MUI Handbook for Providers

Belmont-Harrison-Noble

County Boards of Developmental Disabilities

MAJOR UNUSUAL INCIDENTS

Understanding the MUI Reporting System for Providers

WHO TO CALL

BHN ALLIANCE MUI CONTACT BRI VIEWEG

740-695-0407 ext. 365

Email: mui@bcbdd.org

MUI/On-Call, After Hours Reporting 740-310-2255

Ohio Department of Developmental Disabilities MUI Hotline

1-866-313-6733

Questions? 614-995-3810

ORC 5123-17-02 MUI Rule

Addressing major unusual incidents and unusual incidents to ensure health, welfare, and continuous quality improvement.

PURPOSE

This rule establishes the requirements for addressing major unusual incidents and unusual incidents and implements a continuous quality improvement process in order to prevent or reduce the risk of harm to individuals.

What is a MUI (Major Unusual Incident)?

“Major Unusual Incident” means the alleged, suspected, or actual occurrence of an incident, when there is reason to believe the incident has occurred, that is defined as a Category A, Category B or Category C incident in the MUI Rule.

Category A, B and C MUI’s are defined on pages three and four of this handbook.

MUI CATEGORIES

Category A

Unexplained or unanticipated death means the death of an individual resulting from an accident or that was otherwise unexpected.
Exploitation means the unlawful or improper act of using an individual or an individual’s resources for monetary or personal benefit, profit, or gain.
Failure to report means that a developmental disabilities employee does not immediately report the alleged, suspected, or actual occurrence of an individual suffering or facing a substantial risk of suffering any wound, injury, disability, or condition of such a nature as to reasonably indicate emotional abuse, exploitation, misappropriation, neglect, physical abuse, or sexual abuse to the agency provider, county board, or department.
Misappropriation is when someone deprives, defrauds, or otherwise obtains real or per-sonal property of an individual by any means prohibited by the Revised Code or the Ad-ministrative Code.
Neglect means when there is a duty to do so, failing to provide an individual with medical care, personal care, or other support that consequently results in death or serious injury or places an individual or another person at risk of serious injury. Serious injury means an injury that results in treatment by a physician, physician assistant, or nurse practitioner.
Physical abuse means the use of physical force that can reasonably be expected to result in physical harm to an individual. Such physical force may include, but is not limited to, hitting, slapping, pushing, or throwing objects at an individual.
Prohibited sexual relations is a developmental disabilities employee engaging in consensual sexual conduct or having consensual sexual contact with an individual who is not the employee's spouse, and for whom the developmental disabilities employee was employed or under contract to provide care or supervise the provision of care at the time of the incident.
Rights code violation means any violation of the rights enumerated in section 5123.62 of the Revised Code that creates a likely risk of harm to the health or welfare of an Individual.
Sexual abuse means "unlawful sexual conduct" or "sexual contact" as those terms are de-fined in section 2907.01 of the Revised Code and the commission of any act prohibited by Chapter 2907. of the Revised Code (e.g., public indecency, importuning, and voyeurism) when the sexual conduct, sexual contact, or act involves an individual.
Emotional abuse means the use of actions, words, gestures, or other communicative means to purposefully threaten, coerce, intimidate, harass, or humiliate an individual or a pattern of behavior that creates a hostile environment.

Category B
Attempted Suicide means a physical attempt by an individual that results in emergency room treatment, in-patient observation, or hospital admission.
Death other than unexplained or unanticipated death means the death of an individual by natural cause.
Medical emergency means an incident where emergency medical intervention by a developmental disabilities employee is required to save an individual's life (e.g., choking relief techniques, cardiopulmonary resuscitation, use of an automated external defibrillator, or administration of overdose reversal medication such as "Narcan")
Missing individual means law enforcement has been contacted because an individual's whereabouts are unknown and the individual is believed to be at or pose an imminent risk of harm to self or others.
Peer-to-peer act means one of the following incidents involving two individuals served: Exploitation, Theft, Physical Act, or Sexual Act.
Significant Injury means an injury of known or unknown cause that results in a dental injury that requires treatment by a dentist, concussion, broken bone, dislocation, second or third degree burns or that requires immobilization, casting, or five or more sutures.

Category C
Law enforcement means any incident that results in an individual being tased, charged, incarcerated or arrested.
Unanticipated hospitalization means a hospital admission lasting forty-eight hours or longer that is not associated with planned evaluations, scheduled procedures, or routine diagnostic tests that are part of ongoing medical care, including the diagnosis of conditions; and is due to one or more of the following diagnoses: Aspiration pneumonia; Bowel obstruction; Dehydration; Medication error; Seizure; or Sepsis.
A hospital re-admission lasting forty-eight hours or longer that is not associated with planned evaluations, scheduled procedures, or routine diagnostic tests that are part of ongoing medical care, including the diagnosis of conditions; and is due to any diagnosis that is the same diagnosis as a prior hospital admission lasting forty-eight hours or longer within the past thirty calendar days.
Unapproved behavioral support means the use by a developmental disabilities employee of a prohibited measure as defined in rule 5123:2-2-06 of the Administrative Code or the use of a restrictive measure implemented without approval of the human rights committee or without informed consent of the individual or the individual's guardian in accordance with rule 5123:2-2-06 of the Administrative Code, when use of the prohibited measure or restrictive measure results in risk to the individual's health or welfare.

REPORTING TIMELINE FOR MUI

A provider will, as soon as possible but no later than four hours after following discovery of the major unusual incident, notify the county board through means identified by the county board of the following incidents or allegations:

Unexplained or unanticipated death
Prohibited Sexual Relations
Exploitation;
Misappropriation;
Neglect;
Peer-to-peer act;
Physical abuse;
Sexual abuse;
Emotional Abuse; and
When the provider has received an inquiry from the media regarding a major unusual incident

For all major unusual incidents, all providers shall submit an incident report to the county board contact or designee no later than 3 p.m. the first working day following the day the provider becomes aware of a potential or determined MUI. The incident report will be submitted in a format prescribed by the department. Email MUI related information to mui@bcbdd.org

The county board shall enter preliminary information regarding the incident in the incident tracking system and in the manner prescribed by the department by 5 p.m. on the first working day following the day the county board receives notification from the provider or otherwise becomes aware of the MUI.

REPORTING REQUIREMENTS FOR MUI

Reports regarding all major unusual incidents involving an individual who resides in an intermediate care facility or who receives round-the-clock waiver services shall be filed and the requirements of this rule followed regardless of where the incident occurred. Reports

Accidental or suspicious death
Attempted Suicide
Death other than accidental or suspicious death
Exploitation
Failure to Report
Misappropriation
Neglect

Verbal Abuse
Sexual Abuse
Prohibited Sexual Relations
Physical Abuse
Law Enforcement
Missing Individual
Peer-to-Peer Act

Reports regarding the following major unusual incidents shall be filed and the requirements of this rule followed only when the incident occurs in a program operated by a county board or when the individual is being served by a licensed or certified provider:

Medical emergency
Rights code violation
Significant injury
Unapproved behavioral support
Unanticipated hospitalization

Reporting of Alleged Criminal Acts

The provider shall immediately report to the law enforcement entity having jurisdiction of the location where the incident occurred, any allegation of a criminal act. The provider shall document the time, date, and name of person notified of the alleged criminal act. The county board shall ensure that the notification has been made.

All allegations of abuse or neglect as defined in sections 2151.031 and 2151.03 of the Revised Code of an individual under the age of twenty-one years shall be immediately reported to the local public children's services agency. The notification may be made by the provider or the county board. The county board shall ensure that the notification has been made.

Immediately Upon Identification or Notification of an MUI, the Provider Will:

Take all reasonable measures to ensure the health and welfare of at-risk individuals. Such measures shall include:
- Reasonable measures include, but are not limited to, securing immediate and ongoing medical attention and removal of a developmental disabilities employee from direct contact with any individual when the developmental disabilities employee is alleged to have been involved in physical abuse or sexual abuse.

Who Must Report?

All superintendents, board members, or employees of a county board.
All employees of the department.
An administrator, board member, or employee of a residential facility licensed under section 5123.19 of the Revised Code.
An administrator, board member, or employee of any other public or private provider of services to an individual with a developmental disability.
An independent provider.
Anyone paid to provide Medicaid waiver services.
All providers who are contracted, certified or licensed to serve persons with developmental disabilities are required to report MUIs.

What is an Unusual Incident (UI)?

Unusual incident (UI) means an event or occurrence involving an individual that is not consistent with routine operations, policies and procedures, or the individual service plan, but is not a major unusual incident. "Unusual incident" includes, but is not limited to:

Dental injury that does not require treatment by a dentist,
Fall,
An injury that is not a significant injury,
Medication error without a likely risk to health and welfare,
Overnight relocation of an individual due to a fire, natural disaster, or mechanical failure,
An incident involving two individuals served that is not a peer-to-peer act major unusual incident but does involve: (a) A physical altercation; or (b) The use of actions, words, gestures, or other communicative means to purposefully threaten, coerce, or intimidate when there is the op-portunity and ability to carry out the threat.
Rights code violation or unapproved behavioral support without a likely risk to health and welfare,
Emergency room or urgent care treatment center visit,
An unplanned hospital admission or hospital stay that is not a major unusual incident as defined in paragraph (C)(16)(c)(ii) of this rule,
A situation where an individual's whereabouts are unknown for longer than the period of time specified in the individual service plan that does not result in imminent risk of harm to the individual or others and is not a major unusual incident as defined in paragraph (C)(16)(b)(iv) or (C)(16)(c)(i) of this rule.
Program implementation incident.

Requirements for Unusual Incidents

Unusual incidents shall be reported and investigated by the provider and each agency provider shall develop and implement a written unusual incident policy and procedure that:

Identifies what is to be reported as an unusual incident, which shall include unusual incidents as defined in this rule;
Requires an employee who becomes aware of an unusual incident to report it to the person designated by the agency provider who can initiate proper action;
Requires the report to be made no later than twenty-four (24) hours after the occurrence of the unusual incident; and
Requires the agency provider to investigate unusual incidents, identify the cause and contributing factors when applicable, and develop preventive measures to protect the health and welfare of any at-risk individuals.

Independent providers shall complete an incident report, notify the individual's guardian or other person whom the individual has identified, as applicable, and forward the incident report to the SSA or county board designee on the first working day following the day the unusual incident is discovered.

Each agency provider and independent provider shall review all unusual incidents as necessary, but no less than monthly, to ensure appropriate preventive measures have been implemented and trends and patterns identified and addressed as appropriate.

The unusual incident reports, documentation of identified trends and patterns, and corrective action shall be made available to the county board and department upon request.

Each agency provider and independent provider shall maintain a log of all unusual incidents. The log shall contain only unusual incidents as defined in paragraph (C)(25) of the ORC 5123-17-02 MUI rule and shall include, but is not limited to, the name of the individual, a brief description of the unusual incident, any injuries, time, date, location, cause and contributing factors and preventive measures.

The county board shall review, on at least a quarterly basis, a representative sample of provider unusual incident logs, including logs where the county board is a provider, to ensure that major unusual incidents have been re-ported, preventive measures have been implemented, and that trends and patterns have been identified and addressed in accordance with this rule. The sample shall be made available to the Ohio Department of DD for review upon request.

THE INCIDENT REPORT

The Incident Report is the documentation that contains details about a major unusual incident or an unusual incident. It shall include, but is not limited to the following information:

Individual’s name and address
Date, time and location of the incident
Description of the incident (who, what, when and where)
Type and location of injuries
Immediate actions taken to ensure health and welfare of the individual involved and any at-risk individuals
Name of the primary person involved and that person’s relationship to the individual
Name of witnesses
Statements completed by persons who witnessed or have personal knowledge of the incident
Notifications with name, title and time and date of notice
Further medical follow-up; cause and contributing factors; and Prevention Plan

Role of the Provider in the UI/MUI Process

The provider’s role is to take immediate actions to protect individuals from further harm when incidents occur. The provider must immediately notify the police or the local public children’s services agency when there is an alleged criminal act; report MUIs immediately but no later than four (4) hours of awareness to the County Board, for Unexplained or Unanticipated death; Exploitation; Misappropriation; Neglect; Peer-to-peer act; Physical abuse; Prohibited sexual relations; Sexual abuse; Emotional abuse; and When the provider has received an inquiry from the media regarding a major un-usual incident. All developmental disability employees will cooperate with administrative investigations conducted by entities authorized to conduct investigations.

Role of the County Board

The County Board is required to report and conduct an administrative investigation of all MUIs. County Boards contract, or employ investigative agents who are certified by the Ohio Department of Developmental Disabilities. The County Board shall ensure all required notifications have been made, all reasonable measure necessary to protect the health and welfare of at-risk individuals have been taken, determine if additional measures are needed and notify the department if circumstances of the MUI rule require a department-directed administrative investigation.

Role of the Ohio Department of Developmental Disabilities

The Ohio Department of DD provides oversight and technical assistance. All MUI reports are reviewed by the Department of DD, MUI/Registry Unit to ensure immediate action, timely reporting, good investigations and necessary implementation of prevention plans. The Department reviews patterns and trends reviews for individuals and the state. The Department also conducts investigations where it would be a conflict of interest for the county board to complete. In addition, the Department manages the State of Ohio Abuser Registry.