OTIS Reporting Requirements
Conducting a Thorough
Abuse/Neglect Investigation
Denise Traylor, BSN, RN
DHH/Health Standard Section
LNHA DON Boot Camp
8/26/2014
Conflict of Interest Statement
• There is no conflict of interest present for
planners and faculty/presenter/authors
relative to this educational activity, including
financial relationships
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS/Health Standards Section
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Objectives
• Discuss regulatory reporting timelines
• Define & discuss Abuse, Neglect, Injury of
Unknown Origin, Misappropriation of Property,
Willful Infliction of Injury with Intent to Harm
and their relationship to state & federally
mandated reporting in the Online Tracking
Incident System (OTIS)
• Review & discuss federal regulations governing
the reporting of Abuse, Neglect, Injury of
Unknown Origin and Misappropriation of
Property reporting
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS/Health Standards Section
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Objectives
• Discuss incidents that are and are not
reportable in the OTIS system
• Discuss appropriate referrals
• Discuss the investigation of elopements
• Discuss the components of a thorough
investigation
• Discuss clinical forensic markers to consider in
Abuse/Neglect investigations
• Discuss Health Standards processes in
reviewing OTIS reports
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS/Health Standards Section
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Reporting Requirements
• F-225
– All alleged violations are reported immediately to
administrator and to other officials in accordance
with state law, (including the State survey &
certification agency);
– The facility must have evidence that all alleged
violations are thoroughly investigated, and
prevent further potential abuse while the
investigation is in progress
– the results of the investigation must be reported
to the administrator and other officials in
accordance with state law (including the State
survey & certification agency) within 5 working
days of the incident
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Reporting Requirements
• State Minimum Licensure
– Immediate verbal reporting and a
preliminary written report within 24 hours
of the incident to Health Standard Section
through OTIS
– Appropriate authorities are to be notified
according to state law
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Injury of Unknown Origin
• F-225
– Injury of unknown source must meet both of
these conditions
• Source of the injury not observed by any person, or the
source of the injury could not be explained by the
Resident
and
• the injury is suspicious because of the extent of the
injury or the location of the injury (injury located in an
area not generally vulnerable to trauma) or the number
of injuries observed at one particular point in time or
the incident of injuries over time
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What in Injury of Unknown Origin Is
Not
• An Injury of Unknown Origin does not include
minor bruises, abrasions, scrapes, etc., that
are not suspicious for Abuse.
• Injury that is explained by a cognitive Resident
• Non-serious injury that is in an area that is not
suspicious for Abuse.
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Policies & Procedures
• F-226
– Policies and procedures for screening and training
employees, protection of Residents and for the
prevention, identification, investigation and
reporting of abuse, neglect, mistreatment of
Residents and misappropriation of Resident
property
– Purpose is to assure that the facility is doing all
that is within its control to prevent occurrences
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Reporting Requirements
• The Discovered date is the point at which any
member of your staff becomes aware of an
allegation of Abuse, Neglect, Misappropriation
of Resident property or Injury of Unknown
Origin
• Every staff member should be intimately
familiar with the Abuse policy and should
know how to institute Abuse procedures and
immediately protect the Resident
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Abuse
• F-223
– Willful infliction of injury, unreasonable
confinement, intimidation or punishment
with resulting physical harm, pain or
mental anguish
– Includes deprivation of goods and services
necessary to attain or maintain physical,
mental or psychosocial wellbeing
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Physical Abuse is Not
• Staff to Resident
– “roughness” that leaves no injury
• Resident to Resident
– Non-serious injuries that are not of serious
consequence to the individual, such as those that
cause discomfort, redness to the skin, minor scratches,
superficial lacerations/skin tears, abrasions, minor
bruising; pushing or pulling that causes no injury
– If there is no injury, there is no physical abuse, unless
the incident has potential for serious actual harm
(Resident has knife, gun, etc.)
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Verbal Abuse
• Use of oral, written or gestured language that
willfully includes disparaging and derogatory
terms to Residents or their families, or within
their hearing distance, regardless of their age,
ability to comprehend, or disability
• Includes threats of harm, saying things to
frighten a Resident
• In the OTIS system, this would be reported as
Emotional Abuse
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Verbal Abuse Is NOT
• “rudeness”
• “inappropriate” conversations/comments (within
reason)
• minor cursing
• insults
• nuisance
• offensive remarks
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Mental Abuse
• Includes, but is not limited to, humiliation,
harassment, threats of punishment or
deprivation
• In the OTIS system, this is reported as
Emotional Abuse
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Sexual Abuse
• Includes but is not limited to sexual
harassment, sexual coercion or sexual assault
• In the OTIS system, this is reported as Sexual
Abuse
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Involuntary Seclusion
• Involuntary seclusion is separation of a
Resident from other Residents or from her/his
room or confinement to her/his room with or
without roommates, against the Resident’s
will or the will of the Resident’s RP
• In the OTIS system, this would be reported as
Emotional Abuse
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Involuntary Seclusion is NOT
• Emergency or short term monitored
separation from other Residents, if used for a
limited period of time as a therapeutic
intervention to reduce agitation until
professional staff can develop a plan or care to
meet the Resident’s needs
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Caregiver Neglect
• F-224
– Failure to provide goods and services
necessary to avoid physical harm, mental
anguish or mental illness
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Caregiver Neglect Is Not
• Acts of inefficiency, unsatisfactory conduct,
failure in good performance
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Misappropriation of Resident
Property
• F-224
– Deliberate misplacement, exploitation or
wrongful, temporary or permanent use of a
Resident’s belongings or money without the
Resident’s consent
– The law does not specify a dollar amount or value
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Willful Infliction of Injury with Intent
to Harm
• “determination of abuse requires that the
incident under investigation must have been
willful and/or deliberate. If the perpetrator of
the incident is demented, willfulness cannot
be established.” (Regional S&C letter, 1/20/2000)
• “If the Resident decision-making skills are
impaired, the Resident’s actions cannot be
considered willful, and the Resident cannot be
held accountable.” (Regional S&C letter, 1/20/2000)
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Is the Resident Capable of Willful
Infliction of Injury with Intent to Harm?
• BIMS
• Cognitive skills for daily decision making
• Diagnoses
–
–
–
–
–
Dementia
Alzheimer’s disease
Psychotic disorders
Bipolar
Traumatic brain injury
• Input from nursing staff, CNAs, therapists, etc.
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Incidents between Cognitively
Impaired Residents
• Cognitively impaired Resident cannot be
named as the Accused if determined they
cannot be held accountable for their actions
• Investigate as allegations of Caregiver Neglect;
Accused unknown unknown, Relationship staff,
Title administrative staff
– Evaluate systems in place to protect Residents
– Were systems actively in place to ensure safety
– Were Residents being supervised according to care
plans?
– Are care plan approaches appropriate?
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Serious Injury
• Bodily injury which involves substantial risk of
death, protracted and obvious disfigurement, or
protracted loss or impairment of the function of a
body member or organ, or mental faculty.
• More than a minor cut, bruise or superficial skin
tear.
• Reduces the Resident’s appearance, value,
usefulness etc., and impairs the function or
condition of the Resident.
• Has some connotations of permanence.
• May be physical, mental or psychological.
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Non-Serious Injury
• Any injury determined not to be serious by
the appropriate medical personnel who
assessed the Resident.
• Includes: discomfort, superficial lacerations,
skin tears, abrasions, minor bruising, etc.
• May involve insult, nuisance and offence.
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What is Not Reportable
• Resident to Resident incidents without injuries
• Non-serious Injuries
– Small bruises, skin tears
– Minor injuries not of serious consequence
– Injuries that cause discomfort, redness to the
skin, minor bruising, scratches, superficial
lacerations, skin tears, abrasions
– Insult, disrespect, nuisance, offence, minor
cursing
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What is Not Reportable
• Resident to staff or visitors
• Injury of Unknown Origin
– Explained by Resident
– Cognitive Resident states not from Abuse/Neglect
– Non-serious Injury
– Not in an area suspicious for Abuse
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What is Not Reportable
• Minor occurrences which are not of
serious consequence to the individual
– should be recorded by the facility according
to their policies and procedures for incident
recording, investigation and tracking.
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PLEASE NOTE!
• Residents involved in multiple incidents
triggers at survey
– Ensure that approaches in the care plan are
appropriate
– Ensure that staff are educated and
approaches are being followed
– Consider if there is adequate staff to
supervise and monitor Residents
– Monitor through QA tracking program
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Is This Resident Capable of
Willful Infliction of Injury with Intent to Harm?
↙
↘
YES
↓
Injury??
↙
No Injury or
Non-Serious Injury
NO
↓
Injury??
↘
↙
Serious
Injury
↘
No Injury or
Non-Serious Injury
↓
↓
↓
Do Not
Report
Investigate
Abuse
System Failure??
↙
↘
Yes
No
↓
Investigate
Caregiver Neglect
LOUISIANA DEPARTMENT OF HEALTH AND
HOSPITALS
Serious
Injury
↓
Investigate
Caregiver
Neglect
↓
Do Not Report
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Referrals
• Facility
– Law enforcement (CMS S&C memo, 6/17/2011)
– APS
– NAT-7
– Nursing Board
• Health Standards
– Sheriff’s office, Ag’s office
– APS
– Nursing board and other licensing boards
– CNA desk
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Elopements
• Resident who is an elopement risk leaves the
premises or a safe area without authorization
&/or necessary supervision
• Investigate as Caregiver Neglect; Accused
unknown unknown, Relationship staff, Title
administrative staff (unless 1-on-1)
– Was there a system failure?
– Did the Resident elope because of lack of supervision?
– Was the Resident being supervised according to care
plan?
– Were care plan interventions appropriate?
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Thorough Investigation
• Facilities can best support the detection and
prevention of abuse and neglect by establishing
and facilitating policies and procedures that
reinforce the expectation of immediate reporting
of suspected abuse and neglect.
• Providers should have a process in place that
makes it possible for Residents, staff, family
members, and advocates to report abuse and
neglect in a manner that will elicit immediate
attention by the organization.
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Thorough Investigation
• All allegations should be treated with the
same degree of consideration and seriousness
• Thoroughly collecting information and
corroborating evidence immediately improves
the likelihood of a valid conclusion
• Residents and staff should understand the
meaning of Abuse/Neglect and their role in
Abuse/Neglect reporting
• All should feel protected from retaliation
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS/Health Standards Section
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Thorough Investigation
• Drawing a reasonable inference or an
assumption about what happened does not
negate the requirement for a thorough
investigation and reporting of the incident.
• The investigator must approach the
investigation with an open mind, without
jumping to conclusions, or formulating an
opinion prior to evaluating all the collected
evidence.
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STEPS
PROCEDURES
Step 1:
Protect the
Resident
•Supervisor immediately assesses Resident’s
personal safety & potential of harm to other
Residents
•If caregiver is named, supervisor immediately
removes the accused caregiver from the Resident
care area (obtain Accused’s statement prior to
allowing them to leave the facility)
•Notify designated managers of the allegation
•Contact RP & physician
•Determine if law enforcement should be involved
LOUISIANA DEPARTMENT OF HEALTH AND
HOSPITALS
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Step 2:
Assess the
Effect
on the
Resident
*Nursing supervisor immediately completes an
assessment & documents findings;
*If there is a physical injury, document the size,
location, color, pattern, number of injuries, etc.;
Include if treatment or medical attention is required &
provided
*Lead investigator/nursing supervisor assesses for
psychosocial changes & documents findings
*Appropriate medical/psychosocial treatment &
support to the Resident is provided
*Evaluate to determine if this incident should be
reported in OTIS
LOUISIANA DEPARTMENT OF HEALTH AND
HOSPITALS
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Step 3:
*Who, What, Where, When, Why & How
Investigate
the
*Collect & protect evidence, including any ER,
Allegation hospital, X-ray, etc. reports
*Obtain written, dated, signed statement from the
Accused/s
*Obtain written, dated, signed statements from the
Resident/s & the person/s reporting the incident
*Obtain written, dated, signed statements from all
witnesses or any other persons who may have
knowledge or information about this incident;
ensure that statements are as detailed & objective
as possible
LOUISIANA DEPARTMENT OF HEALTH AND
HOSPITALS
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Step 3:
Investigate
the
Allegation
(con’t)
*Review all statements for use of vague terms (“rough”
treatment, “treated me ugly”, etc.), & obtain clarification
*Review all statements for conflicting information &
obtain clarification
*Document any knowledge of bias between alleged
abuser/s, witnesses or Residents
*Review Accused’s work assignment & determine if
Accused was working at the time of the incident; obtain a
copy of the Accused’s time card
*Review & consider Accused’s personnel record for
history or previous disciplinary actions, accusations, etc.
*Document any Resident outcomes
LOUISIANA DEPARTMENT OF HEALTH AND
HOSPITALS
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Step 4:
Conclude
the
Investigation
*Review all components of the investigation
*Determine if the allegations are Substantiated,
Unsubstantiated, or Unable to Verify
*Document any training done as a result of this
incident, or systems put in place to ensure that
this incident does not re-occur
*Examine facility policies & procedures to
determine if any changes are warranted
LOUISIANA DEPARTMENT OF HEALTH AND
HOSPITALS
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Step 4:
Conclude
the
Investigation
*Review all components of the investigation
*Determine if the allegations are Substantiated,
Unsubstantiated, or Unable to Verify
*Document any training done as a result of this
incident, or systems put in place to ensure that this
incident does not re-occur
*Examine facility policies & procedures to
determine if any changes are warranted
LOUISIANA DEPARTMENT OF HEALTH AND
HOSPITALS
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Clinical Forensic Markers
• Accidental trauma is usually distal: knees, chin,
fingers and toes
• Suspicious injuries generally midline and
proximal: face, neck, chest, breast, back,
buttocks
• Sexual trauma: face, neck, arm, chest, breast,
back and buttocks
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS/Health Standards Section
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Fractures
• Fractures of the head, spine and trunk are
more likely to be assault injuries than limb
fractures, sprains or musculoskeletal injuries
• Spiral fractures of large bones with no history
of gross injury suspicious
• Fractures with rotational component
suspicious
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ADDITIONAL CONSIDERATIONS
• Medications
– Aspirin, Warfarin, Ibuprofen, Celebrex, Ketorolac,
Heparin, Depakote, Valproic Acid, Prednisone,
Plavix
• Herbal Supplements
– St. John’s Wort, Bilberry, Garlic, Ginger, Ginko
Biloba, Vitamin E and Fish Oil
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HSS Processes
• Initial review by PM
– Referrals to Sheriff’s office, NOPD
• Final Review
– Return for corrections
– Request documentation
– Refer to Sheriff’s office, NOPD, AG
– RN board, LPN board, CNA desk, other licensing
boards (Pharmacy board, Medical board, etc.)
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS/Health Standards Section
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EXTENSIONS
• Requests for Extensions
– Granted by Denise Traylor, Program Manager or
Lizzie Armstrong, Secretary
– By email, fax or telephone
•
•
•
•
Denise.Traylor@LA.GOV
Lizzie.Armstrong@LA.GOV
225-342-0453 (fax)
225-342-7715 (Denise), 225-342-5795 (Lizzie)
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS/Health Standards Section
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OTIS Glitches
• When logging into OTIS, you get the message
that you must use Internet Explorer when
accessing this system:
• Click on Tools, Highlight Compatibility View
Settings, click on “Display all websites in
Compatibility View”. If you continue to get
this message, copy the OTIS URL and paste
under “Add this website”, and click “Add”
located to the right of the blank. The OTIS
website should now be in the big box
underneath
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OTIS Glitches
• Input times in the Events section with no “0” in
front: 3:54 pm, not 03:54 pm
• Input of the Accused Title often has to be done
twice, initially as well as when making
corrections
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Senarios
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS/Health Standards Section
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RESOURCES
• OTIS Welcome Page
– http://new.dhh.louisiana.gov/index.cfm/page/280
• OTIS Training Resources
– Located near the bottom of the OTIS Welcome
Page
• http://new.dhh.louisiana.gov/index.cfm/newsroom/det
ail/1693?uuid=1303144003194
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CONTACT INFORMATION
• Denise Traylor – OTIS Program Manager
– 225-342-7715 (phone)
– 225-342-0453 (fax)
– Denise.Traylor@LA.GOV
• Lizzie Armstrong – OTIS Secretary
– 225-342-5795 (phone)
– 225-342-0453 (fax)
– Lizzie.Armstrong@LA.GOV
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