Critical Incident Report User Guide Form 470-4698 - Iowa Medicaid ...

Iowa Department of Human ServicesIMPA Incident Reporting FormIMPA Users Guide – Revised May, 2010INTRODUCTION TO IMPAIMPA is the Iowa Department of Human Services’ Incident Management Provider Access system. IMPA has beendeveloped as a component of the Individualized Services Information System (ISIS). The Iowa Department of Inspectionsand Appeals, and other organizations, may have their own systems and requirements. This user’s guide will provide youwith all the information necessary to submit a major incident report to the Iowa Medicaid Enterprise (IME). The purposeof IMPA is to establish definitions, protocols, procedures and guidelines for the automated Incident ManagementSystem (IMS). The Incident Management System, for the purpose of this policy, means the consistent statewide processof identifying, classifying and reporting of major incidents, as well as conducting trend analysis reviews and reports ofthose incidents.Accessing IMPA on the World Wide Web through Internet Explorer, Firefox, Opera, Safari or Google Chrome providesefficient and timely communications for all participants throughout the state. As you work with Medicaid waivers,habilitation, or case management services, you will be provided with appropriate permissions to access the IMPAsystem. This will allow you timely access to the most current information regarding all cases that involve you. For thosewithout access to a personal computer, paper forms and instructions are available.The IMPA system will provide structure and a consistent, statewide system of incident reporting, trend analysis, and riskmanagement. This automation further refines existing policies and procedures that require incidents that bring harm, orhave the potential to bring harm, to members, are immediately and routinely identified and reported upon to assure themember’s health and safety. The end result will allow the implementation of measures that will prevent the recurrenceof similar incidents, along with other activities that allow providers to be proactive in their responsibilities to reduce therisk of harm to members. By identifying the underlying environmental and system factors that have contributed to anadverse event, the system attempts to find out exactly WHAT happened, WHY it happened, and HOW it can beprevented from happening again. The goal is prevention, both at the individual and systems level.Quality Improvement ProcessIncident Report MonitoringPage 3