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Provider Procedures
INCIDENT REPORTING
Update: Incident Response Improvement System (IRIS)
IRIS ia an online application with which providers can submit Incident Reports and oversight agencies can receive and review Incident Reports. As of May 1, 2010, IRIS is live and fully operational. Providers who have already received training in IRIS are asked to begin submitting their Incident Reports through this system. Future trainings will be available for providers who are unfamiliar with the system. Please continue to check the Training Opportunities page of this Web site for IRIS and Incident Reporting training.
Until further notice, all Level II and III Incident Reports submitted through IRIS must also be submitted on a paper form to the LME, with a paper copy of Level III reports also submitted to the Division. Providers must also continue to submit the paper Incident Reports to other parties and entities as needed (such as the DHSR Health Care Personnel Registry and the DHSR Complaint Intake Unit). Providers may print or download the Incident Report from IRIS and submit copies as needed. The State is requesting this as a temporary measure to protect against human and technical errors until we can confirm that the system is working properly.
Beginning July 1, 2010, all providers will be required to use IRIS to submit their Incident Reports.
Link to Incident Response Improvement System (IRIS)
General Guidelines
Who is required to submit Incident Reports?
Providers of publicly funded services in the following categories: 122C Licensed Services (Category A providers), non-licensed periodic or community-based services (Category B providers). Hospitals, facilities licensed under G.S. 131D or 131E, and individuals certified or licensed to provide only outpatient or day services are not required to submit Incident Reports.
In addition to the above, all opioid treatment providers are required to submit Incident Reports, regardless of whether their services are publicly funded or not.
What Incidents do I report?
An incident is any event that is outside the normal or routine treatment for a consumer and is likely to have adverse effects on that consumer. Incidents are separated into three levels by their severity; providers are required to submit formal reports only for Level II and Level III Incidents. Level I incidents should be tracked internally, and the total number of Level I Incidents will be reported to the LME each quarter. The Incident Reporting Form available here and on the DHHS website contains specific guidelines that will help you determine what level and incident type to report.
How do I report an Incident?
If it’s a Level I Incident, report to your supervisor. No immediate report to the LME is necessary (Level I Incidents are counted quarterly by the LME).
If it’s a Level II Incident, alert your supervisor and begin entering the information into IRIS. The person most knowledgeable about the incident completes the Supervisor Section and submits the report to the LME. This report is due within 72 hours of the incident (or when the provider learns of the incident).
If it’s a Level III Incident, alert your supervisor immediately. The provider must contact the LME by phone as soon as they are aware of the incident. The provider will then complete the Incident Report in the same manner as for Level II Incidents. This form is then submitted to the LME and to the state (NC DMH/DD/SAS). For 122C Licensed facilities, the provider is also required to report to DHSR if the incident is a consumer death by suicide, accident, homicide, violence, or occurring within 7 days of restrictive interventions.
Special Notes
The manual provided below is useful but is not fully up-to-date. Since its publication, there have been several changes that greatly affect how we ask you to respond to incidents. Some of these changes, along with other important notes, are included here:
- Consumer deaths by unknown cause are now considered Level III Incidents and must be reported as such, until the cause of death is determined. For these and all other Level III deaths, providers are required to obtain a copy of the medical examiner’s report to verify cause of death, as soon as that report is available.
- The term “under the care of the provider” has been more broadly defined to include any services provided within 90 days prior to the incident. By this standard, Level II and III Incidents must be reported for any consumer who has received services in the prior 90 days, even if not currently active with that provider. The provider is to submit the report as soon as they are aware of the incident.
- Level II cases involving public scrutiny or media attention (of any kind) are elevated to Level III status and must be reported to the LME by phone immediately.
- Allegations of abuse, neglect, or exploitation are always reportable incidents, regardless of whether the allegations are against provider staff or someone in the community. When reporting allegations of abuse, neglect, or exploitation, also report to other agencies as appropriate (such as DSS and/or the Health Care Registry).
Quarterly Reporting Requirements:
Each quarter, providers are required to submit a quarterly report with total number of incidents in the following categories:
- Level I Restrictive Interventions
- Level I Medication Errors
- Level I Search/Seizure
- Level II Incident Reports
- Level III Incident Reports
We will send a reminder asking providers to submit the report. If you do not receive the reminder, the form is available below, and on the DHHS website. Attached to the form are instructions for completing the form – it’s a relatively quick and easy reporting requirement that allows us to track compliance and monitor the health and safety of our consumers.
Quarterly Reports are not yet available through IRIS. Providers are to continue submitting them by fax or e-mail at the end of each quarter.
Resources
To submit a report, or to ask questions about Incident Reporting:
Daniel McManus
Quality Assurance Specialist
Phone: 641-4174
Fax: 641-8026
E-mail: dmcmanus@guilfordcenter.com
IRIS:
https://iris.dhhs.state.nc.us/
IRIS practice site:
http://hrdhhs63.dhhs.state.nc.us:8000/default.aspx
The state DHHS website’s section on Incident and Death Reporting: http://www.dhhs.state.nc.us/mhddsas/statspublications/manualsforms/index.htm#incident
Implementation Update #55 (see pages 6, 9, 10):
http://www.dhhs.state.nc.us/mhddsas/servicedefinitions/servdefupdates/dmadmh4-3-09update55.pdf
Link to Incident Reporting Manual
Link to Blank Incident Report
Link to Provider Quarterly Incidents Report
Link to Incident Reporting Power Point