Georgia Department of Behavioral Health & Developmental Disabilities

1. Promoting Care of I/DD Individuals through DBHDD Oversight and Risk Mitigation Policies Guidance for DBHDD Community Providers Georgia Department of Behavioral Health & Developmental Disabilities

2. Agenda

3. Major Policy Categories Overarching Policies Risk Mitigation Policies • Registered Nursing Oversight in I/DD Community Settings, 02-808 • Healthcare Plans for Individuals with Intellectual/Developmental Disabilities (I/DD) in Community Settings, 02-266 • Risk Mitigation of Health Conditions or Vulnerabilities in Intellectual and/or Developmental Disability (I/DD) Services, 02-807 • Bowel Management for Individuals Diagnosed with Developmental Disabilities Living in Community Settings, 02-802 • Prevention of Health Complications Related to Seizures, 02-806 • Prevention of Choking and Aspiration for Individuals with Intellectual/Developmental Disabilities Living in the Community, 02-801

4. Critical Policy Components • Purpose • Procedures

5. Overarching Policies Registered Nursing Oversight Healthcare Plans Risk Mitigation

6. Registered Nursing Oversight in I/DD Community Settings, 02-808 Purpose • Statute, law and professional standards of nursing practice • Treatment from licensed nurses or direct support staff • Oversight by Registered Nurses • Provider adherence to policy requirements

7. Registered Nursing Oversight in I/DD Community Settings, 02-808 Procedures - Ensuring High Standards of Professional Nursing Practice • Assessment • Planning of Care (ISP) • Development of HCP • Preventative and Healthcare Maintenance Activities • Advocacy • Health Education • Delegation and Supervision • Health Risk Screening Tool • Clinical and Summary Notes • Availability for Clinical Consultation

8. QUESTIONS

9. Registered Nursing Oversight in I/DD Community Settings, 02-808 Procedures - Monitoring • Individual • HCP • Documentation • Medication Administration • Infection Control Procedures • Incident Follow-up • Verification of Certification • Other Nursing Practice Duties

10. QUESTIONS

11. Healthcare Plans for Individuals with I/DD in Community Settings, 02-266 Purpose • Required upon identified risk or condition in all settings • Mitigated by documented and confirmed existence of individual factors that indicate stability such as relationship(s) with clinical professionals and collateral supports • Develop written Healthcare Plan (HCP) • Individual Service Plan (ISP) • Staff training • Multidisciplinary activities and interventions

12. Healthcare Plans for Individuals with I/DD in Community Settings, 02-266 Procedures – Healthcare Plan Requirements Developed by an RN Individualized Updated as needed and annually Incorporates input from multiple sources Lists steps to be implemented by direct support staff Guided by the Health Risk Screening Tool (HRST)

13. HRST Nursing Assessment and Healthcare Plans Launch in 2019

14. Bowel and Bladder Management Gastrointestinal Management Neurological Management Skin Integrity Management Endocrine Management Respiratory Management Cardiovascular Management Musculoskeletal Management Reproductive Management Mental Health with Medications Management Preventative and Routine Healthcare Maintenance HRST Healthcare Plans

15. Competency Check QUESTIONS Written test

16. Risk Mitigation of Health Conditions or Vulnerabilities in I/DD Services, 02-807 Procedures • Identifying Risk • Reducing or Eliminating Health Risks • Mitigating Risks of Related Clinical Conditions

17. QUESTIONS

18. Risk Mitigation-Specific Policies Bowel Management Prevention of Choking and Aspiration Prevention of Seizure-related Health Complications

19. Bowel Management for I/DD Individuals Living in Community Settings, 02-802 Procedures • Establishment of policy and protocols for monitoring bowel function • Supplementary information for successful bowel management • Minimum policy content requirements

20. Bowel Management for I/DD Individuals Living in Community Settings, 02-802 Rationale for Levels of Risk Surveillance First Level - Screening for the risk and/or diagnosis of bowel obstruction, constipation, and impaction Second Level – Initiated: identified risk or confirmed diagnosis

21. QUESTIONS

22. Bowel Management for I/DD Individuals Living in Community Settings, 02-802 Procedures - Provider Responsibilities • Know Individual’s baseline • Assess Individual’s risk on an ongoing basis • Develop bowel tracking document • Develop awareness of interventions • Adhere to notification and documentation requirement • Provide timely training

23. Bowel Management for I/DD Individuals Living in Community Settings, 02-802 Procedures - Staff Responsibilities • Direct Support • Agency’s DDP or licensed healthcare professional • Other Support Staff

24. Bowel Management for I/DD Individuals Living in Community Settings, 02-802 Procedures - Training Program • Target Audiences – Direct Support Staff • Program Content • Causes of Constipation, Impaction and Bowel Obstruction • Signs/Symptoms of Constipation, Impaction and Bowel Obstruction • Data collection, documentation and competency demonstration • Delivery Schedule – Initial Orientation and at least Annually • Trainer Documentation – Date, Purpose, and Content • On-the-Job Documentation- Competency

25. Bowel Management for I/DD Individuals Living in Community Settings, 02-802 Procedures - Emergency Medical - Suspected Bowel Obstruction or Impaction • Take immediate action • Implement emergency medical procedures (e.g., 911) • Ensure that the individual is out of danger • Make routine notification phone calls

26. QUESTIONS

27. Prevention of Health Complications related to Seizures, 02-806 Purpose • Establishment of policy and protocols for individualized interventions • Direct support staff training

28. Prevention of Health Complications related to Seizures, 02-806 Rationale for Levels of Risk Surveillance First Level - Screening for the risk and/or diagnosis of health complications related to seizures Second Level – Initiated: identified risk or confirmed diagnosis

29. QUESTIONS

30. Prevention of Health Complications related to Seizures, 02-806 Procedures - Provider Responsibilities Provide timely training for direct support staff: • Competency to recognize and respond to seizure activity • Seizure Management (during and after a seizure) • Documentation of observations (before, during and after) Develop an internal policy for addressing seizure activity: • Awareness of seizure status of each individual • Identification of change in condition • Implementation of interim interventions to decrease risk

31. Prevention of Health Complications related to Seizures, 02-806 Procedures - Staff Responsibilities • Identification of a prior risk for seizures • Identification of change in condition • Mitigation of identified risk • Development of an HCP by an RN

32. Prevention of Health Complications related to Seizures, 02-806 Procedures –Training Program • Target Audiences – Direct Support Staff • Program Content • Recognize and respond to seizure activity • Record pertinent information about observed seizure activity • Conduct seizure management during and after a seizure • Know the content and requirements of the Healthcare Plan (HCP) • Document observations, medication and other interventions before, during and after a seizure • Delivery Schedule – Initial Orientation and at least Annually • Training Documentation – Date, Purpose, and Content

33. Prevention of Health Complications related to Seizures, 02-806 Emergency Medical Procedures - Witnessed Seizures • Implement emergency medical procedures (e.g., 911). • Ensure that the individual is out of danger. • Make notification phone calls to individual’s family.

34. QUESTIONS

35. Prevention of Choking and Aspiration for I/DD Individuals Living in the Community, 02-801 Procedures • Establishment of protocols for monitoring and responding to choking and aspiration risks • Training of staff on designated emergency response plan for choking or aspiration

36. Prevention of Choking and Aspiration for I/DD Individuals Living in the Community, 02-801 Purpose Rationale for Levels of Risk Surveillance First Level - Screening for the risk and/or diagnosis of choking and aspiration Second Level – Initiated: identified risk or confirmed diagnosis

37. QUESTIONS

38. Prevention of Choking and Aspiration for I/DD Individuals Living in the Community, 02-801 Contraindicated Foods • Extraordinary precaution and possible exclusion of certain foods • Examples of Chokable Foods

39. Prevention of Choking and Aspiration for I/DD Individuals Living in the Community, 02-801 Procedures - Provider Responsibilities Develop an internal policy for addressing potential risk or actual incidents: • Mitigation of occurrence or lessen frequency of choking • Response to incidents of choking, aspiration and related conditions Provide timely training for direct support staff: • Competency to recognize and respond to aspiration risk • Assessment and treatment at proper level of care • Documentation of clinical recommendations and physician’s orders in individual’s clinical record

40. Prevention of Choking and Aspiration for I/DD Individuals Living in the Community, 02-801 Procedures - Staff Responsibilities • Identification of a prior risk for aspiration and choking • Identification of change in condition • Mitigation of identified risk • Development of an HCP by an RN

41. Prevention of Choking and Aspiration for I/DD Individuals Living in the Community, 02-801 Procedures - Training Program • Target Audiences – Direct Support Staff • Program Content • Recognize aspiration risk status for all individuals • Review individual’s HRST, ISP, HCP and dietary needs to: • Identify prior risk for aspiration and choking • Identify change in condition that indicates development of risk for aspiration and choking • Know how to take immediate action to mitigate risk of harm when risk is identified • Identify individuals who are in need of mealtime and positioning supports (according to HCP) • Delivery Schedule – Initial Orientation and at least Annually • Training Documentation – Date, Purpose, and Content

42. Prevention of Choking and Aspiration for I/DD IndividualsLiving in the Community, 02-801 Emergency Medical Procedures - Witnessed Choking or Aspiration Incidents Staff Actions • Implement emergency medical procedures (e.g., 911) • Ensure that the individual is out of danger • Make notification phone calls to individual’s family Provider Actions • Notify individual’s legal guardian and next of kin (according to HIPAA regulations) • Submit electronic Critical Incident Report (according to DBHDD policy 04-106 Reporting Deaths and Critical Incidents in Community Services)

43. QUESTIONS

44. Summary of Key Points Content - Varies according to each policy’s subject matter. Common Elements - Found throughout all policies. Complete Policies – Access by clicking the appropriate links.

45. Call to Action Access policies in PolicyStat. Compare your policies to DBHDD policies. Make adjustments to practice in order to gain alignment Participate in training on policies from DBHDD.

46. FAQs

48. QUESTIONS

49. Read and Sign Reminder The ONLINE READ AND SIGN ATTESTATION TO BE COMPLETED AFTER WEBINARAfter attending the Webinar, attendees should log into the DD Library on DBHDD University (dbhddu.com) and complete a Read and Sign attesting understanding of the policies, as well as responsibility for adhering to the them and educating direct care staff about the requirements.READ AND SIGN COMPLETION DEADLINEThe Read and Sign must be completed by May 1, 2019. HOW TO ACCESS THE READ AND SIGN:If you are a provider staff with an existing DBHDD Relias account, you can access the Read and Sign using the link below. Developmental Disability Service Providers Library:http://ddlibrarydbhdd.training.reliaslearning.com/ If necessary, contact Michael Moryc at moryc@uga.edu