risk management roles for 1 administrative entities ......greg lives in his own apartment with his...

Pennsylvania Department of Human ServicesOffice of Developmental ProgramsCourse Number C-003

1Risk Management Roles for Administrative Entities & Providers (Scenarios)

Pennsylvania Department of Human ServicesOffice of Developmental Programs

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The written version of the narration appears to the right of the screen.

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Certificates of Achievement will be available to Administrative Entity staff, Providers, Supports Coordinators, and SC Supervisors after completing all course requirements. Please view and then save or print your certificate in order to receive credit for this course.

For SCs and SC Supervisors, course requirements include successful completion of a pre‐test and post‐test.

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Hello, my name is Frank Schweigert. Welcome to the scenarios portion of the Risk Management Roles for Administrative Entities & Providers course.

I am a Training Manager with The Columbus Organization and will be presenting this training on the behalf of the Office of Developmental Programs.

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This training is the last of four trainings in this series. This webcast will provide opportunities for the participants to apply some of the information they have learned to assist the team in recognizing and mitigating risks.

It is recommended that you view the Foundations of Recognizing and Mitigating Risk webcast, the SC Role in Mitigating Risk webcast and the Incident and Risk Management Roles for Administrative Entities and Providers, before viewing this webcast. All are in the same location where you accessed this webcast.

Within this presentation, you will be presented with two scenarios and given the opportunity to apply what you have learned and respond to specific questions regarding risk. While responses are required to continue with the presentation, your responses will not be graded. After providing a response, additional information regarding each question will be presented. Two One Page Descriptions of the individuals in the scenarios are included as a resource where you accessed this webcast (Greg & Vicki). It would be beneficial to download and have these documents available prior to viewing this webcast.

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The primary objective of this training is to create and support a culture of safety that is reflected in all documented information, including the ISP, ISP Monitoring, Incident Management Reports, and Service Notes. Integral to this culture of safety is ensuring that the recognition, assessment and mitigation of risks is a role of the entire team and those who help to manage and fund the supports and services provided.

So let’s take a look at our first scenario, Greg.

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A copy of Greg’s One Page Description is included as a resource where you accessed this webcast. Please take a moment to download and review this information before continuing with the presentation.

When you are ready to proceed, press the play button.

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So here’s the situation….

Greg lives in his own apartment with his girlfriend Sara. Greg typically sees his SC once or twice a year. Greg tends to call frequently to state to his SC that he is broke.

Greg’s neighbor Phyllis, a person Greg considers a friend and one he likes to stop and chat with, calls the ODP Customer Service Line to report that she is concerned for Greg because she noticed a wound on his leg that she described as “rotten.” Phyllis had asked Greg about the wound on his leg and Greg said that he had been to the doctor but the cream he needed to treat the wound costs $100. Phyllis stated that Greg confided in her that his girlfriend told him that he couldn’t buy the cream because it was too expensive and he didn’t have that much money. Greg also told his neighbor that he can’t figure out why he can’t afford the cream, because he just got a social security back payment of $7000.

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Based on what you know about Greg and this situation, what are the potential risk factors?

Enter your responses in the block provided. When you are ready, press the submit button.

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Some of the things you should have identified as risk factors would include Greg’s diabetes and his risk of blood clots and having to take blood thinning medications. Greg is also at risk for forgetting to take his medication and ignoring the recommendations of his doctors. The “rotten” leg wound is certainly a risk factor. And since Greg frequently reports he is broke and is currently unable to purchase the needed medications, managing his finances and possible financial exploitation are a risk.

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What risk factors are imminent for Greg?

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Based on the information you have, you cannot determine if the leg wound is an imminent risk. The descriptive word “rotten” would lead you to believe that this is something serious that needs to be addressed/followed up on today because of the nature of how quickly wounds can become deadly. This is especially true in cases where the person has other underlying medical concerns that can create more complex medical issues. In Greg’s case, he has both diabetes and circulatory problems and at times has had difficulty maintaining consistent administration of the medications that are prescribed to treat these conditions. So while we may not be able to say that the risk is imminent, it certainly needs prompt attention.

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What other information do you need and who would you go to for the information?

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Certainly the status of the leg wound is information you will need as soon as possible. Checking with the physician that assessed the wound and prescribed the topical medication would be a good place to start.

Other things to try and figure out include trying to identify where Greg’s money is going. Talking with Greg, his bank, and even Sara. It may also be necessary to contact Social Security Benefits Division for assistance.

We also should try to understand why Greg says that insurance doesn’t cover his medication? Greg, Greg’s doctor, and the insurance company should be able to shed some light on this.

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So, if you were supporting Greg in this scenario, what would be your plan? How would you prioritize these actions?

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Based on what we know here, the most immediate thing would be to go out to see Greg as soon as possible to assess the condition of his leg. This will dictate the future steps to mitigate this risk. Once the severity of the issue is determined and proper medical attention is given to the wound, then seeking needed in home or out of home supports to help his leg heal might be needed. Greg can then also be offered education regarding his options, including the possibility of having someone Greg trusts to help him with his future medical care and decisions

The financial situation needs to be explored to determine the reasons that Greg frequently has no money. Is it a result of poor money management skills or is he being financially exploited by Sara or others?

These may be only the first couple steps in supporting Greg. Your list may have included other steps as well.

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In our next scenario, we will take a look at what is happening with Vicki. However, in this scenario we will be asking you to look more closely at the teams responses and evaluate the level of their success in mitigating the risks.

A copy of Vicki’s One Page Description is also included in the same resource document that contained Greg’s description.

When you are ready to proceed, press the play button

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So here’s Vicki’s story….

Victoria (Vicki) is a 40‐year‐old woman who lives with her elderly mother in a two‐story house downtown. Vicki has four sisters and a brother. Vicki’s brother still lives in the home and the house is constantly bustling with people in and out of it. Vicki has a feeding tube that requires nursing level of care, she communicates with gestures, and uses a wheelchair to move about her home and community. Vicki’s sisters live close to the home and help out when they can. Vicki’s brother assists with much of the care the nurses or their mother cannot provide her. He is very affectionate towards her, frequently answering questions for her, and checking on her when the nurses are in the home.

The agency providing support with the feeding tube has been having trouble keeping consistent staff in the house and reports that the nurses have felt uncomfortable in the home, both with all the people coming in and out and also with Vicki’s brother.

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In this scenario, while there does not appear to be any imminent risks to Vicki, the team has identified a number of potential non‐urgent risks, including:

• Her elderly mother

• Possible pressure sore issues due to being in a wheelchair

• Stairs in the home make Vicki’s freedom of movement limited due to her reliance on her wheelchair. Does she get carried upstairs? How safe are the practices used for lifts/transfers/carries/other mobility?

• Vicki’s brother may not be allowing her to express herself all the time

• Feeding tube that requires special staffing considerations

• Inconsistent staffing patterns

• Brother makes staff uncomfortable and may be part of the reason that staffing is difficult

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Based on these risks, the team’s priority is to address the inconsistent staffing patterns and if necessary look for potential alternative supports that can provide consistent care for Vicki and meet her numerous medical needs. In addition, the team is going to try to learn more about the relationship between Vicki and her brother. What are the supports he provides that others can’t? Why are staff uncomfortable around him? Does this have anything to do with the challenge of maintaining consistent staff support?

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As the team was working on this plan, things took a turn…

The SC does a home visit to check on Vicki. Vicki’s mother states everything is going well with the nursing services. The SC asks about Vicki’s relationship with her brother and Vicki’s mom states he is a big help with Vicki and she loves her brother and things seemed to be going OK. As the SC is leaving, the nurse arrives and as they are talking outside the house, the nurse indicated that she gets an odd feeling about the brother, but could not be more specific.

The following day the SC receives a phone call from the nursing agency supervisor to report possible sexual abuse. The nursing agency supervisor reported that one of the nurses on duty today had forgotten her cell phone at Vicki’s house and returned to get it about fifteen minutes after the end of her shift. Vicki’s mother let the nurse back in the home and gave her permission to go upstairs to get the phone in Vicki’s room. When she went back up to get it, Vicki’s brother was in bed with Vicki and they were both unclothed.

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Upon hearing this information, the SC immediately contacts the authorities to report this information and request the removal of the brother from the home until things can be sorted out.

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In the Vicki scenario, were immediate and appropriate actions taken by those supporting Vicki?

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This was an imminent risk situation that should not have been reported after the fact. As soon as it was discovered that Vicki was at risk, steps should have been taken to protect Vicki from further contact with her brother and the nurse should have remained in the home until the brother or Vicki were moved and Vicki was safe from further risk.

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What should have been done differently once the abuse was recognized?

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As a mandated reporter, the nurse had a responsibility to ensure Vicki’s safety at the moment the abuse was recognized and should not have left Vicki alone. Once Vicki’s immediate safety was secured, the nurse who witnessed the incident, should have directly reported the abuse allegation as required by regulations.

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Are there any new risks to Vicki that need to be identified/ addressed?

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Some of the new risks that will need to be addressed would include:

The need for a medical evaluation for pregnancy, STDs or other injuries resulting from the abuse.

Assessment of possible trauma resulting from the abuse.

Any potential impacts on Vicki’s continuing care with the brother no longer available to assist mom in supporting Vicki.

Though the team did identify the issues with inconsistent staffing, an important risk factor, it appears as though more could be done to explore and tie in any issues with the brother that may have been contributing to the staffing problem.

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While hind sight is always 20/20, the team did initially identify the issues with inconsistent staffing, an important risk factor, and the possible link to the brother’s behavior. It is possible that more could have been done to explore and tie in these concerns with the staffing problem and possibly revealed the alleged abuse and prevented it from re‐occurring sooner.

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If risks are well recognized and assessed by the team, including the severity and immediacy factors; A mitigation plan is developed that addresses these risks; The implementation of the plan is consistent; And there is thorough monitoring and documentation to evaluate the effectiveness of the plan, the risk of harm to the individual could be avoided at best or at worst, not be repeated.

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This webcast has been developed and produced for the Pennsylvania Department of

Human Services, Office of Developmental Programs by The Columbus Organization.

Thank you for participating in this lesson.

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risk management roles for 1 administrative entities ......greg lives in his own apartment with his...

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