Library: Policy

317:55-5-3. Critical incident reporting system

Revised 7-1-23

(a) The CE shall ensure that any serious incident that harms or potentially harms the Enrollee’s health, safety, or well-being, including incidents of seclusion and restraint, are immediately identified, reported, reviewed, investigated, and corrected, in compliance with state and federal law.

(b) When the Enrollee is in the care of a behavioral health inpatient, PRTF, or crisis stabilization unit, critical incidents shall include, but are not limited to the following:

(1) Suicide death;

(2) Non-suicide death;

(3) Death-cause unknown;

(4) Homicide;

(5) Homicide attempt with significant medical intervention;

(6) Suicide attempt with significant medical intervention;

(7) Allegation of physical, sexual, or verbal abuse or neglect;

(8) Accidental injury with significant medical intervention;

(9) Use of restraints/seclusion (isolation);

(10) AWOL or absence from a mental health facility without permission; or

(11) Treatment complications (medication errors and adverse medication reaction) requiring significant medical intervention.

(c) The CE shall develop and implement a critical incident reporting and tracking system for behavioral health adverse or critical incidents and shall require participating providers to report adverse or critical incidents to the CE, OHS, and the Enrollee's parent or legal guardian.

(d) Participating providers shall contact the CE by phone no later than 5:00pm Central time on the business day following a serious occurrence and disclose, at a minimum:

(1) The name of the Enrollee involved in the serious incident;

(2) A description of the occurrence; and

(3) The name, street address, and telephone number of the facility.

(e) The participating provider must, within three (3) days of the serious occurrence, submit a written facility critical incident report to the CE.

(1) The facility critical incident report must include specific information regarding the incident including the following:

(A) All information listed in OAC 317:55-5-3 (d)(1) through (3);

(B) Available follow-up information regarding the Enrollee's condition;

(C) Debriefings; and

(D) Any programmatic changes that were implemented.

(2) A copy of this report must be maintained in the Enrollee's record, along with the names of the persons at the CE and OHS to whom the occurrence was reported.

(3) A copy of the report must also be maintained in the incident and accident report logs kept by the facility.

(4) The CE shall review the participating provider's report and follow up with the participating provider as necessary to ensure that an appropriate investigation was conducted, and corrective actions were implemented within applicable timeframes.

(f) The CE shall provide appropriate training and take corrective action as needed to ensure its staff and participating providers, as applicable, comply with all critical incident requirements, in the manner and format outlined in the reporting manual.