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Iris incident response improvement system training october 9 2013

IRIS- Incident Response Improvement System Training

October 9, 2013

Presented by: Ashley Armstrong

Contact Information for Questions:

What is iris

What is IRIS?

The DHHS IRIS is a web based incident reporting system for reporting and documenting Level II and III incidents that involve consumers who receive MH/DD/SA funds

Who must submit incident reports
Who must submit Incident Reports?

Providers of publicly funded services licensed under NC General Statutes 122C, except hospitals, (Category A providers) and providers of publicly funded non-licensed periodic or community-based MH/DD/SA services (Category B providers).

Lme mco role in iris

  • Verify incidents and review the 72 hour listing with providers daily.

  • Review for any Safety Concerns and request Safety Plan, if needed

  • Review for data completeness and request any additional information needed

  • Review to assure all appropriate guardian/ agencies have been notified- refer if needed

  • Discuss additional information/ reports needed such as police reports, Medical examiner reports, hospital discharge, etc.

  • Send incident number to providers

  • Assess (or refer to applicable team within LME/MCO) if Provider Monitoring is needed

  • Review Quarterly Provider Report for any concerns or need for Provider Monitoring

  • Contact DMH/DD/SAS within 24 hours (business days) on Level IIIs – unless any media involvement

  • If incident is reported or likely to be reported in media, contact DMH/DD/SAS as soon as possible- on the same day.

  • Review provider handling to ensure safety of consumers, certified copy of record and provider’s review committee convened.

  • Monitor and provide technical assistance as warranted to ensure that problems are

  • corrected.

  • Analyze and respond to patterns of incidents as part of review of QI monitoring processes

  • Review of monthly Unknown Death Report

Dmh dd sas role in iris

  • Weekly contact with LME/MCO for follow-up on reports

  • Review of monthly Unknown Death Report

  • Review to assure all appropriate guardian/ agencies have been notified- refer if needed

  • Inform all appropriate DMH/DD/SAS staff

  • Discuss/ provide technical assistance to LMEs/ MCOs with plans or strategies for complex cases

  • Analyze and respond to statewide patterns of incidents as part of review of QI monitoring and LME/MCO oversight of response processes

What is an incident
What is an Incident?

  • An incident is “any happening which is not consistent with the routine care of a consumer and that is likely to lead to adverse effects upon a consumer” as defined in 10A NCAC 27G .0103(b)(32).

  • There are 3 levels of response to incidents, based on the potential or active severity of the event. Levels are Level I, Level II, & Level III.


  • All incident reports are confidential quality assurance documents.

  • Do not file incident reports in the individual’s service record.

  • Use this form according to confidentiality requirements in NC General Statutes and

    Administrative Code and in the Code of Federal Regulations.

Reporting guidelines
Reporting Guidelines

Documentation of All Incidents –

  • All incidents should be documented and analyzed as part of agencies QA/QI process.

  • Complete all required sections for level II & III incidents

  • Give as much information that is known.

Reporting guidelines continued
Reporting Guidelines (continued)

  • Level I incidents are documented on agency’s internal forms. Level I incidents are not submitted in IRIS.

  • Level II & III incidents must be submitted in IRIS.

  • NEVER file incidents reports in individual’s service record.

Under provider care
Under Provider Care

  • “a consumer under the care of a provider” refers to a consumer who has received any service in the 90 days prior to the incident.

  • Individuals who receive Residential or ACTT services are considered under the provider’s care 24 hours a day.

  • Individuals receiving day services or periodic services are considered under the provider’s care while a staff person is providing services or if the consumer received any services from the provider in the 90 days prior to the incident.

Under provider care continued
Under Provider Care (continued)

  • Providers of crisis, day, and periodic services should report all deaths and errors in self-administration of medication upon learning of the incident, even if it did not happen while under the provider’s care.

  • For additional Information, please refer to Implementation Update # 55.

What staff submits
What staff submits?

The staff person most knowledgeable about the incident should complete the information on the report as soon as possible after learning of the incident.

The staff person should obtain the incident number and notify their supervisor to complete the supervisor section of the report.

Timeframe for submission

Level II Reports

IRIS report must be appropriately submitted within with in 72 hours

Level III Reports

Verbal report immediately to Eastpointe Monitoring

IRIS report must be appropriately submitted within with in 72 hours

IRIS report must be submitted within 72 hours to DMH/DD/SAS

Timeframe for Submission

What if iris is unavailable
What if IRIS is unavailable?

Any time IRIS is unavailable for use, providers must still meet the required timeframe for submission of an incident.

Reports may be faxed to Eastpointe at 910-298-7165.

Provider must enter into IRIS as soon as possible after IRIS back available.

This is the only time paper reports will be accepted.

IRIS replaced the DHHS Incident and Death Report (DMH/DD/SAS form QM02)

Don t forget to
Don’t Forget to:

Print a copy for your records and maintain the incident report number.

Providers are required to complete mandatory items based on the type of incident that occurred. Mandatory items are indicated by red stars beside the item. If you can answer questions without stars, please provide this information.

It is essential to save information at the end of each information tab. It may take several seconds before data saves. Click on each Save icon only 1 time.

Incident report number
Incident Report Number

IRIS provides an Incident Report number for each report in two ways:

1. Save the entire report after completing Provider Incident Information, Incident Information, Consumer Services and Consumer Treatment section. Click “Finish” and the incident number appears on the screen.

Incident report number continued
Incident Report Number (continued)

2. Once you have completed the entire report, to include Supervisor Actions Tab.

Important facts about incident number
Important Facts about Incident Number

Print a copy of the incident number for your record.

There is only 1 number for each incident report.

The Incident Number will not contain the letter “O”. All letters are lower case.

Any “0” will be a numerical zero.

Comment sections
Comment Sections

Comment boxes are located on many tabs for the user to provide brief, specific information on a topic.

Enter incident comments
Enter Incident Comments

To enter specific comments, click on the pencil and paper icon.

Type your information and use spell check

Click “Save”

After you save the information, the paper and pencil will change to a check mark

To report an incident
To Report An Incident

Choices include:

Enter a new incident: Click to enter a new Level II or III incident.

View/Edit: For an existing report, enter the Incident Number and Consumer’s last name.

Please note: If you do not print the Incident Number, please call Eastpointe Provider Monitoring Department to request the number be sent to you.

Provider information tab
Provider Information Tab

Enter Corporation Name

Name and Title of Person completing form

Local facility/Unit/Group Home

Physical Address

Mailing Address, City, Zip Code

Phone Number

Fax Number

Email Address – If the provider agency does not have an email address, provider will need to determine the email address to which the agency will get information regarding the incident. Please make sure the email address is accurate.

Provider information tab continued
Provider Information Tab (continued)


County where services are provided/Host LME: Where the consumer receives services

County of Residence/Home LME: The county in which the consumer legally resides.

IRIS will notify the Host and Home LME of the Incident Report.

Incident information
Incident Information

There are 2 tabs that have to be completed in this section

A. Date and Location Tab

If there is an allegation against the facility, check YES. The supervisor will have to complete the HCPR Facility Allegation section of the incident report.

B. Services Type Provided Tab

Consumer information treatment
Consumer Information/Treatment

There are 2 tabs that have to be completed in this section

A. Consumer Information Tab

B. Consumer Information-Treatment Tab

Consumer information tab
Consumer Information Tab

Consumer Name

Address Where Incident Occurred

LME Client Record Number – If there is not a LME number, use your provider identification number.

Consumer Date of Birth, Gender, Height, and Weight

Date of Last 2 Medical Exams

Diagnosis – select up to 5 different diagnosis, starting with the primary diagnosis. Include ALL as applicable.

This helps to aid oversight staff in determining the appropriate response needed.

Consumer information tab continued
Consumer Information Tab (continued)

Medications: Click on the pencil icon to enter. Include Name, Dosage, Frequency of the medication and the reason the consumer is taking the medication.

Adjudicated incompetent?

TBI recipient?

Receives CAP-MR/DD funding?

MFP program?

Receive ICF-MR/DD?

Consumer information treatment tab
Consumer Information-Treatment Tab

Did this incident result in or is it likely to result in permanent physical or psychological impairment? If reporting a death, select “No”.

Has this incident resulted in or is it likely to result in a danger to or concern to the community or a report in a newspaper, television or other media?

Consumer information treatment tab continued
Consumer Information-Treatment Tab (continued)

Was the consumer treated by a licensed health care professional for the incident?

Do not include visits to a hospital ER if the person received no treatment. Refer to the definition of more than just First Aid found in the Incident Response Manual.

If hospitalized, was it for a medical condition? Was if for a MH/DD/SA issue?

Opioid – Questions relate only for consumers receiving Opioid Treatment.

Consumer information services tab
Consumer Information/Services Tab

There are 6 tabs in this section:

MH/DD and/or SA Tab (3 separate tabs)

Hospital Discharge Tab

Last Appointment Tab

Associated Incidents Tab

Type of incident1
Type of Incident

Choose which type you are reporting

Choices are:


Restrictive Intervention


Medication Error

Allegation of Abuse, Neglect, or Exploitation

Consumer Behavior

Suspension, Expulsion



You must have at least 1 type of incident

You must include pertinent details in the “Incident Comment Tab” relevant to the incident.

Death tab
Death Tab

Manner of Death

Choose one:

Terminal Illness/Natural Cause



Suicide – indicate method from drop down box


Consumer deaths
Consumer Deaths

Report ALL consumer deaths whenever you become aware, even if it did not occur while the individual was under your care.

Cause of Death by Natural Cause or Terminal Illness should be documented by a physician, Medical Examiner or Death Certificate.

Level iii deaths
Level III Deaths

Will include:




Unknown Cause of Death

Requirements of All Level III Deaths are to obtain a copy of the Medical Examiner’s (ME) report and/or autopsy report.

This is in accordance with 10A NCAC 26C .0303 (f) (3).

Iris incident response improvement system training october 9 2013

NOTE:The web address for requesting a free copy of ME report is: sure to complete all information on the request and request all 3 documents.

Iris incident response improvement system training october 9 2013

NC OCME Document Request (only for NC Deaths Since 1975)We are accepting on-line document requests, but cannot currently return all documents in an electronic format. Therefore, we must have a US mail address. Please also provide an email address in case we need to contact you about your request. If you do not have an email address, call us at (919) 445-4410 to request a document.

Your Name and Address

  First              Last

Name *                   * Required

Agency /Address Line 1 *

Address Line 2

City *   State *    Zip *


Email Address

If you provide an email address, it ill be used for all of the documents that we can currently send electronically. You may need to add to your address book to allow the documents to get past your spam filter.

The Decedent

Name of Decedent*  

County of Death*  

Date of Death*  

Documents Requested *

Investigative Report

Autopsy Report (May not exist on every case)

Toxicology Report


Consumer death
Consumer Death

Providers must update the incident report, even if the level does not change.

Updated information should be entered in IRIS, documenting the reason for Re-Submission (in Supervisor Action Tab).

Attach copies of reports, Death Certificate and/or other documents.

Level iii process

Level III Process

For Level III incidents that did not occur while the consumer was receiving a service or was on the provider’s premises, the responsible LME’s may continue to request detailed information regarding services if this information is not already provided in the incident report. (See Attachment B: Suggested Questions for Level III


Manner of death tab
Manner of Death Tab

If manner of death is unknown, check “unknown cause”. Once the death is verified via ME report and/or death certificate, the cause of death has to be updated and the report re-submitted.

Restrictive intervention
Restrictive Intervention

  • Report any restrictive intervention when:

    • Use of unplanned, emergency situation.

    • Planned, but administered improperly or without proper authorization, staff use without proper training, or for longer than the authorized time.

    • Planned, but resulting in discomfort, complaint, death or injury requiring treatment by a licensed health care professional.

Restrictive intervention there are 9 tabs in this section if iris requires based on your responses

General 1 Tab

General 2 Tab

Status Check Tab

Staff Involved in Restrictive Intervention

Debriefing Tab

Person Centered Planning 1 Tab

Person Centered Planning 2 Tab

Person Centered Planning 3 Tab

Follow-up Plans Tab

Restrictive InterventionThere are 9 Tabs in this section if IRIS requires based on your responses.


There are 3 Tabs in this section

Must complete for injuries when the injury requires more than First Aid treatment.

The definition of First Aid is listed in the Incident Response and Reporting Manual February 2011, Appendix XI (page 29).

3 Tabs include:

Injury Description Tab

Injured Body Parts Tab

Injury Due to Tab


Medication error
Medication Error

  • Report all medication errors.

  • In cases of medication errors, the consumer’s physician or pharmacist should be notified immediately of any error, as required by 10A NCAC 27G. 0209(h).

  • If the physician or pharmacist does not believe the error is a threat of health or safety, document the error as a level I.

Level i medication error
Level I Medication Error

  • Level I documentation should indicate the following:

    • The type of error,

    • Name of the physician or pharmacist consulted,

    • The statement made by the physician or pharmacist about the error,

    • Date and time of the contact, and

    • Name of the person making the contact.

Level ii medication error
Level II Medication Error

  • If the physician or pharmacist does believe the error is a threat of health or safety, document the error as a level II or III.

  • Ensure medical attention is provided as necessary and recommended.

  • If after the medication error the consumer shows any side effects or distress, seek immediate medical attention.

  • Report all Level II and III errors in self administration of medications within 72 hours of learning of the incident, even if it did not happen while actively engaged in providing services.

Medication errors report the following

Missed dose

Wrong dosage

Dose preparation error

Wrong time

Wrong Administrative technique

Dose given to wrong consumer

Wrong medication

Loss or spillage



Medication ErrorsReport the following:

Alleged abuse neglect or exploitation
Alleged Abuse, Neglect or Exploitation

  • Complete this section for any allegation or suspicion that a consumer has been abused, neglected or exploited.

  • Report all suspected or alleged cases of abuse, neglect or exploitation of a child or disabled adult to DSS pursuant to GS 108A Article 6, GS 7B Article 3 and 10A NCAC 27G .0610

  • IRIS reports must be submitted.

  • IRIS does not submit reports to DSS. The provider is responsible for contacting DSS to make the report.

Reports made to dss
Reports made to DSS

  • Always ask DSS to follow up with provider agency in writing of the status of the report and findings of the report is accepted

  • Attach DSS letter(s) in IRIS

Allegations against staff
Allegations against staff

  • Reports must be sent to DHSR Health Care Personnel Registry regarding an allegation against an unlicensed staff in a licensed or unlicensed facility should be submitted within 24 hours or the agency becoming aware of the incident.

  • If the allegation is against a staff, the Supervisor must complete the HCPR Facility Allegation section of the Incident Report.

Consumer behavior
Consumer Behavior

  • Types of consumer behavior:

    • Any sexual, aggressive or destructive behavior that involves a report to law enforcement, a complaint to an oversight agency, including LME, DSS, DHSR or DMH/DD/SAS

    • A potentially serious threat to the health or safety of self or others

Consumer behavior continued
Consumer Behavior (continued)

  • Report to the LME any acts that are reported to law enforcements for:

    • Incidents occurring while actively engaged in providing services

    • Incidents related to individual’s treatment

    • When you learn of legal involvement of the individual

Consumer behavior continued1
Consumer Behavior (continued)

  • Consumer Absence

    • Any absence over the time specified in the PCP

    • Any absence that may or may not require police contact

    • If an Amber or Silver Alert is issued, report as a Level III. Alert appropriate agencies ASAP

Suspension or expulsion
Suspension or Expulsion

  • When a consumer is suspended or expelled from services

  • Indicate the length of the suspension

Fire information
Fire Information

Report as Level II or Level III when:

  • there is any injury,

  • Consumer faces a threat to health or safety, or

  • Fire has an impact on public confidence

Authorities contacted
Authorities Contacted

  • Check the box beside any individuals or agencies that you have notified of the incident, such as DSS, Law Enforcement, Parent Guardian, etc.

  • Include the Contact Name, Phone Number and Date of Notification

Provider incident comments
Provider Incident Comments

  • These comments are public comments for IRIS users ONLY

  • Comment Title – for example, Provider Detail of Incident

  • Text – Include all information you want to document about the incident. Be very clear and concise. Paint a picture of what happened with the incident.

  • Check Spelling

  • Save by clicking “Save” button

Supervisor actions there are 4 tabs in this section
Supervisor ActionsThere are 4 Tabs in this section

  • Level of Incident Tab

  • Cause of Incident Tab

  • Incident Prevention Tab

  • Incident Submission Tab

Level of incident
Level of Incident

  • IRIS will determine the level based on the information entered. This screen will automatically show the level of II or III.

Cause of incident tab
Cause of Incident Tab

  • Describe what steps you have taken to determine why the incident occurred and what you have discovered.

  • Describe why the incident occurred – not what happened. That should have been described in the Provider Comment Section.

Incident prevention tab
Incident Prevention Tab

  • Provide a short description of actions that you have taken or plan to take to prevent future incidents of a similar nature.

  • Don’t just refer to “Agency Policy and Procedure”.

Incident submission tab
Incident Submission Tab

  • Upon submission, IRIS will notify Host/Home LME, DMH/DD/SAS will be notified of Level III incidents.

  • IRIS will notify Division of Health Service Regulation (DHSR) of any level III deaths that occur in a 122C licensed facility.

  • IRIS will notify DHSR Health Care Personnel Registry (HCPR) of any level II or III allegation of abuse, neglect, or exploitation against an unlicensed staff member.

Incident submission tab continued
Incident Submission Tab (continued)

  • Name, Title, Phone Number and email address of Supervisor. This needs to include the working title, not degrees and/or licenses

  • IRIS Agency Notification – Iris will provide a listing of agencies notified based on the details provided.

  • Resubmission of Incident – When resubmitting the report, enter explanation.

  • Attestation – By checking the box, you are affirming the information is true and an accurate account of the incident.

  • Do not click on Submit Incident box a second time…be patient.

Attached documents
Attached Documents

  • Attach documents that have been uploaded from a computer into IRIS

  • Examples may include Medical Examiners Report, Death Certificate, DSS Letters, etc.

When attaching
When Attaching

  • Follow All HIPPAA and Confidentiality Rules

  • Choose a Title

  • Click Browse and open the document you want to attach. This will place the name of the file into the Locate Attachment box

  • Click “Add Attachment(s)” and the documents will be added to the report under “Attach Documents” box

To view attachment
To View Attachment

  • Click on Attach Documents Menu Button

  • In the list of documents click on the title and click “Select”

  • Click on “Display Attachment”

Printing incident
Printing Incident

  • Check items that you would like to print.

  • You may “Select All”

  • To print, click on the printer icon

An error occurred in iris
An error occurred in IRIS

  • What do I do?

    Copy the error message that you receive

    Paste it in an email

    Send to

Quarterly reports
Quarterly Reports

  • Form must be submitted by the 10th of the month following the end of the quarter

  • Providers required to submit aggregate data on Level I incidents quarterly that involve:

    • Restrictive Interventions

    • Medication Errors

    • Search and Seizure

What where to report
What/Where to report

  • Report to host LME

  • Total number of incidents

  • Unduplicated count of consumers involved

  • Highest number of incident for any one consumer

  • Brief narrative summarizing patterns or trends (should be documented thru QA/QI process)

  • Brief narrative summary of QA/QI efforts to address improvements identified.

Reporting requirements
Reporting Requirements

  • Agencies are required to submit per Rule Requirement (10A NCAC 27G .0604)

  • Tied to monitoring of agency

Submitting quarterly reports
Submitting Quarterly Reports

  • Submit Quarterly Report through the Forms Desk at

    Or by visiting Eastpointe website at click on “For Provider Community”, “Web Submission Form” and “Quarterly Incident Report (QM11)

Other ways to submit
Other ways to submit

  • Quarterly Incident Reports may also be faxed to 910-298-7165 Attention - Susan Bryan

  • mail to: Eastpointe

    500 Nash Medical Arts Mall Attention Provider Monitoring

    Rocky Mount, NC 27804 or emailed to

Back up staffing nc innovations waiver
Back-Up Staffing (NC Innovations Waiver)

  • To meet the needs of the participant to ensure health and safety

  • Failure to provide back-up staff is considered a Level I Incident per the NC Innovations Waiver

  • The incident report is completed even if the participant/family declines the back-up staff offered

Back up staffing nc innovations waiver continued
Back-Up Staffing (NC Innovations Waiver) (Continued)

  • Level I form can be located in the NC Innovations Waiver Manual (Appendix S)

  • Incident report includes:

    • Description of Incident

    • How the pariticpant was affected

    • How time was covered

    • Follow up Provided

Back up staffing nc innovations waiver continued1
Back-Up Staffing (NC Innovations Waiver) (Continued)

  • Follow-up provided should be accompanied by documentation that supports intervention and its effectiveness

  • Follow-up documentation should be submitted with the incident report

Back up staffing nc innovations waiver continued2
Back-Up Staffing (NC Innovations Waiver) (Continued)

  • The Level I report must be submitted within 72 hours

  • Reports can be faxed to 910-298-7165

  • Back-Up Staffing Incident Reports are not to be included in the Quarterly Incident Report Summary.

Helpful websites
Helpful Websites

IRIS Website:

IRIS Practice Site

IRIS Manual

Helpful websites continued
Helpful Websites (continued)

Incident Response Manual

Quarterly Incident Report

Helpful websites continued1
Helpful Websites (continued)

  • Medical Examiner’s Report, Autopsy Report or Toxicology Reports can be obtained at:

  • Restrictive Interventions

Helpful questions document
Helpful Questions Document

  • MH/DD/SAS website has generated a FAQ document that may be helpful with questions

  • One frequently asked question is, do providers have to have a user ID and password? The answer is No.

Iris incident response improvement system training october 9 2013


All questions and comments will be posted and sent out on the Eastpointe listserv as a Q & A document.