1. Incidents adversely affecting health and welfare.
OAC 5123:2-17-02
1

2. Objectives:





Provide new and/or current staff/providers with
an awareness of the importance incident reporting
Create awareness about abuse and neglect so staff
can identify and report information
Educate staff on types of Unusual Incidents and
MUI’s
Educate staff/providers on the procedures and
process of reporting incidents
Educate staff/providers of roles and
responsibilities of providers, support
administrators, and investigative agent
2

3. The Rule:

Establishes the requirements for
managing incidents adversely
affecting health or welfare.

Implements a continuous quality
improvement process in order to
prevent or reduce the risk of harm to
individuals.
3

4. The Rule:

The Purpose is to establish a system to:
 Report
 Investigate
 Review
 Remedy
 Analyze
4

5. Common Acronyms








Provider: person giving services to eligible client.
MAR: Medical Administrative Record (Med sheet
lists all med’s, dosages, and times given.)
ASD: Autism Spectrum Disorders
MR: Mental Retardation. (It is important to realize
this is seen as an offensive term by most
providers, SA’s and Individuals. It is recommended
you use Developmental Disability when
addressing a client or professional.)
UI Unusual Incident
MUI: Major Unusual Incident
PPI Primary Person of Interest
IA Investigative Agent
5

6. Definitions
Rule Reference: Page 1 (C )(2)
"Agency provider" is a provider, certified or licensed
by the department or a provider approved by the
Ohio office of medical assistance to provide
services under the transitions developmental
disabilities waiver, that employs staff to deliver
services to individuals and who may subcontract the
delivery of services. "Agency provider" includes a
county board while providing specialized
services.
6

7. Definitions
Rule Reference: page 2 (C)(10)
Independent
Provider)
Provider (Replaces Individual
"Independent
provider" means a selfemployed person who provides services for
which he or she must be certified under rule
5123:2-2-01 of the Administrative Code or
approved by the Ohio office of medical
assistance and does not employ, either
directly or through contract, anyone else to
provide the services.
7

8. Support Broker
SELF Waiver
Rule Reference: Page 11(G)(1)(e)
Support
broker for an individual enrolled
in the self-empowered life funding waiver
shall be notified of MUI’s. New addition
with the SELF Waiver.
8

9. QMRP Language change
Rule Reference: Page 6(c)(18)
"Qualified
intellectual disability
professional“ QIDP has the same
meaning as in 42 C.F.R. 483.430 (2012).
9

10. Summar y of MUI rule
changes

Rule title to include MUI and UIs. The new title is
Addressing major unusual incidents and unusual
incidents to ensure health, welfare, and
continuous quality improvement.

Changes to Protocols (A, B, and C category
investigations.)

Peer-to-peer definition changes (Physical Abuse, Verbal
Abuse, Misappropriation). Clarifies the definition for greater
consistency

Verbal Abuse definition changes

Missing Individual Definition Changes
10

11. Summar y of MUI rule
changes




Strengthening of the UI process. More incidents will
be categorized as UI’s = assure process effectively
addresses these incidents.
Revised communication and dispute resolution
opportunities (i.e., information, appeal) for
peer/guardian in a Peer-to-Peer case.
Law enforcement notifications on criminal Peer-toPeer cases. Local conversations to assure
appropriate follow-up
Law Enforcement and Attempted Suicide as an MUI –
even when individual is not being served
11

12. Summary of MUI Rule changes

Known / Unknown Injury Changes

Death- Suspicious or Accidental v.s. Natural

UI Definition

Health and Welfare

Provider Notifications

ICF Reporting Requirements

Support Broker Self Waiver

Peer to Peer Notifications

Incident Report Requirements

Quarterly to Semi Annual for MUI P& T Analysis
12

13. Revisions emphasize…

Improvements that focus on triaging
incidents based on severity

Providing the right amount of safety,
verification and investigation

Reducing unnecessary worry, time, and
effort on paper compliance that doesn’t
impact outcomes
13

14. Reporting Requirements
Rule Reference: Page 8(D)(3)(a-e)
Reports
regarding the following major unusual incidents shall
be filed and the requirements of this rule followed only when
the incident occurs in a program operated by a county board
or when the individual is being served by a licensed or certified
provider:
(i) Medical emergency;
(iii) Rights code violation;
(iv) Significant injury;
(v) Unapproved behavior support; and
(vi)
Unscheduled hospitalization.
14

15. Category A
Category B
Category C
Accidental or Suspicious
Death
Attempted Suicide
Law Enforcement
Exploitation
Medical Emergency
Unscheduled
Hospitalization
Failure to Report
Missing Individual
Unapproved Behavior
Support
Misappropriation
Death from Natural
Causes or disease
Rights code Violation
Significant Injury
Neglect
Peer to Peer Acts
Physical Abuse
Sexual Abuse
Verbal Abuse
Prohibited Sexual
relations
15

16. Required reporting at all
times
MUI only when services
are provided
Attempted Suicide
Medical Emergency
Law Enforcement
Rights code violation
Physical, Sexual, Verbal
abuse
Significant Injury
Peer to Peer Acts.
Unapproved Behavior
Support
Misappropriation
Unscheduled
Hospitalization
Exploitation
Failure to Report
Prohibited sexual relations
Neglect
Death
16

17. Category Summaries

All MUI’s require an investigation meeting
category A , B or C applicable
requirements of this rule.

Category A Alleged Crimes (Police , CSB
and IA involvement)

Category B Investigative Agent

Category C (Format Requirements)

Investigation categories may change
based on the information obtained A, B
and C.
17

18. Training
Rule Reference: Page 22 (P)(1)-(2)
Agency
providers and county boards shall ensure staff
employed in direct services positions are trained on the
requirements of this rule regarding the identification and
reporting of MUIs and UIs prior to direct contact with any
individual. Thereafter, staff employed in direct service
positions shall receive training during each calendar year
which shall include annual training on the requirements
of this rule including a review of health and welfare alerts
issued by the department since the previous calendar
year's training.
18

19. Access To Records
Rule Reference: Page 22-(O)
A
county board or the department shall not review,
copy, or include in any report required by this rule a
provider's personnel records that are confidential
under state or federal statutes or rules, including
medical and insurance records, workers'
compensation records, employment eligibility
verification (I-9) forms, and social security numbers.
The provider shall redact any confidential
information contained in a record before copies
are provided to the county board or the
department. A provider shall make all other
records available upon request by a county board
or the department.
19

20. Oversight
Rule Reference: Page 22 F (N)
(1)
The county board shall review, on at least a
quarterly basis (not monthly), a representative
sample of provider logs, including logs where the
county board is a provider, to ensure that major
unusual incidents have been reported, preventive
measures have been developed, and that trends
and patterns have been identified and addressed in
accordance with this rule.
The sample shall be made available to the
department for review upon request.
20

21. Rule Reference: Page 22- (N)(2)
When the county board is a provider of services,
the department shall review, on a monthly basis, a
representative sample of county board logs to
ensure that major unusual incidents have been
reported and that trends and patterns have been
identified and addressed in accordance with this
rule. The county board shall submit the specified
logs to the department upon request.
21

22. Unusual Incidents
Rule Reference: Pages 21 (M)(d)
Requires
the provider to investigate
unusual incidents, identify the cause
and contributing factors when
applicable, and develop preventive
measures to protect the health and
welfare of any at-risk individuals.
22

23. Unusual Incidents Cont.
Rule Reference: Page 21(M)(5)
Independent
providers shall complete an
incident report, notify the individual's
guardian or other person whom the
individual has identified, as applicable on the
day an unusual incident is discovered.
Independent
Providers will also maintain a
log of unusual incidents. Rule Reference: Page 21 (M)
(8)
23

24. Rule Reference-Page18(L)(2)(a-j)
Specific individuals involved in established trends and
patterns
(i.e., five major unusual incidents of any kind within six
months,
ten major unusual incidents of any kind within a year,
or other
pattern identified by the individual's team);
Specific trends by residence, region, or program;
Previously identified trends and patterns; and
Action plans and preventive measures to address
noted trends and patterns.
24

25. Analysis
Rule Reference-Page18(L)(2)(a-j)
All reviews and analyses shall be completed within
thirty calendar days following the end of the six-month
period. The semi-annual and annual analyses shall
contain the following elements:
Date
of review;
Name of person completing review;
Time period of review;
Comparison of data for previous three years;
Explanation of data;
Data for review by major unusual incident category
type;
25

26. Analysis
Rule Reference: Page 18 (L)(1)
All
agency providers shall produce a semi-annual
(not quarterly) and annual report regarding MUI
trends and patterns which shall be sent to the county
board.
The county board shall semi-annually review all
individual providers for MUI trends and patterns. The
semi-annual review shall be cumulative for the first
two quarters and include an in-depth analysis. The
annual review shall be cumulative for all four quarters
and include an in-depth analysis.
Each review period shall include the preventive
measures taken to address the trends and patterns.
26

27. PROVIDER NOTIFICATION OF
DODD CASE CLOSURES

There is no longer a requirement that the
County Board provide notification to the
provider within 5 days of case being
closed.
27

28. Written Summaries
Rule Reference: Page15 (J)(1)
No
later than five working days following the
county board's, developmental center's, or
department's recommendation via the ITS incident
tracking system that the report be closed, the
county board, or developmental center, or
department shall provide a written summary of the
administrative investigation of each category A
or category B major unusual incident…
28

29. Written Summaries
Rule Reference: Page 16 (J)(5)
An
individual, individual's guardian, other person
whom the individual has identified, or provider may
dispute the findings by submitting a letter of dispute
and supporting documentation to the county board
superintendent, or to the director of the department
if the department conducted the administrative
investigation, within fifteen calendar days following
receipt of the finding. An individual may receive
assistance from any person selected by the
individual to prepare a letter and provide supporting
documentation.
29

30. Written Summaries
Rule Reference: Page15-Section15(J)(1) continued
including
the allegations, the facts and findings,
including as applicable, whether the case was
substantiated or unsubstantiated, and preventive
measures implemented in response to the incident
to the following unless the information in
the written summary has already been
communicated.
30

31. Investigations
Rule Reference: Page 12 (H)(b)-(c)
Based
on the facts discovered during administrative
investigation of the major unusual incident, the category may
change. If a major unusual incident changes category, the
reason for the change shall be documented and the new
applicable category administrative investigation procedure
shall be used to investigate the major unusual incident.
Major
unusual incidents that involve an active criminal
investigation may be closed as soon as the county board
ensures that the major unusual incident is properly coded,
the history of the primary person involved has been
reviewed, cause and contributing factors are determined, a
finding is made, and prevention measures implemented.
Information needed for closure of the major unusual incident
may be obtained from the criminal investigation.
31

32. Investigations
Rule Reference: Pages 12(H)(2)(a)
All
major unusual incidents require an administrative
investigation meeting the applicable investigation
procedure requirements established in appendix A,
appendix B, or appendix C to this rule unless it is not
possible or relevant to the administrative investigation to
meet a requirement under this rule, in which case the
reason shall be documented. Administrative
Investigations shall be conducted and reviewed by
investigative agents.
The
department or county board may elect to follow the
investigation procedure for category A major unusual
incidents for any major unusual incident.
32

33. Peer to Peer Notifications
Rule Reference: Page 11(G)(4)
Notification
shall be made to the
individuals, individuals' guardians, and
other persons whom the individuals have
identified in a peer-to-peer act unless
such notification could jeopardize the
health and welfare of an individual
involved.
33

34. (E) Alleged Criminal Acts

Immediate reporting to law enforcement

Allegations of Abuse including
Misappropriation and Neglect which may
constitute a criminal act

The county board ensures notification has
been made
34

35. (F) Abused or Neglected Children

Allegations of Abuse or Neglect per Ohio
Revised Code 2151.03 and 2151.031

Under the age of 21

Report to local public children’s agency

The county board shall ensure reports
have been made
35

36. Reporting Alleged criminal
acts cont…
Rule Reference: Page 10(E)(3)
The department shall immediately report to
the Ohio state highway patrol, any allegation
of physical abuse, sexual abuse, verbal
abuse, misappropriation, exploitation, neglect,
failure to report, or peer-to-peer act occurring
at a developmental center which may
constitute a criminal act. The department shall
document the time, date, and name of person
notified of the alleged criminal act.

36

37. Reporting alleged Criminal acts
Rule Reference: Page 10 (E)(2)
The
provider shall immediately report to the law
enforcement entity having jurisdiction of the location
where the incident occurred, any allegation of physical
abuse, sexual abuse, verbal abuse, misappropriation,
exploitation, neglect, failure to report, or peer-to-peer
act which may constitute a criminal act. The provider
shall document the time, date, and name of person
notified of the alleged criminal act. The county board
shall ensure that the notification has been made.
37

38. Reporting alleged Criminal acts
Rule Reference: Page 10(E)(1)
Reporting
of alleged criminal acts
Nothing in this rule relieves mandatory reporters of the
responsibility to immediately report to the intermediate care
facility administrator or administrator designee, allegations of
mistreatment, neglect or abuse, and injuries of unknown source
when the source of the injury was not witnessed by any person
and the source of the injury could not be explained by the
individuals and the injury raises suspicions of possible abuse or
neglect because of the extent of the injury or the location of the
injury or the number of injuries observed at one particular point in
time or the incidences of injuries over time pursuant to 42 C.F.R.
483.420(d)(2).
38

39. Reporting MUI’s on Person
served




Abuse, Neglect, Exploitation, Misappropriation, Death,
Prohibited Sexual Relations, Law Enforcement, Attempted
Suicide, Peer to Peer and Failure to Report
Regardless of where the incident occurred
Follow all rule requirements
Remaining categories (All other MUI’s) when:
 Incident occurs in program operated by the county board

OR
 When the individual is being served by a licensed or
certified provider
 Follow all requirements
39

40. (D)(5) Immediate to 4 Hour
Reporting



Provider or county board as a provider
Using county board identified system for
MUIs
Report incidents or allegations of:
○ Abuse
○ Neglect
○ Exploitation
○ Misappropriation
○ Suspicious or accidental death
○ Media inquiries
40

41. (D)(3) Upon Identification or Notification of
MUI, Provider or County Board Shall:

Take immediate actions to protect all at
risk individuals which shall include:
○ Immediate or ongoing medical attention as
appropriate
○ Remove employee from direct contact until
determined unnecessary
○ Other measures as necessary

The Department shall resolve any
disagreements
41

42. (D)(10)

County board shall have a system
available 24-7 to receive and respond to
reports.

MUI notification numbers:
During business hours (8am–4:30pm M-F)
740-201-3608 and 740-201-5812
After hours (4:30pm-8am), weekends, and
holidays: Helpline 211 or1-800-684-2324. Ask
to speak with DCBDD On Call.
42

43. (G)(1) Notifications Upon
Awareness of an Incident
To be made by provider or county board as a
provider
 Made the same day
 Include immediate actions taken
 DODD wants to see time of notification on the
IRF. (Recommend you add a time slot)

 Guardian, advocate, or person identified
 SSA for individual
 Licensed or certified residential provider
 Staff or family in the home
43

44. (G)(2)-(4)




Notifications or effort to notify shall be
documented
The county board ensure notifications have
been made
Do not notify the PPI, PPI’s spouse, or
significant other
Not needed if the report came from person
to be notified or in the case of death where
the family is already aware
44

45. (D)(4) County Board Upon
Notification Shall:

Ensure reasonable measures are
appropriate

Determine if additional measures are
needed
45

46. (G)(5) Notification to Providers When
PPI Works for Multiple Providers





The Department makes these
Alleged crimes
The other provider determines if steps are
needed to ensure health and safety
Notification of case disposition
Providers, county boards, developmental
centers to notify the Department if the PPI
works elsewhere in the system
46

47. (D)(6) Submit Written Incident Report by
3:00 p.m. the Next Working Day




Agency providers, individual providers, and
county boards as providers
Department prescribed format: DCBDD IRF
is included in training packet
Fax #: (740) 201-3608 or (740) 201-5812
Attn: MUI Investigative Agents
DCBDD IA and SA must have report by
3pm the next working day – do not use
postal service or inter-office mail; if fax is
not available, hand delivery is suggested
47

48. (K)(1) Written Procedure Implemented for
Internal MUI Review

County boards and agency providers

Include responsibility for reasonable
steps to prevent
48

49. (K)(2) Development of Preventive
Measures





Team including county board and provider
Address causes and contributing factors
Determine reasonable steps
Plans of Prevention/Correction are due in
their entirety, 21 days from the date the
IDF was mailed
In circumstances of few supports –
implement what is reasonably possible.
49

50. (D)(1) Any Person with DD Not
Served




Report possible Abuse including
Misappropriation or Neglect
To local law enforcement and the county board
OR
Public Children’s Service Agency and county
board
Entry page on ITS
50

51. 
(H) General Investigation
Requirements
51

52. (H)(1)

All MUIs require an investigation
meeting the requirements in Appendix A
or B

Certified investigative agents shall
conduct the investigations
52

53. (H)(2)






The county board shall have at least one
investigative agent. The county board may
contract with a person or a government
entity.
Must be certified
Must receive annual Department-approved
training
53

54. (H)(5)



Agency Provider may conduct HR
investigations from which information
except for interviews may be used
The investigative agent shall conduct all
interviews for MUIs unless Law
enforcement or Children’s services is
investigating
May obtain assistance with interviewing an
individual
54

55. (H)(6)

Commence an investigation immediately
but no later than 24 hours for:
○ Abuse, Neglect, Exploitation, or Misappropriation
○ Rights Code
○ Suspicious or Accidental Death
○ Prohibited Sexual Relations
○ One determined by the county board
55

56. (H)(7)

For other MUIs – Commence no later
than 3 working days after identification
or notification.

Decision based upon:
Initial information received
Consistent with health and safety of at risk
persons
56

57. (H)(10)

When an agency provider conducts an
internal review of an incident, (HR
investigation) and an MUI has been filed

The results of the review including
statements and documents go to the
county board within 14 calendar days of
awareness of the incident
57

58. (H)(11)

All DD and DODD Provider employees
shall cooperate with any administrative
investigation

Providers and the county board shall
respond to information within timeframes
requested
58

59. (H)(12)

The investigative agent submits the
report of investigation for closure in ITS
within 30 working days.

Extensions may be granted by DODD
based on established criteria.
59

60. (I)(1) Dept directed investigations

The Department shall conduct the MUI
investigation when the allegation is against:
Superintendent of a county board or
developmental center
Executive Director or equivalent of a Counsel of
Government
Management employee who reports to the
Superintendent or Executive Director
An investigative agent
An SSA
An MUI contact for a county board
A current member of a county board
60

61. (I)(1) Continued


Known relationship with A-G when it may
present a conflict of interest or the
appearance of a conflict of interest
County board employee who is alleged to
be responsible for individual’s death, has
committed sexual abuse, engaged in
prohibited sexual activity, or committed
physical abuse or neglect resulting in
emergency room treatment or
hospitalization.
61

62. (J)(1)(2)

Those receiving written notice:
Individual or individual’s guardian or
advocate
Licensed or certified provider and provider
at the time of the incident
SSA or person selected to coordinate
services
Not to family in case of death unless
requested
62

63. (J)(3)

Written summary not provided to PPI,
PPI’s spouse, or significant other

A reasonable attempt to notify the PPI of
disposition shall be made no later than 5
working days following case closure
63

64. UI Definition
Rule Reference: Page 7(c)(20)
"Unusual
incident" means an event or occurrence involving an
individual that is not consistent with routine operations, policies
and procedures, or the individual's care or service plan, but is
not a major unusual incident.
Unusual
incident includes, but is not limited to: dental injuries;
falls; an injury that is not a significant injury; medication errors
without a likely risk to health and welfare; overnight relocation of
an individual due to a fire, natural disaster, or mechanical failure;
an incident involving two individuals served that is not a peer-topeer act major unusual incident; and rights code violations or
unapproved behavior supports without a likely risk to health and
welfare.
64

65. UI Definition
Rule Reference: Page 7(c)(20)
Unusual
incident includes, but is not limited to: dental injuries;
falls; an injury that is not a significant injury; medication errors
without a likely risk to health and welfare; overnight relocation of
an individual due to a fire, natural disaster, or mechanical failure;
an incident involving two individuals served that is not a peer-topeer act major unusual incident; and rights code violations or
unapproved behavior supports without a likely risk to health and
welfare.
65

66. Minor Injuries




lacerations, scrapes, contusions or
discolorations of known origin, minor burns,
rash, minor, dental injuries
recreational/work related injuries, falls;
peer-to-peer incidents that are not MUIs;
overnight relocation of an individual due to
fire, natural disaster, or mechanical failure;
66

67. Behavioral episode

a physical or verbal outburst of an eligible
individual that does not require physical
intervention.

Concerning Peer to Peer interaction that is not an
MUI

Unapproved Behavior Supports without a risk to
health or welfare. Ex. Taking radio away.
67

68. Self-medication errors

an individual who administers their own
medication (as outlined in their ISP) fails
to administer the medication as
prescribed (with no adverse effects).
68

69. Atypical behavior

an occurrence where an eligible
individual displays behavior that is
unusual or displays a typical behavior
increasingly which causes concern for
health and safety.
69

70. A Major Unusual Incident
(MUI) is:




The alleged, suspected or actual occurrence of an
incident when there is reason to believe the health
or welfare of an individual may be adversely
affected.
Or when an individual may be placed at a
reasonable risk of harm.
If such individual is receiving services through the
DCBDD service system or will be receiving such
services as a result of the incident.
Major Unusual incidents directly relate to and are
written about the individual receiving services that
the incident happens to. Reports are about the
victim, not the perpetrator
70

71. MUI’s include:









Abuse
Attempted suicide
Death
Exploitation
Failure to report
Significant injury
Law enforcement
Medical emergency
Misappropriation
71

72. MUI’s include:







Missing individual
Neglect
Peer-to-Peer acts
Prohibited sexual relations
Rights code violation
Unapproved behavior support
Unscheduled hospitalization
72

73. Category Summaries

All MUI’s require an investigation meeting
category A , B or C applicable
requirements of this rule.

Category A Alleged Crimes (Police , CSB
and IA involvement)

Category B Investigative Agent

Category C (Format Requirements)

Investigation categories may change
based on the information obtained A, B
and C.
73

74. Category A Incidents



Require 4 hour notification to DCBDD
Require immediate Notification to Law
Enforcement or Children Services in
cases of suspected child abuse (up to
age 21 for DCBDD Eligible individuals).
Require immediate notification to Law
Enforcement for criminal cases.
74

75. Category A Incidents








Cases in which Police, CSP, or IA may be involved
in the investigation
Accidental or Suspicious Death
Exploitation
Failure to report
Misappropriation
Neglect
PTP act
Physical Abuse
75

76. Category A Incidents




Prohibited Sexual Activity
Rights Code
Sexual Abuse
Verbal Abuse
76

77. Failure to report:

When a person has reason to believe that
an individual has suffered or faces
substantial risk of suffering from any
wound, injury, disability, or condition of
such a nature as to indicate abuse or
neglect. Including misappropriation.
77

78. Failure to report:

And that person does not immediately
report the incident to:
 Law enforcement
 Children Services
 The DCBDD

The Omission of the reporting is itself the
MUI and must be reported immediately.
78

79. Abuse:

Physical:
use of physical force
That can be expected to or does result in
physical or serious physical harm.
Including but not limited to:
○ Hitting
○ Slapping
○ Pushing
○ Throwing objects at an individual
○ Prone Restraints
79

80. Abuse:

Sexual Abuse:
Unlawful sexual conduct or sexual contact

Verbal Abuse:
Purposefully using words, gestures or other
communicative means to threaten, coerce,
intimidate, harass, or humiliate an
individual
80

81. Misappropriation:

Depriving, defrauding, or
otherwise obtaining the
real or personal property
of an individual by any
means prohibited by the
Ohio Revised Code.

It is a felony to steal even
one penny!
81

82. Exploitation:

The unlawful or improper act of using an
individual’s resources for monetary or
personal benefit, profit, or gain.
82

83. Neglect:

When there is a duty to do so, failing to
provide an individual with:
Treatment
Care
Goods
Supervision
Services necessary to maintain the health or
safety of the individual.
83

84. Neglect:


Consideration must be given to whether
there is reasonable risk to health and
safety.
Neglect includes patient endangerment
which means an DD caretaker has
created a substantial risk to the health or
safety of an individual.
84

85. Peer To Peer
Rule Reference: Page 4(a)(vi)
(vi)
Peer-to-peer act. "Peer-to-peer act"
means one of the following:
(a)
Exploitation
(b) Theft…The $ limit for an MUI
investigation regarding peer to peer was
raised from $10 to $20.
85

86. Peer To Peer
Rule Reference: Page 4(a)(vi)(c)
Physical
act that occurs when an individual is
targeting, or firmly fixed on another individual such
that the act is not accidental or random. The incident
results in an injury that is treated by a physician,
physician assistant, or nurse practitioner. Allegations
of one individual choking another or any head or neck
injuries such as bloody nose, a bloody lip, a black eye
or other injury to the eye, shall be considered major
unusual incidents.
86

87. Peer To Peer
Rule Reference: Page 4 (a)(vi)(c)
Minor
injuries such as scratches or
reddened areas not involving the head or
neck shall be considered unusual incidents
and shall require immediate action, a
review to uncover possible
cause/contributing factors, and prevention
measures.
87

88. Peer to peer
Rule Reference: Page 4 (a)(vi)(e)
Verbal
act which means the use of words,
gestures, or other communicative means
to purposefully threaten, coerce, or
intimidate the other individual when there
is the opportunity and ability to carryout the
threat.
88

89. Peer to Peer
& Law enforcement
Notifications -discussion

Notifications shall be made to law
enforcement or CSB as appropriate
when an alleged crime has been
committed. (The change in peer to
peer physical act definition will help
assure that appropriate notification to
LE and CSB occurs regarding peer to
peer MUI’s.)
89

90. Prohibited Sexual Relations:

An DD employee engaging in consensual
sexual conduct or having consensual sexual
contact with an individual who is not the
employee’s spouse, and for whom the DD
employee was employed or under contract
to provide care at the time of the incident
and includes persons in the employee’s
supervisory chain of command.
90

91. Rights Code Violation:

Any violation of the rights enumerated
in section 5123.62 of the Revised Code
that creates a reasonable risk of harm to
the health or safety of an individual.
91

92. Category B Incidents

Required to report the same day

Required to implement immediate plan of
correction to ensure health and welfare.
Attempted Suicide
Medical Emergency
Missing Individual
Death from natural causes or disease





Significant Injury (Combined known/unknown
injury
92

93. Attempted Suicide

Attempted Suicide:
 A physical attempt by an
individual that results in
emergency room
treatment, in-patient
observation, or hospital
admission.
93

94. Death MUI’s


Natural Causes, medical condition or
disease.
IA follows Coroner lead.
94

95. MISSING INDIVIDUAL
Rule Reference: Page 5 (b)(iv)
An
incident that is not considered neglect and an
individuals whereabouts after immediate measures
taken are unknown and the individual is believed to be
at or pose an imminent risk of harm to self or
others.
An incident when an individual’s are unknown for
longer than the period of time specified in the
individuals service plan that does not result in
imminent risk of harm to self or others shall be
investigated as an unusual incident.
95

96. Medical Emergency:

An incident where
emergency medical
intervention is required
to save an individual’s
life:
Heimlich maneuver
CPR
IV fluid for
dehydration
Epi-Pen
96

97. Known / Unknown Injury
(Significant Injury)
Rule Reference: Page 6 (b)(v)
Significant
injury. "Significant injury" means an
injury of known or unknown cause that is not
considered abuse or neglect and that results in
concussion, broken bone, dislocation, second or
third degree burns or an injury that requires
immobilization, casting, or five or more sutures.
Significant injuries shall be designated in the
incident tracking system as either known or
unknown cause.
97

98. Category C Incidents

Law Enforcement

Unapproved Behavior Supports

Unscheduled Hospitalizations
98

99. Law Enforcement:


Any incident that
results in the
individual being
charged,
incarcerated, or
arrested.
New: Required even
if client is not
receiving services.
99

100. Unapproved Behavior
Support
Rule Reference: Page 6 (c)(ii)
“Unapproved behavior support” is
an intervention that is prohibited by paragraph
(J) of rule 5123:2-1-02 of the Administrative
Code or an aversive strategy implemented
without the approval by HRC or BSC or without
informed consent, that results in a likely risk to
health and welfare. An intervention that is
prohibited by paragraph (J)of rule 5123:2-02
of the O.A.C. and does not likely pose a
likely risk to health and welfare shall be
investigated as an unusual incident.
100

101. Unscheduled Hospitalization:

Any hospital admission that
is not that is not scheduled
unless the hospital
admission is due to a
condition that is specified in
the ISP or nursing care plan
indicating the specific
symptoms and criteria that
require hospitalization.
101

102. Appendix C and the SSA




Appendix C cases are Law Enforcement, Unscheduled
Hospitalizations and Unapproved Behavior Supports.
These are the only 3 categories where the Appendix C
Protocol and form can be used.
Appendix C forms can be completed by the SSA and the
Provider who was providing services to the individual
when the incident occurred.
The IA or MUI Contact will enter the information from
Appendix C form into ITS.
The IA will be responsible for reviewing it and ensuring
information is complete, incident is properly coded and
meets the requirements of rule.
102