HELP! Accident / Incident Reporting

SouthernLPN2RN, MSN, RN, APRN, NP · Feb 2, 2006

I don't have any real help to offer, but I'd page the student to the office rather than hunt them down.

JulieAW · Feb 2, 2006

We have similar procedures at the school I work at except our forms are in carbon triplicates - this may save you some time(?). The triplicate forms are the ones that have a checklist of what the problem is with space to elaborate and below has another checklist of treatment or what was done. A copy of this goes in the student's file, one to home, and one to the teacher. I document only names, class, and time of visit in the nurse log and use the individual forms as my documentation since they are kept in the student's individual health file. I find I have more time with this method since I am not documenting twice and it protects confidentiality of why the student came to the nurse's office on a particular day. We do have seperate accident report forms that the staff "witness" fills out. Since this is only filed with the office secretary, I usually do not even see it unless the witness gives it directly to me. I don't mind the telephone calls to parents - they are generally more than happy that someone cares enough to inform them of injuries.

Sorry I don't have any other suggestions to save time. Good luck,

~Julie~

bergren · Feb 3, 2006

Why would the teacher get a copy of what you describe?

JulieAW · Feb 3, 2006

Martha Bergren,

Thank you for asking this question! I have been working on changing the procedures at our school in regards to confidentiality of student information at many different levels. I am in a small school district in Illinois that has undergone restructuring in the past year. I am only at the school part time paid through a grant. At present, we have one form for all incidents/accidents. It serves as a communication tool that shows the parent was called and what action is going to be taken for the student (going home, back to class,etc.). The staff likes the communication of knowing that a student is leaving, but I feel that they do not need to know the assessment info. Unfortunately, the assessment is at the top of the page on these forms. I know there has to be a better way of doing this - probably a different set of forms. I have to say I am not the one who ordered these forms - I would have chosen a different format. I am sure if I found a different form(s) that works better the school would order them. At this point they are used to me telling them that things can not be done a certain way. I came into this position a year ago, so I am gradually whittling away how things "have always been done" and am very open to suggestions that would make things better.

Please advise,

~Julie~

:)

michigooseBSN · Feb 3, 2006

I am usually one to complain about computer software but after reading the above posts, I am so grateful almost all of that stuff goes on my computer rather than paper. My school district uses HealthMaster for our charting. Only an incident or injury which results in a child being sent for emergency care calls for a simple triplicate form concerning the incident, the nursing assessment and action, the disposition and the final outcome. The copies are for my files, one for the department nurse leader and one for the head of P.E (only if the incident or accident occured during gym) For anyone else to see the report is a HIPAA violation as I understand it. This is a very simple easy to use system.

bergren · Feb 4, 2006

Inappropriately sharing student health information is a FERPA violation. Most schools are covered by FERPA, not HIPAA. FERPA provided the template for HIPAA, ed records were protected for 25 years longer than health records, but HIPAA has brought more attention to this privacy law.

Schwab, N. C., Rubin, M., Maire, J. A., Gelfman, M. H. B, Bergren, M. D., Mazyck, D. & Hine, B. (2005). Protecting and sharing student health information: Guidelines for developing school district policies and procedures. Kent, OH: ASHA. http://www.ashaweb.org

Bergren, M. D. (2004). Privacy questions from practicing school nurses: Answers from an expert. Journal of School Nursing, 20, 296 - 301. http://www.nasn.org

Bergren, M. D. (2004). HIPAA - FERPA revisited. Journal of School Nursing, 20(2), 107 - 112. http://www.nasn.org

Schwab, N. & Pohlman, K. J. (2004). Records: The Achilles heel of school nurses. Answers to some bothersome questions. Journal of School Nursing, 20, 236 - 241. http://www.nasn.org

School nurses role in education privacy standards for student health records. National Association of School Nurses, http://www.nasn.org

This is free - just download or order:

National Forum on Education Statistics. (2004). Forum Guide to Protecting the Privacy of Student Information: State and Local Education Agencies, NCES 2004-330. Washington, DC: National Center for Education Statistics http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2004330

bergren · Feb 4, 2006

Julie

Are you a member of your local Illinois Association of School Nurses? http://www.iasn.org. Try to go to the next regional meeting and ask others to send you their copies - hand out your business cards, or better yet, an addressed envelope or address labels. Get the district's attorney to OK a new form. And find out who your district's risk manager is. The distribution of these forms should be limited. - it is considered an internal record of an incident and if many people have copies, and the existence is public, the parents can subpoena it.

tencat · Feb 4, 2006

Why would the teacher get a copy of what you describe?

If the teacher was a witness to the accident and has to complete part of the accident report form, the teacher needs a copy for his/her records to cover his/her behind. Anything I filled out as a teacher and had to sign always had a copy for me. I only filled out a couple of accident reports (thank God) but I was given a copy to keep in my files. It is professional suicide not to keep a copy because you never know when that paper might vanish or be misplaced. And if a family comes after you because of the accident/incident, you need to show them that you are well aware of the situation and are organized.

bergren · Feb 4, 2006

Check with your district's attorney, but it is advisable never to share an accident report with a parent, and not to even mention one exists. These are not public records and are not student records. I am not at work, so I do not have the page number in this book to refer you to:

Schwab N. & Gelfman, M. H. B. (2001). Legal issues in school health services: A resource for school nurses, administrators and attorneys. iuniverse.

Incident reports are for risk management purposes. There are district policies, procedures, and protocols regarding when to file incident reports. A formal incident report form must always be used when filing an incident report, or this risk management tool may not be protected under the discovery rules of your state. Most states still protect these documents from being available to a plaintiff's attorney in order to allow agencies to systematically collect and analyze this information in order to improve. If a nurse documents in a student's record, "An incident report was filed", the incident report may become available to the plaintiff's attorney. Also, never chart a students name in any chart except their own. So if your are documenting injuries from a fight, do not mention the other student involved in the nurses note. It is important to document in the student's record the facts of care provided without mentioning that an incident report has been filed. It is also important when creating the incident report to document objective observations and to avoid accusations and opinions about why or who caused the injury. Subjective opinions may damage the school if a legal action results, and the incident report becomes discoverable by the plaintiff's attorney. If the parent sees the report or is told the report exists, the incident report becomes discoverable by the plaintiff's attorney.

Each person who witnesses an incident, accident, or altercation in school should also make a detailed "personal note", anecdotal note about the incident to be used a as memory jogger in the event there is litigation. Again, never tell anyone that you have recorded a personal note, if you do it is no longer personal and it becomes discoverable by the plaintiff's attorney.

It has not been my experience in the schools I have worked in for any individual to be given copies of the incident reports, not the nurse, not the teac hers. They are forwarded to the district's risk manager. The more copies there are, the more likely this existence of the report will be come public.

An exception to that is law enforcement, Case law has determined that it is not a violation of FERPA to share incident reports with law enforcement when reporting a crime.

JulieAW · Feb 6, 2006

Great information - Thank you so much for the resources!