3.07 – Major Unusual Incident Investigations

Open Door will abide by and comply with the MUI rule and regulations found in OAC 5123:17-02 in its entirety as outlined.  (For specific incident reporting procedures, refer to Policy 3.06 Incident Reporting Procedures.)

Reference:      Medicaid Tags W 148-W157

                        Licensure Standards 5123:17-02

Staff Training on MUI Rule

Open Door must ensure that all staff employed are trained on requirement of this rule prior to direct contact with individuals.  Thereafter, all Open Door staff must receive annual training on the requirements of the MUI rule including health and welfare alerts.

Definition of MUI

“Major Unusual Incident” (MUI) means the alleged, suspected, or actual occurrence of an incident described in paragraph (C) (16) (a), (C) (16) (b), or (C) (16) (c) of OAC 5123:17-02, when there is reason to believe the incident has occurred.  There are three categories of MUIs that correspond to three investigation procedures per OAC.

For all incidents alleging a possible MUI, Open Door must forward a copy of the incident report to the County Board MUI during the next working day prior to 3pm. In addition, Open Door must notify the Guardian, SSA, other Licensed/certified providers, staff or family living at the residence within the same day of a MUI allegation. (unless they are Primary Person Involved or Significant other of Primary Person Involved)

Categories of Administrative MUI Investigations

An Administrative Investigation will be completed for any MUI allegation.  This includes gathering and analysis of information related to a MUI so that appropriate action can be taken to address any harm or risk of harm and prevent recurrence.  There are three categories of Major Unusual Incidents referred to as Category A, B, or C.

Category A

(Requires reports to be filed immediately regardless of where the incident occurred.)

• Accidental or suspicious death
• Exploitation
• Failure to report
• Misappropriation
• Neglect
• Physical Abuse
• Prohibited Sexual Relations
• Rights Code Violation
• Sexual Abuse
• Verbal Abuse

Each of these are specifically defined in the OAC 5123:17-02.  Open Door uses this rule guideline for identification of potential incidents in Category A investigations and reporting requirements.  This Category requires provider to notify county board MUI department immediately, but no later than four hours after discovery of the incident.  In addition, any media contact regarding a MUI must be reported to county board MUI with four-hour deadline, as well.   Law enforcement must be notified as per OAC 5123:17-02 when allegation that criminal act. 

Category B

(Reports should be filed immediately when the incident occurs in a program operated by county board or when individual being served by licensed or certified provider.  The incident report must be submitted to county board MUI the next business day within 24 hours of incident.)

• Attempted suicide
• Death (other than suspicious and accidental)
• Medical Emergency
• Missing Individual
• Peer to peer act including exploitation, theft, physical act
• Significant Injury

Category C

(Reports should be filed when the incident occurs in a program operated by county board or when individual being served by licensed or certified provider.)

• Law enforcement involvement
• Unapproved Behavior Support
• Unanticipated Hospitalization

Systems Neglect

“Systems” Neglect: a substantiated MUI attributed to multiple variables and not to a specific person.

Immediate Actions

Immediately upon identification or notification of a possible MUI, Open Door will take all reasonable measures to ensure the health and welfare of at-risk individuals.  Immediate actions may include:

• Removal of employee from direct service for abuse allegations (Incident Hotline personnel will note the time of report and the time that staff were pulled from schedule on follow-up report) This includes assurance of removal from contact even with contract employees for external day services (ie: transportation drivers, etc.)
• Immediate and on-going medical treatment
• Referral for therapy or other specialists
• Immediate and on-going assessments
• Immediate safety repairs or modifications to environment
• Increased supervision or staffing
• Any other necessary measure

Prevention

Prevention of recurrence of incidents must be a primary focus of all staff at Open Door.  Preventative measures are addressed through, but not limited to:

1. Initial, Annual, and ongoing training of all personnel
2. Familiarity with each individual’s Person-Centered Plan
3. Safety and Quality Assurance Recommendations
4. Medical and Ancillary Assessments/Evaluations and referrals
5. Working Knowledge of:
   a. Resident’s Rights
   b. Infection control procedures
   c. Emergency Procedures
   d. First Aid and CPR
   e. Crisis Prevention Training
   f. Human Rights Committee
   g. Informed Trauma Care

The individual’s team must collaborate on the development of preventative measures to address cause and contributing factors to MUIs.  Team members shall jointly determine reasonable steps necessary to prevent or reduce likelihood of recurrence. 

Open Door MUI Analysis/Review Procedure:

Any allegation of MUIs will be included on the daily log that is emailed to the Administrative Teams each day by the Incident Hotline. 

All MUIs will be reviewed by the Divisional Administrative Teams at their Monthly UI meetings. Review will consist of patterns/trends, cause and contributing factors, follow-up on recommendations, and preventative measures. 

MUIs will also be reviewed by each Open Door team weekly during Program meetings. Task grid will ensure completion of follow up recommendations.

The Incident Hotline/Open Door Risk Management Department completes investigation packets containing all relevant documentation, pictures, and other evidence gathered.  The Risk Management Coordinator completes investigation report in conjunction with the County Board MUI department. 

All MUI Investigative Reports and packets will be reviewed by the Executive Director within five days of the incident (or discovery of the incident).    

MUI Summary of occurrences will be reviewed by the Executive Staff Meetings quarterly.   The Risk Management Director will be responsible for reporting to the Board of Directors a MUI summary of occurrences at least semi-annually.

The County Board MUI Units will request MUI Annual Analysis by January 31^st each year.  The annual reviews include review of all MUIs identified. The Risk Management Department will submit the MUI log when requested in the time frame/deadline given by the County Board MUI unit.  This report will include patterns/trends, causes and contributing factors and prevention plan, and overall company policy/procedure or training implementation.

The Open Door Board of Directors and Executive Team will also receive the Annual and MUI Patterns Trends report for review.

Outside of Facility MUI Procedure-ICF

1. The Incident Hotline for Open Door will contact the day program or transportation service immediately notifying them of allegation of abuse or neglect and requesting that the PPI be removed from schedule.
2. If the Primary Person Involved (from external source) is not removed from the schedule or is placed in a “no contact” area, the Open Door Program staff will ensure that the day programming is safe for the individual by making a visit to service location immediately. They will ensure that the individual is protected.
3. The individual will be encouraged to not attend day programming until recommendations have been completed. If the individual chooses to continue attending the day programming, the Open Door Program team will develop a written plan to ensure their safety including providing alternate transportation or staffing necessary to protect the health and welfare of the individual.
4. To ensure the health and welfare of future MUI incidents, the MUI Unit and the Risk Management Department Designee will work in collaboration of ensuring health and welfare of the individual. The Risk Management Department Designee will coordinate the investigation process. The two entities will discuss the investigation and collaborate on recommendations. The facility maintains the right to have discrepancies in the outcome of investigation and will clearly indicate its findings even if they differ from county MUI findings. The facility does not have to wait for county to initiate or complete the investigation as there is a 5-day requirement for ICF.
5. A Systems, Rights, and Safety Review during program meeting will be held within 5 business days to discuss the incident.
6. The Day Program or transportation provider will be notified of the prevention plan by either the County MUI Unit, the Risk Management Department or another designated Open Door staff of the recommendations. The Day programming will provide verification of the recommendations being completed to the MUI Unit and/or Open Door.
7. The MUI Unit will send verification of the recommendations as well as the closure date of the incident to all entities.
8. Follow up visit to the day programming will be implemented by the QIDP and documentation will be provided via QIDP notes until investigation and recommendations are completed.
9. The QIDP will hold an addendum meeting for all MUI Incidents that involve Health and Welfare of the individual with the attendance of the Day Programming or occurring with transportation provider. This will be conducted after the implementation of the recommendations. The subject of this meeting is to discuss the incident after the investigation process has been completed.

If a MUI occurs outside of the setting in external day service or transportation service from a Waiver setting, the following procedure will occur:

1. The Incident Hotline for Open Door will contact the day program or transportation service immediately notifying them of allegation of abuse or neglect and requesting that the PPI be removed from schedule.
2. If the Primary Person Involved (from external source) is not removed from the schedule or is placed in a “no contact” area, the Open Door Program staff will ensure that the day programming is safe for the individual by making a visit to service location immediately. They will ensure that the individual is protected.
3. The individual will be encouraged to not attend day programming until recommendations have been completed. If the individual chooses to continue attending the day programming, the Open Door Program team will develop a written plan to ensure their safety including providing alternate transportation or staffing necessary to protect the health and welfare of the individual.
4. The MUI department will conduct an investigation of ensuring health and welfare of the individual. The Risk Management Director will receive notification from the MUI unit of findings and recommendations and ensure health and welfare of individual during and after investigation. The Risk Management Director will inform the team of recommendations for follow up.
5. The Open Door team is responsible to ensure that the follow-up recommendations including measures to secure training, alternate schedules, or transportation are completed.

Last Revised: 5/20/22