Don’t Overlook the Basics: Incidents & Accidents Can Happen Every Day

by Michelle Saunders, Therap Services

The change in documentation rules and regulations is never ending. As an agency leader, it can sometimes be difficult to stay abreast of all of the new information. Just when you think you have a process updated and implemented, the documentation compliance is altered, and you feel as if you need to start all over again.

These distractions can sometimes take our attention away from basic documentation needs. Incidents and accidents happen nearly every day. When it comes to providing quality services and safety, the reporting and tracking thereof, especially critical incidents, is often considered “mission critical” by the organization. Therefore, incident documentation capture and reporting, even if you believe your agency is performing this task correctly and to the current standards, should be revisited on a regular basis to ensure staff understand your best practices, reporting is completed in a timely fashion, and you are maximizing the power of the data.

Paper-based and many customized reporting systems require direct support professionals (DSPs) to complete a detailed description of an event that may then go through multiple layers of review before reaching the hands of Quality Assurance teams and other administrators. These cumbersome processes affect both timeliness and accuracy of event reporting and require substantial training. Lack of timeliness may keep an agency from making urgent changes that could prevent further incidents.

Custom event reporting systems generally have to be reprogrammed when state or provider requirements change and have many of the same problems as paper systems.

In 2003, the first application that Therap developed for the provider community was an electronic method of incident reporting solution. General Event Report (commonly referred to as the “GER”) could have been called an Incident Report, Unusual Event Report, Unusual Event Report or a variety of other terms and acronyms. Therap settled on creating the unique term, GER, to identify this specific tool.

Development of the application was based on the federal requirement in the 1983 Section 1915(c) of Social Security Act (Home and Community Based Services waiver or HCBS) requiring states to monitor the health and well-being of each individual who receives home- and community-based attendant services and supports, including a process for the mandatory reporting, investigation and resolution of allegations of neglect, abuse or exploitation in connection with the provision of such services and supports.

Therap’s initial product design and development team kept two factors in mind while creating the GER:

1. The need to quickly report on every injury, behavior, unusual event and any other significant event, so that it could be investigated to determine if it rose to the level of neglect, abuse or exploitation.
2. Since most states also have reporting requirements for serious injuries, destruction of property, hospitalization, death and other significant events, there is also a need for a sufficiently detailed reporting structure to capture that information.

Therap’s analysis determined that a checklist type data set that could be completed quickly by DSPs would be the most effective approach. A significant decision was made to develop GERs with consistent data elements. This meant using dropdown list selection, date selection from calendars, time selection from clock picklists, data from the Individual’s Demographic Form (the in system ‘face sheet’) or User (staff) records, radio button picklists and Yes/No buttons.

The strategy was straightforward. It is important to easily report a single event. It is also important to have the capability to quickly identify GER patterns via trend analysis. Another feature of the GER is the capability of linking multiple events for reporting while maintaining the confidentiality of protected health information as required by HIPAA.

Therap‘s design minimizes the decisions DSPs have to make to enter a new GER and the time it takes to track down an administrator by phone or waiting until the end of a shift to complete a detailed report and report to an administrator. Therap designed the GER system so that a DSP can enter a new GER and notify supervisors and/or administrators with that single rapid action. Additionally, once GER data is entered the Submit button is clicked, the GER, a digital signature, that includes a time and date stamp, is applied.

Access and reviewing of submitted GERs is permission and caseload driven as determined by the agency. Staff that serve an Individual can view the submissions to be aware of what has happened during the service day or the last shift. Supervisors, quality assurance staff and reviewers can all be granted job specific permissions to contribute to each GER as required by the organization, for immediate access and action within a single system that can be accessed from any web enabled device with a reliable internet connection. After a submitted GER has been reviewed and acted upon by all personnel and per the agency’s procedures, the report can be “Approved”, denoting the incident has been investigated and is considered ‘closed’.

The basic “GER Search” feature can be used to develop detailed monthly, quarterly, annual or other reports that focus on specific details of GERs or general overviews. Therap’s “Agency Reports” application contains the “Event Summaries” module that allows for more detailed data review based on the Users entered generation criteria. Therap’s “Report Library” offers multiple Excel based GER reports for review and use by the agency.

Therap’s Business Intelligence (BI) GER feature takes GER Reporting to a very sophisticated level. Business Intelligence is used to develop data warehouses that can be data mined with easy-to-use dashboards for very detailed analysis of GERs by administrators. Since Therap’s GER uses consistent descriptors, Therap customers who began in 2003 can perform regression testing from today, back to the day Therap was implemented using GER Search or Business Intelligence.

Therap’s General Event Report module contains many other features…more than I could briefly cover in this month’s edition of Connections. If you’d like to learn more about how Therap can help you improve your incident reporting process, I invite you to reach out to us. Are you a current Therap user and wish to review your GER use and improve your maximization of the data? Get started today.

Michelle Saunders is Associate Director of Business Development at Therap Services. She can be reached at michelle.saunders@therapservices.net.