V. Manual Restraint is Not Allowed in Emergencies

   A. Zing HHC does not allow the emergency use of manual restraint. The following alternative measures must be used by          staff to achieve safety when a person’s conduct poses an imminent risk of physical harm to self or others and less                restrictive strategies have not achieved safety:

                         As an alternative to manual restraint Zing HHC staff may use the following:

                           • Continue to follow individualized strategies in a person’s Support Plan Support Plan;

                           • Continue to utilize the positive support strategies listed above;

                           • Ask the person and/or others if they would like to move to another area where they may feel safer or                                     calmer;

                           • Remove objects from the person’s immediate environment that they may use to harm self or others;

                           • Use an object such as a cushion to block the person’s blows if they are trying to be aggressive towards                                   you;

                           • Call 911 for law enforcement assistance if the alternative measures listed above are ineffective in order to                               achieve safety for the person and/or others. While waiting for law enforcement to arrive staff will                                           continue to offer the alternative measures listed above if doing so does not pose a risk of harm to the                                     person and/or others.

 

  B. Zing HHC will not allow the use of an alternative safety procedure with a person when it has been determined by the          person’s physician or mental health provider to be medically or psychologically contraindicated for a person. This                program will complete an assessment of whether the allowed procedures are contraindicated for each person receiving        services as part of the required service planning required under the 245D Home and Community-based Services                  (HCBS) Standards (section 245D.07, subdivision 2, for recipients of basic support services.

 

Zing HHC does not allow the use of manual restraint in an emergency. If the positive support strategies were not erective in de-escalating or eliminating the person’s behavior, staff will contact “911” for assistance.

 

 VI. Reporting Emergency Use of Manual Restraint

 

 A. While it is the policy of Zing HHC to not allow the emergency use of manual restraints, if a staff witnesses or suspects          an emergency use of manual restraint was used they should report the incident of the emergency use of manual                  restraint according to the following process.

 B. Within 24 hours of an emergency use of manual restraint, the legal representative and the case manager must receive          verbal notification of the occurrence as required under the incident response and reporting requirements in the 245D          HCBS Standards, section 245D.06, subdivision 1. When the emergency use of manual restraint involves more than              one person receiving services, the incident report made to the legal representative and the case manager must not                disclose personally identifiable information about any other person unless the program has the consent of the person.   C. Within 3 calendar days after an emergency use of a manual restraint, the staff person who implemented the                          emergency use must report in writing to the program’s designated coordinator the following information about the              emergency use:

      1. Who was involved in the incident leading up to the emergency use of a manual restraint; including the names of                    staff and persons receiving services who were involved?

      2. A description of the physical and social environment, including who was present before and during the incident                    leading up to the emergency use of a manual restraint;

      3. A description of what less restrictive alternative measures were attempted to de-escalate the incident and maintain              safety before the emergency use of a manual restraint was implement. This description must identify when, how,                 and how long the alternative measures were attempted before the manual restraint was implemented;

      4. A description of the mental, physical, and emotional condition of the person who was manually restrained, leading               up to, during, and following the manual restraint;

      5. A description of the mental, physical, and emotional condition of the other persons involved leading up to, during,                and following the manual restraint;

      6. Whether there was any injury to the person who was restrained before or as a result of the use of a manual                          restraint;

       7. Whether there was any injury to other persons, including staff, before or as a result of the use of a manual                             restraint; and

       8. Whether there was a debriefing with the staff and, if not contraindicated, with the person who was restrained and               other persons who were involved in or who witnessed the restraint, following the incident. Include the outcome of                 the debriefing. If the debriefing was not conducted at the time the incident report was made, the report should                       identify whether a debriefing is planned. 

 

  D. A copy of this report must be maintained in the person’s service recipient record. The record must be uniform and                 legible.

  E. Each single incident of emergency use of manual restraint must be reported separately. A single incident is when the            following conditions have been met:

        1. After implementing the manual restraint, staff attempt to release the person at the moment staff believe the                           person’s conduct no longer poses an imminent risk of physical harm to self or others and less restrictive strategies               can be implemented to maintain safety;

        2. Upon the attempt to release the restraint, the person’s behavior immediately re-escalates; and

        3. Staff must immediately re-implement the manual restraint in order to maintain safety.

 

VII. Internal Review of Emergency Use of Manual Restraint

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 A. Within 5 business days after the date of the emergency use of a manual restraint, Zing HHC must complete and                   document an internal review of the report prepared by the staff member who implemented the emergency procedure.

 B. The internal review must include an evaluation of whether:

        1. The person’s service and support strategies need to be revised;

        2. Related policies and procedures were followed;

        3. The policies and procedures were adequate;

        4. There is need for additional staff training;

        5. The reported event is similar to past events with the persons, staff, or the services involved; and

        6. There is a need for corrective action by the program to protect the health and safety of persons.

  C. Based on the results of the internal review, Zing HHC must develop, document, and implement a corrective action plan        for the program designed to correct current lapses and prevent future lapses in performance by individuals or the                      program.

  D. The corrective action plan, if any, must be implemented within 30 days of the internal review being completed.

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         1. Zing HHC has identified the following person or position responsible for conducting the internal review and for                     ensuring that corrective action is taken, when determined necessary: 245D Designated Manager can be reached at:              651-675-9673

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 VIII. Expanded Support Team Review of Emergency Use of Manual Restraint

 

A. Within 5 working days after the completion of the internal review, Zing HHC must consult with the expanded support           team to:

       1. Discuss the incident to:

             a. Define the antecedent or event that gave rise to the behavior resulting in the manual restraint; and

             b. Identify the perceived function the behavior served.

       2. Determine whether the person’s Support Plan Addendum needs to be revised to:

             a. Positively and effectively help the person maintain stability; and

             b. Reduce or eliminate future occurrences of manual restraint.

  B. Zing HHC must maintain a written summary of the expanded support team’s discussion and decisions in the person’s           service recipient record.

  C. Zing HHC has identified the following person or position responsible for conducting the expanded support team                  review and for ensuring that the person’s Support Plan Addendum is revised, when determined necessary. 245D                  Designated Manager can be reached at: 651-675-9673

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 IX. External Review and Reporting of Emergency Use of Manual Restraint

 

   A. Within 5 working days after the completion of the expanded support team review, Zing HHC must submit the                       following to the Department of Human Services using the online behavior intervention reporting form which                         automatically routes the report to the Office of the Ombudsman for Mental Health and Developmental Disabilities:

                 1. Report of the emergency use of a manual restraint;

                 2. The internal review and corrective action plan; and

                 3. The expanded support team review written summary.

 

X. After an Emergency or Crisis Situation

 

  A. When an individual goes through an emergency or crisis situation, it is important to support the individual as well as           yourself after the event. This stage for the individual can be referred to as Tension Reduction. At this stage, the                     individual is regaining control. They may have gone through a very frightening or traumatic experience, and may not           even remember it all. The individual may feel confused, remorseful, sad, etc. Often the event is more frightening for             them than it is for the staff involved in the event.

  B. At this stage, the employee should provide therapeutic rapport or communication. Many times, the individual is                    seeking to communicate. Some things that you can do to support the individual is to ask them to take a few deep                  breaths. This can serve two purposes, deep breathing helps a person relax, and if they follow your direction, they are            showing that they have regained control. Talk with the person. Ask how they are, if they are willing to discuss the                  incident ask how they might act differently next time. It is time to give back their self-esteem, and give back control.

  C. You can also use the following:

           C – control: The person needs to be in control emotionally, physically, and verbally. Make sure the person is able to                                  carry on a conversation with you.

           O – orient: Make sure you are oriented to the facts. Don’t be judgmental. Listen to the client.

           P – patterns: Are there patterns in the person’s behavior, e.g., day of the week, time of the day, in response to the                                        same activity or person.

           I – investigate: Investigate options or alternatives to the inappropriate behavior. What could have been done                                                  differently. Ask the individual how they could have handled it differently.

          N – negotiate: Negotiate together. You both want to win. Shake on it, write an agreement that the individual                                                   understands.

          G – give: Give the individual verbal support. Give them back their dignity, give them back control.

 

 XI. Employee Self-Care

 

  A. As staff involved in emergency or crisis situations, it is important that you take care of yourself after an incident. Learn        to recognize the signs of stress or trauma, resulting from emergency situations, and develop tools, or actions, to best            address these feelings. Those who recover most quickly are those who take specific actions to manage their responses        and feelings.

 B. Common reactions to emergency or crisis situations include:

         1. Strong emotions including shock, fear, anger, grief, confusion or horror.

         2. Feelings of helplessness, disbelief, powerlessness or aloneness.

         3. Intrusive or upsetting thoughts or memories of the event.

         4. Difficulties sleeping.

         5. Problems with concentration, learning and decision-making.

         6. Extreme mood swings, irritability, restlessness, or outbursts of anger.

         7. Headaches, stomachaches, rashes, or other allergic reactions.

         8. Increased concern about the safety or loved ones or your own safety.

  C. Self-care strategies or coping techniques:

         1. Stay away from mood-altering substances, including drugs and alcohol.

         2. Eat well-balanced meals.

         3. Exercise – even a little bit.

         4. Engage in activities that are meaningful to you.

         5. Get plenty of rest so that you feel rested and relaxed.

         6. Practice stress reduction techniques like deep breathing or meditation.

         7. Ask others directly for what you need and want.

         8. Do something to help others – give blood, donate food, volunteer.

  D. Caring for people can be emotionally overwhelming or stressful, at times, especially after emergency or crisis                         situations. Our challenge is to maintain our resilience so that we can keep doing our work with care, energy, and                   compassion.

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Incident Response, Reporting and Review Policy

 

Policy

 

 It is the policy of Zing hhC  to respond to, report, and review all incidents that occur while providing services in a timely   and effective manner in order to protect the health and safety of and minimize risk of harm to persons receiving services. 

 

 If this is an employee injury, see the Work Comp Policy and report the injury to the Work Comp Coordinator at 651-578-7851

 

 “Incident" means an occurrence which involves a person and requires the program to make a response that is not part of   the program’s ordinary provision of services to that person, and includes:

     A. Serious injury of a person;

             1. Fractures;

             2. Dislocations;

             3. Evidence of internal injuries;

             4. Head injuries with loss of consciousness or potential for a closed head injury or concussion without loss of                           consciousness requiring a medical assessment by a health care professional, whether or not further medical                         attention was sought.

             5. Lacerations involving injuries to tendons or organs and those for which complications are present;

             6. Extensive second degree or third degree burns and other burns for which complications are present;

             7. Extensive second degree or third degree frostbite, and other frostbite for which complications are present;

             8. Irreversible mobility or avulsion of teeth;

             9. Injuries to the eyeball;

            10.Ingestion of foreign substances and objects that are harmful;

             11.Near drowning;

             12.Heat exhaustion or sunstroke; and
             13.Attempted suicide

            14.All other injuries considered serious after an assessment by a health care professional including, but not limited                   to, self-injurious behavior, a medication error requiring medical treatment, a suspected delay of medical                                 treatment, a complication of a previous injury, or a complication of medical treatment for an injury

   B. A person’s death

   C. Any medical emergencies, unexpected serious illness, or significant unexpected change in an illness or medical                     condition of a person that requires Accra staff to call 911, physician treatment, or hospitalization.

   D. Any mental health crisis that requires an employee to call 911, a mental health crisis intervention team, or a similar                mental health response team or service when available and appropriate.

   E. An act or situation involving a person that requires an employee to call 911, law enforcement, or the fire department.

   F. A person’s unauthorized or unexplained absence.

   G. Conduct by a person receiving services against another person receiving services that:

           1. Is so severe, pervasive, or objectively offensive that it substantially interferes with a person’s opportunities to                        participate in or receive service or support;

           2. Places the person in actual and reasonable fear of harm;

           3. Places the person in actual and reasonable fear of damage to property of the person;

           4. Substantially disrupts the orderly operation of the program.

  H. Any sexual activity between persons receiving services involving force or coercion.

          1. “Force” means the infliction, attempted infliction, or threatened infliction by the actor of bodily or commission or                   threat of any other crime by the actor against the complainant or another, harm which (a) causes the                                     complainant to reasonably believe that the actor has the present ability to execute the threat and (b) if the actor                   does not have a significant relationship to the complainant, also causes the complainant to submit.

          2. “Coercion” means words or circumstances that cause the complainant reasonably to fear that the actor will inflict                 bodily harm upon, or hold in confinement, the complainant or another, or force the complainant to submit to                       sexual penetration or contact, but proof of coercion does not require proof of a specific act or threat).

  I. Any emergency use of manual restraint.

 J. A report of alleged or suspected child or vulnerable adult maltreatment.

 K.A report of fraud.

 

 Response Procedures

 

  A. Serious injury

         1. In the event of a serious injury, provide emergency first aid following instructions received during training or as                    directed.

         2. Summon assistance, if available, to assist in providing emergency first aid or seeking emergency medical care.

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3. Seek medical attention, including calling 911 for emergency medical care, as soon as possible. B. Death 1. If alone, immediately call 911 and follow directives given to you by the emergency responder. 2. If there is another person(s) with you, ask them to call 911, and follow directives given to you by the emergency responder. 3. Contact the responsible party as soon as possible for directions. C. Medical emergency, unexpected serious illness, or significant unexpected change in an illness or medical condition 1. Assess if the situation requires a call to 911, seek physician treatment, or hospitalization. 2. If it is a life-threatening medical emergency, call 911 immediately. 3. Provide emergency first aid as trained or directed until further emergency medical care arrives or the person is taken to a physician or hospital for treatment. D. Mental health crisis If the employee believes that a person is experiencing a mental health crisis, call 911 or a specific mental health worker if the individual has one. E. Requiring 911, law enforcement, or fire department 1. For incidents requiring law enforcement or the fire department, call 911. 2. For non-emergency incidents requiring law enforcement, call the local nonemergency law enforcement number. 3. For non-emergency incidents requiring the fire department, call the local nonemergency fire department number. 4. Provide all information requested and follow instructions given by the emergency personnel responding to the call. F. Unauthorized or unexplained absence When a person is determined to be missing or has an unauthorized or unexplained absence, take the following steps: 1. If the person has a specific plan outlined in his/her Support Plan Addendum to address strategies in the event of unauthorized or unexplained absences that procedure should be implemented immediately, unless special circumstances warrant otherwise. 2. An immediate and thorough search of the area that the person was last seen will be completed by the employee and others that might be available. 3. If after no more than 15 minutes, the search of the home and neighborhood is unsuccessful, contact law enforcement authorities and the responsible party.

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