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Critical Incident Reporting

The reporting of critical incidents by providers is an important ongoing monitoring tool to assess network and case-specific Member safety issues. For Calendar Year 2007, the categories of reportable Critical Incidents include:

  • Death of a member.
  • Suicide attempt.
  • Medication error.
  • Any event requiring the services of the fire department, or law enforcement agency.
  • Abuse or alleged abuse involving a Member.
  • Any injury or illness (non-psychiatric) of a Member requiring medical treatment more intensive than first aid.
  • A Member who is out of contact with staff for more than 24 hours without prior arrangement, or a Member who is in immediate jeopardy because he/she is missing for any period of time.
  • Any fire, disaster, flood, earthquake, tornado, explosion, or unusual occurrence that necessitates the temporary shelter in place or relocation of residents.
  • Seclusion.
  • Restraint.
  • Other incident identified by providers as critical, adverse or unusual.

2883 total critical incident reports were submitted by providers in 2007. The submissions increased from the 1917 total critical incidents reported in 2007. This increase was anticipated as a result of the continued focus on reporting of all incidents by all of the network providers.

Report forms

Critical incident reports and categories 2007

Critical Incident Category Count
Death of a member 21
Suicide attempt 24
Medication error 39
Any event requiring the services of the fire department, or law enforcement agency 358
Abuse or alleged abuse involving a member 142
Any injury or illness (non-psychiatric) of a Member requiring medical treatment more intensive than first aid 222
A member who is out of contact with staff for more than 24 hours without prior arrangement, or a member who is in immediate jeopardy because he/she is missing for any period of time 88
Any fire, disaster, flood, earthquake, tornado, explosion, or unusual occurrence that necessitates the temporary shelter in place or relocation of residents 0
Restraint episodes 1,262
Seclusion episodes 167
Other incident identified by providers as critical, adverse or unusual 560

 

During 2007, specific attention was paid to restraints in RTF in an effort to promote member safety at the highest level, as well as to encourage restraint reduction. The individual records of members restrained are reviewed for providers identified with high restraint ratio to members and provider follow up occurs as needed

Restraint measures for individual providers as well as network averages were obtained for the following:

  • % of members restrained – This was a simple percentage of unique members in RTF's who experienced at least one restraint episode.
  • Restraints per 1000 member days – This calculation was chosen as it offers some comparative value. The network average of 14.97 for example, means that almost 15 restraints occur in 1000 days of RTF stays.
  • Restraint ratio to unique members – This calculation was chosen as a measure to determine to what degree a small amount of members may have been generating repeated restraint episodes. The network average of 6.20 means that each member who was restrained, had on average 6 restraint episodes in the year.

RTF restraint analysis

# Restraint Episodes (unduplicated by date) Count of Unique Members Restrained Count of Unique Members Served in RTF % of Members in RTF Restrained Restraint per 1000 Member Days Restraint Ratio to Unique Members
1109 179 475 37.68 % 14.97 6.20

 

This information was also calculated for each individual RTF provider and was included in the updated provider profiling. It is through the treatment record review and provider profiling processes that PerformCare hopes to impact and improve child/adolescent member safety in this important area.