Critical Incident Reporting

• Critical Incident Reporting Form - Attachment PR-008
• PR-008 Critical Incident Report

The reporting of critical incidents by providers is an important ongoing monitoring tool to assess network and case-specific Member safety issues. For Contract Year 2005-06, 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 or restraint.

• Other incident identified by providers as Critical, Adverse or Unusual.

Critical Incident Reports and Categories 2005-06

For 2005-06, there was a continued emphasis in obtaining accurate restraint reporting, particularly from RTF providers. The efforts at restraint reduction in RTFs had been targeted by the QI Committee as a Member safety issue, consistent with DPWs statewide initiatives in this area. It was felt that by establishing measurement of restraint use by RTF providers, benchmarks and best practices could be established. CBHNP is participating in quarterly meetings held by DPW to train providers in the use of restraint reduction tools, debriefing techniques, trauma informed care trainings, and workforce development and the use of data to inform practice.

High-volume RTF facilities have been added to annual Treatment Record Reviews in 2005-06, again with an emphasis on reviewing for proper restraint use, training, and medical oversight. 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.

• Restraint Ratio per Member Days – As there is not a generally accepted restraint ratio calculation, the QI Committee used a ratio that represented 1 Restraint Episode per X Member Days. This calculation was chosen as it holds some intuitive value. The network average of 82.83 for example, means than one restraint occurred for about every 83 Member Days. Higher numbers indicate lower restraint use.

• 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 6.65 means that each Member who was restrained, had on average almost 7 restraint episodes in the year. Higher numbers indicate that a small number of Members are likely experiencing multiple restraint episodes.

RTF Restraint Analysis

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 CBHNP hopes to impact and improve child/adolescent Member safety in this important area.