MUI for Ohio DD (9/2013)


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  • This means that a person cannot be working during their orientation w/o training, even if they are supervised
  • Need to address that IP are required to notify guardians and CB same day for UI which may be more stringent than the MUI requirement in some cases.
  • Deleted the extra “could.”
  • ORC:
    Abuse include Misappropriation in the criminal statute
    Physical Abuse 2901.01 use of force
    Physical harm any injury, illness, or psychological impairment regardless of gravity or duration.
    Sexual Abuse 2907 ORC
    Misappropriation 2913.01 .02 ORC
    Failure to Report
  • All other MUIs
    Being served means being with the person or responsible for the person at the time of the incident.
    Discuss missing person.
  • These are more serious events
    Notification to county board so they can initiate investigation/notification
    County board system for MUIs to be communicated
  • Steps should reasonably assure that individual(s) is/are safe
    Abuse, Physical & Sexual – separation of PPI from individual
    Other cases may be handled differently based on severity
  • System needs to be responsive so that a call back is made when required.
  • No surprises for others
    Know what happened
    Prevents second reporting of same situation
  • Paragraph I are investigations that the Department is required to direct
    Notification via phone call
  • New:
    Added for protection of individual where a provider may continue to work elsewhere.
    Criminal and/or administrative disposition.
  • Individual providers notify county board phone/fax/email
    County board needs to determine best way to receive them
    Explain why the change
  • Someone in the family home who receives just SSA…what can reasonably be done?
  • Will be a front page on ITS
    Type of incident – 3 or 4 word description
    Notification made
  • Difference MUI investigation (IAs) and HR investigation (provider).
    Other information means other than interviews.
  • On-call person can initiate by means listed.
    Must initiate when law enforcement or PCSA decline.
  • Judgment call by the investigative agent. Based on the circumstances and health/safety of individual(s).
  • Not only agencies but MRDD employees.
  • (H)(14) Extension may be granted:
    Outside entity investigating
    Large number of interviews
    Key witness is unavailable
    New allegations are uncovered and you are interviewing some persons for multiple allegations
    Waiting for medical documents other records
    Prevention plan not completed
  • Note: PPI receives disposition. Can create a form with a checkbox.
  • Is peer to peer filed as a group MUI? No it is filed on individual 1 the perceived victim. Individual number 2 is the “aggressor.”
    Will there be a drop down category for peer to peer injury in ITS?
    Is biting firmly fixed?
    Is a punch to the head an MUI if there is no injury? What is the individual says their head hurts where they were punched?
    Is a red mark on the face that quickly fades considered an MUI?
    How will ITS look with a peer to peer incident? Will there be a prevention plan area for each individual?
  • “or an injury” was added to the slide
  • A brief hands down with no resistance is a UI.
    A hand hold with resistance is an MUI because there is a potential for harm.
    Is turning off a wheelchair a UBS? Is it considered a time out because egress is prevented? Is holding a wheelchair or pulling a wheelchair against a person’s will a UBS MUI? If the wheelchair is considered part of the person’s body is it considered a restraint?
  • MUI for Ohio DD (9/2013)

    1. 1. Incidents adversely affecting health and welfare. OAC 5123:2-17-02 1
    2. 2. Objectives:      Provide new and/or current staff/providers with an awareness of the importance incident reporting Create awareness about abuse and neglect so staff can identify and report information Educate staff on types of Unusual Incidents and MUI’s Educate staff/providers on the procedures and process of reporting incidents Educate staff/providers of roles and responsibilities of providers, support administrators, and investigative agent 2
    3. 3. The Rule:  Establishes the requirements for managing incidents adversely affecting health or welfare.  Implements a continuous quality improvement process in order to prevent or reduce the risk of harm to individuals. 3
    4. 4. The Rule:  The Purpose is to establish a system to:  Report  Investigate  Review  Remedy  Analyze 4
    5. 5. Common Acronyms         Provider: person giving services to eligible client. MAR: Medical Administrative Record (Med sheet lists all med’s, dosages, and times given.) ASD: Autism Spectrum Disorders MR: Mental Retardation. (It is important to realize this is seen as an offensive term by most providers, SA’s and Individuals. It is recommended you use Developmental Disability when addressing a client or professional.) UI Unusual Incident MUI: Major Unusual Incident PPI Primary Person of Interest IA Investigative Agent 5
    6. 6. Definitions Rule Reference: Page 1 (C )(2) "Agency provider" is a provider, certified or licensed by the department or a provider approved by the Ohio office of medical assistance to provide services under the transitions developmental disabilities waiver, that employs staff to deliver services to individuals and who may subcontract the delivery of services. "Agency provider" includes a county board while providing specialized services. 6
    7. 7. Definitions Rule Reference: page 2 (C)(10) Independent Provider) Provider (Replaces Individual "Independent provider" means a selfemployed person who provides services for which he or she must be certified under rule 5123:2-2-01 of the Administrative Code or approved by the Ohio office of medical assistance and does not employ, either directly or through contract, anyone else to provide the services. 7
    8. 8. Support Broker SELF Waiver Rule Reference: Page 11(G)(1)(e) Support broker for an individual enrolled in the self-empowered life funding waiver shall be notified of MUI’s. New addition with the SELF Waiver. 8
    9. 9. QMRP Language change Rule Reference: Page 6(c)(18) "Qualified intellectual disability professional“ QIDP has the same meaning as in 42 C.F.R. 483.430 (2012). 9
    10. 10. Summar y of MUI rule changes  Rule title to include MUI and UIs. The new title is Addressing major unusual incidents and unusual incidents to ensure health, welfare, and continuous quality improvement.  Changes to Protocols (A, B, and C category investigations.)  Peer-to-peer definition changes (Physical Abuse, Verbal Abuse, Misappropriation). Clarifies the definition for greater consistency  Verbal Abuse definition changes  Missing Individual Definition Changes 10
    11. 11. Summar y of MUI rule changes     Strengthening of the UI process. More incidents will be categorized as UI’s = assure process effectively addresses these incidents. Revised communication and dispute resolution opportunities (i.e., information, appeal) for peer/guardian in a Peer-to-Peer case. Law enforcement notifications on criminal Peer-toPeer cases. Local conversations to assure appropriate follow-up Law Enforcement and Attempted Suicide as an MUI – even when individual is not being served 11
    12. 12. Summary of MUI Rule changes  Known / Unknown Injury Changes  Death- Suspicious or Accidental v.s. Natural  UI Definition  Health and Welfare  Provider Notifications  ICF Reporting Requirements  Support Broker Self Waiver  Peer to Peer Notifications  Incident Report Requirements  Quarterly to Semi Annual for MUI P& T Analysis 12
    13. 13. Revisions emphasize…  Improvements that focus on triaging incidents based on severity  Providing the right amount of safety, verification and investigation  Reducing unnecessary worry, time, and effort on paper compliance that doesn’t impact outcomes 13
    14. 14. Reporting Requirements Rule Reference: Page 8(D)(3)(a-e) Reports regarding the following major unusual incidents shall be filed and the requirements of this rule followed only when the incident occurs in a program operated by a county board or when the individual is being served by a licensed or certified provider: (i) Medical emergency; (iii) Rights code violation; (iv) Significant injury; (v) Unapproved behavior support; and (vi) Unscheduled hospitalization. 14
    15. 15. Category A Category B Category C Accidental or Suspicious Death Attempted Suicide Law Enforcement Exploitation Medical Emergency Unscheduled Hospitalization Failure to Report Missing Individual Unapproved Behavior Support Misappropriation Death from Natural Causes or disease Rights code Violation Significant Injury Neglect Peer to Peer Acts Physical Abuse Sexual Abuse Verbal Abuse Prohibited Sexual relations 15
    16. 16. Required reporting at all times MUI only when services are provided Attempted Suicide Medical Emergency Law Enforcement Rights code violation Physical, Sexual, Verbal abuse Significant Injury Peer to Peer Acts. Unapproved Behavior Support Misappropriation Unscheduled Hospitalization Exploitation Failure to Report Prohibited sexual relations Neglect Death 16
    17. 17. Category Summaries  All MUI’s require an investigation meeting category A , B or C applicable requirements of this rule.  Category A Alleged Crimes (Police , CSB and IA involvement)  Category B Investigative Agent  Category C (Format Requirements)  Investigation categories may change based on the information obtained A, B and C. 17
    18. 18. Training Rule Reference: Page 22 (P)(1)-(2) Agency providers and county boards shall ensure staff employed in direct services positions are trained on the requirements of this rule regarding the identification and reporting of MUIs and UIs prior to direct contact with any individual. Thereafter, staff employed in direct service positions shall receive training during each calendar year which shall include annual training on the requirements of this rule including a review of health and welfare alerts issued by the department since the previous calendar year's training. 18
    19. 19. Access To Records Rule Reference: Page 22-(O) A county board or the department shall not review, copy, or include in any report required by this rule a provider's personnel records that are confidential under state or federal statutes or rules, including medical and insurance records, workers' compensation records, employment eligibility verification (I-9) forms, and social security numbers. The provider shall redact any confidential information contained in a record before copies are provided to the county board or the department. A provider shall make all other records available upon request by a county board or the department. 19
    20. 20. Oversight Rule Reference: Page 22 F (N) (1) The county board shall review, on at least a quarterly basis (not monthly), a representative sample of provider logs, including logs where the county board is a provider, to ensure that major unusual incidents have been reported, preventive measures have been developed, and that trends and patterns have been identified and addressed in accordance with this rule. The sample shall be made available to the department for review upon request. 20
    21. 21. Rule Reference: Page 22- (N)(2) When the county board is a provider of services, the department shall review, on a monthly basis, a representative sample of county board logs to ensure that major unusual incidents have been reported and that trends and patterns have been identified and addressed in accordance with this rule. The county board shall submit the specified logs to the department upon request. 21
    22. 22. Unusual Incidents Rule Reference: Pages 21 (M)(d) Requires the provider to investigate unusual incidents, identify the cause and contributing factors when applicable, and develop preventive measures to protect the health and welfare of any at-risk individuals. 22
    23. 23. Unusual Incidents Cont. Rule Reference: Page 21(M)(5) Independent providers shall complete an incident report, notify the individual's guardian or other person whom the individual has identified, as applicable on the day an unusual incident is discovered. Independent Providers will also maintain a log of unusual incidents. Rule Reference: Page 21 (M) (8) 23
    24. 24. Rule Reference-Page18(L)(2)(a-j) Specific individuals involved in established trends and patterns (i.e., five major unusual incidents of any kind within six months, ten major unusual incidents of any kind within a year, or other pattern identified by the individual's team); Specific trends by residence, region, or program; Previously identified trends and patterns; and Action plans and preventive measures to address noted trends and patterns. 24
    25. 25. Analysis Rule Reference-Page18(L)(2)(a-j) All reviews and analyses shall be completed within thirty calendar days following the end of the six-month period. The semi-annual and annual analyses shall contain the following elements: Date of review; Name of person completing review; Time period of review; Comparison of data for previous three years; Explanation of data; Data for review by major unusual incident category type; 25
    26. 26. Analysis Rule Reference: Page 18 (L)(1) All agency providers shall produce a semi-annual (not quarterly) and annual report regarding MUI trends and patterns which shall be sent to the county board. The county board shall semi-annually review all individual providers for MUI trends and patterns. The semi-annual review shall be cumulative for the first two quarters and include an in-depth analysis. The annual review shall be cumulative for all four quarters and include an in-depth analysis. Each review period shall include the preventive measures taken to address the trends and patterns. 26
    27. 27. PROVIDER NOTIFICATION OF DODD CASE CLOSURES  There is no longer a requirement that the County Board provide notification to the provider within 5 days of case being closed. 27
    28. 28. Written Summaries Rule Reference: Page15 (J)(1) No later than five working days following the county board's, developmental center's, or department's recommendation via the ITS incident tracking system that the report be closed, the county board, or developmental center, or department shall provide a written summary of the administrative investigation of each category A or category B major unusual incident… 28
    29. 29. Written Summaries Rule Reference: Page 16 (J)(5) An individual, individual's guardian, other person whom the individual has identified, or provider may dispute the findings by submitting a letter of dispute and supporting documentation to the county board superintendent, or to the director of the department if the department conducted the administrative investigation, within fifteen calendar days following receipt of the finding. An individual may receive assistance from any person selected by the individual to prepare a letter and provide supporting documentation. 29
    30. 30. Written Summaries Rule Reference: Page15-Section15(J)(1) continued including the allegations, the facts and findings, including as applicable, whether the case was substantiated or unsubstantiated, and preventive measures implemented in response to the incident to the following unless the information in the written summary has already been communicated. 30
    31. 31. Investigations Rule Reference: Page 12 (H)(b)-(c) Based on the facts discovered during administrative investigation of the major unusual incident, the category may change. If a major unusual incident changes category, the reason for the change shall be documented and the new applicable category administrative investigation procedure shall be used to investigate the major unusual incident. Major unusual incidents that involve an active criminal investigation may be closed as soon as the county board ensures that the major unusual incident is properly coded, the history of the primary person involved has been reviewed, cause and contributing factors are determined, a finding is made, and prevention measures implemented. Information needed for closure of the major unusual incident may be obtained from the criminal investigation. 31
    32. 32. Investigations Rule Reference: Pages 12(H)(2)(a) All major unusual incidents require an administrative investigation meeting the applicable investigation procedure requirements established in appendix A, appendix B, or appendix C to this rule unless it is not possible or relevant to the administrative investigation to meet a requirement under this rule, in which case the reason shall be documented. Administrative Investigations shall be conducted and reviewed by investigative agents. The department or county board may elect to follow the investigation procedure for category A major unusual incidents for any major unusual incident. 32
    33. 33. Peer to Peer Notifications Rule Reference: Page 11(G)(4) Notification shall be made to the individuals, individuals' guardians, and other persons whom the individuals have identified in a peer-to-peer act unless such notification could jeopardize the health and welfare of an individual involved. 33
    34. 34. (E) Alleged Criminal Acts  Immediate reporting to law enforcement  Allegations of Abuse including Misappropriation and Neglect which may constitute a criminal act  The county board ensures notification has been made 34
    35. 35. (F) Abused or Neglected Children  Allegations of Abuse or Neglect per Ohio Revised Code 2151.03 and 2151.031  Under the age of 21  Report to local public children’s agency  The county board shall ensure reports have been made 35
    36. 36. Reporting Alleged criminal acts cont… Rule Reference: Page 10(E)(3) The department shall immediately report to the Ohio state highway patrol, any allegation of physical abuse, sexual abuse, verbal abuse, misappropriation, exploitation, neglect, failure to report, or peer-to-peer act occurring at a developmental center which may constitute a criminal act. The department shall document the time, date, and name of person notified of the alleged criminal act.  36
    37. 37. Reporting alleged Criminal acts Rule Reference: Page 10 (E)(2) The provider shall immediately report to the law enforcement entity having jurisdiction of the location where the incident occurred, any allegation of physical abuse, sexual abuse, verbal abuse, misappropriation, exploitation, neglect, failure to report, or peer-to-peer act which may constitute a criminal act. The provider shall document the time, date, and name of person notified of the alleged criminal act. The county board shall ensure that the notification has been made. 37
    38. 38. Reporting alleged Criminal acts Rule Reference: Page 10(E)(1) Reporting of alleged criminal acts Nothing in this rule relieves mandatory reporters of the responsibility to immediately report to the intermediate care facility administrator or administrator designee, allegations of mistreatment, neglect or abuse, and injuries of unknown source when the source of the injury was not witnessed by any person and the source of the injury could not be explained by the individuals and the injury raises suspicions of possible abuse or neglect because of the extent of the injury or the location of the injury or the number of injuries observed at one particular point in time or the incidences of injuries over time pursuant to 42 C.F.R. 483.420(d)(2). 38
    39. 39. Reporting MUI’s on Person served     Abuse, Neglect, Exploitation, Misappropriation, Death, Prohibited Sexual Relations, Law Enforcement, Attempted Suicide, Peer to Peer and Failure to Report Regardless of where the incident occurred Follow all rule requirements Remaining categories (All other MUI’s) when:  Incident occurs in program operated by the county board  OR  When the individual is being served by a licensed or certified provider  Follow all requirements 39
    40. 40. (D)(5) Immediate to 4 Hour Reporting    Provider or county board as a provider Using county board identified system for MUIs Report incidents or allegations of: ○ Abuse ○ Neglect ○ Exploitation ○ Misappropriation ○ Suspicious or accidental death ○ Media inquiries 40
    41. 41. (D)(3) Upon Identification or Notification of MUI, Provider or County Board Shall:  Take immediate actions to protect all at risk individuals which shall include: ○ Immediate or ongoing medical attention as appropriate ○ Remove employee from direct contact until determined unnecessary ○ Other measures as necessary  The Department shall resolve any disagreements 41
    42. 42. (D)(10)  County board shall have a system available 24-7 to receive and respond to reports.  MUI notification numbers: During business hours (8am–4:30pm M-F) 740-201-3608 and 740-201-5812 After hours (4:30pm-8am), weekends, and holidays: Helpline 211 or1-800-684-2324. Ask to speak with DCBDD On Call. 42
    43. 43. (G)(1) Notifications Upon Awareness of an Incident To be made by provider or county board as a provider  Made the same day  Include immediate actions taken  DODD wants to see time of notification on the IRF. (Recommend you add a time slot)   Guardian, advocate, or person identified  SSA for individual  Licensed or certified residential provider  Staff or family in the home 43
    44. 44. (G)(2)-(4)     Notifications or effort to notify shall be documented The county board ensure notifications have been made Do not notify the PPI, PPI’s spouse, or significant other Not needed if the report came from person to be notified or in the case of death where the family is already aware 44
    45. 45. (D)(4) County Board Upon Notification Shall:  Ensure reasonable measures are appropriate  Determine if additional measures are needed 45
    46. 46. (G)(5) Notification to Providers When PPI Works for Multiple Providers      The Department makes these Alleged crimes The other provider determines if steps are needed to ensure health and safety Notification of case disposition Providers, county boards, developmental centers to notify the Department if the PPI works elsewhere in the system 46
    47. 47. (D)(6) Submit Written Incident Report by 3:00 p.m. the Next Working Day     Agency providers, individual providers, and county boards as providers Department prescribed format: DCBDD IRF is included in training packet Fax #: (740) 201-3608 or (740) 201-5812 Attn: MUI Investigative Agents DCBDD IA and SA must have report by 3pm the next working day – do not use postal service or inter-office mail; if fax is not available, hand delivery is suggested 47
    48. 48. (K)(1) Written Procedure Implemented for Internal MUI Review  County boards and agency providers  Include responsibility for reasonable steps to prevent 48
    49. 49. (K)(2) Development of Preventive Measures      Team including county board and provider Address causes and contributing factors Determine reasonable steps Plans of Prevention/Correction are due in their entirety, 21 days from the date the IDF was mailed In circumstances of few supports – implement what is reasonably possible. 49
    50. 50. (D)(1) Any Person with DD Not Served     Report possible Abuse including Misappropriation or Neglect To local law enforcement and the county board OR Public Children’s Service Agency and county board Entry page on ITS 50
    51. 51.  (H) General Investigation Requirements 51
    52. 52. (H)(1)  All MUIs require an investigation meeting the requirements in Appendix A or B  Certified investigative agents shall conduct the investigations 52
    53. 53. (H)(2)       The county board shall have at least one investigative agent. The county board may contract with a person or a government entity. Must be certified Must receive annual Department-approved training 53
    54. 54. (H)(5)    Agency Provider may conduct HR investigations from which information except for interviews may be used The investigative agent shall conduct all interviews for MUIs unless Law enforcement or Children’s services is investigating May obtain assistance with interviewing an individual 54
    55. 55. (H)(6)  Commence an investigation immediately but no later than 24 hours for: ○ Abuse, Neglect, Exploitation, or Misappropriation ○ Rights Code ○ Suspicious or Accidental Death ○ Prohibited Sexual Relations ○ One determined by the county board 55
    56. 56. (H)(7)  For other MUIs – Commence no later than 3 working days after identification or notification.  Decision based upon: Initial information received Consistent with health and safety of at risk persons 56
    57. 57. (H)(10)  When an agency provider conducts an internal review of an incident, (HR investigation) and an MUI has been filed  The results of the review including statements and documents go to the county board within 14 calendar days of awareness of the incident 57
    58. 58. (H)(11)  All DD and DODD Provider employees shall cooperate with any administrative investigation  Providers and the county board shall respond to information within timeframes requested 58
    59. 59. (H)(12)  The investigative agent submits the report of investigation for closure in ITS within 30 working days.  Extensions may be granted by DODD based on established criteria. 59
    60. 60. (I)(1) Dept directed investigations  The Department shall conduct the MUI investigation when the allegation is against: Superintendent of a county board or developmental center Executive Director or equivalent of a Counsel of Government Management employee who reports to the Superintendent or Executive Director An investigative agent An SSA An MUI contact for a county board A current member of a county board 60
    61. 61. (I)(1) Continued   Known relationship with A-G when it may present a conflict of interest or the appearance of a conflict of interest County board employee who is alleged to be responsible for individual’s death, has committed sexual abuse, engaged in prohibited sexual activity, or committed physical abuse or neglect resulting in emergency room treatment or hospitalization. 61
    62. 62. (J)(1)(2)  Those receiving written notice: Individual or individual’s guardian or advocate Licensed or certified provider and provider at the time of the incident SSA or person selected to coordinate services Not to family in case of death unless requested 62
    63. 63. (J)(3)  Written summary not provided to PPI, PPI’s spouse, or significant other  A reasonable attempt to notify the PPI of disposition shall be made no later than 5 working days following case closure 63
    64. 64. UI Definition Rule Reference: Page 7(c)(20) "Unusual incident" means an event or occurrence involving an individual that is not consistent with routine operations, policies and procedures, or the individual's care or service plan, but is not a major unusual incident. Unusual incident includes, but is not limited to: dental injuries; falls; an injury that is not a significant injury; medication errors without a likely risk to health and welfare; overnight relocation of an individual due to a fire, natural disaster, or mechanical failure; an incident involving two individuals served that is not a peer-topeer act major unusual incident; and rights code violations or unapproved behavior supports without a likely risk to health and welfare. 64
    65. 65. UI Definition Rule Reference: Page 7(c)(20) Unusual incident includes, but is not limited to: dental injuries; falls; an injury that is not a significant injury; medication errors without a likely risk to health and welfare; overnight relocation of an individual due to a fire, natural disaster, or mechanical failure; an incident involving two individuals served that is not a peer-topeer act major unusual incident; and rights code violations or unapproved behavior supports without a likely risk to health and welfare. 65
    66. 66. Minor Injuries     lacerations, scrapes, contusions or discolorations of known origin, minor burns, rash, minor, dental injuries recreational/work related injuries, falls; peer-to-peer incidents that are not MUIs; overnight relocation of an individual due to fire, natural disaster, or mechanical failure; 66
    67. 67. Behavioral episode  a physical or verbal outburst of an eligible individual that does not require physical intervention.  Concerning Peer to Peer interaction that is not an MUI  Unapproved Behavior Supports without a risk to health or welfare. Ex. Taking radio away. 67
    68. 68. Self-medication errors  an individual who administers their own medication (as outlined in their ISP) fails to administer the medication as prescribed (with no adverse effects). 68
    69. 69. Atypical behavior  an occurrence where an eligible individual displays behavior that is unusual or displays a typical behavior increasingly which causes concern for health and safety. 69
    70. 70. A Major Unusual Incident (MUI) is:     The alleged, suspected or actual occurrence of an incident when there is reason to believe the health or welfare of an individual may be adversely affected. Or when an individual may be placed at a reasonable risk of harm. If such individual is receiving services through the DCBDD service system or will be receiving such services as a result of the incident. Major Unusual incidents directly relate to and are written about the individual receiving services that the incident happens to. Reports are about the victim, not the perpetrator 70
    71. 71. MUI’s include:          Abuse Attempted suicide Death Exploitation Failure to report Significant injury Law enforcement Medical emergency Misappropriation 71
    72. 72. MUI’s include:        Missing individual Neglect Peer-to-Peer acts Prohibited sexual relations Rights code violation Unapproved behavior support Unscheduled hospitalization 72
    73. 73. Category Summaries  All MUI’s require an investigation meeting category A , B or C applicable requirements of this rule.  Category A Alleged Crimes (Police , CSB and IA involvement)  Category B Investigative Agent  Category C (Format Requirements)  Investigation categories may change based on the information obtained A, B and C. 73
    74. 74. Category A Incidents    Require 4 hour notification to DCBDD Require immediate Notification to Law Enforcement or Children Services in cases of suspected child abuse (up to age 21 for DCBDD Eligible individuals). Require immediate notification to Law Enforcement for criminal cases. 74
    75. 75. Category A Incidents         Cases in which Police, CSP, or IA may be involved in the investigation Accidental or Suspicious Death Exploitation Failure to report Misappropriation Neglect PTP act Physical Abuse 75
    76. 76. Category A Incidents     Prohibited Sexual Activity Rights Code Sexual Abuse Verbal Abuse 76
    77. 77. Failure to report:  When a person has reason to believe that an individual has suffered or faces substantial risk of suffering from any wound, injury, disability, or condition of such a nature as to indicate abuse or neglect. Including misappropriation. 77
    78. 78. Failure to report:  And that person does not immediately report the incident to:  Law enforcement  Children Services  The DCBDD  The Omission of the reporting is itself the MUI and must be reported immediately. 78
    79. 79. Abuse:  Physical: use of physical force That can be expected to or does result in physical or serious physical harm. Including but not limited to: ○ Hitting ○ Slapping ○ Pushing ○ Throwing objects at an individual ○ Prone Restraints 79
    80. 80. Abuse:  Sexual Abuse: Unlawful sexual conduct or sexual contact  Verbal Abuse: Purposefully using words, gestures or other communicative means to threaten, coerce, intimidate, harass, or humiliate an individual 80
    81. 81. Misappropriation:  Depriving, defrauding, or otherwise obtaining the real or personal property of an individual by any means prohibited by the Ohio Revised Code.  It is a felony to steal even one penny! 81
    82. 82. Exploitation:  The unlawful or improper act of using an individual’s resources for monetary or personal benefit, profit, or gain. 82
    83. 83. Neglect:  When there is a duty to do so, failing to provide an individual with: Treatment Care Goods Supervision Services necessary to maintain the health or safety of the individual. 83
    84. 84. Neglect:   Consideration must be given to whether there is reasonable risk to health and safety. Neglect includes patient endangerment which means an DD caretaker has created a substantial risk to the health or safety of an individual. 84
    85. 85. Peer To Peer Rule Reference: Page 4(a)(vi) (vi) Peer-to-peer act. "Peer-to-peer act" means one of the following: (a) Exploitation (b) Theft…The $ limit for an MUI investigation regarding peer to peer was raised from $10 to $20. 85
    86. 86. Peer To Peer Rule Reference: Page 4(a)(vi)(c) Physical act that occurs when an individual is targeting, or firmly fixed on another individual such that the act is not accidental or random. The incident results in an injury that is treated by a physician, physician assistant, or nurse practitioner. Allegations of one individual choking another or any head or neck injuries such as bloody nose, a bloody lip, a black eye or other injury to the eye, shall be considered major unusual incidents. 86
    87. 87. Peer To Peer Rule Reference: Page 4 (a)(vi)(c) Minor injuries such as scratches or reddened areas not involving the head or neck shall be considered unusual incidents and shall require immediate action, a review to uncover possible cause/contributing factors, and prevention measures. 87
    88. 88. Peer to peer Rule Reference: Page 4 (a)(vi)(e) Verbal act which means the use of words, gestures, or other communicative means to purposefully threaten, coerce, or intimidate the other individual when there is the opportunity and ability to carryout the threat. 88
    89. 89. Peer to Peer & Law enforcement Notifications -discussion  Notifications shall be made to law enforcement or CSB as appropriate when an alleged crime has been committed. (The change in peer to peer physical act definition will help assure that appropriate notification to LE and CSB occurs regarding peer to peer MUI’s.) 89
    90. 90. Prohibited Sexual Relations:  An DD employee engaging in consensual sexual conduct or having consensual sexual contact with an individual who is not the employee’s spouse, and for whom the DD employee was employed or under contract to provide care at the time of the incident and includes persons in the employee’s supervisory chain of command. 90
    91. 91. Rights Code Violation:  Any violation of the rights enumerated in section 5123.62 of the Revised Code that creates a reasonable risk of harm to the health or safety of an individual. 91
    92. 92. Category B Incidents  Required to report the same day  Required to implement immediate plan of correction to ensure health and welfare. Attempted Suicide Medical Emergency Missing Individual Death from natural causes or disease      Significant Injury (Combined known/unknown injury 92
    93. 93. Attempted Suicide  Attempted Suicide:  A physical attempt by an individual that results in emergency room treatment, in-patient observation, or hospital admission. 93
    94. 94. Death MUI’s   Natural Causes, medical condition or disease. IA follows Coroner lead. 94
    95. 95. MISSING INDIVIDUAL Rule Reference: Page 5 (b)(iv) An incident that is not considered neglect and an individuals whereabouts after immediate measures taken are unknown and the individual is believed to be at or pose an imminent risk of harm to self or others. An incident when an individual’s are unknown for longer than the period of time specified in the individuals service plan that does not result in imminent risk of harm to self or others shall be investigated as an unusual incident. 95
    96. 96. Medical Emergency:  An incident where emergency medical intervention is required to save an individual’s life: Heimlich maneuver CPR IV fluid for dehydration Epi-Pen 96
    97. 97. Known / Unknown Injury (Significant Injury) Rule Reference: Page 6 (b)(v) Significant injury. "Significant injury" means an injury of known or unknown cause that is not considered abuse or neglect and that results in concussion, broken bone, dislocation, second or third degree burns or an injury that requires immobilization, casting, or five or more sutures. Significant injuries shall be designated in the incident tracking system as either known or unknown cause. 97
    98. 98. Category C Incidents  Law Enforcement  Unapproved Behavior Supports  Unscheduled Hospitalizations 98
    99. 99. Law Enforcement:   Any incident that results in the individual being charged, incarcerated, or arrested. New: Required even if client is not receiving services. 99
    100. 100. Unapproved Behavior Support Rule Reference: Page 6 (c)(ii) “Unapproved behavior support” is an intervention that is prohibited by paragraph (J) of rule 5123:2-1-02 of the Administrative Code or an aversive strategy implemented without the approval by HRC or BSC or without informed consent, that results in a likely risk to health and welfare. An intervention that is prohibited by paragraph (J)of rule 5123:2-02 of the O.A.C. and does not likely pose a likely risk to health and welfare shall be investigated as an unusual incident. 100
    101. 101. Unscheduled Hospitalization:  Any hospital admission that is not that is not scheduled unless the hospital admission is due to a condition that is specified in the ISP or nursing care plan indicating the specific symptoms and criteria that require hospitalization. 101
    102. 102. Appendix C and the SSA     Appendix C cases are Law Enforcement, Unscheduled Hospitalizations and Unapproved Behavior Supports. These are the only 3 categories where the Appendix C Protocol and form can be used. Appendix C forms can be completed by the SSA and the Provider who was providing services to the individual when the incident occurred. The IA or MUI Contact will enter the information from Appendix C form into ITS. The IA will be responsible for reviewing it and ensuring information is complete, incident is properly coded and meets the requirements of rule. 102