] individual s own home or the home of his family, while an employee, contracted agent or volunteer is providing services in the home. This means that if you are providing a supports coordination service when an incident occurs and it is not associated with the provision of another provider-delivered service, you are responsible to take appropriate action to ensure the individual s safety and file an incident report. SCO practices around who files an incident report varies across the state. Some may have a point person who files incident reports while others may have SCs act as the point person and file incident reports.
The SC s Role in Incident Management 4 Let s look at two examples of an incident and whether a report should be filed. Example one You are monitoring Juan s services and there is no other provider service being rendered. His mom decides to take him to the hospital because he is having trouble breathing. Would you file an incident report for this situation? Yes, you would report this as you are the only provider rendering service at the time the incident occurred. Example two You are in the grocery store and see Juan s mom. She tells you that Juan is in the hospital because he was having trouble breathing. Would you file an incident report for this situation? No, you are not required to report this incident because you were not providing an SC service to Juan at the time he went to the hospital. Juan s mom seeing you at the grocery store and her informing you of him being in the hospital is an example of a notification of an incident. When, as an SC, you receive notification of an incident of abuse, neglect, exploitation or death of an individual residing in his or her family home and it is not associated with the provision of a provider-delivered service, the SC or SCO point person needs to file an incident report. If you, as an SC, become aware of an incident that is NOT abuse, neglect, exploitation or death of an individual and it is not associated with the provision of a provider-delivered service, then there is no need for you, as an SC, to report the incident. However, there is no harm in reporting these additional incidents. For individuals receiving participant-directed services using the Vendor Fiscal/Employer Agent model, the SC or SCO point person, depending on SCO practices, must file an incident report for incidents that occur during the provision of any service. Incidents may be reported to the SC by anyone, such as the common law employer which is the individual or surrogate, a support service worker, an employee of the vendor fiscal/employer agent, etc. The requirement of the common law employer to inform the SC of incidents is outlined in the Vendor Fiscal/Employer Agent Financial Management Services Bulletin 00-08-14. The bulletin states that As the common law employer, the individual or his or her surrogate assumes full and legal responsibility to Report incidents to the SC as required in Bulletin 6000-04-01, Incident Management. To view the Vendor Fiscal/Employer Agent Financial Management Services Bulletin, click on the picture of it. When you are ready, click [Continue].
The SC s Role in Incident Management 5 There is a resource for common law employers, which is the individual or surrogate, family members, and support service workers which describes learning opportunities about incident management. This resource may support SCs in discussions with the common law employer about incidents that need to be reported. To view this resource, click on the button on the screen. When you are ready, click [Continue]. For individuals receiving participant-directed services using the Agency with Choice model or AWC, the AWC provider is responsible to file incident reports. If the SC is informed of alleged incidents by the managing employer or support service worker, the SC should notify the AWC provider to file an incident report. Keep in mind that alleged incidents of abuse, neglect, exploitation, or death of an individual residing in his or her family home are always reportable whether or not the incidents occurred when services were being rendered. To download a copy of the decision tree about when and to whom to report an incident, click on the graphic on the screen. When you are ready, click [Continue]. Take a moment to respond to some questions about when an SC or SCO point person, depending on the SCO practice, is required to file an incident report. After selecting a response, click [Submit]. (no narration) (no narration) (no narration) Incident Management Process The First 24 Hours When, as an SC, you recognize or discover an incident, prompt action is to be taken to protect the individual s health, safety, and rights as described in The First 24 Hours webcast of the Understanding Incident Management course. When you notify a provider agency of an incident that they are responsible for reporting, you should ensure that the incident report is filed within 24 hours, or for medication errors and restraints, 72 hours. If the provider agency does not file the incident report, then as an SC you should notify your supervisor for further actions to be taken. Your supervisor will work with the SCO, AE, and provider agency to ensure that the report is filed. If the incident is not associated with the provision of another provider-delivered service and the incident is one of abuse, neglect, exploitation, or death, or you witnessed the incident while providing an SC service, then either you or the SCO point person, depending upon SCO practice, need to file an incident report.
The SC s Role in Incident Management 6 When, as an SC, you review the first section of the incident report, you want to make sure that the actions taken to protect the individual s health, safety, and rights make sense for that person. If the actions do not make sense or seem insufficient for what you know about the individual, you would want to take further action. Further action may be informing your supervisor who may then raise the concern to the AE or contacting the provider agency. This is helpful to the AE staff who review filed incident reports as they may not know the individual as well as you do. It is the AE s responsibility to ensure that actions taken to protect the health and safety have occurred and are appropriate. If by chance an SC is the target of an incident, then the SCO point person files the incident report and assigns an investigator. A supervisor or new SC may be assigned to support the individual while the incident is investigated. Incident Management Process Critical Incidents Within the group of reportable incident categories, some incidents require investigation by the provider agency and, in some cases, also by the AE. ODP utilizes the term critical incidents when referring to those incidents that require an investigation. It is important for SCs to have a general knowledge of the investigatory process because they review incident reports that contain summaries of investigations. Also, depending upon the circumstances, SCs may be contacted for an interview during an investigation. Individuals and families may also ask general questions about the investigatory process. Let s now take a look at some key components of an investigation. Only someone who has successfully completed the ODP Certified Investigator Training may conduct an investigation. It is critical that the certified investigator is assigned and begins the first interview no more than 24 hours after the incident is recognized. Witnesses memories may change or be lost if too much time passes before their interviews. Certified Investigators are responsible for the process of identifying, collecting, and assessing evidence such as witness testimony in order to objectively describe and explain what actually happened at the time of the reported incident. The investigation is complete when the investigator presents his or her findings to the provider agency and a determination is made so that the report can be finalized. The determination is a statement about what is more likely than not to have happened.
The SC s Role in Incident Management 7 Within the context of ODP s incident investigations, investigations are civil and not criminal in nature. A preponderance of evidence is used to make a determination in the investigation. A preponderance of evidence is a tipping of the scale 51 percent or more in one direction. Incident investigations do not prove what is true or false, or determine who is innocent or guilty. They simply confirm, or not confirm what it was reported to have happened, and reveal the facts to be considered for resolving any problems that have been identified. In rare circumstances, there will be an inconclusive determination, but in almost every circumstance, there are actions that can be taken to address the individual s health and safety needs. If, as an SC, you report an incident that requires an investigation, the SCO point person would assign a certified investigator. The certified investigator may be an SCO employee or may be coordinated through an agreement with another agency. Incident Management Process Finalize Incident Within 30 days of the incident being recognized, the filing agency is required to finalize the incident report by submitting the final section of the report. There are times, such as with long hospitalizations, when the final section of the report cannot be filed within 30 days. In these situations, the reporting agency files an extension in the incident report and includes the reason for the extension. You may be wondering why it is important for you to know the timeline for finalizing incident reports. Depending upon the situation, you may wish to see the entire incident report to follow up on a situation or for monitoring purposes. You will not be able to see the entire report until it has been finalized by the provider agency and submitted for review. Also, sometimes the incident report may be categorized differently in the final report which may impact your monitoring visit and follow up. Incident Management Process Incident Review Once an incident is finalized by an agency, AEs have 30 days to review the report and approve or not approve it. If the incident is not approved, the provider agency is expected to respond to the reviewer and re-finalize the report as quickly as possible. Once the AE approves the incident report, the regional office has 30 days to review the report to approve or disapprove it. If you notice that a particular provider agency consistently seems to be struggling to file incident reports on time and have them approved, this may warrant further examination. The individual s health and safety could be put at risk if incidents are not being resolved in a timely and appropriate fashion. Further examination would occur by speaking with your supervisor for next steps. Incident Management Process Corrective Actions Corrective actions are preventive measures that the filing agency puts into place to mitigate risk or reduce the likelihood of reoccurrence of an incident to that person or to others. The filing agency must make sure that the corrective actions can and will be implemented within the timeframes specified in the incident report.
The SC s Role in Incident Management 8 The incident report contains a section where corrective actions are to be located. As an SC, you are an important partner in validating that the corrective actions in the incident reports have been implemented. This is accomplished through the monitoring component of the incident management system which will be reviewed shortly. In reviewing corrective actions, you would want to make sure that the corrective actions make sense with what you know about the individual. If not, you would want to discuss this with your supervisor. Incident Management Process Monitoring There are multiple monitoring processes in place that review incidents and incident management information in Pennsylvania. From an SC perspective, you monitor incidents at the individual level when you conduct monitoring visits. Let s take a closer at this. Anytime you re preparing to meet with an individual, whether it s a team meeting or a monitoring visit, you should review any incidents that have been filed for that individual. In regard to the SC Individual Monitoring Tool, there are two questions about incident management in it. The first question, Have there been any incidents since the last monitoring that were not reported? requires you to know what incidents were reported and talk with the individual, staff, and others to see if there were events that occurred that should have been reported and were not. You may also become aware of incidents that were not reported by reading an individual s progress notes. Of course, if you become aware of an incident that was not reported and should be, you would immediately notify the provider agency of this so that an incident report can be filed. If the person participant directs his or her services using the vendor fiscal/employer agent model, then either you, as the SC, or the SCO point person would be responsible to file the incident report. The second question, Were all reportable incidents completed, investigated and corrective plans implemented? requires you to have knowledge of the requirements of incident management and to spend some time reviewing the incident reports. In the monitoring tool, you should list or identify all incidents that occurred since the last monitoring. Be sure to note the status of open incidents such as under investigation, finalized, not approved, etc. You should continue to review incident reports that are not finalized to make sure they are completed during a subsequent monitoring visit. You would also want to review the corrective action plans for the incidents to make sure that they have been implemented as intended. To discover this, interview the individual and provider agency staff to determine if the actions were implemented. If corrective actions were recently implemented, you may need to review these during the next monitoring visit to make sure they are working. When an incident is reported, the question, Were all reportable incidents completed, investigated and corrective plans implemented? should be answered no until all aspects of the incident report are completed including an investigation, the final report submitted, and appropriate corrective actions have been put into place.
The SC s Role in Incident Management 9 In the monitoring tool, there is an area for you to enter comments and any issues that are identified. The comments area is where you would list or identify the incidents that have occurred since the last monitoring. In the issues area, you would indicate any issues noted during the monitoring such as unreported incidents. In HCSIS on the Individual Monitoring screen, you can select the PRINT ISSUES link. What will then show is the question, the information you typed in the Issues box, a blank area for who is responsible, an area for the plan of correction, and a target date. You could print this report and share it with the provider agency so the agency can follow up on any issues and rectify them. Which of these two situations would concern you while completing a monitoring? Situation A Vince has six reported incidents over the past three months. Three of the incidents were Injury requiring treatment beyond first aid and three of the incidents were Emergency room visits. All of these incidents seem to be related to some sort of fall. In Situation B, Jewel has had six reported incidents over the past three months, but each one was different. There was a report for a Hospitalization, Emergency room visit, Medication error, Missing persons, Psychiatric hospitalization and Individual-to-individual abuse. There seems to be no relationship or pattern between these incidents. Click on the button for which situation you would be most concerned about. Either situation may be of concern, but with the information provided, Situation A with Vince is more concerning as all the incidents seem to be related to one circumstance which is that he is falling. Therefore, this is something that you would note as a concern on the monitoring tool to find out about the actions Vince s provider agency has already taken and whether additional proactive actions may be warranted. Additional proactive actions might be determined at a team meeting or through a risk management process. We ve been talking about SCs conducting individual monitoring of incidents. At the last monitoring visit prior to the annual ISP meeting, it is expected that the SC will review the handout describing an individual s right to be safe and report abuse as described in the Right to be Free from Abuse Informational Packet. By knowing what constitutes abuse and how to report it, people may be more likely to stop abuse before it happens and report it. Click on the picture of the Informational Packet to view it. When you are ready, click [Continue].
The SC s Role in Incident Management 10 There are other monitoring processes in place that review incidents and incident management information in Pennsylvania such as the SCO Monitoring, Provider Monitoring and the AE Oversight Monitoring Process. ODP s monitoring can change as trends or other needs arise. An example of this is in regard to the ODP priority of restraint elimination. ODP monitored restraint incidents across the state. The elimination of restraints was supported by trainings, technical assistance and policy updates. The data is now showing that unnecessary restraints have been minimized and that corrective actions have been put into place to support this initiative. Therefore, monitoring of restraint incidents may not occur as frequently. Incident Management Process Analysis Now that we ve looked at other components of incident management, the final one is analysis. Part Q of the Supports Coordination Services Bulletin has the requirement that SCOs are to complete semi-annual incident management reports that analyze incidents that the SCO reported. The intent of the semi-annual report is to provide an analysis of incidents and the systematic interventions implemented to improve the health and safety protections afforded to the individuals served. You may be impacted by this report if it is found that additional processes or protections need to be put into place after incident analysis. The SCO s semi-annual incident management report is due to the AE in December and in June. December s report would review the data from April through September and the June report would review data from October through March. Incident Management Process - Conclusion We have now looked at the various pieces of the incident management system and the role you, as the SC, plays in each. Let s now look a bit more at how incident information can inform the ISP process. Relationship to ISP In addition to the specific incident management tasks that have been reviewed, part of developing an ISP is looking at the pattern of incidents experienced by the individual. The example earlier in the webcast of Vince falling six times generated multiple incident reports that can help inform the ISP process and team. The team should discuss the corrective actions the provider agency put in place and incorporate this information into Vince s ISP in the appropriate sections. IM Alerts A tool that may assist you in monitoring incidents is alerts. An alert is an electronic message triggered from within the incident management system in response to an action related to an incident report that informs the user of an event that occurred or did not occur as expected. Alerts may be used for informational or reminder purposes. How to access and manage alerts can be found in the SC materials in the Learning Management System or LMS. There are a number of alerts that you receive as an SC related to incident management. Take a moment to review the alerts on the screen. When you are ready, click [Continue]. Which alerts related to incident management are you currently using?
The SC s Role in Incident Management 11 Which alerts related to incident management are you not currently using, but might be helpful for you to use? Billable IM Activities All incident management activities that are SCO responsibilities and are completed by the SC are billable activities. All billable incident management activities are considered part of the SC functions of locating, coordinating, and monitoring. According to the wavier, the SC has the responsibility while monitoring to Respond to and assess emergency situations and incidents and assure that appropriate actions are taken to protect the health and welfare of participants. Let s look at some specific scenarios related to incident management activities that are billable or not. If you are performing a monitoring visit and you are informed of a situation of alleged abuse and there is no relationship with a reporting provider agency, then the time spent taking action to protect the individual such as calling 911 and contacting victim s assistance as well as the time to actually report and/or file the incident, would all be billable time. If an administrative entity requests an SC to report an incident on behalf of the administrative entity, that is not billable time. Anytime an AE delegates an AE function to an SCO, the SCO is wearing the AE hat, so to speak, therefore the SCO cannot bill for a waiver service for this activity. The AE and SCO should have a written agreement which should include terms of compensation. Click on the AE Operating Agreement picture if you would like to read about the AE delegating functions. Otherwise, click [Continue]. The next few slides provide some additional scenarios. Decide whether the time spent in each scenario would be billable time for an SC. After clicking [Submit], be sure to check to see if the response was correct or not. (no narration) (no narration) Thank You Thank you for viewing this webcast about the SC roles in incident management. The SC s role in each piece of incident management was reviewed. The two questions in the SC Individual Monitoring Tool about incident management were reviewed as well as incident management alerts that SCs receive and incident management activities that are billable. Be sure to complete the course requirements to earn a Certificate of Achievement. (music playing) This webcast has been developed and produced by the Office of Developmental Programs Consulting System on behalf of the Pennsylvania Department of Public Welfare, Office of Developmental Programs. (music playing)