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Provider Procedures

Incident Reporting
Incident Reporting is a quality improvement practice used to assure a consistent statewide process for protecting the health and safety of consumers and to provide standardized data from across the state. It is so important that reporting is required in the North Carolina Administrative Code. The State provides the required standardized Incident Reporting Form (224k dot), the chart of Definitions (56k PDF ) that includes criteria for determining the level of response to incidents, and the description of the Incident Reporting Process (52k PDF ).

What is a reportable incident?
Any event that is not consistent with the routine operation of a facility or service or the routine care of a consumer may be considered “an incident.” However, all incidents do not need to be reported.

The State defines three levels of incidents:

  • Level I incidents do NOT need to be reported to the Guilford Center or the State at the time they occur, but should be documented at the provider level. Providers should follow their own policies and procedures and use their own internal forms. A description of the minimum required Level I incidents is included in the chart of Definitions (56k PDF ), which is also listed on pages 5 and 6 of the State Incident Reporting Form (224k dot). Level I incidents should be reported to The Guilford Center quarterly using the Provider Quarterly Incidents Report.
  • Level II incidents are defined by the State chart of Definitions (56k PDF ) and also listed on pages 5 and 6 of the Incident Reporting Form. Level II incidents must be documented using the State Incident Reporting Form (224k dot). These must be reported to The Guilford Center’s Quality Improvement Department within 72 hours after learning of the incident.
  • Level III incidents are defined by the State Chart of Definitions (56k PDF ) and also listed on pages 5 and 6 of the Incident Reporting Form (224k dot). Level III incidents must be documented on the Incident Reporting Form (224k dot) and verbally reported immediately to The Guilford Center. The written report should be sent to The Guilford Center’s Quality Improvement Department and   the State within 72 hours of learning of the incident.

Who is responsible for reporting?

  • Providers of publicly funded Mental Health, Developmental Disabilities and Substance Abuse Services licensed under N.C. General Statutes 122C, except hospitals.
  • Providers of publicly funded non-licensed periodic or community-based mental health, developmental disabilities and substance abuse services.

Failure to report incidents as required by 10A North Carolina Administrative Code
27G .0600 may result in DHHS taking administrative action against the provider’s license or authorization to provide services.

When is an incident reported?

  • Level I Incidents must be reported quarterly to the Guilford Center's Quality Improvement Department.
  • Level II incidents must be submitted to the Guilford Center’s Quality Improvement Department within 72 hours of learning of the incident.
  • Level III incidents must be verbally reported immediately to The Guilford Center’s Quality Improvement Department. A completed form must be submitted to The Guilford Center’s Quality Improvement Department and to the State within 72 hours of learning of the incident

How is an incident reported?
Level I Incidents must be reported on the State Provider Quarterly Incidents Report – Form QM11 (76k PDF) .
Level II and Level III Incidents must be reported on the State Incident Reporting Form (224k dot), following the Incident Reporting Process ( 52k PDF ).
Level II and Level III Restrictive Intervention Incidents must be reported on the State Restrictive Interventions Details Report (155k dot). The form should be completed and submitted with the State’s Incident Reporting Form (224k dot).

Incident Reports may be submitted by mail or fax to The Guilford Center’s Quality Improvement Department:
Andee Gable, Quality Improvement Specialist
Fax: 336.641.8026
The Guilford Center
232 North Edgeworth Street
Greensboro, N.C. 27401

How to get assistance with incident reporting
The Guilford Center provides technical assistance to help providers understand incident reporting requirements. If you have questions, contact:

Andee Gable, Quality Improvement Specialist
Phone: 336.641.4174
Email: lgable@guilfordcenter.com

Incident Reporting trainings are held twice monthly. July to December 2008 Incident Training