Significant Member Incident Reporting

A Significant Member Incident (SMI) or sentinel event is an unexpected and undesirable outcome that has an adverse impact on the outcome of a member's care.

  • Providers may use their own internal incident form for reporting or Community Care's form.
  • Every provider is required to report the types of incidents Community Care considers reportable.
  • Incidents must be reported to Community Care within 24 hours of the incident occurring or within 24 hours of the provider learning of the incident.

Providers may report Significant Member Incidents the following ways:

  • Completing the online form and faxing to the Community Care office according to the member's county of eligibility.
  • Calling or faxing Community Care with the pertinent SMI information.

Significant Member Incident Definitions

Death

All deaths regardless of cause for members in current treatment or who have been active in treatment within past 30 days.

Serious or potentially lethal suicide attempt

The intentional and voluntary attempt to take one's own life. A suicide attempt is limited to the actual occurrence of an attempt that requires medical treatment and/or where the member suffers or could have suffered significant injury or death.

Non-reportable events include:

  • Threats of suicide, which do not result in an actual attempt
  • Gestures, which clearly do not place the member at risk for serious injury or death
  • Actions, which may place the member at risk but where the member is not attempting harm to himself/herself
Apparent homicide by member

The killing of another person by a member while in treatment or within 30 days of treatment.

Apparent sexual assault perpetrated by member

An act or attempted acts such as rape, sexual molestation, sexual harassment, and inappropriate or unwanted touching of a sexual nature while in treatment or within 30 days of treatment.

Apparent serious physical assault perpetrated by a member

The infliction of injury by a member toward another person, while in treatment or within 30 days of treatment, requiring medical treatment beyond basic first aid.

Non-reportable events include:

  • Altercations among residents/members that may result in physical contact but do not cause serious injury and which do not reflect a pattern of physical intimidation or coercion.
  • Discord, arguments, or emotional distress resulting from normal activities and disagreements that can be found in typical congregate living situations.
Sexual contact with a member occurring at a provider site *

Any sexual contact or allegation of sexual contact, consensual and non-consensual, between a member and another individual (not provider/staff) occurring at provider site.

Physical assault on a member occurring at a provider site *

The infliction of injury or allegation of infliction of injury on a member by another person (not provider/staff) occurring at provider site requiring medical treatment beyond basic first aid. Non-reportable events include:

  • Discord, arguments, or emotional distress resulting from normal activities and disagreements that can be found in typical congregate living situations.
Sexual contact between a member and provider not occurring at a provider site *

Consensual or non-consensual sexual activity, or allegation of sexual activity, between a member and provider occurring beyond the provider site.

Physical assault on a member perpetrated by a provider not occurring at a provider site *

Any infliction of injury or allegation of infliction of injury on a member by a provider occurring beyond the provider site.

Allegation of sexual contact by member against provider *

Any allegation of sexual contact between a member and provider occurring at a provider site.

Allegation of physical abuse by member against provider *

Any allegation of an act by provider against member that causes or may cause impairment of physical condition or substantial pain, unreasonable confinement, intimidation, punishment, or mental anguish.

Member injury due to restraint or seclusion *

Any injury incurred by a member due to restraint/seclusion/physical intervention

Any restraint that does not adhere to guidelines in the PA Code and other bulletins or notifications of licensing bodies *

Police called to provider site (no arrest)

An event requiring the services of law enforcement called to the provider site.

Arrest while in treatment or within 30 days of treatment

An event in which the member is charged with a crime and/or arrested.

Medication error requiring medical intervention

A missed medication, incorrect medication, or incorrect dosage where a member suffers an adverse consequence that is either short- or long-term in duration or receives treatment to offset the effects of the error. Any error in the five rights of medication (right patient, right drug, right dose, right route, and right time) would meet criteria for an SMI. Medical intervention may include a physician's order for, but not limited to, increased observations and increased frequency of vital signs, holding one or more doses, administration of a medication to counteract or limit adverse effects, studies (e.g., EKG, blood levels), a face-to-face evaluation with nurse and or doctor following the error, and/or more serious medical interventions including ER evaluation or hospitalization.

Non-reportable events include:

  • Refusal by the member to take prescribed medication
Fire at provider site requiring emergency services of the fire department

Non-reportable events include:

  • Routine services by the fire department
  • Testing of alarm systems
Elopement from facility or facility supervised activity

Adults - a member who is out of contact with staff without prior arrangement or who may be considered to be in "immediate jeopardy" based on his/her personal history; any time the provider contacts the police about a missing person or the police independently find and return the member regardless of the time he or she was missing.

Non-reportable events include:

  • Members who are admitted voluntarily or court ordered to substance use disorder treatment and leave or walk out of the program without signing himself or herself out.
  • Routine outpatient appointments.

Children/Adolescents - a member who is absent from the premises without the approval of staff or a member who is out of contact with staff without prior arrangement who may be considered to be in "immediate jeopardy" based on his/her personal history; any time the police are contacted about a missing person or the police independently find and return the member regardless of the time he or she was missing.

Elopement while on therapeutic leave/pass

Any elopement of a member while on therapeutic leave/pass.

Injury or illness while on provider site requiring medical attention

Any member injury or illness while at the provider site that requires medical attention beyond basic first aid, including assessment at ER/urgent care and/or hospitalization. Agencies that are responsible for 24-hour per day service must report incidents that may occur off-site when they are made aware of such incidents or when it becomes that agency's responsibility for follow-up care.

Other

Any other serious incident not detailed above

* Dependent on the specific nature of the incident, a mandated report to ChildLine, police, and/or Adult Protective Services (APS) may be required.