Understanding incident reporting
Betty Norman, BSN, MBA, CPHRM
What exactly is an incident? An incident is generally defined as any happening that is not consistent with the routine care of a particular resident or an event that is not consistent with the routine operation of the organization.
Most organizations find that incident reports can be a positive management tool. They may serve as an early alert mechanism of operational or procedural problems, as well as potential liability. Encouraging employees to complete a report when things do not go as planned provides management with information to help improve the quality of services and perhaps limit the possibility of a repeat occurrence.
Written policies and guidelines provide staff direction as to which types of events are reportable. Written policies may also help staff identify those events that would be considered sentinel events and might require more extensive follow up, such as a root cause analysis.
The purpose of incident reporting can include, but not be limited to, the following:
- Improving the management of resident care and treatment by assuring that appropriate and immediate intervention occurs and corrective measures are implemented to prevent recurrences.
- Providing a database for the organization's Quality Assurance/Performance Improvement (QAPI) activities so that care and services can be evaluated and changes can be made to improve quality.
- Alerting Risk Management/Administration of an occurrence that could result in a claim so that loss control measures can be implemented.
- Providing a factual record of the event.
Analyzing incident report data
During the review and sign off on individual incident reports, consider whether the information documented is adequate to establish a clear picture of the event. Additional information may be needed to identify whether procedures were followed or to identify root causes.
In addition to identifying immediate interventions to reduce resident risk, incident report data that has been tabulated may be analyzed to identify:
- Types of occurrences, severity of injury and frequency in order to help establish priorities for loss-prevention activities.
- Event patterns to show a particular location, time of day or day of week.
- Resident demographics, such as age and gender.
- Staff characteristics, such as employee or agency.
- Number of incidents over a period of time to show changes in the frequency.
- Effectiveness of corrective measures based on the number and type of a particular event being reported.
- It is important for an organization to periodically review and evaluate its incident reporting procedures. The belief that everything is fine because the reported incident numbers are low may not be accurate. It is possible that staff is not reporting all incidents or near misses that occur.
Incident report data alone cannot provide an all-inclusive picture of an organization's activities and potential exposures. To achieve this, other sources of data such as quality improvement statistics, safety and security reports, resident/family satisfaction and complaint reports and results from internal and external surveys, etc., also need to be reviewed. This allows an organization to have a thorough view of potential loss exposures.
Reporting of incidents should not only be seen as something that is done because regulatory agencies or insurance companies require it. A review of reported incidents, along with trending and analysis of the information included, can provide valuable risk management information to an organization. This information may lead to more timely communication of untoward events, appropriate interventions to prevent recurrences and improvements in the quality of resident care.
Betty Norman, BSN, MBA, CPHRM, is Risk Control Director at Glatfelter Healthcare Practice, part of Glatfelter Program Managers, a strategic business unit dedicated to Glatfelter Insurance Group's program business.