Reporting and Follow Up- Internal Incident/Critical Incidents

Introduction

It is TMS policy that all occurrences of a serious or unusual nature shall be reported verbally and documented in writing as quickly as possible after the incident occurs.

Incidents of a serious nature, as defined by Ministry for Children Development and Community Living BC, will be documented on a Critical Incident Report (CIR). Other instances that are not defined as a Critical Incident Report will be documented on a TMS Internal Incident Report (IIR).

TMS has implemented reporting, accountability and emergency on call procedures to ensure that appropriate steps are taken when a serious or unusual event occurs. These steps also ensure that the appropriate person(s) are contacted if a serious event occurs. This may include police, fire, child protection or legal decision makers/emergency contact identified for the individuals TMS supports.

TMS provides ongoing training for employees and management on policy and procedures regarding the reporting of serious and unusual incidents.

TMS addresses the need for appropriate follow up after an Internal Incident or Critical Incident occurs. This includes debriefing for individuals involved if necessary. 

All incidents CIRs/IIRs will be reviewed at the next Health & Safety Meeting; any analysis or recommendation implemented by management will also be reviewed   The Health & Safety committee may make additional recommendations.  

A comparative analysis of CIRS/IIRs will be conducted annually to consider additional trends, issues and any action items necessary to prevent further instances.

Critical Incident

Critical incidents are clearly defined by both MCFD and CLBC. They require TMS to follow a prescribed reporting process using a Critical Incident Report. 

The following list includes examples of Critical Incidents as defined by both funding agencies:

Emotional Abuse: Alleged or actual act or lack of action that diminishes an individual’s sense of well-being and is perpetrated by a person in a position of trust or authority, including verbal harassment, yelling, or confinement.

Financial Abuse: Alleged or actual misuse or abuse of an individual’s funds or assets by a person in a position of trust or authority. Obtaining property or funds without the knowledge and full consent of the individual or a formal or informal representative.

Physical Abuse: Alleged or actual excessive or inappropriate physical force directed at an individual by:

a person in a position of authority or trust, including a staff member or volunteer, or a person who is not responsible for providing services and is not a supported individual.

Sexual Abuse: Alleged or actual sexual behaviour, directed at an individual, whether consensual or not, by a staff member, volunteer or any person in a position of trust or authority.
Sexual behaviour includes inappropriate, unsolicited, or forced sexual attention from a person who is not responsible for providing supports or services. Sexual behaviour between two consenting individuals is not a critical incident.

Aggression between individuals: Aggressive behaviour by an individual towards another individual that causes injury requiring first aid (e.g.  bandage, ice pack), emergency care by a medical practitioner or nurse practitioner, or transfer to a hospital.

Aggressive/unusual behaviour: Aggressive behaviour by an individual towards a person (including another supported individual, staff, or others) or unusual behaviour that:

  • is not appropriately addressed or documented in the individual’s Behaviour Support and Safety Plan, or
  •  results in harm (physical or emotional)

If the harm is to another individual, refer to Aggression Between Individuals to determine if it would be more appropriate to report it as that incident type. Unusual behaviour is behaviour that is unusual for the individual.

Attempted Suicide: Attempt by an individual to intentionally self-harm for the purpose of taking his or her own life.

Choking: An individual’s airway is obstructed, requiring first aid, emergency care by a medical practitioner or nurse practitioner, or transfer to a hospital.

Death: Death of an individual while participating in a program.

Disease/Parasite outbreakd: Outbreak or occurrence of a communicable disease above the normally expected level, including a communicable disease or parasite such as scabies.  Contact your local Health Authority if you have questions.

Fall: A fall that results in an injury requiring emergency care by a medical practitioner or nurse practitioner, or transfer to a hospital.

Missing/Wandering:  Unscheduled or unexplained absences of an individual from a TMS service.

Motor Vehicle Incident: Injury to an individual as a result of a motor vehicle accident while accessing TMS services.

Other injury:  Any other injury to an individual that requires emergency care by a medical doctor or nurse practitioner, or transfer to a hospital.

Neglect: Alleged or actual failure to meet the individuals needs including the need for food, shelter, medical attention or supervision which endangers the individuals safety.

Poisoning: Ingestion of a poison or toxic substance by an individual (excluding licit or illicit drugs)

Service delivery problem/disruption of services: Condition or event that could impair a service of which affects the individual’s health, safety, dignity or well- being. Examples include floor and fire.

Unexpected illness/food poisoning: Illness of an individual requiring emergency care by a medical practitioner or nurse practitioner, or transfer to hospital including food poisoning.

Use of seclusion: Involuntary separation of an individual form normal participation and inclusion. The person is restricted to a segregated area and denied the freedom to leave it and is left alone. Use of seclusion must be reported as a critical incident.

Use or possession of illicit drugs or misuse of illicit drugs: Misuse of a legal substance such as mouth wash, or injection of aftershave. Serious misuse of legal substances such as prescription drugs or alcohol. Any use or possession of an illicit drug.

Weapon Use: An individual uses, or threatens to use, a weapon to harm or threaten somebody. Use of a weapon by a person to harm or threaten an individual. A weapon includes any object used to threaten, hurt or kill a person or destroy property.

Communicable Disease: Any occurrence of an illness caused by a micro-organism (bacteria, virus or fungus, parasite) and transmissible from an infected person or animal to another person or animal. Transmission can be by direct or indirect contact with infected persons or with their excretions (e.g. blood, mucus, semen) in the air, water, food, or on surfaces or equipment.

Use of Infection Control: Implementation of policies and procedures to reduce the occurrence and spread of infections, especially in hospitals and health care facilities.

Bio-hazardous Accident: An accident involving any material that can cause disease in humans or animals, or cause significant environmental or agricultural impact. Bio-hazardous material includes viruses, fungi, parasites, and bacteria and their toxic metabolites; as well as blood, other body fluids, and human tissues, cells or cell cultures.

Restricted practices, including:

Exclusionary Time Out: Removal of an individual from a situation or environment for a period of time to prevent harm to him/her or others. It does not include positive redirection of an individual to a safe, quiet place. It differs from seclusion in that the individual is not left alone.

Restraint: Use of physical or mechanical restraint to temporarily subdue or limit the individual’s freedom of movement including containment. Containment means restricting an individual within a certain area (eg using half door or locked exits).

Restriction of rights: Removal of an individual’s access to activities. It does not include standard safety practices or reasonable house rules.

Medication error:  Mistake in administering medication that: adversely affects an individual, or requires emergency care by a medical practitioner, nurse practitioner, or transfer to a hospital.

Internal Incident: 

Other serious/unusual events that do not require the reporting of a critical incident report. In these instances, a TMS Internal Incident Report will be used. Examples of an internal incident include:

·       Aggressive behaviours by a participant/individual in the community

·       Emergency procedures being used (not for drill purposes)- ex: fire alarm, emergency/facility shut down

·       Any serious damage of TMS property or equipment (no matter what the cause)

·       Motor vehicle accident

·       Any serious damage to third party property

·       Safety hazards identified in a program/residence that can/may disrupt services

·       Any other occurrence judged by an employee to be sufficiently serious, unusual, or extraordinary to merit the attention of management.

 

Reporting Procedures

Verbal reports: Verbal reports of all incidents, serious or minor (internal or critical) will be reported to the on-call supervisor immediately. The on-call supervisor will help determine what further action, if any, should be taken.

If necessary, the on-call supervisor will respond to the incident and provide support to staff/individual(s). The on-call supervisor will help determine/direct staff concerning reporting requirements and ensure that proper reporting procedure is followed.

Critical Incident Reports will be reported to TMS operations manager and executive director as soon as possible. 

Written reports:  Incident reports should be written in a professional manner and in the first person. Reports should always include full factual details, objectively recorded, and followed by individual observations, conclusions and recommendations (if required). The names of other staff working and individuals present at the time of incident should be noted in the incident report. Black ink must be used on Critical Incident Reports.

Submitting & Reporting A Critical Incident Report: The TMS emergency on call supervisor that responds to the report of a critical incident report is required to review the written document, provide and obtain necessary signature(s) and submit to appropriate funding agency.  Reports of non-urgent nature must be received within 5 days of the incident.

CLBC: Faxed to CLBC office 250-720-2680

MCFD/USMA: Dropped off in person at the local office

 Reporting incidents of an Urgent Nature: Incidents of urgent nature must be reported to MCFD and CLBC immediately. When MCFD and CLBC offices are closed and an urgent Critical Incident Report occurs the MCFD after hours’ number must be called @310-1234

The following information will need to be provided:

-       Individuals name and date of birth

-       Service provider contact information and alternate contact

-       An explanation of incident.

Filing: A copy of all Critical incident reports must be filed at the administration office in both the case management file for the individual and the annual critical incident report binder.

Debriefing/Follow Up

Critical incident debriefing is designed to help people deal with their reactions to incidents by allowing them to talk about the incident when it happens without judgement or criticism. Teachable Moments Services encourages employees to participate in debriefing to allow people to talk about how an incident has affected them personally as well as to understand what may have led to the incident occurring and how to reduce the chances of a similar incident occurring again. Often debriefing occurs informally, when a supervisor or residence coordinator checks in with a staff member after an internal or critical incident occurs. 

If co-workers, supervisors, or management feel that anyone continues to experience ongoing stress because of involvement in a critical incident or sentinel event the person will be referred by management to counseling or medical support.

When a serious critical incident occurs, debriefing will happen immediately following the incident and a follow up meeting will be scheduled the next working day after an incident occurs.  This meeting will involve the employees present during the critical incident and members of management.  Members of the health and safety committee may also be asked to participate.  Information gathered during these meetings will often be included in the annual Critical Incident review.

Review/Analysis 

All Internal and Critical Incidents will be filed at the administration office. The trend analysis data sheet will be completed and forms will be filed in the designated area of the yearly binder.  This quality assurance practice is done to help recognize/determine patterns, action items and changes necessary to prevent further instances.