Critical Client Incident Management Instruction technical update 2014 Information Session Purpose of today’s session Overview of Critical Client Incident Management Instruction technical update 2014 • Define client incident reporting – what it is and why we do it. • Provide an overview of the incident management and reporting requirements, including when a client incident report is required. • Explain incident types and categories. • Demonstrate how to complete the Client Incident Report form. • Illustrate how we can learn and improve our service delivery through good incident reporting and analysis. 2 The benefit of reporting critical client incidents Reporting critical client incidents is an important part of quality improvement and safety. The key reason for reporting incidents is to learn from them and, if possible, prevent their repetition. 3 Without a detailed analysis of incidents and near misses, we may fail to uncover problems that are potential hazards to clients and staff. 4 Who is in scope for the Critical client incident management instruction? Refer to Section 2 Scope of the instruction (pp. 2,3 and 4,) Category Program 1 2 Disability Services X X Out of Home Care (CYF) X X Youth Services and Youth Justice X X Housing & Community Building X X Housing & Community Building: Crisis Accommodation Services and Crisis Support Services X Family Services and Child FIRST X Family Violence/Sexual Assault Services X 5 When is a client incident report required? A client incident report is required for all critical incidents that occur at the service or during service delivery which involve and/or impact upon clients. This includes all critical incidents that occur: • while a staff member is with the client • when the client attends a service provider’s premises, including offices, residential services, respite facilities or day services • when a staff member is providing in-home support or support in the community with the client • onsite at the service, including inside and around the building and locations that are within view of staff 6 When is a client incident report required? If a service provides 24-hour care (residential care, custodial services or statutory child protection) a report is required for all incidents involving clients of this service, regardless of location. If a service does not provide 24 hour care critical incidents that occurred outside of service delivery may also need to be reported (e.g. breaches of privacy). Considerations include: ▪ Was the client hurt and is the client still at risk? ▪ Do you need to significantly change your service delivery to the client as a result (including police intervention)? 7 Incident Type and Category A descriptor or incident type is selected for each incident. Incidents are graded or categorised according to the actual impact or the potential risk. There are two categories. Category One Category Two Resulted in a serious outcome Serious threat to health, safety and/or well being of clients and others 8 Category One incidents These are the most serious incidents. All Category One incidents must be reported as soon as possible and at the latest within one working day. 9 Category Two incidents A Category Two incident involves events that threaten client or others health, safety or well being. Must be reported as soon as possible and at the latest within two working days. 10 Example Scenarios Example A A disability client’s known health condition deteriorated and he was hospitalised on Monday. A phone call was received by the disability residential service that evening from the hospital to advise the client had died. Example B An out of home care client discloses to you that she had been hit by her carer resulting in bruising. 11 Assessing need for a client incident report Professional judgement by a senior staff member is required. Severity of outcome ◦ Nature and extent of the trauma. ◦ Level of distress. Vulnerability of client ◦ Age and stage of development, culture and gender of the client. ◦ Balance of power or position between the alleged perpetrator and victim, and potential for exploitation. ◦ Client’s individual capacity, understanding of potential risks and communication skills. Pattern and history of behaviour ◦ ◦ ◦ ◦ History and pattern of offending or being offended against. Client’s risk taking behaviour. Frequency of the event (and recency if it is disclosed during service delivery). Likelihood of recurrence. 12 Reporting a critical client incident Category One incidents must be reported within one working day Category Two incidents must be reported within two working days Completing Client Incident Report form • All reports must be legible and on the specified report form. • The Client Incident Report form can be downloaded from ◦ the Funded Agency Channel www.fac.vic.gov.au or ◦ the department’s website www.dhs.vic.gov.au. • One form, three formats (handwritten, with macro help text and with no macros) • Support materials to help you complete a Client Incident Report form include: ◦ Client Incident Report - How to complete ◦ Writing effective Department of Human Services Client Incident Reports November 2011 • Only send one incident report per fax 14 Organisational learning Critical client incidents must be reviewed to learn from events and improve future service quality and safety. 15 Using incident data Top 5 Cat 1 incident types FY 2010-11 - all DHS Client Death 15% Physical Assault 28% Client Illness 16% Sexual Assault 18% Other 23% 16 Summary • The Critical Client Incident Management Instruction technical update 2014 outlines the management and reporting requirements for incidents involving or impacting upon clients. • Incident reporting is part of quality improvement and safety. • The key reason for reporting incidents is to learn from them and if possible, prevent their repetition. • Client incident reports are required for all incidents that involve or impact upon clients that occur during service delivery. • A descriptor or incident type is selected for each incident. • Incidents are graded or categorised according to the actual impact or the potential risk. • Incidents must be reviewed to learn from events and improve future service quality and safety. 17