IRIS- Incident Response Improvement System Training October 9, 2013

1. IRIS- Incident Response Improvement System Training October 9, 2013 Presented by: Ashley Armstrong Contact Information for Questions: providermonitoring@eastpointe.net

2. What is IRIS? The DHHS IRIS is a web based incident reporting system for reporting and documenting Level II and III incidents that involve consumers who receive MH/DD/SA funds

3. Who must submit Incident Reports? Providers of publicly funded services licensed under NC General Statutes 122C, except hospitals, (Category A providers) and providers of publicly funded non-licensed periodic or community-based MH/DD/SA services (Category B providers).

4. LME/ MCO Role In IRIS • Verify incidents and review the 72 hour listing with providers daily. • Review for any Safety Concerns and request Safety Plan, if needed • Review for data completeness and request any additional information needed • Review to assure all appropriate guardian/ agencies have been notified- refer if needed • Discuss additional information/ reports needed such as police reports, Medical examiner reports, hospital discharge, etc. • Send incident number to providers • Assess (or refer to applicable team within LME/MCO) if Provider Monitoring is needed • Review Quarterly Provider Report for any concerns or need for Provider Monitoring • Contact DMH/DD/SAS within 24 hours (business days) on Level IIIs – unless any media involvement • If incident is reported or likely to be reported in media, contact DMH/DD/SAS as soon as possible- on the same day. • Review provider handling to ensure safety of consumers, certified copy of record and provider’s review committee convened. • Monitor and provide technical assistance as warranted to ensure that problems are • corrected. • Analyze and respond to patterns of incidents as part of review of QI monitoring processes • Review of monthly Unknown Death Report

5. DMH/DD/ SAS Role in IRIS • Weekly contact with LME/MCO for follow-up on reports • Review of monthly Unknown Death Report • Review to assure all appropriate guardian/ agencies have been notified- refer if needed • Inform all appropriate DMH/DD/SAS staff • Discuss/ provide technical assistance to LMEs/ MCOs with plans or strategies for complex cases • Analyze and respond to statewide patterns of incidents as part of review of QI monitoring and LME/MCO oversight of response processes

6. What is an Incident? • An incident is “any happening which is not consistent with the routine care of a consumer and that is likely to lead to adverse effects upon a consumer” as defined in 10A NCAC 27G .0103(b)(32). • There are 3 levels of response to incidents, based on the potential or active severity of the event. Levels are Level I, Level II, & Level III.

7. Confidentiality • All incident reports are confidential quality assurance documents. • Do not file incident reports in the individual’s service record. • Use this form according to confidentiality requirements in NC General Statutes and Administrative Code and in the Code of Federal Regulations.

8. Reporting Guidelines Documentation of All Incidents – • All incidents should be documented and analyzed as part of agencies QA/QI process. • Complete all required sections for level II & III incidents • Give as much information that is known.

9. Reporting Guidelines (continued) • Level I incidents are documented on agency’s internal forms. Level I incidents are not submitted in IRIS. • Level II & III incidents must be submitted in IRIS. • NEVER file incidents reports in individual’s service record.

10. Under Provider Care • “a consumer under the care of a provider” refers to a consumer who has received any service in the 90 days prior to the incident. • Individuals who receive Residential or ACTT services are considered under the provider’s care 24 hours a day. • Individuals receiving day services or periodic services are considered under the provider’s care while a staff person is providing services or if the consumer received any services from the provider in the 90 days prior to the incident.

11. Under Provider Care (continued) • Providers of crisis, day, and periodic services should report all deaths and errors in self-administration of medication upon learning of the incident, even if it did not happen while under the provider’s care. • For additional Information, please refer to Implementation Update # 55.

12. What staff submits? The staff person most knowledgeable about the incident should complete the information on the report as soon as possible after learning of the incident. The staff person should obtain the incident number and notify their supervisor to complete the supervisor section of the report.

13. Level II Reports IRIS report must be appropriately submitted within with in 72 hours Level III Reports Verbal report immediately to Eastpointe Monitoring IRIS report must be appropriately submitted within with in 72 hours IRIS report must be submitted within 72 hours to DMH/DD/SAS Timeframe for Submission

14. What if IRIS is unavailable? Any time IRIS is unavailable for use, providers must still meet the required timeframe for submission of an incident. Reports may be faxed to Eastpointe at 910-298-7165. Provider must enter into IRIS as soon as possible after IRIS back available. This is the only time paper reports will be accepted. IRIS replaced the DHHS Incident and Death Report (DMH/DD/SAS form QM02)

15. Don’t Forget to: Print a copy for your records and maintain the incident report number. Providers are required to complete mandatory items based on the type of incident that occurred. Mandatory items are indicated by red stars beside the item. If you can answer questions without stars, please provide this information. It is essential to save information at the end of each information tab. It may take several seconds before data saves. Click on each Save icon only 1 time.

16. Incident Report Number IRIS provides an Incident Report number for each report in two ways: 1. Save the entire report after completing Provider Incident Information, Incident Information, Consumer Services and Consumer Treatment section. Click “Finish” and the incident number appears on the screen.

17. Incident Report Number (continued) 2. Once you have completed the entire report, to include Supervisor Actions Tab.

18. Example of Incident Number

19. Important Facts about Incident Number Print a copy of the incident number for your record. There is only 1 number for each incident report. The Incident Number will not contain the letter “O”. All letters are lower case. Any “0” will be a numerical zero.

20. Comment Sections Comment boxes are located on many tabs for the user to provide brief, specific information on a topic.

21. Enter Incident Comments To enter specific comments, click on the pencil and paper icon. Type your information and use spell check Click “Save” After you save the information, the paper and pencil will change to a check mark

22. IRIS Home Page

23. To Report An Incident Choices include: Enter a new incident: Click to enter a new Level II or III incident. View/Edit: For an existing report, enter the Incident Number and Consumer’s last name. Please note: If you do not print the Incident Number, please call Eastpointe Provider Monitoring Department to request the number be sent to you.

24. Provider Information Tab Enter Corporation Name Name and Title of Person completing form Local facility/Unit/Group Home Physical Address Mailing Address, City, Zip Code Phone Number Fax Number Email Address – If the provider agency does not have an email address, provider will need to determine the email address to which the agency will get information regarding the incident. Please make sure the email address is accurate.

25. Provider Information Tab (continued) Counties County where services are provided/Host LME: Where the consumer receives services County of Residence/Home LME: The county in which the consumer legally resides. IRIS will notify the Host and Home LME of the Incident Report.

26. Incident Information There are 2 tabs that have to be completed in this section A. Date and Location Tab If there is an allegation against the facility, check YES. The supervisor will have to complete the HCPR Facility Allegation section of the incident report. B. Services Type Provided Tab

27. Consumer Information/Treatment There are 2 tabs that have to be completed in this section A. Consumer Information Tab B. Consumer Information-Treatment Tab

28. Consumer Information Tab Consumer Name Address Where Incident Occurred LME Client Record Number – If there is not a LME number, use your provider identification number. Consumer Date of Birth, Gender, Height, and Weight Date of Last 2 Medical Exams Diagnosis – select up to 5 different diagnosis, starting with the primary diagnosis. Include ALL as applicable. This helps to aid oversight staff in determining the appropriate response needed.

29. Consumer Information Tab (continued) Medications: Click on the pencil icon to enter. Include Name, Dosage, Frequency of the medication and the reason the consumer is taking the medication. Adjudicated incompetent? TBI recipient? Receives CAP-MR/DD funding? MFP program? Receive ICF-MR/DD?

30. Consumer Information-Treatment Tab Did this incident result in or is it likely to result in permanent physical or psychological impairment? If reporting a death, select “No”. Has this incident resulted in or is it likely to result in a danger to or concern to the community or a report in a newspaper, television or other media?

31. Consumer Information-Treatment Tab (continued) Was the consumer treated by a licensed health care professional for the incident? Do not include visits to a hospital ER if the person received no treatment. Refer to the definition of more than just First Aid found in the Incident Response Manual. If hospitalized, was it for a medical condition? Was if for a MH/DD/SA issue? Opioid – Questions relate only for consumers receiving Opioid Treatment.

32. Consumer Information/Services Tab There are 6 tabs in this section: MH/DD and/or SA Tab (3 separate tabs) Hospital Discharge Tab Last Appointment Tab Associated Incidents Tab

33. Type of Incident

34. Type of Incident Choose which type you are reporting Choices are: Death Restrictive Intervention Injury Medication Error Allegation of Abuse, Neglect, or Exploitation Consumer Behavior Suspension, Expulsion Fire Other You must have at least 1 type of incident You must include pertinent details in the “Incident Comment Tab” relevant to the incident.

36. Death Tab Manner of Death Choose one: Terminal Illness/Natural Cause Accident Homicide/Violence Suicide – indicate method from drop down box Unknown

37. Consumer Deaths Report ALL consumer deaths whenever you become aware, even if it did not occur while the individual was under your care. Cause of Death by Natural Cause or Terminal Illness should be documented by a physician, Medical Examiner or Death Certificate.

38. Level III Deaths Will include: Accident Homicide/Violence Suicide Unknown Cause of Death Requirements of All Level III Deaths are to obtain a copy of the Medical Examiner’s (ME) report and/or autopsy report. This is in accordance with 10A NCAC 26C .0303 (f) (3).

39. NOTE:The web address for requesting a free copy of ME report is:http://www.ocme.unc.edu/docrequest.shtmlMake sure to complete all information on the request and request all 3 documents.

40. NC OCME Document Request (only for NC Deaths Since 1975)We are accepting on-line document requests, but cannot currently return all documents in an electronic format. Therefore, we must have a US mail address. Please also provide an email address in case we need to contact you about your request. If you do not have an email address, call us at (919) 445-4410 to request a document. Your Name and Address   First              Last Name *                   * Required Agency /Address Line 1 * Address Line 2 City *   State *    Zip * Telephone Email Address If you provide an email address, it ill be used for all of the documents that we can currently send electronically. You may need to add documents@ocme.unc.edu to your address book to allow the documents to get past your spam filter. The Decedent Name of Decedent*   County of Death*   Date of Death*   Documents Requested * Investigative Report Autopsy Report (May not exist on every case) Toxicology Report SUBMIT RESET

41. Consumer Death Providers must update the incident report, even if the level does not change. Updated information should be entered in IRIS, documenting the reason for Re-Submission (in Supervisor Action Tab). Attach copies of reports, Death Certificate and/or other documents.

42. Level III Process For Level III incidents that did not occur while the consumer was receiving a service or was on the provider’s premises, the responsible LME’s may continue to request detailed information regarding services if this information is not already provided in the incident report. (See Attachment B: Suggested Questions for Level III Incidents.)

43. Manner of Death Tab If manner of death is unknown, check “unknown cause”. Once the death is verified via ME report and/or death certificate, the cause of death has to be updated and the report re-submitted.

44. Restrictive Intervention • Report any restrictive intervention when: • Use of unplanned, emergency situation. • Planned, but administered improperly or without proper authorization, staff use without proper training, or for longer than the authorized time. • Planned, but resulting in discomfort, complaint, death or injury requiring treatment by a licensed health care professional.

46. General 1 Tab General 2 Tab Status Check Tab Staff Involved in Restrictive Intervention Debriefing Tab Person Centered Planning 1 Tab Person Centered Planning 2 Tab Person Centered Planning 3 Tab Follow-up Plans Tab Restrictive InterventionThere are 9 Tabs in this section if IRIS requires based on your responses.

48. There are 3 Tabs in this section Must complete for injuries when the injury requires more than First Aid treatment. The definition of First Aid is listed in the Incident Response and Reporting Manual February 2011, Appendix XI (page 29). 3 Tabs include: Injury Description Tab Injured Body Parts Tab Injury Due to Tab Injury

49. Medication Error • Report all medication errors. • In cases of medication errors, the consumer’s physician or pharmacist should be notified immediately of any error, as required by 10A NCAC 27G. 0209(h). • If the physician or pharmacist does not believe the error is a threat of health or safety, document the error as a level I.

50. Level I Medication Error • Level I documentation should indicate the following: • The type of error, • Name of the physician or pharmacist consulted, • The statement made by the physician or pharmacist about the error, • Date and time of the contact, and • Name of the person making the contact.