EWCDHH Policy
Reporting of Critical Incidents Policy
Purpose: To insure the timely notification of critical incidents to EWCDHH and all appropriate authority.
Effective Date: Upon signature
Attachments: A. Reporting Critical Incidents Form Revision Date(s):
POLICY
The purpose of this policy is to define and explain the circumstances under which EWCDHH staff, board, volunteers and contractors are to report critical incidents to EWCDHH.
EWCDHH requires that all parties named above promptly and accurately report critical incidents pursuant to this policy. EWCDHH's objective is to insure that critical incidents are documented, in order for EWCDHH to direct further activity regarding the matter.
This policy shall be seen as consistent with any state statutes governing activities of sign
language interpreters. To the extent that this policy is inconsistent with sign language interpreter statutes, the statutes shall control interpreter activity regarding the reporting of critical incidents.
DEFINITIONS
1) Definition of Critical Incident: Occurrences considered to be critical incidents are those situations that might present a risk of significant bodily harm, property damage, legal involvement, media activity, or other unusual activity that falls outside the scope of activity undertaken by EWCDHH. EWCDHH includes within the scope of critical incidents activities such as, by way of example, the following:
(a) Any definition of critical incidents contained in a EWCDHH contract for services with federal, state or local public authorities.
(b) Death: Death of a client who is actively receiving services from EWCDHH.
(c) Injury: The infliction of bodily harm (including drug overdoses, alcohol related toxicity, and attempted suicide), which causes a client to seek voluntary or involuntary hospitalization. Communicable diseases as defined in WAC 246-101-010 which occur at EWCDHH or otherwise severely impact EWCDHH operational activity.
(d) Damaged Property: The intentional or willful damage to property or EWCDHH that would severely impact operational activities by a client, the extent to which requires voluntary or involuntary hospitalization.
(e) Significant Occurrences: Whether by a client, volunteer or staff person on duty or other person: any threats or physical assaults, or behavior so bizarre or disruptive that it places others in a reasonable risk of harm, or in fact causes harm. This would include behavior that leads to a report being issued to any public authority, including but not limited to, adult or child protective services. In certain circumstances where EWCDHH would be impacted, this would also include alleged criminal activity by clients, staff, volunteers or board members.
(t) Sexual contact or attempted contact by a staff person on or off duty, volunteer or board member, directed at a client (unless consensual relationship existed prior to individual becoming a client) receiving services funded by a federal, state or local public authority under contract with EWCDHH.
(g) Situations potentially generating publicity in the media.
(h.) Situations requiring reporting under state or federal statute including, but not be limited
to, RCW 26.44 (children) and RCW 74.34 (vulnerable adults to include seniors and the developmentally disabled).
(i.) All staff (or volunteer, contractor or board member) car accidents occurring while in the scope of activity related to EWCDHH or during staff working hours.
2) Critical Incident Process. The process for reporting critical incidents is as follows:
(a) The reporter will telephone the EWCDHH Quality Assurance staff person to report directly, or to voicemail, deaths or situations potentially generating media publicity. All critical incidents shall then be reported by hand delivered, mailed, faxed or e-mailed to the EWCDHH quality assurance staff person, within one (1) business day of knowledge of a critical incident, on the form noted as Attachment A. Required reporting prescribed by the state or federal reporting agency shall also be completed at the same time.
(b) EWCDHH shall adequately document the nature and circumstances related to the critical incident in its report, and include at least the following:
i) The circumstances of the incident and any support services or other treatment provided. ii) Recommendations for any quality improvement activities that EWCDHH should
consider as a result of the critical incident.
iii) Determination of follow-up activity to be undertaken.
3) EWCDHH Oversight. The EWCDHH Quality Assurance staff person will review the documentation prepared and/or submitted to recommend what activity will be undertaken regarding the incident. This review shall include a determination as to whether services provided were consistent in type, frequency and duration with EWCDHH's best practices.
a) EWCDHH Executive Director shall be forwarded all critical incident reports for his/her review and action.
4) Confidentiality. Reporting of critical incidents shall be in conformance with all state and federal privacy laws and regulations.
5) Quality Management. EWCDHH shall track and analyze critical incidents on an ongoing basis to identify trends or recurrence potential.
6) Provider Training. EWCDHH shall ensure that all clients, members, staff, volunteers, board members and contractors are aware of their obligations related to this critical incident reporting policy.
THIS POLICY SHALL BECOME EFFECTIVE UPON SIGNATURE:
By: Date:
Char Parsley, EWCDHH Executive Director
12/02 Z:\Policies\Critical Incidents.doc
Attachment A
EWCDHH
Critical Incident Form
Reporter Name: Date of Incident:
Phone: Fax:
E-Mail:
Date Report Submitted: Reported Within 24 Hours? _Yes - No
If not within 24 hours, why?
Client/Member participating or involved:
Critical Incident Type:
Natural Death Suicide Threat
Homicide Attempted Suicide Assault
Attempted Homicide Injury Damage to property
Vehicle Accident Other
1. Description of the Critical Incident (Use Additional Sheets as Necessary):
2. Individuals Involved (include full name and address, phone, e-mail inf01mation):
By signature below, I hereby certify that this information is true and correct. I acknowledge that
any falsification of information may result in civil or criminal penalties being assessed against
me. I am assuring that this information is being sent by me pursuant to all State and Federal confidentiality statutes and regulations.
Signature: Date:
Title:
EWCDHH Policy
Reporting of Critical Incidents
Policy ___________
Purpose: To insure the timely notification of critical incidents to EWCDHH
and all appropriate authority.
Effective Date: Upon signature
Attachments: A. Reporting Critical Incidents Form Revision Date(s):
POLICY
The purpose of this policy is to define and explain the circumstances under
which EWCDHH staff, board, volunteers and contractors are to report critical
incidents to EWCDHH.
EWCDHH requires that all parties named above promptly and accurately report
critical incidents pursuant to this policy. EWCDHH's objective is to
insure that critical incidents are documented, in order for EWCDHH to direct
further activity regarding the matter.
This policy shall be seen as consistent with any state statutes governing
activities of sign language interpreters. To the extent that this policy is
inconsistent with sign language interpreter statutes, the statutes shall control
interpreter activity regarding the reporting of critical incidents.
DEFINITIONS
1) Definition of Critical Incident: Occurrences considered to be
critical incidents are those situations that might present a risk of significant
bodily harm, property damage, legal involvement, media activity, or other
unusual activity that falls outside the scope of activity undertaken by
EWCDHH. EWCDHH includes within the scope of critical incidents activities such
as, by way of example, the following:
(a) Any definition of critical incidents contained in a EWCDHH contract for
services with
federal, state or local public authorities.
(b) Death: Death of a client who is actively receiving services from EWCDHH.
(c) Injury: The infliction of bodily harm (including drug overdoses, alcohol related toxicity, and attempted suicide), which causes a client to seek voluntary or involuntary hospitalization. Communicable diseases as defined in WAC 246-101-010 which occur at EWCDHH or otherwise severely impact EWCDHH operational activity.
(d) Damaged Property: The intentional or willful damage to property or EWCDHH that would severely impact operational activities by a client, the extent to which requires voluntary or involuntary hospitalization.
(e) Significant Occurrences: Whether by a client, volunteer or staff person on duty or other person: any threats or physical assaults, or behavior so bizarre or disruptive that it places others in a reasonable risk of harm, or in fact causes harm. This would include behavior that leads to a report being issued to any public authority, including but not limited to, adult or child protective services. In certain circumstances where EWCDHH would be impacted, this would also include alleged criminal activity by clients, staff, volunteers or board members.
12/02 Z:\Policies\Critical Incidents.doc
(f) Sexual contact or attempted contact by a staff person on or off duty, volunteer or board member, directed at a client (unless consensual relationship existed prior to individual becoming a client) receiving services funded by a federal, state or local public authority under contract with EWCDHH.
(g) Situations potentially generating publicity in the media.
(h.) Situations requiring reporting under state or federal statute including, but not be limited to, RCW 26.44 (children) and RCW 74.34 (vulnerable adults to include seniors and the developmentally disabled).
(i.) All staff (or volunteer, contractor or board member) car accidents occurring while in the scope of activity related to EWCDHH or during staff working hours.
2) Critical Incident Process. The process for reporting critical
incidents is as follows:
(a) The reporter will telephone the EWCDHH Quality Assurance staff person to
report
directly, or to voicemail, deaths or situations potentially generating media
publicity. All critical incidents shall then be reported by hand delivered,
mailed, faxed or e-mailed to the EWCDHH quality assurance staff person, within
one (1) business day of knowledge of a critical incident, on the form noted as
Attachment A. Required reporting prescribed by the state or federal reporting
agency shall also be completed at the same time.
(b) EWCDHH shall adequately document the nature and circumstances related to
the critical incident in its report, and include at least the following:
i) The circumstances of the incident and any support services or other
treatment provided.
ii) Recommendations for any quality improvement activities that EWCDHH should
consider as a result of the critical incident.
iii) Determination of follow-up activity to be undertaken.
3) EWCDHH Oversight. The EWCDHH Quality Assurance staff person will review the
documentation prepared and/or submitted to recommend what activity will be
undertaken
regarding the incident. This review shall include a determination as to
whether services provided were consistent in type, frequency and duration with
EWCDHH’s best practices.
a) EWCDHH Executive Director shall be forwarded all critical incident reports
for his/her
review and action.
4) Confidentiality. Reporting of critical incidents shall be in conformance with
all state and federal privacy laws and regulations.
5) Quality Management. EWCDHH shall track and analyze critical incidents on an
ongoing basis to identify trends or recurrence potential.
6) Provider Training. EWCDHH shall ensure that all clients, members, staff,
volunteers, board members and contractors are aware of their obligations related
to this critical incident reporting policy.
THIS POLICY SHALL BECOME EFFECTIVE UPON SIGNATURE:
By: ______________________________________ Date: __________________
Char Parsley, EWCDHH Executive Director
12/02 Z:\Policies\Critical Incidents.doc
Attachment A
EWCDHH
Critical Incident Form
Reporter Name:___________________________ Date of Incident: ____________
Phone: __________________________ Fax
: ______________________
E-Mail: __________________________
Date Report Submitted: ________ Reported Within 24 Hours? ____Yes ____ No
If not within 24 hours, why?
_____________________________________________________
____________________________________________________________________________
Client/Member participating or involved:
__________________________________________
Critical Incident Type:
_____ Natural Death _____ Suicide _____ Threat
_____ Homicide _____ Attempted Suicide _____ Assault
_____ Attempted Homicide _____ Injury _____ Damage to property
_____ Vehicle Accident _____ Other
1. Description of the Critical Incident (Use Additional Sheets as
Necessary):
2. Individuals Involved (include full name and address, phone, e-mail
information):
By signature below, I hereby certify that this information is true and correct.
I acknowledge that any falsification of information may result in civil or
criminal penalties being assessed against me. I am assuring that this
information is being sent by me pursuant to all State and Federal
confidentiality statutes and regulations.
Signature: ____________________________________ Date: _______________
Title: ____________________________________
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