Abuse and Allegations of Abuse - PowerPoint Presentation

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Abuse and Allegations of AbuseSlide2

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Upon completion of this module, the employee will be able to:

Differentiate between the term “Abuse” and “Abuse Allegations”

List the different types of abuseList the criteria that identifies victims of abuseDiscuss the CHSB policy regarding reporting of abuse and abuse allegations Discuss the appropriate procedure for reporting and notificationsIdentifies who is responsible for abuse reporting and what the individuals role is.

Module ObjectivesSlide3

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All Community Hospital of San Bernardino employees are designated as

“Mandated Reporters”

and are required by law to report known or suspected abuse, neglect, or exploitation.All employees will notify the appropriate authorities as well as complete the required forms. Did you know?Slide4

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Abuse/ Neglect reporting includes child, elder, dependant adult, domestic violence.

A dependant adult is any one who is physically developmentally and mentally challenged adults…

AND all adults who are inpatients in an acute hospital setting.What to report...Slide5

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Dependant Adult

- Any person between the ages of 18 and 64 who has physical , mental limitations which restrict his or her ability to carry out normal activities or to protect his or her rights.

Mandated Reporters - All employees of Community Hospital of San Bernardino are required to make a report in situations of observed or suspected abuse

How does that include me? Let’s define it further…Slide6

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What exactly does

“Abuse”

mean?Slide7

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Abuse

– Misuse, maltreatment, or excessive use.As defined in the policy – the willful inflection of injury, unreasonable confinement, intimidation, or punishment, with resulting harm, pain, or mental anguishNeglect– A form of abuse that includes failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness.Definitions of Abuse/NeglectSlide8

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Child Abuse

Non-accidental use of physical force or the non-accidental act of omission by a parent or other custodian responsible for the care of a child.

Domestic Abuse Abuse of a person by another person with whom the victim is living, has lived or with whom a significant relationship exists.Elder Abuse Maltreatment of an older adult, ranging from passive neglect of needs to overt mental, physical, or sexual assault.

Physical Abuse

- Assault, battery, sexual assault, assault with a deadly weapon or force likely to produce great bodily injury, unreasonable physical restraint, prolonged or continual deprivation of food or water.

Types of AbuseSlide9

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Sexual Abuse

Sexual battery, rape, incest, sodomy, oral copulation, or penetration of genital or anal opening by a foreign object.

Mental Abuse Deliberately inducing fear, agitation confusion, severe depression, or other forms of serious emotional distress through verbal assaults, threats, harassment or other forms of intimidating behaviorFinancial Abuse Situation in which a caretaker takes, hides, or appropriates money or property of an elder or dependent adult for use or purpose that is not in due and lawful execution of his or her trust

Types of AbuseSlide10

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Criteria for IdentificationSlide11

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Bruises, burns, abrasions, cuts or swelling caused by other than accidental means.

Belt-buckle marks, handprints, bite marks or pinches.

The child says an injury was caused by abuse.A history of previous or recurrent injuries.Unexplained injuries, or conflicting explanations of injury.Caretaker attempts to hide injuries.Extreme changes in behavior, such as loss of appetite.Recurrent nightmares or disturbed sleep patterns.Regression to thumb sucking, bed wetting, or excessive crying.

Fear of a person or intense dislike at being left somewhere or with someone.

Criteria for Identification of Child Abuse or NeglectSlide12

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Contusions, abrasions and minor lacerations, fractures /sprains and head, neck, chest, breast and abdominal injuries with delays in seeking treatments.

Multiple sites and/or repeated or chronic injuries.

Sleep and appetite disturbances.Fatigue, decreased concentration, sexual dysfunction, and chronic headaches.Atypical chest pain, palpitations, dizziness, paresthesia, and dyspnea.Abdominal and gastrointestinal complaints.Frequent vaginal and urinary tract infections.Late onset/Lack of prenatal care during pregnancy as well as poor pregnancy outcomes.Depression and suicide attempts

Criteria for Identification of Adult Abuse/DomesticSlide13

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Bilateral bruises, welts, discoloration, and/or swelling to the upper arms.

Lacerations and puncture wounds especially to the face.

Pale appearance, sunken eyes, and hollow cheeks.Pain and/or tenderness on touching.Vaginal lacerations and/or bruises.Twisting bone fractures.Bed sores, soiled clothing and bed linen.Absence of hair or bleeding of the scalp.Dehydration, malnourishment and lack of personal hygiene.Flinching or shrinking away by the elder/dependant when caretaker is present.Elder/Dependant not given the opportunity to speak for themselves.

Criteria for Identification of Elder/Dependant Adult/NeglectSlide14

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Patient states there was forced sexual contact.

Genital bruises, abrasions, pain and/or bleeding.

Oral cavity injury (torn frenulum, broken teeth, split lip).Petechiae of the face and conjunctiva (from being choked).Loss of scalp hair.Labial swelling, vaginal wall lacerations, abrasions or bruises of the vulva.Positive blood test, vaginal smears, or cultures for STD’s.

Criteria for Identification of Sexual Abuse/RapeSlide15

STAFF AWARENESS

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Staff awareness and sensitivity to issues regarding adult abuse is essential

Elder/dependent adult abuse is a hidden problem.

Victims who are patients are fearful to report abuse due to fear of abandonment or escalation of abuse

Victims who are hospitalized patients are physically dependent on caregivers.

Older adults are afraid of not being believed

Take the First Step – Be aware…Slide17

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Patient appears fearful when the caregiver approaches them to provide care or perform a procedure

Patient reports being ashamed or uncomfortable with the care provided, a procedure or a caregiver

Patient reports “something funny” or “something was not right” following the provision of care or procedurePatient change in behavior is noticed – e.g., withdrawn, tearful, agitated, etc.Patient reports inappropriate contact by caregiverFamily reports that the patient appears fearful when the caregiver approaches them to provide care or perform a procedureFamily reports that the patient seems uncomfortable with the care provided, a procedure or caregiver

Family reports “something funny” or “something was not right” following the provision of care or a procedure

Family reports a change in patient behavior – e.g., withdrawn, tearful, agitated, etc.

Family reports that the patient claims inappropriate contact by caregiver

Abuse of the Hospitalized Adult – Watch for indicatorsSlide18

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Protect the patient’s right of privacy when providing care to private body parts (i.e., genitalia, breasts, buttocks).

Prior to providing any care, the

caregiver must explain to the patient what will be doneEvery time a private place on a patient’s body will be exposed or touched, the caregiver must ask the patient for consent: -

“If you feel uncomfortable at all, I am fine with having someone else with me while I do this” or

- “You may stop me at any time and I’ll explain what is being done”

Caregiver

must be sensitive to patient/family expressions (verbal and/or non-verbal) of discomfort or concern when any care is provided and especially when care involves touching or exposing private body parts.

Always remember…Slide19

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Provide a

safe and private environment

for screening (alone with client and away from their children or a potential batterer).Let the client know that your are concerned.Let them know that abuse is a reportable crime.Let the client know that they are not alone and that help is available.Identify the abuse potential and ask about it.

Let them know that they are not responsible for another’s behavior

Provide an opportunity for the client to “break the silence.”

Key Points for Successful Abuse ScreeningSlide20

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Direct

“Did someone hit you? Who was it?”“Has your partner/parent/caretaker ever hit or physically hurt you?”“Does your partner/parent/caretaker restrict your freedom?”

“Do you ever feel afraid of your partner/parent/caretaker?”

“Do you feel you are in danger?

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Indirect

“ This may not apply to you, but because abuse is an issue in our society, we screen our clients by asking if violence is occurring in their lives. Are you currently in a relationship where violence is occurring?”

“All couples/families argue sometimes; are you having fights?”

“Have you been under any stress lately?”

“How are things going with your partner/parent/caregiver?”

Asking the questions…Slide21

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Do not assume that someone else has reported an incident.

If the incident was witnessed, protect the patient immediately. Remove the patient from the area to a safe place or ask the individual in question to please leave the room or the area. Report within 1 hour of the incident.

If the incident was not witnessed but reported by the patient, calm the patient before leaving him/her to report it.Call the appropriate authorities.Notify your Supervisor or Charge Nurse of the incident.Complete the appropriate forms. Be as detailed as possible about the incident. Note time and where the incident occurred. Indicate if anyone else was in the area that may have seen something, the condition of the patient, and any other details that could help later.

Deliver the completed report to Case Management within

48 hours

of the incident.

Reporting Procedure – Mandated ReporterSlide22

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Reporting is the individual responsibility of the mandated reporter. No physician, supervisor or administrator may prohibit the filing of a required report.

The law provides civil and criminal liability protection for anyone who makes a report in good faith.

Reports made under this law are confidential. Identity of all persons making reports of abuse is also confidential.All mandated reporters are required to sign statements with their employers or with the State agency issuing their license of certificate. These statements confirm knowledge of the reporting requirements and agreement to comply with the law.“FYI” for the Mandated Reporter Slide23

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Role of Staff Member

Staff member hearing or witnessing the allegation will report the incident to the charge nurse, supervisor or manager immediately or within one hour of hearing or witnessing the incident.Social Services will be triggered if complainant is a patient.HR designee will be informed of the incident if or when the employee is involved in the allegationReporting and NotificationSlide24

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Role of Charge Nurse

Charge Nurse or Supervisor will notify the patient’s physician of the allegation as soon as possible

Charge Nurse, Supervisor or Manager will notify the Department Director and the House Supervisor who then will notify Public Safety, Risk Management and Administration-on-call, and will provide name, location and nature of allegation.Reporting and NotificationSlide25

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House Supervisor

Notifies the patient’s family of the allegation as soon as possible in conjunction with the Director of Risk ManagementDirector of Risk ManagementNotifies the Chief Medical Officer or his designee if or when the allegation includes a Licensed Individual PractitionerClinical Social WorkerNotifies Adult Protective Services (APS) or Child Protective Services (CPS) as appropriateDirector of Public SafetyObtains and complete a report and will notify local law enforcement as appropriate after receiving notification of the allegation

Reporting and Notification - Slide26

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File an

iVOS

Event ReportReports of suspected Child Abuse are to be called immediately to Child Protective Services (CPS) 24 hour hotline or local law enforcement with a follow-up written reports within 36 hours.

Reports of Adult/Elder abuse are to be called immediately or as soon as possible to local long term care ombudsman or local law enforcement agency and follow-up written reports must be sent within

two working days (48 hours).

The appropriate written report is to be filled out completely and legibly. This form may also be used instead of a telephone report to make a voluntary report of mental abuse, financial abuse, neglect, isolation, or abandonment of an elder or a dependent adult/child by that person’s caretaker.

The written report is to be

hand delivered

to the Case Management office for centralized tracking and mailing.

(This must be completed within 48 hours).

Filing the Abuse ReportSlide27

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Mandatory ReportsSlide28

Abuse and Abuse Allegations Policies along with the mandated forms are located in the Administrative Manual of CHSB Policy and Procedure Manual under the Patient Care tab. The policy identifies the process for reporting and completion of mandated forms

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Thank You