Incident Reporting

Purpose: 

An incident report is completed for events/incidents/accidents/complaints that are out of the ordinary course of events. Tracking is completed to determine potential liability and/or opportunities for improvement. Home care staff shall be made aware of incident management procedure. 

Regulation: 144A,4791(11)
Policy: RC-A11

Definition of Incident:

Incidents are defined as events that are out of the ordinary and affect a client (e.g. client fall) or an employee (e.g. med error). An Incident may start as a grievance and be elevated to an L3 Incident. For example, “Jane Smith was late today” is a client grievance documented through the grievance process, unless it results in an outcome for the client. For example, if the client fell, because he/she couldn’t wait any longer for the caregiver; and got out of bed without assistance; the event would be elevated to an Incident Report.

PROCEDURE: 

  1. An Incident Report form is completed for all occurrences that meet the definition of “incident” and/or warrants further investigation to determine client outcome, potential liability or opportunities for improvement.
  2. All employee and client-related incidents or unusual occurrences, accidents and injuries must be documented on an Incident Report form. Incidents include, but are not limited to:
    1. Endangerment of staff or client
    2. Equipment or medical device malfunctions or failure
    3. Financial Exploitation
    4. Injuries – including those of unknown source
    5. Safety hazards
    6. Theft
    7. Deaths
    8. Verbal or physical abuse
    9. Falls – witnessed or non-witnessed
    10. Medication Error

Categories & Levels:

  1. All incidents will be documented on the Incident Report Form.  Incidents will be categorized as either client or employee. While incidents may involve both staff and client (and both names will be documented) only one category should be checked on the Incident Tracking Form. To determine how to categorize, identify the nature of the incident and the outcome.
    1. Client Example: If there is any client outcome, regardless of staff involvement, the incident is categorized under client. For example, an employee was transferring a client in a Hoyer lift; the client fell from the sling and broke a hip. This incident would be categorized as client, even though there will be investigation into staff performance and training.
    2. Employee Example: If an employee is responsible for an incident – falsification of time card, alleged abuse, exploitation, etc., the incident is categorized under employee.
  2. The reporting protocol for 1st report of injury should be completed in the event of employee work-related injury.
  3. Incident reports will be completed within 24 hours. The Administrator is responsible for initiating the report, gathering all information, and discerning in which level the incident should be categorized. They will be categorized into one of three levels which reflect risk to the client and/or company as determined by the following parameters:
    1.  Level 1: Low risk example: minor incident such as small amount of bruising noted
    2.  Level 2: Moderate risk example: med error without outcome
    3.  Level 3: Significant risk examples: significant injuries i.e., injuries resulting in surgery, unexplained bruises, unexpected deaths; abuse/neglect allegations, allegations of theft, fraud, inappropriate behavior
      1.   Unexpected DeathsRecover Care completes Death Chart Review & Evaluation documentation for all unexpected deaths to ensure that there is a review of services in the weeks preceding the death. The review:
        1. Establishes that all services were provided appropriately
        2. Evaluates that all assessments were completed
        3. Determines that all changes with the client were addressed appropriately
        4. Ensures that the highest quality of care was provided by RC staff

Notification:

  1. All level 3 incidents are reported to the Compliance Officer (612-805-8961) who will evaluate next steps. Contact must be made immediately via phone with all incidents that pose immediate jeopardy to the client, have resulted in actual harm, or have a high risk for actual harm.
    • If unable to reach the CSO, the COO / or designee will start the investigation and ensure that the appropriate notifications are made.
  2. Level 3 Incidents require additional investigation on subsequent pages of Incident form.
  3. If it is not clear if an incident is a Level 3 incident – the Administrator shall assume it is and follow the reporting protocol and start the investigation.

Investigation & Quality Assurance:

  1. All Level 3 incidents will require an investigation. The investigation will be conducted at the site level and monitored by the Compliance Officer or designee to ensure a thorough evaluation of risk, liability, and appropriate response to events.
  2. All incident reports are maintained in an administrative quality assurance file and are not part of the medical record. The form is confidential and privileged and is an internal document only.
  3. Each branch will maintain a Tracking Log in which all incidents are recorded for analysis of patterns, trends, and opportunities for improvement.
  4. Incident tracking will be reviewed at quarterly meetings as part of the Quality Improvement Program.
  5. Incident reports are confidential documents and as such must not be left in public areas or placed in committee minutes.

Processing:

  1. All Incident Reports are logged on the site’s tracking report for quality assurance review and recommendations for improvement. 
    1. The Incident Tracking Form and completed incident forms (Incident Report Form / Death Chart Review & Evaluation) will be stored in the shared administrative database. 
  2. Site leadership will be responsible for reviewing the incident reports, determining the causal factors which contributed to the incident, and preparing a written report of findings which includes recommendations for actions to correct or prevent a similar occurrence.
  3. Recommendations for improvement may include, but are not limited to: practice changes, recommendations for revisions to company policies, procedures and operating practices, staff education, training and supervision, and employee disciplinary action.