Operational Features of Program
- • Characteristics of Reporting Program
Every “licensed facility’ is mandated to have an incidence reporting program [FAC §59a.10.005(1 - 3)]. Noteworthy features of the process are:
- ◊ Health Risk Manager Position created
The law created the position of Health Care Risk Manager, who must be properly credentialed and licensed by the Agency for Health Care Administration (AHCA). The risk manager manages reporting responsibilities for no more than 4 sites for a medical facility. The risk manager, who is employed by the medical facility “as an insurance coordinator . . . or a consultant”, is responsible to the standards established by the AHCA, including responsibility for the regular and systematic reviewing of all incident reports (see §59A-10.031 to §59A-10.037, FAC for credentialing and training requirements [PDF, p205-10].) The risk manager provides an annual confidential report to the AHCA, which includes “the measures taken by the facility and its risk manager to reduce the risk of injuries and adverse incidents, and the results of such measures . . .” [§395.0197(6)(c), FS]
- ◊ NO ANONYMITY IN REPORT TO AHCA
No anonymity exists in reports since a “listing of all persons . . . known to be involved directly in the incident” is included in the report along with “corrective actions”, which might include punitive actions or fines against health providers or hospitals.
- ◊ ANONYMITY IN WEB-REPORTING
Anonymity is observed in the web-reporting process for incidents, which does “not include information that would identify the patient, the reporting facility, or the health care practitioners involved” (§395.0197(8), FS).
- ◊ NO ANONYMITY FOR PROVIDERS, IF ‘PROBABLE CAUSE’
The anonymity of physicians and facilities in AHCA's web reports is trumped by DOH Medical Quality Assurance, which provides for publication of physician-identified and physician-specific sanctions under ‘Physician Profiling.’ Furthermore, if a physician is involved with an ‘adverse incident’ subject to a probable cause for investigation by the AHCA, both physician and facility providers are identified publicly within 10 days, apparently in the MQA newsletter and/or the Physician Profiling website. [§456.081, FS]
- ◊ Transparency
Transparency of ‘adverse incident’ reporting to physician peer review and medical malpractice, as the numerous legislative efforts confirm. Information regarding providers is shared across regulatory agencies and punitive action against physicians may occur outside of peer-review processes.
- ◊ Patient Safety Plan, Committee and Officer
An emphasis on Patient Safety is manifest in 2003 legislation that required that each facility have a Patient Safety Plan, complete with a Patient Safety Committee and a Patient Safety Officer. The Patient Safety Plan was added on to existing Internal risk management program, quality assurance / peer review programs. The intent of the legislation was related to medical malpractice [per §395.0193, FS – History]. The patient safety program is tied legislatively to the ‘Incident Reporting program’ via the references to ‘medical incident’ and ‘malpractice’ issues.
- ◊ Health Risk Manager Position created
- • Processes of Reporting Program
- ◊ Initial Notification:
It is the “ . . duty of all health care providers and all agents and employees of the licensed health care facility to report adverse incidents to the risk manager, or to his or her designee, within 3 business days after their occurrence” [§395.0197(1), FS]
- ◊ Report to Agency for Health Care Administration (AHCA)
“...adverse incidents, whether occurring in the licensed facility or arising from health care prior to admission in the licensed facility, shall be reported by the facility to the agency within 15 calendar days after its occurrence” (§395.0197(7), FS) These reports are known as the Code 15 Report. The law also states that justifiable extensions to the 15-day deadline are possible, possibly requiring additional reports.
- ◊ 24 Hour Report to Agency for Health Care Administration (AHCA) Cancelled in 2003
With the passage of 2003 Laws of Florida, Chapter 2003-416 [PDF, p10], the ‘24 Hour Report ’ requirement (§395.0197(7), FS) was repealed from the the Internal Risk Management program. The 24 hour Report constituted duplicative work to the Code 15 Report and was perceived as beaurocratic waste. 24 Hour Reports ceased to be prepared on the Medical Errors Resolution And Tracking Programs website.
- ◊ Follow-up by Agency for Health Care Administration (AHCA)
“The agency may investigate, as it deems appropriate, any such incident and prescribe measures that must or may be taken in response to the incident. The agency shall review each incident and determine whether it potentially involved conduct by the health care professional who is subject to disciplinary action, in which case the provisions of s. 456.073 shall apply.” [§395.0197(7), FS]
- ◊ Publishing Reports on Web:
The agency shall publish on the agency's website, no less than quarterly, a summary and trend analysis of adverse incident reports received pursuant to this section, which shall not include information that would identify the patient, the reporting facility, or the health care practitioners involved. The agency shall publish on the agency's website an annual summary and trend analysis of all adverse incident reports and malpractice claims information provided by facilities in their annual reports, which shall not include information that would identify the patient, the reporting facility, or the practitioners involved.” [§395.0197(8), FS]
The AHCA publishes annual, quarterly, and ‘Code 15 Reports’ on the Medical Errors Resolution And Tracking Programs website.
- ◊ Initial Notification:
- • Education
The State of Florida addresses education in facilities and for health providers in a number of different ways, including a mandate for inclusion of patient safety curricula in private and public schools that affect all allied health fields:
- ◊ Nonphysician Personnel: “ . . .At least 1 hour of such education and training annually for all personnel of the licensed facility working in clinical areas and providing patient care.” (§395.0197(1)(b) FS)
- ◊ Physicians: “The boards, or the department when there is no board, shall require the completion of a 2-hour course relating to prevention of medical errors as part of the licensure and renewal process.” (§456.013, FS - Department; general licensing provisions
- ◊ Institutional Curricula, Public schools: “Each public school, college, and university that offers degrees in medicine, nursing, or allied health shall include in the curricula applicable to such degrees material on patient safety, including patient safety improvement.” (§1004.08, FS - Patient safety instructional requirements)
- ◊ Institutional Curricula, Private Schools: “Each private school, college, and university that offers degrees in medicine, nursing, and allied health shall include in the curricula applicable to such degrees material on patient safety, including patient safety improvement.” (§1005.07, FS - Patient safety instructional requirements)
- ◊ Education Related to Risk Management Program: The risk manager uses the incident reports “as a part of each internal risk management program . . . to develop categories of incidents which identify problem areas. Once identified, procedures shall be adjusted to correct the problem areas.” (§395.0197(4), FS) Correction of problem areas requires on-going education within the facility as part of the internal risk management program.