Core Functions 1 & 2: Determine Who Is at Risk Transcript

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1 Core Function: Determine Who Is at Risk 1 Core Functions 1 & 2: Determine Who Is at Risk Title Slide (music playing) Webcast Tips This webcast includes spoken narration. At the bottom of the viewing pane are the play and pause buttons as well as buttons to go back and forth. There are also buttons to adjust the volume and view the closed captioning. On the left is a table of contents that can be used to navigate to a specific area of the webcast. There are also times when buttons may appear on the screen. They will typically appear at the bottom. The webcast may pause until you click the button. To continue, click the [Continue] button that appears in the lower right hand corner. Certificates of Achievement will be available to Administrative Entity staff, Providers, Supports Coordinators, and SC Supervisors after completing all course requirements. Please view and then save or print your certificate in order to receive credit for this course. For SCs and SC Supervisors, course requirements include successful completion of a pre-test and a post-test. Welcome Hello and thank you for viewing this webcast about risk management. My name is Ann Ligi and I work for the Office of Developmental Programs. I will be your narrator for this webcast. This course about the core functions of risk management builds upon risk management concepts presented in other courses in the Unraveling the Processes of Incident Management and Risk Management series. If you haven t done so already, it is recommended you view the three webcasts about risk management in the Foundation of Incident Management and Risk Management course prior to continuing on this course about the core functions of risk management. The three webcasts are Introduction to Incident Management and Risk Management, Risk Management Structure, and Risk Management Overview. These webcasts can be accessed in the resources area of the course where you launched this webcast. Everyone has a role to play in managing risk, including the individual. The individual s team, direct support professionals, the supports coordinator, and the family member or guardian, all work together to meet the individual's needs for safety and well-being. The provider, administrative entity, and ODP work together to assure policies and their implementation protect the individual's health, safety, and rights. Webcast Focus From previous webcasts in this series, we know that risk management is about prevention and being proactive. We accomplish this by using the five core functions of risk management. This webcast will focus on the first two core functions of risk management: determining who is at risk for what and identifying factors that put people at risk.

2 Core Function: Determine Who Is at Risk 2 These first two core functions are interrelated which is why we re talking about them together in this webcast. The first two core functions of risk management answer the questions: How do we determine who is at risk? and How do we determine what that person is at risk for? In order to answer these two questions, we need to know the factors associated with a person. Identifying Factors - Introduction If you recall from previous webcasts, a factor is a descriptive characteristic for a person such as age, gender, or health condition. There are also environmental factors such as time of day, physical location as well as things in the environment such as tables and chairs, the lighting, noises, etc. You may be wondering why we care about discovering factors. We need to identify factors because this knowledge will help us mitigate risk. From formal research and data analysis findings, we know that certain factors are associated with certain outcomes. We can take steps to minimize or eliminate the impact of factors and prevent the associated adverse outcomes from occurring. Without identifying descriptive factors for a person or other factors that play a role in the event occurring, we don t have the information we need to identify effective preventive measures. There are multiple ways to identify factors. There are some factors that we know because they are documented for us already such as demographic information and any medical conditions including both physical health and mental health. There are also factors that we will need to discover by using incident management data. These factors may be specific to an individual. There may also be population-based evidence common to a group of people. We can use these factors to help identify who is at risk and what they are at risk for. Identifying Factors - Demographic Factors

3 Core Function: Determine Who Is at Risk 3 Let s begin by looking at demographic information. This is the most obvious set of factors, especially as the information is already documented for us in the person s physical record and also in HCSIS, the Home and Community Services Information System. Demographic factors to consider would be items such as gender, age, ethnicity, or race. Identifying Factors - Health Factors Medical or health factors include both physical health and mental health. Physical health factors would include whether the person has a chronic medical condition such as asthma, congestive heart failure, or dysphagia. Mental health factors would be if the person also has a diagnosis of a mental illness. Additional factors to be aware of are sensory impairments such as hearing or sight difficulties. And the population we serve is unique in that one factor everyone has in common is a diagnosis of an intellectual disability. Two other health factors we may not think about are the person s mobility and whether or not the person uses words to communicate. Incident Data The demographic and medical factors are known to us or identified for us. So, the question is, how do we identify factors that may not be identified for us? One way to identify factors is to use incident management data. When a reportable incident occurs, information is documented in HCSIS. Depending on your role, you may or may not have access to incident information in HCSIS. For example, most direct support professionals probably do not have HCSIS access. However, someone in the agency does and that person could provide a report from HCSIS that contains incident management data that can then be used to help identify factors. The information documented in HCSIS answers the questions of who, what, where, why, and how. This information needs to be comprehensive, accurate, and detailed not only to document the incident itself and the response, but also because the information drives our prevention activities in risk management. By looking at incidents from the past year, we can ask a variety of questions. Take a moment to read the questions on the slide and when you are finished, click [Continue]. If the answer is yes to any of these questions, then in order to mitigate risk, we need to explore the cause and discover why these incidents occurred. This is because if something has already happened, there is a possibility it will happen again. When we know why something happened, there is the potential to prevent recurrence and its associated adverse outcome. If we are unable to prevent the recurrence, we may be able to minimize the severity of the adverse outcome.

4 Core Function: Determine Who Is at Risk 4 When we look at the cause, we want to know the specific details or factors associated with the event that resulted in the incident occurring. To do that we need to ask questions such as: Where was the person? What was he doing? What was going on in the environment? Don t forget that environment includes time such as meal time, time of day, etc. The environment also includes other people around the person including staff, others receiving services, and people not known by the person. Was the person doing something she enjoys? Keep in mind these are not the only questions you want to ask. The situation, incident trends that you see, and responses to the questions would all help to guide you to additional questions to ask. Click on [Critical Thinking Questions] to see additional example questions. There are two important things to remember when reviewing incident data and identifying common causes. First, make sure that you go back far enough in time to identify a potential cause or contributing factor. Sometimes, it may be necessary to go back weeks or even months in order to identify the cause. For example, a young man whose grandmother died seemed to cope well after her death. It wasn t until a few months later that incidents began to occur. At first, the team was challenged to understand why these incidents were occurring. Eventually, the team was able to pinpoint that the young man s behavior started to change after his grandmother s death. While his support staff were aware she passed away, it took a while for the young man to realize she no longer came to visit. When he was provided the supports needed to understand why she no longer came to visit, his behavioral incidents eventually stopped. Also, don t forget to rule out possible medical issues as a cause for the incident. A team struggled supporting a woman who had been doing well for a couple of years when all of a sudden behavioral symptoms began to reappear. After being admitted to the hospital for a psychiatric evaluation, it was discovered that she had an infected tooth and needed a root canal. These are only two examples of understanding what caused or contributed to the incident occurring. Understanding the cause can guide which preventive actions to follow through with. Population Data What do you do if the individual you are working with does not have any incidents? How do you then identify potential risk factors? An additional way to identify potential risk factors, regardless of whether there are incidents or not, is to look at population-based evidence or aggregate level data.

5 Core Function: Determine Who Is at Risk 5 You may be wondering where population data can be found. There are a variety of sources, such as Pennsylvania s Department of Health, which collects a variety of information such as birth, death and other vital statistics, cancer, minority health and health equity, behavioral risk and injury statistics, communicable diseases, and other health statistics for those living in Pennsylvania. The Centers for Disease Control and Prevention, also known as the CDC, is another populationbased source of potential risk factors for everyone living in the United States. Data is grouped by illness, topic, geography, and initiative. Another source of data within the CDC is Healthy People Healthy People 2020 is a comprehensive, nationwide health promotion and disease prevention plan. Healthy People 2020 contains 600 objectives designed to serve as a framework for improving the health of all people in the United States. Two overarching goals are to increase quality of life and years of healthy life and to eliminate health disparities among different groups. A new component in Healthy People 2020 is the recently launched National Prevention Strategy that aims to guide our nation in the most effective and achievable means for improving health and well-being. The Strategy prioritizes prevention by integrating recommendations and actions across multiple settings to improve health and save lives. In addition to looking at data for the general population from these data sources, you would also want to look at the subpopulation data for people diagnosed with an intellectual disability, a mental illness, a chronic health condition such asthma or high blood pressure, and also Autism Spectrum Disorders. Click on any of the website buttons to investigate theses sources of population data further. When you are ready, click [Continue]. Thus far, the examples of population-based data have either been at a national or state level. However, your organization may also have population-based data about all the people served by your organization. Your organization may have its own data collection methods or access to other data sources such as HCSIS. Examples of what you might look at are hospitalizations during a certain timeframe or for a specific diagnosis, people who fell or had a fracture, people with a high frequency of restraints, or someone identified as the target in multiple individual-to-individual abuse incidents. The examples provided are just a few of the many areas to explore when looking at aggregate data. Once you have some familiarity with the population-based data sources, the next step is to review factors associated with the person you are supporting and see if that person has any similarities to the factors identified in the population-based data. Sometimes there may be something that happens to only one person, but it is so serious that we need to ask if it could happen to someone else. This type of event is called a sentinel event.

6 Core Function: Determine Who Is at Risk 6 An example of a sentinel event that was discovered a long time ago is that peanut butter is a potential choking hazard. Another sentinel event occurred during the late 1990s when both birds and humans were being impacted by an unknown disease. It turned out to be West Nile virus. Anyone can be bitten by a mosquito that carries the West Nile virus. We also know that the elderly and the very young are at a higher risk for serious complications from this infection, including death. When we understand enough about the cause, we can put preventive interventions in place. Two sentinel events from the intellectual disability system in Pennsylvania unfortunately involve the death of two individuals. During the summer, there are typically advance communications through Health Alerts to remind people of the potential for death due to extreme temperatures. In the summer of 2010, there was publicity about a young man who died after being left alone in a vehicle. The response to this sentinel event was additional communications to all interested stakeholders about the risks associated with extreme temperatures and leaving individuals alone in vehicles. There was also statewide publicity in 2011 of a young woman from western Pennsylvania who was murdered by people she believed were her friends. The response to this sentinel event was again a variety of communications that raised awareness among all in the service system to consider if anyone they supported might be at risk for a similar situation occurring. Example - Ivan We have now looked at how risk factors can be identified by looking at demographic information, health information including both physical and mental health, incident data and populationbased data including a high profile or sentinel event. Let s learn about Ivan to see how all this information can be used to identify risk factors for him. Ivan is in his late 60s and you know from working with him that he walks differently than most people and shuffles his feet, all of which is documented in his record as a gait issue. In the past, Ivan has seen a physical therapist for his gait. Here is a brief summary of Ivan s incidents from the past year. Take a moment to read the summaries and then click [Continue]. (no narration) What are the items that are common to all of these incidents? Take a moment to review the correct response to the question and then click [Continue]. In addition to the demographic and health factors, we now know from reviewing incident reports over the past year that Ivan has a history of injuries from falls.

7 Core Function: Determine Who Is at Risk 7 In checking population data from the CDC, we find that the leading cause of nonfatal unintentional injury for people 55 and above is unintentional falls. In looking at the Pennsylvania Department of Health data, we learn that unintentional falls were the leading cause of injury hospitalization for males and females of all ages, races, and ethnicities. Also, unintentional falls were the leading cause of injury death among females and the leading cause of injury death among those ages 65 and older. What we know is that Ivan is in his late 60s, has a gait issue, and has had multiple incidents of falling over the past year. We also know that the number one cause of injury and death for someone with similar factors to Ivan is falling. In order to mitigate Ivan s risk for injury and death from falling, we need to put some personcentered preventive strategies in place to help prevent Ivan from falling and should Ivan fall, reduce the severity of the outcome, such as injury or fracture. Preventive strategies look at how to manage the factors of person, place, and time to prevent the alignment of them which can result in an adverse outcome. For more information about the alignment of person, place, and time, review the Risk Management Overview webcast. Preventive strategies are reviewed in more detail in the next webcast of this course. After putting person-centered preventive strategies in place to prevent Ivan from falling, we would want to monitor the impact, if any, of these strategies on reducing the number of falls. Or if Ivan does fall, a reduction in the severity of injury from the fall. If there are others that we serve who have the same risk factors as Ivan, we would want to see if it would make sense to put similar preventive strategies in place for them as well to prevent falls. This is an example of how an individual situation can help us to manage and mitigate risk for others who share the same risk factors. Thank You Thank you for watching this webcast about the first two core functions of risk management: determining who is at risk for what and identifying factors that put people at risk. No matter your role in supporting an individual, you have a role in identifying factors that may put the person at risk. Please watch the next webcast titled Preventive Strategies which is about how to avoid the alignment of person, place, and time in order to mitigate risk. (music playing) This webcast has been developed and produced by the Office of Developmental Programs Consulting System on behalf of the Pennsylvania Department of Public Welfare, Office of Developmental Programs.

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