Iowa Medicaid Critical Incident Report (Page 4 of 4) in pdf

Page 4

IOWA MEDICAID CRITICAL INCIDENT REPORT

Systemic Resolutions

(Please note: Completion of the Systemic Resolutions section is optional. If you chose to complete this section, please provide a brief

Systemic

summary with a detailed description of the changes and/or modifications made.)

Resolution

Policy - Reviewed

formal written policy or procedure governing the activity, and modified as needed. Staff are able to reference agency

guidelines or protocols.

Consistent implementation of policy – Reviewed, and modified as necessary, to assure that

verbal instructions are the same as

procedural requirements. Policies and procedures are up to date.

Adequate policy -

Policies and procedures are complete, meet regulatory requirements, and are consistent with established standards

and accepted practice expectations. Policies and procedures are clear and concise.

Communication and awareness -

There is adequate communication re: new policy requirements. Staff and others are aware of

changes or revisions to policy or procedure.

Employee screening -

There were adequate policy requirements for screening employees. Individuals with established histories of

behavior that could compromise member safety/care – including abuse and neglect – are not working with members.

Training -

There are adequate policy requirements for training. Staff are required by policy to meet any minimum training

requirements or demonstrate competencies.

Fiscal control -

There are adequate and consistent policy requirements for the management and control of member funds.

Assessment -

There are adequate policy requirements for proper assessment of member health, behavioral, and other critical support

needs and preferences.

Planning -

There are adequate policy requirements for proper member planning and revision of supports based on changing needs.

Monitoring -

There are adequate policy requirements for monitoring services and supports to assure safety, meeting critical needs, and

providing services in accordance with member plans and agency requirements.

Documentation -

There are adequate policy requirements for member records – including privacy – and documentation.

Other, describe _______________________________________________________________________________

Resolution of systemic factor(s). Describe specifically how these reviews and/or assurances will prevent or diminish the probability of

future occurrence(s). _____________________________________________________________________________________________

No resolution required. Describe how this adverse incident was isolated with a minimal probability of a reoccurrence.

_______________________________________________________________________________________________________________

Detailed description:

470-4698 (Rev 5/10)

(MAIL) Provider Correspondence, PO Box 36450, Des Moines, IA 50315 (FAX) 515-725-1360

Iowa Medicaid Critical Incident Report Page 4

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