

OTIS (Online Tracking Incident System)
is a web based application created by
DHH.
Reports submitted via the internet to
meet State and Federal reporting
requirements; mandatory use since
5/1/09


Abuse means the willful infliction of
injury, unreasonable confinement,
intimidation or punishment with
resulting physical harm, pain or
mental anguish. (CMS)
Includes sexual abuse, sexual
harassment, sexual coercion or sexual
assault

Abuse is the infliction of physical or
mental injury or the causing of
deterioration of a consumer by means
including but not limited to sexual
abuse, or exploitation of funds or
other things of value to such an extent
that his health or mental or emotional
well-being is endangered. (Minimum
Licensure)

Physical abuse including hitting,
slapping, pinching and kicking

Controlling behavior though corporal
punishment

Mental abuse, including humiliation,
harassment, threats of punishment or
deprivation

Verbal-use of oral, written or gestured
language that willfully includes
disparaging and derogatory terms to
Residents or families, or within
hearing distance, regardless of their
age, ability to comprehend or
disability (CMS)

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 legal
representative (CMS)

Emergency or short term monitored
separation from other Residents will
not be considered involuntary
seclusion and may be permitted if
used for a limited period of time as a
therapeutic intervention to reduce
agitation until professional staff can
develop a plan of care to meet the
Resident’s needs.

Willful means that the individual
intended the action itself that he/she
knew or should have known could
cause physical harm, pain or mental
anguish.


Even though a Resident may have a
cognitive impairment, he/she could
still commit a willful act
There may still be instances when a
Resident’s willful intent cannot be
determined


Neglect is the failure to provide goods
and services necessary to avoid
physical harm, mental anguish or
mental illness. (CMS)
Neglect is the failure to provide the
proper or necessary medical care,
nutrition or other care necessary for a
consumer’s well-being. (Minimum
Licensure)


Facilities should investigate Allegations
of Caregiver Neglect when altercations
occur between Residents who are
incapable of willful abuse
It is important that a facility take
reasonable precautions, including
providing adequate supervision when
the risk of Resident-to-Resident
altercations is identified

Misappropriation of Resident Property
means the deliberate misplacement,
exploitation, or wrongful, temporary
or permanent use of a Resident’s
belongings or money without the
Resident’s consent. (CMS)

Injuries of Unknown Origin must meet the
following two criteria:
◦ The source of the injury was not observed
by any person or the source of the injury
could not be explained by the Resident
◦ The injury is suspicious because of the
extent of the injury or the location of the
injury (e.g.: the injury is located in an area
not generally vulnerable to trauma) or the
number of injuries observed at one
particular point in time or the incidence of
injuries over time

Major injuries of unknown origin
(fractures, burns, suspicious
contusions, head injuries, etc.) for
which the facility is unable to
determine the cause and could
possibly be the result of abuse or
neglect shall be reported (Minimum
Licensure)

All other injuries not meeting the two
conditions listed should be
investigated by the facility and
documentation of the investigation
retained by the facility.



Reporter is name of person who
completed the incident report
Witness – person(s) who witnessed the
incident
Discovered – date and time incident
discovered by any facility staff or
reported to any facility staff


Substantiated – facility investigation
established proof that Abuse, Neglect or
Exploitation occurred
An incident should not be considered
substantiated because you proved it
really happened, but because your
investigation proved that Abuse, Neglect
or Exploitation occurred



If you substantiate Abuse or Neglect,
you must show outcome to the
Resident.
Outcomes include harm, pain or
mental anguish
This should be included in the
Summary.


Unsubstantiated – facility investigation
determined no
Abuse/Neglect/Exploitation occurred
Unable to verify – facility investigation
unable to determine
Abuse/Neglect/Misappropriation
occurred due to lack of information or
evidence


Incidents that meet the definition of
Abuse, Neglect, Misappropriation or
Injury of Unknown Origin
Incidents must have been “willful
and/or deliberate” and have caused
harm to be considered Abuse or
Neglect

Resident to staff incidents
◦ Local authorities
◦ Internal investigation and
documentation



Initial report must be input in the OTIS
system within 24 hours. 24 hours
means 24 hours, not 1 business day
Report must be complete within 5
business days
Automatic email notifications of
incomplete reports being sent


The 24 hour reporting requirement is not met
by accessing the system and creating a
“placeholder” with little or no information;
this may result in surveyors citing a tag
Minimum information required:
◦
◦
◦
◦
Victim
Accused/Allegation/Incident Category
Statement describing allegation/s in Description
Date discovered in facility

Reporter
◦ Name of the person who completed the facility
incident report.
◦ May be different than the person who is actually
entering the data in the OTIS system.

Witness
◦ Person or persons who witnessed the incident. Can
be a staff member, a Resident, a family member,
etc.

Other Contacts
◦ May be entered as desired
 Verbal
abuse = Abuse: Emotional
 Description
= brief statement
describing the incident

Summary
◦ Include details about your
investigation and findings
◦ Investigation findings should
logically show how you made the
decision whether the Allegations
were substantiated, unsubstantiated
or unable to verify.

Summary
◦ Must show what measures have been put in place
to ensure this incident doesn’t reoccur
◦ Include information about inservice or other
trainings, new policies and procedures, etc.
◦ Include information about what is being done
facility-wide to protect Residents
◦ Include information about what you did to resolve
the incident, such as reimburse Resident
◦ Include information about the final disposition of
the Victim and the Accused; ex: moved Victim,
trained or terminated Accused, etc.


When typing in Description or Summary, do
not use all caps
If facility substantiates
Abuse/Neglect/Financial Exploitation by a
CNA, this should be included on the NAT-7
Employment/Termination form and mailed to
the CNA Registry within 5 working days. This
and the OTIS report meet the facility’s
reporting requirements

Date and time format

Incident Category used only in cases
of: (otherwise should be left blank)
◦ 1/5/2010; 3:51pm (no “0” in front of time)
◦ Death w/restraints/seclusion
◦ Injury of unknown origin

Remove Injury of Unknown Origin when
Accused is discovered or Abuse is
suspected/investigated



Correct DOB, SSN for Accused
Last known address of Accused staff,
not facility address
First name of Accused and Victim in
correct box

Protective Actions
◦ Be sure to give yourself credit for everything you
did to protect the Resident. Include all Protective
Actions, whether they be for the Resident Victim
or the Accused.
◦ Resident Accused – “moved out of client care” is
not an appropriate protective action. If the
Resident has to be moved, you would choose
“relocated”


Complete “Protective Action” box with
final disposition of Accused and Victim
Unknown Accused = unknown, unknown
◦ Relationship = other, client or staff
◦ Staff = facility address, title, SSN


Input of “facility/CEO finding” locks
report so always input that data last
Report unlocked by Program Manager
at State Office; fax request on
letterhead, signed by Administrator


“Facility/CEO finding” should be the
same as the Allegation findings
If one or more Allegations are
substantiated, the “Facility/CEO
finding” is substantiated

Printing the Complete Report
◦ Click on the print button in any screen
except the Case Notes screen
◦ Click “Select a format” and highlight
“Acrobat (PDF) file”
◦ Click Export
◦ Click Open
◦ Click printer picture at top left under File
◦ Click OK at bottom right

Many blank reports are being created

To Create A New OTIS Report:
◦ Click “New Incident”
◦ Left click “Save new incident”
◦ These 2 actions will result in the creation of a new
incident number

To Open a Previously Created OTIS Report
◦ Log into system
◦ Enter previously created number into empty box
◦ Click on “GO”



Review all OTIS reports
Determination is made after reviewing
OTIS reports whether an on-site
investigation is warranted
Referral may be made to local Sheriff’s
Office, CNA Registry, Professional Board
or Nursing Home Complaint Desk
Most common nonaccidental injuries
are the face and neck, chest wall,
abdomen and buttocks
 Injuries suggestive of defensive
maneuvering:

◦ Back of arms and hands
◦ Injuries related to grasping, squeezing or
forcible restraint

Color is helpful in dating bruises



50% of nursing home Residents fall
Spontaneous fractures
◦ Vertebral fractures in osteoporotic women
◦ Hip fractures
Prolonged bed rest, chronic limb paralysis,
non-weight bearing status increase risk for
spontaneous fractures
(Kane and Goodwin, 1991)



Fractures of the head, spine and trunk are
more likely to be assault injuries than limb
fractures, sprains or musculoskeletal
injuries
(Fanslow et al, 1998)
Spiral fractures of large bones with no
history of gross injury diagnostic of abuse
Fractures with rotational component
diagnostic of abuse (Medical Tribune, 1995)



Accidental trauma is usually distal:
knees, chins, fingers, toes
Abusive trauma usually midline and
proximal
Sexual trauma: face, neck, arm, chest,
breast, back and buttocks
(Daniel J. Sheridan, PhD, RN)


Aspirin, Warfarin, Ibuprofen, Celebrex,
Ketorolac, Heparin, Depakote, Valproic
Acid, Prednisone, Plavix
Supplements: Bilberry, Garlic, Ginger,
Ginko, Vitamin E and Fish Oil



Dementia present in 15% over age 65,
50% over age 80 (Abrams et al, 1995)
Dementia noted in 51% of
abused/neglected patients
Dementia noted in 30% of patients
referred for other reasons



Affects from 15-50% of elderly
Institutionalized elders and those with
medical illness have highest incidences of
depression, which can be as high as 70%
following a stroke
62% of neglected or abused patients had
depressions compared with 12% referred for
other reasons


Elderly with depression more prone to
psychosis (Abrams et al, 1995)
4-5% of elderly experience psychosis
(Abrams etal, 1995)

Present in up to 5% of older persons

More common in men than in women


75-77% of Sexual Abuse victims have
cognitive impairment and 67-92%
have functional limitations
72% of elder abuse victims did not
complain of the abuse at the time of
presentation to an emergency center
OTIS User Guide can be downloaded at:
http://www.dhh.louisiana.gov/offices/
publications.asp?ID=112&Detail=171









Denise Traylor, BSN, RN
LTC Abuse/Neglect Program Manager
DHH/Health Standards Section
500 Laurel St., Suite 100
Baton Rouge, La. 70801-1811
225-342-7715 phone
225-342-0453 fax
Denise.Traylor@LA.GOV
http://www.dhh.louisiana.gov/offices/?ID=112
A copy of this Power Point Presentation
can be obtained at:
http://www.dhh.louisiana.gov/offices/p
ublications.asp?ID=112&Detail=2558