PURPOSE OF INCIDENT PURPOSE OF INCIDENT REPORTINGREPORTING

To ensure that serious adverse events To ensure that serious adverse events involving persons receiving publicly-involving persons receiving publicly-

funded mental health, developmental funded mental health, developmental disabilities and/or substance abuse disabilities and/or substance abuse (MH/DD/SA) services are addressed (MH/DD/SA) services are addressed

quickly and analyze trends to prevent quickly and analyze trends to prevent future occurrences and improve the future occurrences and improve the

service systemservice system

WHO MUST SUBMIT?WHO MUST SUBMIT?

Providers of publicly funded services licensed Providers of publicly funded services licensed under NC General Statutes 122C, except hospitals under NC General Statutes 122C, except hospitals (Category A providers) and;(Category A providers) and;

Providers of publicly funded non-licensed periodic Providers of publicly funded non-licensed periodic or community-based mental health, or community-based mental health, developmental disabilities and/or substance developmental disabilities and/or substance abuse services (Category B providers). abuse services (Category B providers).

All Opioid Treatment Providers.All Opioid Treatment Providers. Failure to report incidents as required NC Failure to report incidents as required NC

Administrative Code 10A NCAC 27G.0600 may Administrative Code 10A NCAC 27G.0600 may result in DHHS taking administrative action result in DHHS taking administrative action against the provider’s license or authorization to against the provider’s license or authorization to provide services.provide services.

WHAT IS AN INCIDENTWHAT IS AN INCIDENT

There are three levels of response to incidents based on the potential or actualThere are three levels of response to incidents based on the potential or actualseverity of the event. severity of the event.

Level I – Level I incidents are events that, in isolated numbers, do not Level I – Level I incidents are events that, in isolated numbers, do not significantly threaten the health or safety of an individual, but could indicate significantly threaten the health or safety of an individual, but could indicate systematic problems if they occur frequently. systematic problems if they occur frequently. (Level I incidents are NOT (Level I incidents are NOT submitted in IRIS. They must be documented internally and reviewed as submitted in IRIS. They must be documented internally and reviewed as part of the providers’ quality assurance process.) part of the providers’ quality assurance process.)

Level II – Includes any incident, as defined in 10A NCAC 27G .0602, which Level II – Includes any incident, as defined in 10A NCAC 27G .0602, which involves a consumer death due to natural causes or terminal illness, orinvolves a consumer death due to natural causes or terminal illness, or results in a threat to a consumer’s health or safety or a threat to the results in a threat to a consumer’s health or safety or a threat to the health or safety of others due to consumer behaviorhealth or safety of others due to consumer behavior. .

Level III – Includes any incident, as defined in 10A NCAC 27G .0602, that results Level III – Includes any incident, as defined in 10A NCAC 27G .0602, that results in (1) in (1) a death, sexual assault or permanent physical or psychological impairment a death, sexual assault or permanent physical or psychological impairment to a consumerto a consumer, (2) , (2) a substantial risk of death, or permanent physical or a substantial risk of death, or permanent physical or psychological impairment to a consumerpsychological impairment to a consumer, (3) , (3) a death, sexual assault or a death, sexual assault or permanent physical or psychological impairment caused by a consumerpermanent physical or psychological impairment caused by a consumer, (4) , (4) a a substantial risk of death or permanent physical or psychological impairment substantial risk of death or permanent physical or psychological impairment caused by a consumer orcaused by a consumer or (5) (5) a threat caused by a consumer to a person's safety. a threat caused by a consumer to a person's safety.

REPORTS TO LAW REPORTS TO LAW ENFORCEMENTENFORCEMENT

For the purposes of the DHHS incident For the purposes of the DHHS incident system, this includes reports to police, system, this includes reports to police, sheriff departments, and magistrates of sheriff departments, and magistrates of destructive, aggressive, absences/missing destructive, aggressive, absences/missing person or potentially dangerous acts by person or potentially dangerous acts by consumers, including self endangerment.consumers, including self endangerment.

Do not include reports related to a Do not include reports related to a consumer’s violation of a probation consumer’s violation of a probation judgment.judgment.

CONFIDENTIALITYCONFIDENTIALITY

All incident reports are confidential All incident reports are confidential quality assurance documents, quality assurance documents, protected by G.S. 122C-30, 31, 91 protected by G.S. 122C-30, 31, 91 and 192. and 192.

Do not file a copy of the incident Do not file a copy of the incident report in the consumer’s record; report in the consumer’s record; however, staff should document the however, staff should document the incident in the consumer’s record.incident in the consumer’s record.

HOW TO SUBMITHOW TO SUBMIT

Beginning July 1, 2010 all Level II and Level III incident reports must be entered into Beginning July 1, 2010 all Level II and Level III incident reports must be entered into the Incident Reporting and Improvement Systems (IRIS). the Incident Reporting and Improvement Systems (IRIS).

All Level II and Level III incidents are to be submitted electronically through IRIS at All Level II and Level III incidents are to be submitted electronically through IRIS at the following website: https://iris.dhhs.state.nc.us/the following website: https://iris.dhhs.state.nc.us/

If IRIS is unavailable at any time, providers must still meet the required If IRIS is unavailable at any time, providers must still meet the required reporting timeframes for submission of an incident.reporting timeframes for submission of an incident. Incident reporting forms Incident reporting forms may be obtained at the IRIS website address. If you are unable to access the incident may be obtained at the IRIS website address. If you are unable to access the incident reporting forms, please contact Angie Kivett at 336-625-4351 for a copy of the forms.reporting forms, please contact Angie Kivett at 336-625-4351 for a copy of the forms.

The provider MUST enter the incident report into IRIS as soon as possible The provider MUST enter the incident report into IRIS as soon as possible once the IRIS system is availableonce the IRIS system is available..

Once an incident report has been submitted, IRIS will automatically notify all the Once an incident report has been submitted, IRIS will automatically notify all the appropriate agencies, except DSS, of the submission and the report is made available appropriate agencies, except DSS, of the submission and the report is made available to each of these agencies.to each of these agencies.

Provider is required to notify DSS for allegations of Abuse, Neglect or Provider is required to notify DSS for allegations of Abuse, Neglect or ExploitationExploitation. . IRIS does not notify DSSIRIS does not notify DSS..

Provider must also notify the parent/guardian and clinical treatment plan team when Provider must also notify the parent/guardian and clinical treatment plan team when appropriate.appropriate.

When the provider obtains or is informed about new or additional information related When the provider obtains or is informed about new or additional information related to the incident, the provider must update the original report and submit the update to the incident, the provider must update the original report and submit the update information by the end of the next business day after becoming aware of the information by the end of the next business day after becoming aware of the information.information.

UNDER YOUR CAREUNDER YOUR CARE

Report all incidents that occur while the consumer is Report all incidents that occur while the consumer is under the care of the reporting provider. The under the care of the reporting provider. The definition for “definition for “a consumer under the care of the a consumer under the care of the providerprovider” refers to ” refers to a consumer who has received a consumer who has received any service in the 90 days prior to the incidentany service in the 90 days prior to the incident..

Individuals receiving Individuals receiving Residential or ACTTResidential or ACTT services services are considered are considered under the provider’s care 24 under the provider’s care 24 hours a dayhours a day. .

Individuals receiving Individuals receiving day services or periodic day services or periodic services are considered services are considered under the provider’s care under the provider’s care while a staff person is providing services or if while a staff person is providing services or if the consumer received any services from the the consumer received any services from the provider in the 90 days prior to the incidentprovider in the 90 days prior to the incident..

ILLNESS OF A CONSUMERILLNESS OF A CONSUMER

Medical illness is not reportable Medical illness is not reportable unless it results in injury or death, or unless it results in injury or death, or is believed to be caused by is believed to be caused by abuse/neglect or medication error.abuse/neglect or medication error.

DEATHSDEATHS

Report all consumer deaths whenever you Report all consumer deaths whenever you become aware of the death even if it did not become aware of the death even if it did not occur while the individual was under your care.occur while the individual was under your care.

Death certificate/ME Report/documentation by Death certificate/ME Report/documentation by physician must be submitted for deaths due to physician must be submitted for deaths due to natural cause/terminal illness. natural cause/terminal illness.

Death due to unknown cause is a Level III.Death due to unknown cause is a Level III. When the cause of death is determined by the When the cause of death is determined by the

death certificate/ME report, death information in death certificate/ME report, death information in IRIS must be updated and the report resubmitted. IRIS must be updated and the report resubmitted. This may downgrade death report from Level III to This may downgrade death report from Level III to Level II.Level II.

INJURYINJURY

Complete this section whenever a consumer is injured and Complete this section whenever a consumer is injured and requires more than first aid.requires more than first aid.

A visit to an emergency room (in and of itself) is not A visit to an emergency room (in and of itself) is not considered an incident. Do not submit incident reports for considered an incident. Do not submit incident reports for visits to a hospital emergency room, if the person received visits to a hospital emergency room, if the person received no treatment. An X-ray, CAT Scan, drawing of blood or any no treatment. An X-ray, CAT Scan, drawing of blood or any other diagnostic assessment is not considered treatment. other diagnostic assessment is not considered treatment. (Example: Bob thinks his arm is broken and goes to the E.R. (Example: Bob thinks his arm is broken and goes to the E.R. An x-ray is performed and his arm is not broken. This is not An x-ray is performed and his arm is not broken. This is not an incident. If the x-ray showed his arm to be broken and an incident. If the x-ray showed his arm to be broken and the doctor applied a cast, the application of the cast is the doctor applied a cast, the application of the cast is treatment. Putting a sprained arm in a cast, stitches, treatment. Putting a sprained arm in a cast, stitches, cleaning a wound, all of these are treatment. Shots and cleaning a wound, all of these are treatment. Shots and prescription medication are treatment.prescription medication are treatment.

ALLEGATIONS OF ALLEGATIONS OF ABUSE/NEGLECT/EXPLOITATIOABUSE/NEGLECT/EXPLOITATIO

NN Report allegations of abuse, neglect and Report allegations of abuse, neglect and

exploitation to county DSS in which the suspected exploitation to county DSS in which the suspected activity occurred. activity occurred. Provider must notify DSS - Provider must notify DSS - IRIS IRIS does notdoes not submit reports to DSS submit reports to DSS..

Report to the DHSR Healthcare Personnel Report to the DHSR Healthcare Personnel Registry, if the activity involves healthcare Registry, if the activity involves healthcare personnel. personnel.

An allegation against an unlicensed staff in a An allegation against an unlicensed staff in a licensed or unlicensed facility should be licensed or unlicensed facility should be submitted within 24 hours of the agency submitted within 24 hours of the agency becoming aware of the incident.becoming aware of the incident.

RESTRICTIVE RESTRICTIVE INTERVENTIONSINTERVENTIONS

Report any restrictive intervention that is:Report any restrictive intervention that is: (a) used in an unplanned, emergency situation (a) used in an unplanned, emergency situation

(i.e., not part of the individual’s service plan (i.e., not part of the individual’s service plan and approved according to 10A NCAC and approved according to 10A NCAC 27E .0104);27E .0104);

(b) planned, but administered improperly or (b) planned, but administered improperly or without proper authorization, by staff without without proper authorization, by staff without proper training, or for longer than the proper training, or for longer than the authorized time; orauthorized time; or

(c) planned, but resulting in discomfort, (c) planned, but resulting in discomfort, complaint, death or injury requiring treatment complaint, death or injury requiring treatment by a licensed health professional.by a licensed health professional.

INCIDENTS OF CONCERN FOR INCIDENTS OF CONCERN FOR COMMUNITYCOMMUNITY

A Level II incident is upgraded to a Level III A Level II incident is upgraded to a Level III incident when the incident resulted in or is incident when the incident resulted in or is likely to result in a danger to or concern to likely to result in a danger to or concern to the community or a report to newspaper, the community or a report to newspaper, television or other media.television or other media.

If an incident is perceived to be a significant danger If an incident is perceived to be a significant danger to the community or involves a consumer whose to the community or involves a consumer whose behavior poses an eminent concern to the behavior poses an eminent concern to the community, community, the provider is tothe provider is to verbally report verbally report the incident to the Host LME and the the incident to the Host LME and the DMH/DD/SAS Customer Service and DMH/DD/SAS Customer Service and Community Rights Team (919-715-3197)Community Rights Team (919-715-3197) immediately upon learning of the incidentimmediately upon learning of the incident..

MEDICATION ERRORSMEDICATION ERRORS

In the case of any medication error, the consumer’s physician or In the case of any medication error, the consumer’s physician or pharmacist, should be notified immediately of any medication pharmacist, should be notified immediately of any medication error, as required by 10A NCAC 27G.0209(h).error, as required by 10A NCAC 27G.0209(h).. The physician, . The physician, pharmacist, physician's assistant or a nurse practitioner pharmacist, physician's assistant or a nurse practitioner should determine the level of threat to the consumer’s should determine the level of threat to the consumer’s health and determine the treatment required, if any.health and determine the treatment required, if any.

Level I report if the physician or pharmacist indicates that the Level I report if the physician or pharmacist indicates that the medication error medication error does notdoes not threaten the consumer’s health or threaten the consumer’s health or safety, document the medication error as a Level I incident. safety, document the medication error as a Level I incident.

Report Level II or III errors in self-administration of medications Report Level II or III errors in self-administration of medications within 72 hours of learning of the incident, even if it did not within 72 hours of learning of the incident, even if it did not happen while actively engaged in providing services.happen while actively engaged in providing services.

Report the following medication errors: Missed dose, wrong dose, Report the following medication errors: Missed dose, wrong dose, dose preparation error, wrong administrative technique, dose dose preparation error, wrong administrative technique, dose given to wrong consumer, wrong medication, loss or spillage of given to wrong consumer, wrong medication, loss or spillage of medication, refusal of medication and other.medication, refusal of medication and other.

CONSUMER BEHAVIORCONSUMER BEHAVIOR

Report any sexual, aggressive, or Report any sexual, aggressive, or destructive behavior that involves a destructive behavior that involves a report to law enforcement, a report to law enforcement, a complaint to an oversight agency, complaint to an oversight agency, including any LME, DSS, DHSR or including any LME, DSS, DHSR or DMH/DD/SAS, or a potentially serious DMH/DD/SAS, or a potentially serious threat to the health or safety of self threat to the health or safety of self or others.or others.

A CONSUMER ABSENCEA CONSUMER ABSENCE

Is any absence over the time specified in the Is any absence over the time specified in the individual’sindividual’s

Service plan; any absence that may or may not Service plan; any absence that may or may not require police contact is an incident.require police contact is an incident.

The level of the incident is determined by the The level of the incident is determined by the number of hours that a person is absent and number of hours that a person is absent and whether police contact is required. whether police contact is required.

If an If an Amber or Silver AlertAmber or Silver Alert has been issued, it has been issued, it is a is a Level IIILevel III incident and providers should alert incident and providers should alert appropriate agencies as soon as possible.appropriate agencies as soon as possible.Amber and Silver Alert website address:Amber and Silver Alert website address:http://www.nccrimecontrol.org/Index2.cfm?http://www.nccrimecontrol.org/Index2.cfm?a=000003,000014,000081,001670a=000003,000014,000081,001670

SUSPENSION OR EXPULSION SUSPENSION OR EXPULSION FROM SERVICEFROM SERVICE

Complete this section whenever a Complete this section whenever a consumer is suspended or expelled consumer is suspended or expelled from services.from services.

For suspensions of an individual from For suspensions of an individual from services, check the box and also services, check the box and also enter the length of the suspension.enter the length of the suspension.

FIREFIRE

Complete an incident report for:Complete an incident report for: Any fire that threatens the health or Any fire that threatens the health or

safety of consumers or others;safety of consumers or others; Results in permanent physical or Results in permanent physical or

psychological impairment; orpsychological impairment; or Perceived to be a significant danger Perceived to be a significant danger

to or concern of the community.to or concern of the community.

REPORTING TIMELINESREPORTING TIMELINES

Level II Level II Written report - submit within 72 hours of Written report - submit within 72 hours of

provider learning of the incident.provider learning of the incident. Level III Level III

Verbal report to the HOST LME and HOME LME Verbal report to the HOST LME and HOME LME as soon as possible upon learning of the as soon as possible upon learning of the incident but no longer than 24 hours.incident but no longer than 24 hours.

Written report - submit within 72 hours of Written report - submit within 72 hours of learning of the incident.learning of the incident.

Death within 7 days of seclusion or restraint – Death within 7 days of seclusion or restraint – submit report immediately.submit report immediately.

PROVIDER QUARTERLY PROVIDER QUARTERLY INCIDENT REPORT (QM11)INCIDENT REPORT (QM11)

Providers are required to report aggregate Providers are required to report aggregate information on Level I incidents involving information on Level I incidents involving restrictive interventionsrestrictive interventions, , medication errorsmedication errors, , and and searches and seizuressearches and seizures to the host LME to the host LME quarterly, using a form provided by the quarterly, using a form provided by the DHHS. The Quarterly Provider Incident Report DHHS. The Quarterly Provider Incident Report is available on the DMH/DD/SAS website at is available on the DMH/DD/SAS website at http://www.ncdhhs.gov/mhddsas/statspublicahttp://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/index.htm#incident tions/manualsforms/index.htm#incident

Aggregate information on Level II and Level Aggregate information on Level II and Level III incidents are also included on the QM11.III incidents are also included on the QM11.

WHEN TO REPORTWHEN TO REPORT

The quarterly reports must be submitted The quarterly reports must be submitted by the 10th of the month following the end by the 10th of the month following the end of theof the

quarter.quarter. --October 10--October 10thth - First quarter (July-Sept) - First quarter (July-Sept) --January 10--January 10thth - Second quarter (Oct-Dec) - Second quarter (Oct-Dec) --April 10--April 10thth - Third quarter (Jan-Mar) - Third quarter (Jan-Mar) --July 10--July 10thth - Fourth quarter (April-June) - Fourth quarter (April-June)

INTERNAL REVIEW TEAM INTERNAL REVIEW TEAM LEVEL III INCIDENTSLEVEL III INCIDENTS

All Category A and B providers except ICF-MR's are required All Category A and B providers except ICF-MR's are required to conduct an internal team (formerly “peer review”) review to conduct an internal team (formerly “peer review”) review of Level III incidents of Level III incidents when a consumer was receiving a when a consumer was receiving a service at the time the incident occurred or if the service at the time the incident occurred or if the incident occurred on the provider’s premisesincident occurred on the provider’s premises. . (ICF-(ICF-MRs are required to abide by federal regulations to MRs are required to abide by federal regulations to ensure client protection, investigate incidents and ensure client protection, investigate incidents and take appropriate corrective action. CFR 483.420)take appropriate corrective action. CFR 483.420)

Refer to the Incident Response and Reporting Manual (page Refer to the Incident Response and Reporting Manual (page 14) for specific internal review team requirements 14) for specific internal review team requirements including, but not limited to, submission of a written including, but not limited to, submission of a written preliminary findings of fact within 5 working days of the preliminary findings of fact within 5 working days of the incident and a final written report signed by the owner incident and a final written report signed by the owner within 3 months of the incident or sooner if completed.within 3 months of the incident or sooner if completed.

RESOURCESRESOURCES

IRIS WEBSITEIRIS WEBSITE:  :  https://iris.dhhs.state.nc.us/https://iris.dhhs.state.nc.us/

INCIDENT RESPONSE AND REPORTING MANUALINCIDENT RESPONSE AND REPORTING MANUALhttp://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/incidentmhttp://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/incidentmanual2-25-11.pdfanual2-25-11.pdf

*Please refer to “The Criteria for Determining the Level of Response to *Please refer to “The Criteria for Determining the Level of Response to Incidents” on pages 20-25 for guidance in determining the level of response Incidents” on pages 20-25 for guidance in determining the level of response to Level I, Level II and Level III incidents.to Level I, Level II and Level III incidents.

IRIS TECHNICAL MANUALIRIS TECHNICAL MANUAL

http://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/iris6-4-10dhhsmanuhttp://www.ncdhhs.gov/mhddsas/statspublications/manualsforms/iris6-4-10dhhsmanual.pdfal.pdf

Medical Examiner’s Report, Autopsy Report or Toxicology Report website Medical Examiner’s Report, Autopsy Report or Toxicology Report website address:address:http://www.ocme.unc.edu/docrequest.shtmlhttp://www.ocme.unc.edu/docrequest.shtml

IRIS “IRIS “PRACTICEPRACTICE” WEBSITE – ” WEBSITE – DO NOT ENTER REAL INCIDENTS HEREDO NOT ENTER REAL INCIDENTS HEREhttps://irisuat.dhhs.state.nc.us/https://irisuat.dhhs.state.nc.us/

INCIDENT REPORTINGINCIDENT REPORTING

CONTACT INFORMATIONCONTACT INFORMATION

Angie Kivett - Incident Reporting Angie Kivett - Incident Reporting ManagerManager

E-mail : angiek@sandhillscenter.org E-mail : angiek@sandhillscenter.org

Phone: 336-625-4351Phone: 336-625-4351

Fax: 336-625-3661Fax: 336-625-3661