Community First Health Centers

Community First Health Centers

Policy & Procedure Manual

Patient\Visitor Incident AND Adverse Events Reporting

Report Form Completion

Environment of Care\QI

1. Event Occurrence (Incident\Adverse)

2. Incident\Adverse Event Report initiated and received by Program or Practice Manager (Immediately) or same day as event.

3. Completed Incident\adverse event form to COO (Acting COO) and Risk Manager within 48 hours or 2 business days.

4. COO forwards completed form to QI Specialist or Safety Officer

5. Summary reports are provided to Compliance and Performance Improvement Committee

6. CEO notification as determined appropriate by COO, Risk Management Officer and Medical Director.

8. Board of Directors report through COO, Risk Management officer, Medical Director or CEO.

9. Time Frame for event investigation completion: Within 14 (fourteen) working days of Incident\event or timeframe determined per QIC\MD.

For Medication Related events: the event investigation completion and staff education follow up is determined by the time frames outlined in the Medication Related Event Corrective Action\Performance Improvement Plan Guideline.

For Medication Related Events:

1. The Manager will complete the full investigate to ensure it is truly an error. This is completed by gathering all documentation in the medical records as well as talking with staff involved and completing the incident report. This must be completed within 5-7 business days depending on the step of the MRE process.

2. Once a MRE is evident/confirmed based on the investigation/documentation, it is then communicated to the Quality Team for their confirmation prior to or at the same time as COO involvement.

3. The corrective action is then completed and forwarded for approval to the COO & HR Director.

4. The PM and QI meet to discuss the reeducation process.

April, 2014 Confidential under

Healthcare Quality Improvement Act and

Mich. Comp. Laws 333.20175(8),333.21513(d), and 33.21515.