Problem solving flowchart upon discovery of an incide­nt/­all­ega­tion:
1. Immedi­ately treat ill effects to resident.
2. Determine if a report should be made… if yes you MUST report immedi­ately to the State Agency.
3. Protect resident against further occurr­ences.
4. Institute other interv­entions as needed.
5. Begin invest­igation upon discovery of the incident.
6. Gather facts to answer who, what, when, where, how, and why.
7. Analyze inform­ation to rule out or establish the likelihood that abuse, neglect, financial exploi­tation has occurred, or may have contri­buted to the incident.
Record:
(1) The details of the incident in the resident’s medical record(s); and
(2) The details of the invest­igation according to the requir­ements and facility protocol.

Look for compliance with F323 Accidents and Superv­ision, F223 Abuse, F279 Compre­hensive Care Plans, F281 Meet Profes­sional Standards, and F309 Quality of Care. A copy of S&C 11-30-NH is available at http:/­/ww­w.c­ms.g­ov­/Me­dic­are­/Pr­ovi­der­-En­rol­lme­nt-­and­-Ce­rti­fic­ati­on/­Sur­vey­Cer­tif­ica­tio­nGe­nIn­fo/­dow­nlo­ads­/sc­let­ter­11_­30.pdf

Two different incident types (A& B) that will not need to be reported. You know what happened, the incident is directly related to diagnosis and predic­table, the resident is able to explain what happened, an ACCIDENT occurred. If in doubt, call your regional office.

A: Substa­ntial injury seems reasonably related to:
resident’s condition, known & predic­table intera­ctions with surrou­ndings, diagnoses, etc. OR a known sequence of prior events**

B. There was an unexpe­cted, unusual, unintended event (an accident) which could not have been predicted, given prevailing circum­sta­nces.

C: You have reasonable cause. The incident is suspected abuse, neglect, exploi­tation, or misapp­rop­ria­tion. You need to immedi­ately take action. This must be reported to the Abuse Hotline immedi­ately and to Local Law Enforc­ement within 2 HOURS of SUSPIC­ION.
For example:
(1) a resident tells you another resident hit them or sexually abused them; or
(2) a family member or visitor hit them or sexually abused them; or
(3) a staff member hit them or sexually abused them;
(4) that someone is taking advantage of them financ­ially or
(5) money/­pro­perty has been stolen or misapp­rop­riated.
(6) visual physical abuse. In addition, an injury of unknown origin that is suspicious in nature i.e., excessive or large bruising, skin tear(s), or broken bones would require immediate reporting to the State Agency (hotline) and Local Law Enforc­ement.

D: Cause cannot be Determ­ined. You are unable to determine how the incident occurred. Report Immedi­ate­ly!
E: Gather Additional Facts.** Continue with your invest­igation and analyze the facts for abuse/­neg­lec­t/m­isa­ppr­opr­iation.
F: Cause cannot be determ­ined. For substa­ntial injury, REPORT incident to State Agency (hotline). If you are SUSPICIOUS a crime has occurred you must also report within 2 HOURS of Suspic­ion to Local Law Enforc­eme­nt.