New reporting requirements go into effect September 17, 2008
The Department of Inspections & Appeals published the final rule on August 13, 2008, changing the obligations to report accidents and “major injury” under 481 IAC 50.7. After meeting with the Department a number of times, there was consensus to provide a definition to “major injury” as published below. Some noteworthy changes have been underlined for your convenience. Although we anticipate less reporting of accidents resulting in injuries, we do anticipate expanded reporting in other areas, particularly elopements as they now must be reported regardless of injury.
During the educational sessions on the new reporting requirements on August 26-28, DIA provided additional guidance on the application and terminology used in the published rules and that guidance is set forth in red.
481—50.7(10A,135C) Additional notification. The director or the director’s designee shall be notified within 24 hours, or the next business day, by the most expeditious means available (I,II,III):
50.7(1) Of any accident causing major injury.
a. “Major injury” shall be defined as any injury which:
(1) Results in death; or
(2) Requires admission to a higher level of care for treatment, other than for observation; (Admission to a higher level of care will likely be a hospital for a NF/SNF or a NF/SNF for an RCF) or
(3) Requires consultation with the attending physician, designee of the physician, or physician extenderwho determines, in writing on a form designated by the department, that an injury is a “major injury” basedupon the circumstances of the accident, the previous functional ability of the resident, and the resident’sprognosis.
b. The following are not reportable accidents:
(1) An ambulatory resident, as defined in rules 481—57.1(135C), 58.1(135C), and 63.1(135C), who falls when neither the facility nor its employees have culpability related to the fall, even if the resident sustains a major injury; (In SNFs, when determining whether a resident is “ambulatory” surveyors will be looking at section G of the MDS as well as the care plan. In RCFs surveyors will consider the mental capabilities, and physical capabilities ambulating without staff assistance and the ability to maneuver stairs.)
(2) Spontaneous fractures; or
(3) Hairline fractures.
50.7(2) When damage to the facility is caused by a natural or other disaster. (regardless of whether it impairs the ability of the facility to function). (Although this may include a leaking roof, DIA emphasized that “damage” must be something more than losing a few shingles off the roof from a windstorm.)
50.7(3) When there is an act that causes major injury to a resident or when a facility has knowledge of a pattern of acts committed by the same resident on another resident that results in any physical injury. For the purposes of this subrule, “pattern” means two or more times within a 30-day period.
50.7(4) When a resident elopes from a facility. For the purposes of this subrule, “elopes” means when a resident who has impaired decision-making ability leaves the facility without the knowledge or authorization of staff. [Regardless of injury]. (Cognitively impaired residents who regularly go outside with the knowledge and authorization of staff are not considered elopements for purposes of reporting under 50.7, if they have not made prior attempts. Further, it is not a reportable incident if the cognitively impaired resident who regularly goes outside leaves for the first time so long as the facility puts proper interventions in place following this event).
50.7(5) When a resident attempts suicide, regardless of injury. (Statements alone do not constitute a suicide attempt. There must be some action taken to carry out the threat, i.e. wrapping the call light cord around their neck.)
50.7(6) When a fire occurs in a facility and the fire requires the notification of emergency services, requires full or partial evacuation of the facility, or causes physical injury to a resident.(“Evacuation” means moving staff and residents outside of the building and not merely from one hall to another.)
50.7(7) When a defect or failure occurs in the fire sprinkler or fire alarm system for more than 4 hours in a 24-hour period. (This reporting requirement is in addition to the requirement to notify the state fire marshal.)
The Department intends on releasing a final version of the form to utilize when having the physician sign off on whether or not an injury is or is not “major.” That form will be published on the DIA Health Facilities website and IHCA will be sure to publish the link in the weekly bulletin.
As with any new process, there will be situations that come up where you have questions or need clarification. Please contact Kelly Verwers Meyers at IHCA – with questions or at DIA contact Kathy Sutton or Dawn Fisk . Please do not contact your program coordinator as DIA is trying to track any challenges or difficulties with this regulation and proposed form.
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