We appreciate OHR’s efforts to reduce the administrative burden on providers, as well as the recognition that there is room to consider alternative approaches in the area of peer-on-peer aggression in light of the data presented regarding the low base rates of situations where these result in founded allegations of neglect. We further recognize and respect that it may be difficult to strike a balance when changing a long-standardized, yet nuanced, process.
First, we recommend the addition of several definitions and clarification of others. Specifically:
“Allegation” – use this term uniformly throughout the guidance document, vs. using complaint and allegation interchangeably.
“Internal Review” – define, including information about scope and differentiation between internal review and investigation.
"Neglect" - this definition should include “directly impacts health/safety of individual” or “results or could result in significant harm to individual”. We encourage efforts to align with definitions of neglect set forth by other entities with which providers interact, such as Adult Protective Services, Child Protective Services, the Department of Health Professions, and Managed Care Organizations. The current OHR definition is more aligned with concepts of negligence or quality of care than neglect.
“Peer-on-peer aggression” - elaborate/clarify ‘demeaning expression’. How is ‘emotional harm’ determined? Also include examples of non-physical harm that could lead to emotional harm. Often, results of events in this area result in harm based on accumulation and are evident much later. We recommend moving relevant information about physical and emotional harm from the second to last paragraph to the Defined Terms section.
“Provider” - means any person, entity, or organization offering services licensed, funded, or operated by the Department.
“Quality of Care Incident” - any incident that calls into question the competence or professional conduct of a healthcare provider in the course of providing medical services and has adversely affected, or could adversely affect, the health or welfare of a member. These are incidents of a less critical nature than those defined as sentinel events. (This definition aligns with that used by multiple Managed Care Organizations.)
“Serious injury” - means any injury resulting in bodily hurt, damage, harm, or loss that requires medical attention by anyone above RN (to be consistent with definition in the Licensing regulations).
“Untoward event” - unpredictable event that was not preventable.
We recommend a delineation of an Internal Review, particularly in light of previous education that such screenings were inappropriate. Operationalization of this might include specification of a timeframe allotted for this, (e.g., 3 business days), and delineation between obtaining clarifying information and engaging in investigative techniques, (e.g., conducting formal interviews with witnesses, obtaining witness statements, and review of policy and procedure documents). This may help prevent providers from conducting full, but brief, investigations and the resultant outcome of reporting only founded cases into the CHRIS system.
The Date of Discovery must be based on the date the Internal Review determines an allegation is indicated (vs. the event being an untoward event or quality of care incident) to ensure reports requiring entry into CHRIS are not flagged as late.
Consistent language distinguishing between an internal review and an investigation is necessary. Therefore, avoid use of the more confusing term “internal investigation.” In the context of this guidance document, it is understood that a situation warranting an investigation is one conducted by the provider (i.e., is internal). Similarly, change “substantiated complaints” to “substantiated violations”, so language is consistent.
It is inappropriate to enter the name of a staff member merely alleged (Accused) to be involved in a situation of this or any type into CHRIS. Doing so potentially skews the focus of an investigation to look only at that named staff member, instead of allowing all data to be gathered before a final determination is made. In addition, this compounds the fears of staff members, many of whom are already concerned about any entry of their name into the CHRIS system, inherently tainting the investigation process and staff member’s ability to trust that the person conducting the investigation is truly impartial.
In the section referencing incidents that may be a crime or require reporting to another entity, include:
We are grateful for the efforts to clarify expectations regarding reporting responsibilities and hope additional, similar, data driven guidance regarding medication errors will be forthcoming.