Observing and Reporting Incidents

Accidents inevitably occur--people in all lines of work make mistakes. Errors can be prevented, however, by designing systems that make it difficult for people to make mistakes and easy for people to do the right thing when they do. This proactive stance is supported by the notion that to prevent is cheaper than to cure. Understanding why errors and near misses occur helps home health care workers improve client safety because they learn from previous mistakes. Identifying and correcting errors results in decreased:

• personal and facility risk liability,

• negative publicity, and

• harm to clients and workers

Although it may be human nature to make mistakes, it also is human nature to create solutions and discover alternative methods.

INCIDENT REPORTING

The term incident report is common in the health care environment. Rather than a piece of paper, this is a process in which occurrences that are inconsistent with routine client care are documented.

Incident reports:

• describe occurrences that are unexpected, unusual, or out of the ordinary routine of a home health care worker, whether or not they cause injury;

• provide the basis for a timely investigation of an incident, if necessary;

• provide information with which corrective or remedial action may be planned;

• provide raw data to identify risk trends for recurring issues and patient safety risks and to institute procedural changes or in-service training; and

• provide the information necessary to defend staff members or health care facilities in the case of a lawsuit.

All health care providers need to understand the purpose of generating incident reports and appropriate reporting behaviors. Workers need an accurate understanding of what is a reportable incident.

Incident reports help protect the worker. For example, let’s say you go to your client’s home and find your client has a fresh bruise on her arm. You ask her what happened and she reports that she fell off of the couch earlier in the day. You think nothing of it and continue with your chores. Two days later you hear that your client went to the ER and that her arm has several stress fractures. The client’s family is accusing you of abuse. Had you reported the incident verbally at the time and followed up with a written incident report you could have reduced your vulnerability to this charge. When you called you we may have called the family or directed you to take the client to the doctor. A written report would help indicate that you were aware to the situation and were not attempting to cover anything up.

When and what should you report:

Listed below are reasons that you should contact the office for further instruction. This list is not all inclusive, things may happen that should be reported that are not on this list, Call the office when in doubt. We may be able to make a note in the file and that will suffice. If not, we will instruct you to fill out an incident report.

• A noticeable change in your clients behavior

• Unexplained bruises or marks on your client

• A client lets you know that they fell earlier

• All medical emergencies after the immediate situation has been taken care of

• If you injure yourself on the job

• If you have an accidental exposure to infected material

• If you have an accident when transferring your client that results in a fall. Report this whether you or the client notices any injury.

• Your client accidental takes the wrong medication or too much medication

• Accidents in the home or car while you are on duty.

• Verbal Confrontations with client or client’s family members

• If your client accuses you of something that you have not done. Sometimes this can be an early indicator of dementia

• Sores or open wounds on your senior

• If you notice a change in your client’s medical conditions that would indicate it is getting worse.

Basically, call the office and report any unusual or out of the ordinary occurrences. We can help you out if we are aware of the problem. One thing we can do is call our nurse or MD for further instructions; this is another way to protect you from liability.

What happens after you file the report?

The report goes to the Director of Nursing for review and is reported at the next Quality Improvement (QI) meeting. Only the incident is reviewed at this meeting, the client and worker involved remain anonymous. It is the job of the QI committee to look for trends in risks based upon the incident reports. For example, our “no lift” policy was the result of a trend of incident reports indicating that both clients and workers were being injured when transferring. At that point we felt we needed to initiate the no lift policy to prevent future injuries.

Always remember, you won’t get in trouble for reporting an incident or calling for help. You can only get in trouble when you don’t.