at the mall, picnic, or bedroom)?
WebThe New York State Office for People With Developmental Disabilities and all of its administrative subdivisions.
Previous episodes? Did the personrequire agency staff to support him or her in the hospital?
(6 steps, in brief, see full checklist on the website). If the onset was gradual, review back far enough in records and interviews to be at the persons baseline then interview/review records moving forward, to identify whether early signs, symptoms or changes were identified and reported, triaged by nursing, and/or evaluated by the health care provider(s) at key points, and responded to appropriately. How many?
Start or increase another medication that can cause constipation? Was there a nursing care plan regarding this diagnosis?
OPWDD 149 signed and dated by the investigator - mandatory. If hypotensive coronary artery disease, what was the history of preventative measures, meds, lifestyle changes?
Falls. DNR? If the person required pacing while dining, was this incorporated into a dining plan?
Was the agency RN involved in communications?
Were vital signs taken after the fall (this may determine hypotension)? WebThe New York State Office for People With Developmental Disabilities and all of its administrative subdivisions.
Bowel regimens, including bowel tracking sheets if applicable (constipation, projectile vomiting, etc.). Facilitate individuals learning and skill training in fire safety. If monitoring urine output report what amount, or qualities? How quickly did they appear?
Was the person receiving any medications related to this diagnosis?
Were the actions in line with training? Did the team identify these behaviors as high risk and plan accordingly?
WebProtective Oversight Assisted Living Facility (ALF) Shall mean any premises, other than a residential care facility, intermediate care facility, or skilled nursing care facility, that is Documentation related to the plan, if required. What were the diagnoses prior to this acute issue/illness? When was the last blood level done for medication levels? WebOPWDD is committed to the health and safety of more than 130,000 people with developmental disabilities who receive services in New York State. If seizures occurred, what was the frequency? Did necessary communication occur? Which doctor was coordinating the health care?
As a If so, was it followed and documented?
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Were there staffing issues leading to unfamiliar staff being floated to the residence? Was the device being used at the time of the fall? When was the last consultation? Was it provided? What is the policy for training? Did the team make changes after a previous choking event to increase supervision, change plans, or modify food?
Were there signs that nursing staff were actively engaged in the case? Did plan address Pica as a choking risk?
Did PRN orders have direction on what to do if not effective?
Did this occur per the plan? Stop/reduce a bowel medication? Were plans and staff directions clear on how to manage such situations?
How frequent were the person's vital signs taken?
Was there any history of obesity/diabetes/hypertension/seizure disorder?
Were there previous episodes of choking?
Life Plan/CFA and relevant associated plans. Plan and Staff Actions?
Any medical condition that would predispose someone to aspiration?
What did the bowel records show? WebIndividual Plan of Protective Oversight.
Did the person have an injury or illness that impaired mobility? If diagnosed with seizures, frequency? Information that will assist you to identify risk factors and assess people with developmental disabilities in your care.
Was the plan clear?
911? Were the decisions in the person'sbest interest? Did the person receive any medications that could cause drowsiness?
When was his or her last EKG? 0 Were any gastro-intestinal diagnostic tests performed, including upper endoscopy (EGD), diagnostic colonoscopy, abdominal/ pelvic CT scan, abdominal x-rays, etc.? Did the person start a narcotic pain medication?
Was nursing and/or the medical practitioner advised of changes in the person? Did staff follow orders/report as directed?
An authorized provider's written Did the person use any assistive devices (gait belt, walker, etc.)? Were appointments attended per practitioners recommendations?
Had the person received sedative medication prior to the fall? Did the person require staff assistance to stand, to walk?
Once this happens, multiple organs may quickly fail and the patient can die. (x) Oversight, protective. Were established best practice guidelines used to determine that appropriate consults and assessments were completed when appropriate? Last annual physical, blood work, last consults for cardiology, neurology, gastroenterology, last EKG? Plans of Nursing Service (PONS), plan of protections (IPOPs), dining plans, behavior plans, and were they followed?
Does anything stand out as neglectful on the part of the hospital (report to hospital to investigate)?
Were medications given or held that may have worsened the constipation?
Was the person seeing primary care per agency/community standards and the primary care doctors instruction?
Who was the doctor/provider managing the illness? What communication occurred between OPWDD service provider and hospital?
When was the last neurology appointment? Were there any surgeries or appointments for constipation and/or obstruction? Was it communicated? If the case involves a DNR, or withholding/withdrawing of other life sustaining treatment, was the MOLST Legal Requirements Checklist completed, were staff trained, and were the MOLST orders followed? DNI?
Did the choking occur off-site or in a nontraditional dining setting (e.g. What was the person's level of supervision?
WebProviding High-Quality Supports and Services.
Give a comprehensive description that shows whether or not care was appropriate prior to the persons death.
Was there a diagnosed infection under treatment at home?
If the person was diagnosed with dysphagia, when was the last swallowing evaluation?
Did staff understand and follow dining/feeding requirements?
OPWDD maintains a high standard for governance, fiscal and safety compliance practices. The best way to prepare for your survey or agency review is through good operational practices and ongoing self-assessment. What to do after your survey when deficiencies are identified and a plan of corrective action is needed
Note: Lack of dental care and poor dental hygiene may impact aspiration pneumonia, cardiovascular disease, diabetes, etc.
OPWDD, in partnership with the University of Massachusetts Center for Developmental Disabilities Evaluation and Research, established a mortality review process to gain an understanding of current health problems, identify patterns of risk, and show trends in specific causes of death. Use these questions, as appropriate.
Were the risks addressed?
Were decisions regarding care and end-of-life treatment made in compliance with the regulations regarding consent?
Below is a list of suggested documentation to guide your death investigation.
Artificial hydration/ nutrition? Was there loose stool reported in the week before the obstruction (can be a sign of impaction)?
Can they describe the plan?
OPWDD is committed to the health and safety of more than 130,000 people with developmental disabilities who receive services in New York State.
Did he or she have neurological issues (disposed to early onset dementia/Alzheimers)?
Was there a specific plan? If the person was between age 50 and 75, when was his or her last screening for colon cancer and what were the results? Did staff report to nursing when a PRN was given?
If you are not familiar with the MOLST process please see here. Claims will be disallowed if the relevant habilitation plan(s) was If no known infection at home, when did staff start to notice a change in the person (behavior, activity, verbal complaint, or sign of illness)? Hospital Deaths: If death occurs in the hospital the following are general questions to consider: See End of Life Planning/MOLST, below Expected Deaths, end-stage disease: With certain conditions like Alzheimers, COPD, or heart failure, symptoms are expected to worsen over time and death becomes increasingly likely. Web(w) OPWDD.
Web(3) OPWDD shall verify that each person has a plan for protective oversight, based on an analysis of the person's need for same, and that such need has periodically, but at least If law enforcement or the Justice Center is conducting an investigation related to the death of the person, the agency should inquire as to actions, if any, it may take to complete the death investigation.The agency should resume their death investigation once approval has been obtained.
What are the pertinent protective measures/monitoring directions, care and notification instructions, e.g. food-stuffing, talking while eatingor rapid eating?
OPWDD - What does OPWDD stand for? Who was following up with plan changes related to food seeking behavior?
Was there a PONS?
Confirm the person's lack of capacity to make health care decisions.
Did it occur per practitioners recommendation?
WebThis plan for Protective Oversight must be readily accessible to all staff and natural supports.
Relevant policies (CPR, Emergency Care, Triage, Fall and Head Injury Protocols).
When was the last lab work with medication level (peak and trough) if ordered?
Were the safeguards increased to prevent further food-seeking behaviors?
Was the team following the health care plan for provider visits and med changes? WebIndividual Plan of Protective Oversight All Individuals have an Individual Plan of Protective Oversight for their own safety; Fire evacuation and general safety Supervision levels
Ensure the 1750b surrogate makes informed decisions about end of life care. (CDC.gov, 2014) Most often people are in the hospital when they die from sepsis.
Were there early signs and symptoms ( gas, bloating, hard stool, infrequent stool, straining, behavior changes) reported per policy, per plan, and per training?
endstream endobj startxref What are the pertinent agency policies and procedures?
Were staff trained per policy (classroom and IPOP)? Were staff trained on the PONS? Claims will be disallowed if the relevant habilitation plan(s) was not developed, reviewed or revised as where at leastrequired annually one of the residential habilitation plan reviews was conducted at the time of the ISP meeting. Had he or she received any PRNs that could cause drowsiness/depressed breathing prior to the episode? Was there a PONS for dysphagia/dementia/seizures? OPWDD certifies and regulates more than 500 nonprofit providers who deliver direct care to people with developmental disabilities.
Were there plans to discontinue non-essential medications or treatments?
Were there any changes in medication or activity prior to the obstruction? Was it related to a prior diagnosis?
Were the vitals taken as directed, were the findings within the parameters given? Were staff aware of the risks/ plan? Future hospitalizations? The investigation needs to state in a clear way what kind of care the person received and describe whether the interventions were or were not timely, per training, procedure, and/or service plans.
Was this reported?
Training records (CPR, Plan of Nursing Services, Medication Site specific Plan of Protective Oversight.
WebEnsure appropriate supervision, health and safety of individuals; Implement Individual Plan of Protective Oversight.
Were they followed?
unusually agitated, progressive muscle weakness, more confused? Did the person have a history of Pica? Did it occur per practitioners recommendations? Were missed doses reviewed with the provider?
consistency, support, storage, positioning?
What is the pertinent staff training? Did a plan include identified ranges and were there any outliers?
The Free Dictionary.
Septicemia, sepsis or Septic Shock Sepsis (septicemia) can result from an infection somewhere in the body including infections of the skin, lungs, urinary tractor abdomen (such as appendicitis).
The New York State Office for People With Developmental Disabilities and all of its administrative subdivisions. Contact Agency People With Developmental Disabilities, Office for Title Habilitation Specialist 2 Occupational Category Health Care, Human/Social Services Salary Grade 17 Bargaining Unit PS&T - Professional, Scientific, and Technical (PEF) Salary Range From $57984 to $73813 Annually Employment Type Full-Time Appointment Type Permanent What was the diagnosis?
Any changes in medications prior to the acute incident?
What was follow up time to PRN given? Plan(s) of Nursing Service as applicable.
Did the PONS address positioning and food consistency?
Seizure frequency? If fluids are to be given, how much? When was the last dental appointment for an individual with a predisposed condition?
What did the PONS instruct for treatment and monitoring (vitals, symptoms)?
Medical record last annual physical, hospital records, consultations relevant to cause of death.
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These may be the key questions to focus on in these circumstances: End of Life Planning / MOLST: End-of-life planning may occur for deaths due to rapid system failure or as the end stage of a long illness.
What occurrence brought the person to the hospital?
`d8W`\!(@Q )#q(f`d`aZ(hTq9+LgjW.JmtgCx AX vn@` 6G93 Were there any recent changes in auspice/service providers which may have affected the care provided?
Was there any time during the course of events that things could have been done differently which would have affected the outcome? Available? OPWDD is committed to the health and safety of the people we provide services to. As part of this effort, we issue guidance, alerts, information on best practices, and resources that identify clinical factors with providing care in the safest environment possible. To stay up to date on Safety Alerts, please visit our Safety Alerts page.
As part of this effort,
Was written information related to choking risk and preventive strategies available to staff?
When was his or her last consultation with a cardiologist? What were the directions for calling a nurse?
Did the person receive any blood thinners (if GI bleed)?
Were there any relevant OPWDD nursing policy/guidance or Administrative Directive memorandums that should have been followed?
What were the PONS in place at the time? Is it known whether the person hit his or her head during the fall?
Exhibit any behavior or pain?
Were the plans followed? 690 0 obj <>/Filter/FlateDecode/ID[<59ED846B642C84478C9F98D6F6215179>]/Index[665 40]/Info 664 0 R/Length 110/Prev 246535/Root 666 0 R/Size 705/Type/XRef/W[1 3 1]>>stream %%EOF What were the symptoms which sent the person to the hospital?
Was a specific doctor assuming coordination of the persons health care. Certify notifications made and no objections.
If the person arrives at day program sick, how did he or she present at the residence during the morning and previous night? Was there evidence of MD or RN oversight of implementation?
Transfer of Oversight/Service Provision Between Programs. Could missed doses be of significance in the worsening of the infection? Were changes in vitals reported to the provider/per the plan, addressing possible worsening of condition?
Was there a written bowel management regimen? This Plan must also be submitted to the Regional Resource Development WebThe Individual Plan of Protective Oversight (IPOP) is a documented and approved plan used for the sole purpose of enhancing individual safety.
Were problems identified and changes considered in a timely fashion? Webgwen araujo brother; do male actors wear lipstick.
Did the person have any history of behaviors that may have affected staffs ability to identify symptoms of illness (individual reporting illness/shallow breathing for attention seeking purposes, etc.)? Effective September 4, 2018, OPWDD issued Administrative Memorandum #2018-09, entitled Staff Action Plan Program and Billing Requirements, describing Staff
What was the diagnosis at admission?
WebThe PPO (refer to Appendix C - form C.4) indicates all key activities that directly impact the health and welfare of the participant and clearly identifies the individual (s) responsible for
Other? Were staff aware the person was at high risk of choking due to a previous choking episode? Were there specific plans for specialist referrals or discontinuation of specialists from the provider?
Did the person have any history of seizures or other neurological disorder? Identify the appropriate 1750b surrogate. Bowel Obstruction Most commonly, bowel obstruction is due to severe, unresolved constipation, foreign-body obstruction, obstruction due to cancerous mass, volvulus twisted bowel," or Ileus (no peristaltic movement of the bowel).
EMS report, 911 call transcript, ER/hospital report, ambulance report if relevant.
Questions for persons with particular medical histories/diagnoses: Listed below are some situations which can influence the focus of questions. Specialist care, per recommendations?
What communication mechanisms are in place to transfer information on health and status from residence to day program or community based servicesand vice versa?
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Were there any diagnoses requiring follow up?
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Is it known whether the person lost consciousness prior to the fall?
Were staff trained?
Seizure?
Dysphagia, dementia, seizures can happen with neurological diagnosis.
Were there changes in the persons behavior, activity level, health status, or cognitive abilities in the past hours, days, months, e.g.
What was the treatment?
Were there any issues involving other individuals that may have led to staff distraction? Was there an order for Head of Bed (HOB) elevation?
Did staff report per policy, per plans, and per training? Were appointments attended per practitioners recommendations?
Aspiration Pneumonia (People who are elderly are at a higher risk)?
Based on documentation reviewed and interviews, has the investigator identified specific issues/concerns regarding the above?
Were the orders followed? Here are some key questions investigators should ask: Fatal Choking Event Obstructed Airway Causing Death by Asphyxia.
What was the bowel management regimen e.g. Was it realistic given other staff duties? Were appointments attended per practitioners recommendations? If so, what guidelines?
When was his or her last lab work (especially if acute event)?
Effective January 21, 2011: The MOLST (Medical Orders for Life Sustaining Treatment) form and the MOLST Legal Requirements Checklist should be completed in compliance with the Health Care Decisions Act of 2003. Any history of constipation/small bowel obstruction? Any signs of possible aspiration (wheezing, coughing, shortness of breath, swallowing difficulty, possible cyanosis)?
On the agencys part?
Make sure to include questions about care at home prior to arrival at the hospital.
Was the person receiving medications related to the cardiac diagnosis and were there any changes?
Were there any previous swallowing evaluations and when were they? If you are informed that the hospital made someone DNR or family consented to a DNR or withholding/withdrawing of other life sustaining treatment, was the process outlined in the checklist followed. What were the prior diagnoses?
What were the safeguards for safe dining e.g. Contact Agency People With Developmental Disabilities, Office for Title Habilitation Specialist 1 Occupational Category Education, Teaching Salary Grade 14 Bargaining Unit PS&T - Professional, Scientific, and Technical (PEF) Salary Range From $49202 to $62806 Annually Employment Type Full-Time Appointment Type Permanent OPWDD, in coordination with the Justice Center for the Protection of People with Special Needs, has
Was the person on any medications that could cause drowsiness/depressed breathing?
What PONS were in effect and were staff trained? Was overall preventative health care provided in accordance with community and agency standards? Was the fall observed? Was there a known behavior of food-seeking, takingor hiding?
Was it implemented?
routine medications, PRN medications? Please visit the Choking Initiative webpage.
If the fall was not observed, did staff move the individual?
They are not diseases or causes of death, but rather circumstances.
It clearly enlists the key activities that Was end-of-life planning considered?
Were there any recent medication changes? Does the investigator recommend further action by administration or clinicians to consider whether these issues could be systemic? Severity? WebMaintain facility in compliance with the OPWDD and COA standards.
How and when was the acute issue identified?
convert pressure cooker whistles to minutes; toll roads owned by china Diet orders and swallow evaluation, if relevant. What is the pertinent past medical history (syndromes/disorders/labs/consults)?
Hospice/palliative care plans, if applicable. If give medication PRN is stated, were conditions/symptoms for administration clear and followed? the person's clinical and support needs as identified through an OPWDD approved assessment (described in more detail in Assessments); the necessary and appropriate services and supports (paid and unpaid) that are based on the person's preferences and needs;
Was there anything done or not done which would have accelerated death? Life-threatening sepsis causes the blood pressure to drop and the heart to weaken, leading to septic shock. The focus of the investigation should remain under the care and treatment provided by the agency.
Did it occur per practitioners recommendations?
Any predispositions?
endstream endobj 666 0 obj <. The death investigation is always the responsibility of the agency.
Did it occur per practitioners recommendation?
Was the preventative health care current and adequate? Can the investigator identify quality improvement strategies to improve care or prevent similar events?
Circumstances?
Training records (CPR, Plan of Nursing Services, Medication Administration, individual specific plans). Was there a plan for provider follow-up?
704 0 obj <>stream Was there any illness or infection at the time of seizure? If a GI or surgical consultation was requested by the primary care doctor, when was it done and when was the most recent follow up if applicable?
When was the last GYN consult? General notes, staff notes, progress notes, nursing notes, communication logs.
Were they followed or not?
What was the course of stay and progression of disease? History vs. acute onset?
Was this well-defined and effective?
Any history of aspiration?
Did the plan address refusal of food, vomiting, and/or distended abdomen? Was it provided? What was the latest prognosis?
Were appointments attended per practitioners recommendations?
Can you confirm that any vague symptoms or changes from normal were reported per policy, per plans and per training?
Could it have been identified/reported earlier? WebFor residential habilitation services, the initial habilitation plan must be written within 60 days of the start of the habilitation service and forwarded to the Medicaid Service Coordinator
Was there a PONS in place for those who have a condition that would predispose the person to aspiration pneumonia (dysphagia, dementia)?
What was the infection?
Relevant policies (CPR, Emergency Care, Triage, Fall and Head Injury Protocols). Written statements (expected for all death investigations).
Was there a MOLST form and checklist in place? Who reviewed the bowel records (MD, RN)?
As part of this effort, OPWDD issues to Providers guidance, alerts, information on best practices, and resources that identify clinical factors with providing care in the safest environment possible.
Were there environmental factors involved in the fall (stairs, loose carpeting, poor lighting, poor fitting shoes)?
Was there an emergency protocol for infrequent or status epilepsy?
Dining behavior risk e.g.
Was food taking/sneaking/stealing managed?
Did the person receive sedation related to a medical procedure? Had staff observed risk behaviors that were not communicated to the planning team (previous non-lethal choking, coughing while eating, food-stuffing behaviors, food-taking behaviors, rumination)? Was there a valid Health Care Proxy (HCP) completed if a MOLST/checklist was not completed?
When was the last lab work, check for medication levels?
Were staff trained on relevant signs/symptoms?
Antibiotics?
Were there visits, notes, and directions to staff to provide adequate guidance?
What was the content of the MOLST order? Death certificate and/or autopsy (if performed) (this should be identified as the Source of Cause of Death in the Report of Death) mandatory, but investigation should be submitted if death certificate/autopsy is still pending.
Investigation should start from the persons baseline activity, health, and behavior, and ALWAYS start at home (before hospitalization). Was staff training provided on aspiration and signs and symptoms?
Did staff decide this independently, or was it with nursing direction? Were staff aware of the MOLST?
Determine the necessary medical criteria. When was the last visit to this doctor? Was there a known mechanical swallowing risk?
is gene dyrdek still alive. Was it up-to-date? Did staff follow plans in the non-traditional/community setting?
Was the PONS followed?
Was there bowel tracking?
Web(3) OPWDD shall verify that each person has a plan for protective oversight, based on an analysis of the person's need for same, and that such need has periodically, but at least If not, were policies and procedures followed to report medication errors? Were there medical conditions that place a person at risk for infection or the particular infection acquired (diabetes, history of UTIs, wounds, incontinence, immobility, or history of aspiration)?
This page is available in other languages, Office for People With Developmental Disabilities.
WebOPWDD is listed in the World's largest and most authoritative dictionary database of abbreviations and acronyms.
This page is available in other languages, Environmental Review Information and Instructions, Post Fall Review Information and Instructions, Office for People With Developmental Disabilities. Were the medications given as ordered? Were staff involved trained? Not all documents may be relevant to your investigation.