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Guidelines for Reporting to the Department of Health Services

PDF Version of DQA 10-020  (PDF, 50 KB)

Date: August 5, 2010 -- DQA Memo 10-020
To: Adult Family Homes AFH 07
Community Based Residential Facilities CBRF 10
From: Kevin Coughlin, Director
Bureau of Assisted Living
Via:

Otis Woods, Administrator
Division of Quality Assurance

Guidelines for Reporting to the Department of Health Services

PURPOSE

The purpose of the memo is to assist providers in determining what information to submit to the department when the reporting of certain situations is required by administrative rule. Chapter DHS 83 (CBRF administrative rule) and Chapter DHS 88 (AFH administrative rule) include requirements for mandatory reporting of specific incidents. This memo provides guidance to providers about information that should be included when the reports are related to resident falls, elopements, injury, change in condition, or behaviors resulting in police intervention. It is important that providers include sufficient information for department review in conjunction with these reports.

RELEVANT REPORTING REQUIREMENTS

Adult Family Homes:

Section DHS 88.03(5)(e)1. requires a significant change in resident status be reported to the department within 24 hours. This includes, but is not limited to, an accident requiring hospitalization or when a resident is missing from the home.

Community-based Residential Facilities:

Section DHS 83.12(4)(a) requires reporting to the department anytime a resident's whereabouts are unknown.

Section DHS 83.12(4)(b) requires reporting to the department anytime law enforcement personnel are called to the CBRF as a result of an incident that jeopardizes the health, safety, or welfare of residents or employees.

Section DHS 83.12(4)(c) requires reporting of any incident or accident resulting in serious injury requiring hospital admission or emergency room treatment of a resident.

GENERAL REPORTING GUIDELINES

It is important that any reports submitted to the department minimally include the following information:

  1. WHO - names of residents, staff or other individuals involved in the incident.
  2. WHAT - an accurate and thorough description of the incident.
  3. WHERE - the location where the incident occurred.
  4. WHEN - the date and time of the incident.
  5. WHY- a description of factors that contributed to the incident and an explanation of how the incident occurred.
  6. FACILITY RESPONSE - information regarding what the facility did in response to the incident.

REPORTING GUIDELINES FOR RESIDENT FALLS RESULTING IN SERIOUS INJURY, EMERGENCY ROOM TREATMENT OR HOSPITALIZATION

The following information should be included:

  1. What was the resident's ambulation status at the time of the fall?
  2. Had the resident's risk for falls been assessed?
  3. Did the resident have a history of falls?
  4. Were interventions in use to reduce or prevent falls from occurring?
  5. Were there environmental factors that contributed to the fall? (for example, wet floors, rugs, tripping hazards)
  6. What injury did the resident sustain?
  7. How and when was the resident assessed for injury?
  8. What was the facility's response to the fall?
  9. Did the resident receive treatment?
  10. What was the treatment?
  11. When did the resident receive treatment?
  12. What changes has the facility implemented to reduce or prevent further falls?
  • Has the resident been reassessed for fall risk?
  • Have changes been made to the resident's individual service plan?

REPORTING GUIDELINES FOR RESIDENT ELOPEMENT

The following information should be included:

  1. Did the resident have a history of elopement?
  2. Had the resident's risk for elopement been assessed?
  3. What interventions were in place to reduce the risk of elopement?
  4. Does the facility have an alarm system designed to alert staff to a possible elopement?
  5. Did the alarm system sound, and what was the staff response to the alarm?
  6. How did the facility determine the resident was missing?
  7. How long had the resident been missing?
  8. When was the resident found?
  9. Where was the resident found?
  10. Was law enforcement notified that the resident was missing?
  11. Did any injury result?
  12. Did the resident receive treatment for injuries?
  13. What were the weather conditions?

REPORTING GUIDELINES FOR SERIOUS INJURY TO A RESIDENT OR A SIGNIFICANT CHANGE IN A RESIDENT'S STATUS

The following information should be included:

  1. What was the injury or change in condition?
  2. How did the injury or change in condition occur?
  3. Did the resident have a known risk for injury? (for example, history of choking)
  4. What factors contributed to the injury? (for example, medication error, hot water)
  5. Did the facility assess the resident for the injury or change in condition?
  6. What treatments or interventions were provided and when were they provided?
  7. Was the physician notified?
  8. What is the resident's current status?
  9. What changes have the facility implemented in response to the injury or change in condition?
  • Has the resident been reassessed?
  • Have changes been made to the resident's individual service plan?

REPORTING GUIDELINES FOR RESIDENT BEHAVIOR RESULTING IN POLICE INTERVENTION

The following information should be included:

  1. What behavior led to the police involvement?
  2. Did the resident have a history of behaviors?
  3. Were interventions in place to reduce or prevent the behavior?
  4. Has staff been trained in the behavior intervention techniques?
  5. What residents and/or staff were involved?
  6. What factors contributed to the behavior?
  7. What interventions were attempted by facility staff at the time of the behavior?
  8. Did any injuries occur because of the behavior?
  9. At what point was law enforcement notified?
  10. What changes has the facility implemented in response to the behavior?
  • Has the resident been reassessed for additional behavioral interventions?
  • Have changes been made to the resident's individual service plan?

For additional information related to all facility reporting requirements, see memo: http://www.dhs.wisconsin.gov/rl_dsl/Publications/07-018.htm 

If you have questions regarding this memo, contact the assisted living regional director.  http://www.dhs.wisconsin.gov/rl_DSL/Contacts/alsreglmap.htm

 

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Last Updated: September 30, 2011