NIMRS Incident Reporting Changes Effective June 30 th 2013

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1 NIMRS Incident ing Changes Effective June 30 th 2013 The Justice Center for the Protection of People with Special Needs (Justice Center) becomes operational on June 30, 2013, resulting in changes OMH Part 524 incident definitions and the process for reporting incidents using the New York State Incident Management & ing System (NIMRS). OMH has made modifications NIMRS and updates will continue be made over the coming weeks adapt the system the new requirements. The purpose of this document is orient you these changes and provide instructions on how report incidents OMH and the Justice Center beginning on June 30 th. Web-based video turials that further describe these changes are being developed will be distributed in the near future. Incident ing Changes: The new OMH Part 524 regulations define Incidents which include Allegations of Abuse, and Significant Incidents which are required be reported the Justice Center and OMH, and Reviewable Incidents which should be internally reviewed and tracked. It is recommended that NIMRS be used for recording Reviewable incidents. Guidance identify incidents and determine reportablity is included on pages 3 through 10 of this document. All Incidents are required be reported the Justice Center Vulnerable Persons Central Register (VPCR) prior being entered in NIMRS. To report an incident the VPCR, call or submit the web form which can be accessed on the Justice Center website at ***You will no longer be able click on New Incident record these incidents in NIMRS*** Once the incident has been received by the Justice Center, the incident information will be loaded in NIMRS where it will be reviewed first by OMH and then transferred a new NIMRS queue where it will be available for you review and create an incident report OMH, consistent with past practice. See NIMRS screen-shots below which describe this new process. Step Action Related Screen 1. Use your ken log in NIMRS as in the past. For a link the system and other resources, go the following link: 2. Click on the Incident Management tab. 3. Select the option for the new Justice Center Import queue. (Until further notice, do not select JC Incident List by Status. ) 4. Click on View Details display the incident information that was reported the VPCR. Incidents received by the VPCR will be transferred this queue within 1 hour during normal business days. Incidents received near the end of a business day or outside normal business hours will be transferred on the following business day. (OMH is in the process of developing an system notify providers when an incident has been transfered their queue. Providers should monir this queue regularly until this notification system is implemented.) Page 1 of 2

2 NIMRS Incident ing Changes Effective June 30 th 2013 Step Action Related Screen 5. Click Show All display all content. Information can also be printed by clicking Print View, rightclicking on the screen and selecting Print. This information should be reviewed for accuracy. There are only two data fields in the JC Import report that can be adjusted by the user prior creating the incident: 1 ) Ward Program - Confirm if Ward/Program is correct and update, if necessary, by clicking on the drop-down arrow and selecting the appropriate program. 2) Nimrs Client Data - If the incident data involves a patient that already exists in NIMRS, the patient s Name, DOB etc. will appear under Nimrs Client Data. If no data exists in NIMRS for the patient, an option Add As New Client will be displayed create a new client using the client information from the VPCR. At any time, Search for Client can be selected search for a NIMRS client or enter new clients. 6. Once information has been reviewed and confirmed be accurate, scroll the botm of the screen and click Create Incident load the information in a NIMRS incident. To return the Justice Center Import queue without creating a NIMRS incident, scroll the botm right of the screen and click Cancel. The incident will remain in the queue until further action is taken. 7. Incident information including the program, client and narrative will be loaded in a new NIMRS incident. Data should be entered in remaining required NIMRS fields and the incident should be ed OMH using the same process as prior June 30 th. Please note that not all information in the JC Import incident will populate NIMRS fields. It is recommended that you print the JC Import incident report for future reference. Functions of the CQC will be transferred the Justice Center on June 30 th however NIMRS won t reflect this until a future update. Until then, Allegations of Abuse/Neglect and Patient Deaths should continue be reported using the CQC function as in the past. The QCC 100 must still be completed for Deaths prior ing CQC. Page 2 of 2

3 Adverse Drug Reaction, Severe able Unintended, undesirable, unexpected or excessive response a medication given at normal doses, which causes significant harm. Allegation of Abuse or Neglect: Abuse and neglect involve an act (or failure act) by an employee. Physical Abuse Non-accidental contact with a client which causes or potentially causes physical pain or harm. Psychological Abuse Verbal or non-verbal action by an employee which causes or potentially causes emotional distress. Sexual contact between employee and client, or nonconsensual Sexual Abuse contact among clients allowed or encouraged by employee. Medication Abuse Intentionally improper administration of medication. Neglect Assault * Action or failure act by employee which impairs or potentially impairs physical, mental or emotional condition of client. Physical attack using force or violence in which client is either victim or aggressor. Severe adverse drug reaction **** Unintended, undesirable, unexpected or excessive response a medication given at normal doses, which causes significant harm. Allegation of Abuse or Neglect: Abuse and neglect involve an act (or failure act) by an employee. Physical Abuse Non-accidental contact with a client which causes or potentially causes physical pain or harm Psychological Abuse Includes any verbal or nonverbal conduct that is intended cause a patient emotional distress. Any sexual contact involving a cusdian and a Sexual Abuse patient, or any sexual contact involving a patient that is encouraged or allowed by a cusdian Neglect Deliberate Inappropriate Use of Restraint Obstruction of reports of Incidents Unlawful use or administration of a controlled substance Assault ** Any action, inaction or lack of attention that breaches a cusdian's duty and that results in or is likely result in physical injury or serious or protracted impairment of the physical, mental or emotional condition of a patient. Restraint that is done for the purpose of punishment, for the convenience of a cusdian, or with deliberate cruelty. Conduct by a cusdian intended impede the reporting or investigation of a reportable incident. Any illegal administration or use by an employee of a controlled substance, as defined by Article 33 of the Public Health Law. A violent or forceful physical attack by a person other than a cusdian, in which a patient is either the victim or aggressor, and which results in injury or harm. Ver /19/2013 3:12 PM Page 1 of 8

4 Child Missing from Staff Supervision Contraband, Possession of * able Child whose whereabouts is not accounted for when expected be present and under the supervision of staff at an outpatient program. Client is found possess an item or substance which is forbidden by program rules and/or has the potential cause harm or interfere with client safety and treatment. Crimes Not listed Elsewhere: Event which appears be a crime, involves a client as either aggressor or victim, and affects or potentially affects the health or safety of one or more persons and/or the property or operation of the program. Note that arson (fire setting), assault, and sexual assault are reported as discrete incident categories. Homicide by Client If client is victim of homicide, report as client death. Narcotics, Sale or Possession Include client acts which are or appear be crimes. Robbery Include client acts which are or appear be crimes. Possession of Deadly Possession of deadly weapon not properly registered Weapon or otherwise considered a crime. Other Crime * Crime not listed elsewhere which endangered or potentially endangered the life, health, or welfare of a client or other individual. Include client acts which are or appear be crimes. Child Missing from Staff Supervision Contraband *** Crime **** A patient of an outpatient mental health program who is under the age of 18, and whose whereabouts are not accounted for when expected be present or under the supervision of an employee. (With new Part 524 regulations, this incident type falls under Missing Patient; however incidents should continue be reported in NIMRS under the old incident type.) Possession by a patient on the premises of inpatient or residential setting of an item or substance which is forbidden by the mental health provider and which has the potential cause harm self and/or others and interfere with patient safety and treatment. An event, which is or appears be a crime under New York State or Federal law, which occurs on program premises or under the intended supervision of staff; which 1) involves the patient as the victim, or 2) does or could affect the health or safety of one or more patients, or 3) could have a significant adverse impact on the property or operation of the program. Serious violent crimes involving patients that take place in the community must be reported OMH. (The new Part 524 Regulation collapses the definition; however NIMRS will continue break out discrete incident sub-types.) Ver /19/2013 3:12 PM Page 2 of 8

5 able Death of a Client: the death of any client who was enrolled and/or receiving services at the time of death or was discharged within thirty days of death. Death of a client due known medical causes Natural Causes, Expected following the expected course of illness or disease, while under treatment consistent with standard medical practices (a natural death) Natural Causes, Unexpected Death of a client due unexpected natural causes. Homicide of Client Death of a client apparently caused by an act by another individual. Suicide Death of client caused by deliberate self-inflicted injury intended end his/her own life. Accidental Accidental and unexplained, except those related treatment provided. Death of a client which is related the lack of Lack of Appropriate treatment provided in accordance with generally Treatment accepted medical standards. Restraint or Seclusion Death of a client associated with the use or attempted use of restraint or seclusion. Unexplained Cause of death is not known. Fall: As of 1/1/04, all client falls are be entered using this incident type. Client falls should no longer be entered using "Injury-Accidental" or any facility defined incident type. Fall - With Injury * Fall - Without Injury * Fight * Fire Setting * A fall which results in any level of physical injury the client. A fall which does not result in any physical injury the client. Physical altercation between two or more clients, other than an assault. Client action resulting in fire, either deliberate or accidental. Ver /19/2013 3:12 PM Page 3 of 8 Death Falls by Patients ** **** Death of a patient of a State operated or licensed mental health provider who was enrolled in or receiving services from the facility or program at the time of the death. Must include any patient death occurring within 30 days after admission or discharge from a mental health program. (The new Part 524 Regulation collapses the definition; however NIMRS will continue break out discrete incident sub-types.) Events where patients trip, slip or otherwise fall in an inpatient or residential setting A physical altercation between two or more patients, Fights ** in which there is no clear aggressor and no clear victim Action by a patient, either deliberate or accidental, Fire Setting that results in fire on program premises and which causes serious injury, or a risk of serious injury, any person.

6 able **** Inappropriate Sexual Behavior, Children * For children and adolescents only, inappropriate sexual behaviors not defined elsewhere, including sexually oriented taunting, threats, or intimidation and any sexually oriented behavior or language that has or potentially has a negative impact on the well being of another client. Inappropriate Sexual Behavior *** Inappropriate sexual language or behaviors engaged in by patients under age 18 of providers of mental health services for children. This includes harassing behavior, including sexually oriented taunting, verbally aggressive threatening or intimidating language and any sexually oriented behavior or language that has a negative impact, or the potential for a negative impact, on the well being of another patient. Injury - Accidental * Physical injury client which does not appear be deliberately caused by the patient or another person. Injury of Unknown Origin * Physical Injury client for which a cause cannot be immediately determined. Medication Event: Any preventable event that may cause or lead inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer Category C * Error reached the patient but did not cause harm Category D * Error reached the patient and required moniring and/or intervention preclude/prevent harm Category E * Error may have contributed and/or resulted in temporary harm and required intervention Error may have contributed and/or resulted in Category F * temporary harm requiring initial or prolonged hospitalization (normally Risk Level 3) Category G * Error may have contributed and/or resulted in permanent harm patient (normally Risk Level 3) Category H * Error occurred that required intervention necessary sustain life (normally Harm Level 3 and Risk Level 3) Injury ** Injury of Unknown Origin Any suspected or confirmed harm, hurt, or damage a patient caused by an act of that individual or another, whether or not by accident, and whether or not the cause can be identified, which results in serious injury. Any suspicious injury a patient for which a cause cannot be immediately determined. Ver /19/2013 3:12 PM Page 4 of 8 Medication Error ** An error in prescribing, dispensing, or administering a drug. (The new Part 524 Regulation collapses the definition; however NIMRS will continue break out discrete incident sub-types.)

7 Missing Client (Inpatient- Residential): Missing Subject of AOT Court Order: Self Abuse * able * A client of an inpatient or residential program who has not been accounted for when expected be present and who has not been found on the facility grounds or other expected location. Only outpatient programs should use this category report a client who is subject an AOT court order who fails keep a scheduled appointment and/or who cannot be located within a 24 hour period. Inpatient and residential programs should report missing AOT persons under "Missing Client". Self-inflicted harm by a client not intended result in death. Sexual Assault: Non-consensual sexual activity involving force or violence or deemed nonconsensual because one or more participants is found lack the capacity consent, and all sexual contact between a person who is 18 years of age or older and a person who is less than 15 years old, or between a person who is 21 years of age or older and a person who is less than 17 years old. Rape or Non-consensual Sodomy Other Sexual Assault Sexual assault resulting in vaginal, anal, or oral penetration. A sexual attack, other than rape or sodomy, which otherwise meets the criteria for sexual assault (force or violence, inability consent, statury age differences of participants), including attempted sodomy and forcible sexual encounters. Missing patient Missing Subject of AOT Court Order: OMH Only Self Abuse ** Sexual Assault **** A patient of an inpatient or residential program who has not been accounted for when expected be present and who has not been found on the facility grounds or other expected location, or who is known have left the facility grounds without the permission of an employee, when such permission is otherwise required; or (For children under 18 years of age in outpatient mental health programs see incident type Child Missing from Staff Supervision above.) Only outpatient programs should use this category report a client who is subject an AOT court order who fails keep a scheduled appointment and/or who cannot be located within a 24 hour period. Inpatient and residential programs should report missing AOT persons under "Missing Client". Self-inflicted injury not intended result in death that results in serious injury or harm. A sexual attack including but not limited those that result in vaginal, anal, or oral penetration, i.e., rape or attempted rape and sodomy or attempted sodomy; and/or any sexual contact between a person who is 18 years old or more and a person who is less than 15 years old, or between a person who is 21 years of age or older and a person who is less than 17 years old, or which involves a patient who is deemed incapable of consent, and which occurs on program premises or when a patient involved in the event is under the actual or intended supervision of staff. (The new Part 524 Regulations collapses the definition; however NIMRS will continue break out discrete incident sub-types.) Ver /19/2013 3:12 PM Page 5 of 8

8 able Sexual Contact: Any uching of the sexual or other intimate parts of a person's body with the intent of gratifying sexual desire of either party. Sexual Contact - Child Non-consensual Contact - Adult Consensual Contact - Adult Suicide Attempt Other Incident * * * Any sexual contact between children that does not meet the criteria for sexual assault. Any non-consensual sexual contact involving an adult client that does not meet the criteria for sexual assault, such as groping, grabbing, or uching intimate areas not marked by force or violence. Any sexual contact involving adult clients capable of giving consent (Inpatient Only) An act committed by a client in an effort cause his or her own death. An event, other than those listed above, which has or may have an adverse effect on the life, health or welfare of the client and/or another person; which has or potentially has a significant adverse impact on the program or operations; or which has or may attract adverse media attention. Sexual contact between children. Sexual activity between children Sexual Contact between adults non-consensual Sexual Contact between adults - consensual Suicide Attempt A choking event experienced by a patient as a result of ingestion of food or other foreign object, resulting in life threatening harm or admission a hospital, and there is a written directive for such patient concerning risk of choking in place at the time of the event. Ver /19/2013 3:12 PM Page 6 of 8 *** *** *** Other Incident ** Choking **** Vaginal, anal, or oral penetration by patients under age 18 that occurs in a setting where the patient receives around-the-clock care or on the premises of an outpatient program; Any sexual activity that does not meet the criteria for sexual contact between children or sexual assault but which occurs between patients under age 18 years of age. Any unwanted sexual contact involving an adult patient not marked by force or violence (i.e., not a sexual assault), including but not limited groping, grabbing, or uching intimate areas of the body Sexual contact involving adult patients, who are capable of such consent, that occurs in a setting where a patient receives around-the-clock care or on the premises of an outpatient program. An act committed by a patient of a mental health provider in an effort cause his or her own death. An event, other than one identified in this subdivision, which has or creates a risk of, an adverse effect on the life, health, or safety of a patient.

9 able **** Mistreatment: - Unauthorized Restraint or Seclusion Unauthorized use of restraint or seclusion that is inappropriate because it was implemented without a valid physician s order or in a manner that was otherwise not compliant with applicable state or federal regulations, but which does not rise the level of abuse, as defined in this section. - Intentional Improper Administration of medication Intentional administration a patient of a prescription drug or over-the-counter medication which is not in substantial compliance with a prescription. - Misappropriation of patient resources Misappropriation of a patient s resources, including but not limited funds, assets, or property, by deception, intimidation, or similar means, with the intent deprive the patient of those resources. Verbal Aggression by Patients A sustained, repetitive action or pattern by a patient or patients of ridiculing, bullying, demeaning, making derogary remarks, verbally harassing, or threatening inflict physical or emotional harm on another patient or patients, which causes serious harm. Ver /19/2013 3:12 PM Page 7 of 8

10 Rating Severity Facr Harm Select the severity rating which reflects the level of physical and/or psychological harm, along with the medical and/or psychiatric intervention needed as a result of the incident. Risk Select the risk severity rating which reflects the potential for harm, given the actions taken and the level of motivation of the person(s) involved in the incident. Incident Severity Rating Reviewable (Serious) 1 - Low 2 - Moderate 3 - Severe -Moderate physical harm; -Medical intervention and treatment beyond first aid, e.g., x-rays and sutures; and/or -Moderate psychological harm, e.g., negative changes in affect, behavior or cognition; -Change in psychotropic or psychotherapeutic intervention. -No physical harm or minor harm, e.g., bruise, minor laceration; -Medical intervention limited first aid or less; and/or -No or little psychological harm; -No psychiatric treatment beyond reassurance and support. No risk or slight risk of complications or serious harm. Potential for moderate injury. -Serious physical injuries; -Emergency life saving procedures, admission hospital, or treatment in ER; and/or -Life threatening psychiatric conditions; -Major change in treatment, e.g., admission more intensive treatment setting or level of supervision. Risk for life-threatening harm. CALL (518) IF YOU HAVE ANY QUESTIONS ABOUT REPORTING AN INCIDENT. Ver /19/2013 3:12 PM Page 8 of 8