Significant Member Incidents
A Significant Member Incident (SMI) or sentinel event is an unexpected and undesirable outcome that has an adverse impact on the outcome of a member’s care. SMIs include critical events, provider-member centered incidents and medical incidents.
- Providers may use their own internal incident form for reporting or Community Care will provide one upon request.
- Every network provider is required to report the types of incidents Community Care considers reportable.
- Incidents must be reported to Community Care within 24 hours* of the incident occurring or within 24 hours* of the provider learning of the incident.
*This is a new reporting time frame.
Providers may report Significant Member Incidents the following ways:
- Calling the Community Care Provider Line at 1-888-251-2224.
- Calling your individual Care Manager at Community Care.
- Faxing the incident form to Community Care’s Quality Management Department.
For your convenience Community Care office fax numbers are listed below.
| Allegheny |
1-888-251-0087 |
Capital
(Adams, Berks and York Counties) |
1-866-418-0366 |
| Carbon/Monroe/Pike |
1-866-901-8367 |
| Chester |
1-888-589-6559 |
| North Central |
DuBois
(Cameron, Clarion, Clearfield, Elk, Forest Jefferson, McKean, Potter and Warren Counties) |
1-866-294-1142 |
Moosic
(Bradford, Columbia, Montour, Northumberland, Schuylkill, Snyder, Sullivan,
Tioga, Union and Wayne Counties) |
1-866-558-2618 |
State College
(Centre, Huntingdon, Juniata and Mifflin Counties) |
1-866-294-4134 |
Northeast
(Lackawanna, Luzerne, Susquehanna and Wyoming Counties) |
1-866-284-9184 |
The following includes types of incidents defined by Community Care as reportable. Please note this is not an exhaustive list.
Critical Incidents
RTF to Inpatient
Any voluntary or involuntary admission to an inpatient psychiatric unit from a Residential Treatment Facility.
Death
- Natural causes
- Apparent accident
- Apparent suicide
- Cause not clear
Potentially lethal suicide attempt
The intentional and voluntary attempt to take one’s own life. A suicide attempt is limited to the actual occurrence of an attempt which requires medical treatment and/or where the member suffers or could have suffered significant injury or death.
Examples of non-reportable potentially lethal suicide attempt events include:
- Threats of suicide, which do not result in an actual attempt
- Gestures, which clearly do not place the member at risk for
serious injury or death
- Actions which may place the member at risk but where the
member is not attempting harm to himself/herself
Apparent homicide by member
The killing of another person by a member.
Apparent serious physical/sexual assault by member
The occurrence of the infliction of injury, unreasonable confinement, intimidation, punishment, mental anguish, or sexual abuse by a member towards another person.
Life threatening injury or illness while on provider site requiring hospitalization
Agencies that are responsible for 24 hour per day service must report incidents that may occur off-site when they are made aware of such incidents or when it becomes that agency’s responsibility for follow up care.
An example of a non-reportable injury/illness while on provider site requiring hospitalization events includes:
- Scheduled treatment of medical conditions, on an outpatient or inpatient basis
Sexual/physical abuse allegation by member against provider
A member alleging the occurrence of the infliction of injury, unreasonable confinement, intimidation, punishment, mental anguish, or sexual abuse by the provider.
Sexual abuse is defined as a member alleging an act or attempted acts such as rape, sexual molestation, sexual harassment, and inappropriate or unwanted touching of a sexual nature by a staff person; any sexual contact between a staff person and a member is abuse.
Physical abuse is defined as a member alleging a physical act by staff that causes or may cause physical injury to a member.
ChildLine and the police must be contacted in these instances.
Sexual/physical assault/neglect incurred by member
The occurrence of the infliction of injury, unreasonable confinement, intimidation, punishment, mental anguish, or sexual abuse.
Neglect is defined as the failure to obtain or provide the needed services and supports defined as necessary or otherwise required by law, contract, or regulation. This can include the failure to provide for needed care such as shelter, food, clothing, personal hygiene, medical care, and protection from health and safety hazards.
ChildLine and the police must be contacted in these instances.
Examples of non-reportable neglect events include:
- Discord, arguments, or emotional distress resulting from normal activities and disagreements that can be found in typical congregate living situations
Serious/potentially serious fire while in any level of care
Any fire requiring the emergency services of the fire department. Examples of non-reportable serious/potentially serious fire events include:
- Routine services by the fire department
- Testing of alarm systems
Arrest
An event requiring the services of a law enforcement agency in which the member is charged with a crime.
Police involvement (no arrest)
An event requiring the services of a law enforcement agency in which the member is not charged with a crime; police involvement for interviewing purposes (i.e. as a victim of crime or as a witness in an investigation); police involvement in returning a member in an “Absence Without Leave” (AWOL) situation.
Examples of non-reportable police involvement (no arrest) events include:
- 911 calls made by members that are unrelated to criminal activity or emergencies
- Presence of law enforcement personnel during any activity governed by the Mental Health Procedures Act, such as a Commitment Procedure
RTF/Consensual sexual contact between peers
Intimate sexual contact between peers. All incidences must be called into ChildLine.
Juvenile Detention Placement
Any placement of a member in a Juvenile Detention Center.
Provider-Member Centered Incidents
Elopement from facility
- Adults - A member who is out of contact with staff without prior arrangement or who may be considered to be in “immediate jeopardy” based on his/her personal history; any time the police are contacted about a missing person or the police independently find and return the member regardless of the time he or she was missing. Any elopement of a member while on therapeutic leave/pass that the provider is made aware of should be reported.
- Children/adolescents– A member who is absent from the premises without the approval of staff or a member who is out of contact with staff without prior arrangement who may be considered to be in “immediate jeopardy” based on his/her personal history; any time the police are contacted about a missing person or the police independently find and return the member regardless of the time he or she was missing. Any elopement of a member while on therapeutic leave/pass that the provider is made aware of should be reported.
Staff assault
A violent physical attack by a member on a staff person.
Failure to follow mandated ChildLine reporting requirements
Violation of confidentiality
Failure to comply with the rules regarding confidential information related to a member.
Medical Incidents
Serious/adverse effect of medication requiring medical intervention
A missed medication, incorrect medication, or incorrect dosage where a member suffers an adverse consequence that is either short or long-term in duration or receives treatment to offset the effects of the error.
An example of a non-reportable serious/adverse effect of medication events includes:
- Refusal by the member to take prescribed medication
Member injury due to restraint/seclusion
Any injury incurred by a member due to restraint/seclusion/physical intervention.
Injury/illness while on provider site requiring medical attention
Agencies that are responsible for 24 hour per day service must report incidents that may occur off-site when they are made aware of such incidents or when it becomes that agency’s responsibility for follow up care.
An example of a non-reportable injury/illness while on provider site events includes:
- Scheduled treatment of medical conditions, on an outpatient or inpatient basis
Self Injuring Behavior requiring medical attention
A self-inflicted injury where the member requires medical attention.
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