Transcript DETECTION AND PREVENTION OF ABUSE AND NEGLECT Quality Improvement Nurse Consultants

DETECTION AND PREVENTION OF
ABUSE AND NEGLECT
Quality Improvement Nurse
Consultants
BACKGROUND INFORMATION

CMS (HCFA) RESPONSE TO ABUSE &
NEGLECT:

Standardized definition
Identification of residents at risk
Specified contributing factors
Developed a national strategic approach



RULES AND REGULATIONS

The Feds say:
Report, report!!
Investigate and---

Report again!!


Where do you find the Federal Requirements?

CFR 483.13 (c) (1)
(iii)

CFR 483.13 (c) (2)

CFR 483.13 (c) (3)

CFR 483.13 (c) (4)
TAG ALONG

F 223 Abuse

F 224 Freedom from Mistreatment, Neglect or
Misappropriation of Resident Property

F 225 Prevention and Reporting

F226 Policies and Procedures
STATE OF MICHIGAN LAWS




M Tag 0090 Section 21771- (1) Facility staff of a nursing home shall
not physically, mentally, or emotionally abuse, mistreat, or harmfully
neglect a patient.
(2) When aware of a violation of Number 1, go directly to Number 2;
i.e., report the matter to the administrator (employees); report the
matter to the Michigan Department of Community Health
(administrators).
(3) Any person may report a violation to the Department.
(4) A physician or other licensed health care personnel of a hospital
or other health care facility to which a patient is transferred who
becomes aware of an act prohibited by this section shall report the
act to the Department.
STATE OF MICHIGAN LAWS


(5) The Department
investigates after
receiving report and may
request additional info.
(6) A licensee or nursing
home administrator shall
not evict, harass, dismiss,
or retaliate against a
patient, a patient’s
representative, or an
employee who makes a
report under this section
STATE OF MICHIGAN LAWS

Section 21771 also requires the reporting of other
occurrences which threaten the welfare, safety, or health of
residents, such as:
a.
Resident to-resident altercations that result in injuries that interfere with
vital physiologic functions which are an immediate threat to life or have a
strong potential to become an immediate threat to life. Multiple (3 or
more) resident-to-resident altercations by a specific resident.
Elopement of a resident/patient missing for more than 2 hours and/or
has a strong potential to become an immediate threat to life and/or
neglect.
Injuries of unknown origin that result in interference with physiologic
functions which are an immediate threat to life or have a strong potential
to become an immediate threat to life and or abuse.
b.
c.
TERMS TO REMEMBER


ABUSE- the willful infliction of injury,
unreasonable confinement, intimidation, or
punishment with resulting physical harm,
pain, or mental anguish.
NEGLECT- The failure to provide goods
and services necessary to avoid physical
harm, mental anguish, or mental illness
TYPES OF ABUSE/NEGLECT









Physical abuse
Sexual assault
Misuse of restraints
Emotional or psychological
abuse
Verbal abuse
Involuntary seclusion
Medical neglect
Abandonment
Financial or material
exploitation
WHAT TO LOOK FOR?







Bruises, black eyes, welts, lacerations, rope
marks, imprint injuries
Fractures
Open wounds, cuts, punctures
Sprains or dislocations
Unexplained VD or genital infections
Unexplained vaginal/anal bleeding
Bruises around breast/genital area
WHAT TO LOOK FOR? (CONT.)

Malnutrition

Contractures

Pressure Ulcers

Certain psychosocial
behaviors
State of Michigan Interim policy
for reporting Alleged Abuse, etc..



Proposal
Alleged violations of abuse, mistreatment,
neglect, etc. are reported to the
administrator
The investigation commences
immediately, while the residents are
safeguarded
Incidents-Involving Harm




Are to be reported immediately to the
Bureau of Health Systems (BHS)
BHS-OPS-362 24 Hour Report Completed
Recorded on BHS Facility Log
Investigation commences, while residents
are safeguarded
Incidents-Involving Harm (cont.)



Report results of your investigation to
BHS, complete the BHS-OPS-363, 5 day
report form
Record the investigation results on the
BHS Facility Log
Harm means some physical injury or
damage, pain, or mental anguish
Incident-Without Harm




Recorded on BHS Facility
Log
Investigation
commences, while
residents are
safeguarded
Investigation results
reported to administrator
Facility takes corrective
action as needed
BHS Facility Log -- Expectations




Facilities begin recording on 12/1/06.
Facilities send BHS Facility Log to Licensing
Officer on/or about 1/15/07.
Licensing Officer or designee reviews BHS
Facility Log upon receipt for timeliness of
entries, completeness, understanding of harm.
Licensing Officer works with facilities, as
appropriate, to ensure the BHS Facility Log is
correct.
BHS Facility Log -- Expectations
BHS Facility Logs are reviewed as part of
off-site preparation for standard surveys to
note:
•
•
•
•
Patterns of injury.
Patterns involving a resident victim.
Patterns involving a resident/staff perpetrator.
Possible inclusion in survey sample.
Facility Log Instructions

Facilities are asked to make an initial determination about incidents and decide what is reportable
and what is not, in accordance with CMS Regulations. If the facility has a question about whether
or not an incident is reportable, they are advised to report. Incidents (and investigation findings)
involving any level of harm should be reported to the Bureau’s Complaint Investigation Unit and
summarized on the Facility Log. Incidents that do not involve harm should be summarized on the
log, only. In all cases, facilities should assess the incident and implement corrective measures, as
appropriate.

Facilities are to submit this form to their Licensing Officer by the 15th of the month, or more
frequently, as directed.

The Licensing Officer will review the log and may contact you with additional questions or for
copies of investigational materials. Facilities should complete an internal investigation on each
event. Information should include documentation that supports a summary statement of the
event, conclusions reached and evidence of corrective action initiated, if appropriate. The
Licensing Officer will determine what additional follow up or on-site surveyor investigation will be
necessary.

UpNorth Team Phone:
Metro West Team Phone:
Metro East Team Phone:
Mid-Mich Team Phone:
Southwest Team Phone:




(989) 732-8062
(313) 456-0350
(313) 456-0320
(517) 334-8404
(517) 334-8406
Fax:
Fax:
Fax:
Fax:
Fax:
(989) 732-8958
(313) 456-0348
(313) 456-0348
(517) 334-8473
(517) 334-8473
BHS Facility Log -- Expectations
Complaint Team surveyors will review the
BHS Facility Logs completed since the last
standard survey for entries relevant to the
complaint/facility reported incident under
investigation.
Standard Survey Team will review on-site
the log entries since the last report.
BHS Facility Log -- Expectations
As part of discretionary review, (between standard
surveys) Licensing Officers may:
• Require a Plan of Correction to address an
incident.
• Request copies of reports or documents related
to FRI.
• Request a voluntary in-service.
• Initiate a State Monitoring visit.
• Require immediate reports and 5 day
investigation reports for all alleged abuse,
neglect, and mistreatment incidents.
7 KEY
COMPONENTS(Detection/Prevention)

Prevent

Protect

Screen

Report/Investigate

Identify

Respond

Train
PREVENT
The provider has the capacity to prevent the
occurrence of abuse and neglect and reviews
specific incidents for “lessons learned” which
form a feedback loop to affect policy change.
PREVENT (CONT.)
Mission statement:
Goals, values, vision.
and a guiding principle.
 Policies/Procedures:
~ Abuse and neglect
~ Individual/family rights
and responsibilities
~Admission/discharge
~ Assessment/care
planning
~ Clinical protocols

PREVENT (CONT.)






Monitoring: Review of individual
complaints
Satisfaction surveys (resident/family/staff)
Problem identification program
Staff competencies
Clinical outcomes
Process
QUALITY IMPROVEMENT






Periodic review/revision of
policies/procedures
Monitoring activities
Analysis of incidents
Satisfaction surveys
Review of incident reports
Identification of trends
Facility Self- Check





Application of Federal definitions
Effective program planning, implementation,
monitoring, and quality improvement
Is your approach to managing this issue
understood by the appropriate parties?
Clear understanding of what to do if
abuse/neglect occurs
Resident, staff, advocates, can identify S/S of
abuse/neglect
FACILITY SELF-CHECK

Policy and Procedure Manual containing: Mission statement,
P/P for the various form of abuse/neglect,complaint
file,incident reports, and a review of process outcome
documentation

Problem Identification Process/System:
Consideration of staff competencies, report tracking and
identification of trends, outcome tracking, and evaluation of
organizational processes, including compliance. What
methods/approaches for detecting/preventing abuse/neglect
have been instituted since last survey? What were the
outcomes?
FACILITY SELF-CHECK



Mission of organization?
Process for reporting
abuse/neglect, theft of
resident property, injuries
to resident?
Staff demonstration of
knowledge, skill, ability to
assess, plan, respond, &
evaluate resident needs
as a continuous process,
support QOL/Quality
care?
SCREEN



Facility screens for any previous history of
A/N against prospective employees.
Facility screens for employee’s experience
in working with the population.
Facility makes sure the needs of the
resident can be met by the facility prior to
admission.
Screen: Detecting Abuse/Neglect




Why did this happen?
Could it have been prevented?
Did I overlook something in the hiring
process?
Do we need to revise our screening
process?
IDENTIFY
The provider creates and maintains a
proactive approach for identifying
events and occurrences that may
contribute to A/N
Is your facility at risk?
Staff
characteristics
Administrative
structures
Staffing
patterns
Resident
characteristics
Tradition
Wages
Facility
environment
Communication Support
patterns
systems
TRAIN



Employee reporting
requirements
Procedures for
detection, intervention,
prevention
Resident/advocate
trained re: identification
of S/S of A/N
PROTECT

The provider protects
individuals from
abuse during
investigation of any
allegations of abuse
and neglect.
Report & Investigate

Any employee who suspects or witnesses abuse
or neglect toward a resident must report it
(immediately) to a facility administrator or his/her
designee.

The provider ensures that any suspected or
alleged incidents of A/N are investigated quickly,
thoroughly, and objectively. Report substantiated
incidents to state and local law enforcement and
regulatory agencies as required.
Priority “1” Exceptions






Injury or incident involving a death or potential
criminal activity under investigation by a state or
local law enforcement agency.
Abuse with injury
Elopement of a resident missing for more than 2
hours
Serious injury which is life-threatening to resident
Sexual assault
An allegation of failure to readmit a Medicaid
resident
RESPOND
The provider assures that the
appropriate corrective, remedial, or
disciplinary action occurs in accordance
with applicable local, state, or federal law
REFERENCES







Abuse Prohibition Review Survey Checklist: MDCIS
BHS Complaint and Facility Reported Incident Manual
(Rev. April 20, 2005)
CMS (HCFA Staff)
Mike Dankert, Director, Bureau of Health Systems
(2006)
State of Michigan Nursing Homes and Nursing Care
Facilities Rules
State Operations Manual
To obtain training materials, Michigan facilities may
contact: HCAM and MAHSA