1 / Policy & Procedure: Abuse and Neglect Prevention

POLICY:Abuse and neglect prevention

PURPOSE:To prevent abuse/neglect and protect residents from harm.

PERSON

RESPONSIBLE:All staff

PROCEDURE:

It is the policy of this facility to prevent abuse and neglect of residents by screening applicants and residents, training staff, responding appropriately and promptly to all incidents of abuse and neglect, and identifying trends and patterns. Facility staff will investigate all incidents, protect residents, report to the proper authorities, respond to findings, formulate conclusions, and implement measures to minimize future similar occurrences.

  1. SCREENING
  2. All applicants for employment and volunteers will complete a Washington State Criminal History Background Check form as part of the application process.
  3. Human Resources will fax the inquiry to the Criminal History Background Unit at DSHS at 360.902.0292.
  4. Upon receipt of the application, the appropriate staff person will verify the license/certification/registration (if appropriate) with the Washington State Department of Health.
  5. If open complaints exist on the applicant’s license, the appropriate staff person will seek further information from the Nursing Commission as to the nature of the complaint.
  6. For nursing homes, the appropriate staff person will fax/forward the NAC information to the OBRA registry.
  7. The appropriate department manager will verify the applicant’s references and document feedback from each contact.
  8. All findings will be routed to the appropriate staff person for placement in the applicant’s file.
  9. Only after completion and clearance from the governing bodies will an applicant be offered employment at the home.
  10. Prior to admission, every attempt will be made to assess potential residents for prior history of aggressive and/or combative behaviors. Should such behaviors exist either currently or previously, management will determine whether or not the home can meet the person’s needs as well as provide protection to other residents.
  11. TRAINING
  12. During initial general orientation to the home, the appropriate staff person will inservice all new employees on:
  13. What constitutes abuse and neglect
  14. How, when, and to whom to report abuse and neglect without the fear of reprisal.
  15. How to deal with aggressive behaviors from a resident.
  16. How to recognize the signs of potential abuse and/or neglect from a staff member towards a resident.
  17. The appropriate staff person will provide further training on the above topics as the need is identified.
  18. The appropriate management staff will inform and provide education to residents and their families upon admission, at resident council meetings, and during care conferences/reassessments.
  19. Appropriate staff will advise residents and families of the resident’s rights, and who to call when they feel that infringement of these rights have occurred. The residents and their families will also be advised regarding the whereabouts of the DSHS reporting hotline number, and contact information for the state Ombudsman.
  20. PREVENTION
  21. The following areas of the home are considered most at risk for resident abuse and/or neglect:
  22. Day rooms
  23. Solariums
  24. Dining rooms
  25. Smoking area
  26. Shower/bathrooms
  27. Resident rooms/apartments
  28. Courtyard
  29. Other areas of the home that are less supervised
  30. Signs to watch for that may lead to potential abuse and/or neglect by staff include:
  31. Burnout
  32. Persistent absenteeism/tardiness
  33. Complaints about trivial issues
  34. Derogatory language
  35. Inappropriate handling of residents
  36. Ignoring residents while providing care
  37. Telling residents to “act appropriately”
  38. Bad mouthing the home, supervisor(s), co-worker(s)
  39. Failure to seek assistance from co-worker or supervisor when providing care to a difficult resident
  40. Residents with known difficult behaviors will be assessed and interventions for safety dealing with residents will be care planned/included in the service agreement.
  41. All incidents will be viewed collectively for potential trends or repeated issues that warrant further investigation and subsequent planning.
  42. All areas of the building are to be supervised by the Department Managers, nursing supervisors, and licensed staff during the shift.
  1. IDENTIFICATION
  2. Events constituting abuse and/or neglect are described as but not limited to the following:
  3. Not providing care
  4. Failure to follow the resident’s individualized care plan
  5. Taking/stealing money or property from the resident or financially exploiting the resident
  6. Rough handling of the resident while providing care
  7. While in the presence of a resident, speaking in a language unknown to the resident
  8. Willfully causing harm to a resident
  9. Preventing the resident from expressing their own free choice
  10. Failure to protect a resident from harm
  11. Examples of actions to a resident that are abusive are defined as but not limited to the following:
  12. Verbal abuse: any use of written, oral, or gestured language that willfully includes a threat
  13. Sexual abuse: inappropriate touching, sexual harassment, coercion, or assault (real or imagined)
  14. Physical abuse: hitting, slapping, poking, prodding, sticking with sharp object, pushing, shoving, pinching, spitting, twisting, squeezing, and kicking. It may also include controlled behavior through means of punishment such as withholding treatment, food, activity, etc.
  15. Mental abuse: Humiliation, harassment, threats of punishment, deprivation, withholding cigarettes, teasing, placing unreasonable restrictions on the resident, withholding communication (mail, telephone calls, etc.), limiting visitation, and not providing privacy during care.
  16. Involuntary seclusion: isolating a resident against his/her will (exception: you may temporarily isolate a resident for his/her protection until the threat is removed).
  17. Willful deprivation by inaction: refusal of staff to intervene when a resident seeks assistance from a staff member and is ignored.
  18. Patterns of abuse and/or neglect will be trended and identified by the incident reporting log (skilled nursing only), grievance log (skilled nursing only), and CQI committee (skilled nursing only) there by directing the course of the investigation.
  19. PROTECTION

Staff-to-resident

  1. Remove the resident from harmful or potentially harmful situation.
  2. Reassign or suspend staff member during investigation of unwitnessed occurrences.
  3. If witnessed, immediately suspend the employee

Visitor-to-resident

  1. If allegation of visitor-to-resident abuse and/or neglect has occurred, ask visitor to leave the building. Seek assistance as needed from security and/or administrator.
  2. Provide first aid and/or seek medical attention as needed.

Resident-to-resident

  1. If resident-to-resident abuse, separate residents and make assignment of room if necessary. Notify physician, family, mental health professionals (as needed), Hotline, and police.
  2. Protect all other residents who may also be in harm’s way.
  3. Initiate investigation and document all findings.
  4. Determine which resident was the aggressor in the incident.
  5. Review the aggressor’s plan of care to determine whether the interventions and strategies for prevention were implemented and/or need to be revised.
  6. Assess to determine if incident could have been prevented and if visible signs of escalation were present.

Injuries of unknown origin

  1. When an injury is identified, staff persons must determine how the injury occurred in order to rule out abuse or assault.
  2. Methods to evaluate if abuse or assault occurred include but are not limited to:
  3. Interviewing the witness(es) involved
  4. Interviewing the resident(s) involved
  5. Evaluating the environment for possible contributing factors
  6. Comparing the services the resident receives to the care plan/negotiated service agreement.
  7. If, following immediate evaluation, abuse or assault cannot be ruled out as a potential cause of the injury, staff must report to the Department Hotline at 1-800-562-6078 and proceed with the investigation.

Sexual abuse/assault

  1. If sexual assault has occurred or is suspected, preserve all evidence.
  2. Notify the police department immediately.
  3. Do not question the resident, as s/he has the right to receive counseling from a person trained in sexual assault intervention.
  4. Send resident and evidence to emergency department for evaluation
  5. DO NOT ATTEMPT TO CLEAN RESIDENT, AS YOU MAY INADVERTANTLY WASH OFF EVIDENCE
  6. Call ahead to the emergency department and advise that a resident who may have been sexually assaulted is on his/her way.
  7. Arrange for counseling by a professional trained in sexual assault.
  1. INVESTIGATION
  2. The staff member seeing abuse or being notified of abuse or neglect will fill out an Event/Incident Report form (please refer to the Event/Incident Reporting procedure).
  3. Phase 1 of the investigation will answer the following questions as completely as possible
  4. The following topics will be addressed by the person filling out the form:
  5. WHO? Who was involved in the incident – the victim, the person causing the harm, and any witnesses.
  6. WHAT? What is the nature of the complaint/what happened.
  7. WHERE? Where the event occurred.
  8. Notification of the resident’s physician, family, administrator, and supervisor of the event.
  9. Indicate notification of the State Hotline, police, 911 if appropriate
  10. How the staff protected the resident from further incident.
  11. The following issues will be addressed by the person responsible for investigating the incident:
  12. HOW? How the event occurred.
  13. WHY? Why the event occurred.
  14. Phase 2 of the investigation will include the following:
  15. Gather statements from potential witnesses/other involved parties that may have knowledge about the incident.
  16. Review personnel files of staff members who may have been involved.
  17. Determine how injury could have occurred, provided there was an injury.
  18. Review grievance and state reporting log (skilled nursing only) for incidents involving the same parties.
  19. Review the resident record and plan of care for patterned behavior.
  20. Notify Hotline, police, and Nursing Commission when appropriate.
  21. Conclusion
  22. Summarize findings
  23. Take necessary action to prevent future similar incidents
  24. Make adjustments to the plan of care when appropriate
  25. Reassign, retrain, discipline, suspend, and/or terminate employee as appropriate
  26. REPORT/RESPOND
  27. All employees are MANDATORY REPORTERS.
  28. Report to the DSHS hotline (1-800-562-6078) immediately for witnessed and suspected abuse/neglect/exploitation. Seek assistance of a supervisor if necessary.
  29. Report to the police department when appropriate
  30. Cases of physical or sexual assault and theft of resident property must be reported to the police.
  31. Report to the Department of Health when appropriate
  32. Alleged perpetrators who are licensed, registered, or certified through the Department of Health must be reported. This includes NAR, NAC, RN, LPN, PT, OT, MD, ARNP, nursing technicians (skilled facilities only), licensed pharmacists.
  33. Notify resident’s physician, responsible party, DNS, and administrator.
  34. Once the incident has been reported to the appropriate agencies, the facility investigator must report final investigation findings to the hotline within five days.