Rule: OAC 5123:2172 Training on Incidents Adversely Affecting Health

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Rule OAC 51232-17-2Training onIncidents
Adversely Affecting Health Safety(Rule
Statute Legally required)
Effective 1/1/07
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MUI Means

• Alleged, suspected or actual occurrence
• Reason to believe a person is at risk of harm
  based on facts present not opinion
• Receiving services or will be as a result of
  incident

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Application

• County Boards, Developmental Centers Providers
  (MRDD Personnel)
• NOTE All staff are potential
• discoverers of incidents. The
• discoverer MUST take action and
• report! Failing to do so leads to
  individuals/families suffering risks, citations
  from DMR, conflict and discipline.
• IF SF is the discoverer, you must follow report!
  If provider is discover, ensure their follow
  thru. Document.

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Action Reporting Steps for Protocol Cases
(All Steps Required)

• 1) ENSURE health and safety (remove or minimize
  threat, check and care for injury)
• 2) Notify Law Enf. Or 241-KIDS
• Immediately
• 3) Notify MUIP within 0-4 Hours
• 4) Notify Guardian, SF, Provider asap - no
• later than within same day.
• 5) Send written report to MUIP by
• 300 PM next working day.

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Action and Reporting Steps for Non-Protocol
Incidents (Required)

• Do steps 1, 4 5 from Protocol List.
• 1) ENSURE health and safety (remove or
  minimize threat, check and care for injury).
• 4) Notify Guardian, SF, Provider asap no
• later than within same day.
• 5) Send written report to MUIP by
• 300 PM next working day.

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NON-Protocol Exception

• A non-protocol incident is applied when the event
  happens in the care of or under the
  responsibility of a paid MRDD Provider or MRDD
  staff. This would include any situation whereby
  an MRDD Provider or Staff person carries out any
  intervention on behalf of the individual.
• Be sure there is no neglect or abuse then
• If the non-protocol happened outside the
  responsibility,care or intervention of the
  provider or MRDD Staff, then it is not an MUI.
  Examples Happened under the care of the family,
  individual is independent, happened on
  individuals alone time, etc.

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TIPS on Notifying Police or 241 KIDS

• If a protocol incident, identify yourself, who
  you work for and that you are required to report.
  Police may not see the case reported as a
  priority or a crime.
• You are NOT required to make the police or 241
  KIDS take the case. You are only required to
  notify them. Always ask what action they will
  take from that point. Document it.

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WRITTEN REPORTS

• Fill out all three pages of ISIS!
• ODMRDD requires the following and will contact us
  immediately if we do not demonstrate it
• Provide full account of incident
• When Law Enforcement/241 KIDS contacted and your
  discovery date?
• Immediate actions must detail what was done to
  ensure the health and safety of the individual.
  Always include a check for injury and what care
  was provided.
• Must document required notifications (page/tab 3).

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Individual Plan (My Plan) Requirements

• Must address level of supervision including what
  is the level and WHAT is the level for?
• Risks should be clearly identified and the
  service language clear as to what the duty is for
  staff charged with remedying or minimizing those
  risks.
• Alone time should clearly be spelled out as to
  what is expected of the provider with regard to
  that alone time.

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Individual Plan (My Plan) Requirements continued

• Too often plans do not specify what the care is
  or what it looks like
• Duties are thereby neglected due to
  misunderstandings about what care was to be
  provided.
• Perhaps one meant Eyes on but the plan only
  says supervision which implies a lesser
  attention. Will help is different than will
  do. Etc.
• What does Alone time really mean?

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CATEGORIES OF MUIs

• The following offer criteria via rule to guide
  the determination of whether an incident is an
  MUI or not. Since we are supporting human beings
  and not products, many of these determinations
  are not black and white. But the criteria gives
  us a good starting place.
• There are Protocol (Potential Criminal type)
  and Non- Protocol incidents (other serious
  medical, health or safety issues). These are
  identified for you.

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Physical AbuseProtocol (always do Steps 1-5)

• Was there an Injury? (Type Severity)
• Level of Physical Force (What was it)
• Could it reasonably be expected to result in
• harm?
• Impact on the Individual?
• Examples Hitting, slapping, pushing, dragging
  or throwing an object when the allegation
  indicates that it could reasonably result in harm.

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Sexual Abuse Protocol (always do Steps 1-5)

• Unlawful sexual contact
• Unlawful sexual conduct
• Public indecency, voyeurism,
• importuning, etc.

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Verbal Abuse Protocol (always do Steps 1-5)

• Purposeful use of words or gestures
• Knew words/gestures would have the following
  impact
• Threaten, coerce, intimidate, harass, humiliate
• (Like a verbal punch)

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Prohibited Sexual Relations Protocol (always do
Steps 1-5)

• MR/DD employee
• Consensual sexual conduct or contact
• With an individual who is not their spouse
• Employed or under contract to provide care to the
  individual at the time of the incident
• Anyone in the MR/DD employees supervisory chain
  of command

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Peer-to-Peer Acts Protocol (always do Steps 1-5)

• One individual against another (PPI firmly
  fixed/targeted victim vs. a random act)
• Physical Abuse with intent to harm
• Verbal Abuse with intent to threaten, coerce,
  intimidate, harass or humiliate
• Any Sexual Abuse
• Any Exploitation
• Any intentional Misappropriation of significant
  value

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DeathProtocol (If suspicious or
accidental, do DeathSteps 1-5 for all deaths
ensure Coroner notified)For natural deaths do
steps 1, 4, 5).Document activity of last 72
hours and add to report.

• All deaths of individuals served

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Misappropriation Protocol (always do Steps 1-5)

• With intent
• Deprive, defraud, or otherwise obtain real or
  personal property (beware of medication
  theftparticularly pain killers, sleeping pills
  and psychotropics
• As prohibited in Ohio Revised Code 2911 and 2913

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Exploitation Protocol (always do Steps 1-5)

• Unlawful or improper act
• Using individual
• Individuals resources
• for personal benefit, profit, or gain
• (tricks or uses power over alleged victim or
  manipulate vs straight theft)

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Failure to Report (Criminal) Protocol (always
do Steps 1-5)

• Person has reason to believe
• Individual suffered or faces a substantial risk
  of suffering
• Any wound, injury, disability or condition to
  reasonably indicate Abuse or Neglect (including
  Misappropriation)
• Did not immediately report to law enforcement or
  a county board

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Failure to Report -Continued (Registry)
Protocol (always do Steps 1-5)

• MR/DD employee unreasonably failed to report
  Abuse or Neglect
• Knew or should have known
• Failure would result in a substantial risk of harm

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Neglect Protocol (always do Steps 1-5)

• A duty
• That failing to provide treatment, care, goods,
  supervision or services
• result in a reasonable risk of harm
• (See Individual Plans slide)

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Rights Code Violation
Protocol (always do Steps 1-5)

• Any violation of rights listed in Ohio Revised
  Code 5123.62 and it creates a reasonable risk of
  harm

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Missing IndividualNon-Protocol (Do Steps 1, 4,5)

• Has been reviewed for neglect
• Not located per ISP and actions identified in
  plan and in search of immediate surrounding area
• OR
• Circumstances indicate immediate jeopardy
• OR
• Law enforcement was called to assist
• (See Individual Plans slide)

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Attempted Suicide Non-Protocol (Do Steps 1, 4,5)

• Physical attempt that
• Results in ER treatment
• or
• Inpatient observation
• or
• Hospital admission

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Known Injury Non-Protocol (Do Steps 1, 4,5)

• Known cause
• Not Abuse or Neglect
• Requires
• Immobilization or casting
• Five or more sutures or equivalent
• 2nd or 3rd degree burns
• Dental injuries
• Injury that prohibits participation in daily
  routine tasks for more than 2 consecutive days

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Unknown Injury Non-Protocol (Do Steps 1, 4,5)

• Unknown cause
• Not Abuse or Neglect
• Requires treatment that only a physician,
  physician assistant, or nurse practitioner can
  provide

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Medical Emergency Non-Protocol (Do Steps 1, 4,5)

• Emergency medical intervention
• required to save ones life includes
• Heimlich Maneuver, CPR, and IV
• for dehydration, etc.

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Unscheduled Hospital
Non-Protocol (Do Steps 1, 4,5)

• Hospital admission that is not scheduled
• Unless
• Due to condition specified in ISP or nursing care
  plan
• Specific symptoms and criteria must be listed
  that lead to hospitalization

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Law Enforcement Non-Protocol (Do Steps 1, 4,5)

• Individual is charged (C)
• incarcerated (I)
• arrested (A)
• URGENT While non-prots are not generally
  reported as MUIs if individual was not under the
  care of a provider, REPORT THESE AS MUIs.

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Unapproved Behavior Support Non-Protocol (Do
Steps 1, 4,5)

• Any adverse strategy or intervention Implemented
  without approval by committee and guardian or
  without informed consent. Examples
• (Restraint, time out, medicine for behavior
  wherein it was not prescribed for a specific MH
  diagnosis)

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Unusual Incident(Still requires same day
notification to Guardian, SF, Provider, Advocate
Requires Admin. action and Prevention Plan

• Event not consistent with routine operation,
  policy and procedure, or care or plan for the
  individual
• Includes but not limited to
• Medication errors, Falls, injuries
• Peer-to-peer that are not MUIs
• Overnight relocation
• That do not meet MUI criteria but have some risk
  involved.
• More on UIs further along in this presentation.

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(K)(2) Development of Preventive Measures

• Investigation cannot be closed until a Prevention
  Plan is done!
• Must be Collaborative Team including county
  board and provider
• Align the preventative measures such that they
  relate to the causes and contributing factors
  (identified factors and risks).

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(K)(2) ContinuedDevelopment of Preventive
Measures

• Identify the risks clearly and then the steps
  that will reduce recurrence.
• Determine reasonable steps to ensure health and
  safety minimize likelihood of recurrence! In
  circumstances of few supports implement what
  is reasonably possible but ensure efforts are
  made to do so. Clear, concise, doable,
  reasonable.

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(K)(2) ContinuedDevelopment of Preventive
Measures

• Call the Investigator if you are unsure if steps
  will reasonable address the situation.
  Investigators will provide consultation or
  liaison with ODMRDD if more consult is needed.
• Call the Investigator well ahead of time if more
  time is needed to develop the plan to ensure the
  well being of the individual and avoid violating
  ODMRDD rules (citations, etc).

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Prevention

• How does one prevent death, unscheduled
  hospitalizations, one-time events?
• The requirement under the rule is to to
  demonstrate that actions were taken to prevent or
  minimize recurrence.
• For death cases, include statements that assure
  all that the appropriate care was provided
  including regular doctors check ups, etc. Post
  alerts if there is some knowledge gained by a
  death so that others served in that environment
  may reduce risks, address any systemic issues.
  Example choking death led MUIP to post the
  choking and all alerts on its website for all
  families.
• Unscheduled Hospitalization Follow discharge
  orders, ensure follow up doctors visit, intensify
  monitoring for an established period. Ensure
  staff are trained to deal with any new treatment.

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(M)(10) Trends and Patterns of Unusual Incidents
Must Be Addressed in the ISP (Prevention plan for
trend just like an MUI prevention plan)

• Who agency provider and county board as a
  provider
• Catching trends before they become MUIs
  often prevents injuries, rights violations and
  deaths.
• Example Series of falls alarms staff to upgrade
  gait training, areas of risks, etc. before more
  serious injury occurs.

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MUIP Commitment

• To serve Individuals well reduce harmful
  circumstances.
• To be easily accessible
• To be good, consistent consultants. We aim to
  prevent incidents and errors. Once they are
  committed, the individuals risks increase and
  ODMRDD requires our response to the errors.
• Note Many folks feel pressured to report only to
  be frustrated to find out incident was
  re-determined not to meet MUI rule criteria.
  MUIP understands the frustration and works
  closely with ODMRDD to be consistent and still
  help resolve issues where appropriate.

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• (M) Unusual Incident Requirements

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(M)(1) Implement a Policy and Procedure

• Each agency provider and county board as a
  provider
• Identifies what is to be reported
• Anyone who becomes aware report to designated
  person
• No later than 24 hours
• Appropriate actions to protect health and safety

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(M)(2) Trained and Knowledgeable Staff

• Agency provider and county board as a provider
• On unusual incident policy and procedure

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(M)(3)Unusual Incident Notification

• If the incident occurs at a county board operated
  or contracted site, the county board or
  contracted entity notifies the licensed provider,
  staff, or family at the individuals home
• Same day notification

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(M)(4)

• Individual providers make reports to the
• person designated by the county board on the same
  day as discovery
• The county board designates a person to log the
  incidents

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(M)(5) Unusual Incidents are Reviewed at Least
Monthly

• Who agency providers and county board as a
  provider
• Appropriate preventive measures
• Trends and patterns identified and addressed

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(M)(6)

• Unusual incident reports, documentation of trends
  and patterns, and corrective action made
  available to the county board and Department upon
  request.

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(M)(7) Maintain a Log of Unusual Incidents

• Who agency providers and county
• board as a provider
• Name of individual
• Brief description of incident
• Any injuries
• Time/date/location
• Preventive measures

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(M)(8) County Board Review of Representative
Sampling of Logs

• Monthly
• Provider logs, individual logs, and county
• board as a provider
• Ensure none are MUIs
• Ensure trends and patterns have been
• identified and addressed
• Provide to Department to review upon
• request

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(M)(9) Department Review of Representative
Sampling of Logs

• Monthly
• County board as a provider logs
• Submit to Department upon request
• Ensure none are MUIs
• Ensure trends and patterns have been identified
  and addressed

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(M)(10) Trends and Patterns of Unusual Incidents
Addressed in the ISP

• Who agency provider and county board as a
  provider

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• (N) Oversight

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(N)(1)

• The Department conducts reviews of county
• boards and providers to ensure
• Health and safety of individuals
• Compliance with rule requirements
• Failure to comply may be considered by the
• Department in its regulating capacity.

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(N)(2)

• Access to ITS for Ohio Department of Jobs
  Family Services and Ohio Legal Rights
• Commission.

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(O) Access to Records

• Some records are confidential
• Some records are not public records
• Some are public records
• The type of record will determine who may receive
  them

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(O)(1)

• MUI reports are not public records and are to be
  provided to the individual or individuals
  guardian upon request
• The MUI may also be provided to any governmental
  entity authorized to investigate allegations of
  Abuse, Neglect, Misappropriation, and
  Exploitation and to other parties where it is
  necessary to ensure the health and safety of an
  individual

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(O)(2) Confidential Records

• Medical and insurance records
• Workers compensation
• I-9
• Social Security numbers
• May not be reviewed, copied or included in
• MUI reports.

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(O)(3)May be reviewed and included in an MUI
report but not copied

• Payroll records
• Performance evaluations
• Disciplinary records
• Correspondence on employment status
• Criminal record check

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(O)(4)

• County board may review and copy
• personnel records of daily operation such
• as training records, timesheets and work
• schedules.

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(O)(5)-(6)

• Upon request, the provider shall provide to the
  Department copies of personnel records that are
  not confidential
• May redact any confidential information

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(O)(7)

• Receipt of report may be waived in writing
• from anyone entitled to receive the report.

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• (P) Training

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(P)(1) Training on Identification and Reporting
Requirements

• Who All agency providers and county
• boards.
• When Prior to unsupervised contact
• and no later than 30 calendar days
• after employment and annually
• thereafter (calendar year). Includes
• review of health/safety Alerts issued
• since the last training.

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(P)(2) Individual Provider Training on
Identification and Reporting

• Based accordingly to certification requirements
• Annually, based on certification date
• Includes review of Alerts issued since the
  previous years training

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(P)(3) Staff Responsible for Administrative
Compliance to the Rule

• Receive training on all applicable rule
  requirements
• At the time of employment but no later than 90
  days
• Annually, thereafter including health/safety
  Alerts released since the previous training

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(P)(4)

• Investigative agents shall receive initial and
• Annual Department approved training.

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(P)(5)

• The Department shall provide technical
• assistance as necessary
• The Department shall periodically monitor
  compliance with the rule

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