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Incident Reporting and Response Information

Incident Reporting and Response Information

Incident Response Improvement System (IRIS)

IRIS is a web-based incident reporting and documentation system for Level II and III incidents involving consumers receiving services for mental health, substance abuse, and intellectual/developmental disabilities.

Category A providers (except hospitals) and Category B providers are required to report these incidents. Level II and III incidents must be entered and submitted in IRIS within 72 hours of a provider learning of the incident.


IRIS Technical Manual and Other Resources                      LIVE IRIS Website


 IRIS Practice Website

There is a Practice IRIS Website that can be used to train staff on how to enter incident reports in IRIS prior to going to the LIVE Iris website to enter real incidents. (Do NOT enter real incidents in the practice website.)

Level I Incidents and Level I Quarterly Provider Incident Report Form (QM11)

The state requires providers to document all Level I incidents and have documentation available onsite for regular reviews. Level I incidents are NOT to be entered into the IRIS web based reporting system.

Instead, submit a Level I Quarterly Provider Incident Report form (QM11) within 10 days of the end of the quarter. Please revise the SFY (State Fiscal Year) and Quarter on the report so that it is current.

Guilford County: Submit completed forms to the QM Department via email or fax to (336) 389-6534.

Other counties: Submit via email or fax to (336) 389-6535.

Page three of the form includes instructions if you are unclear who needs to submit or when.

Level II and III Incidents

All Level II and Level III incident reports must be entered and submitted electronically through IRIS online.

If IRIS is unavailable, providers must fax a copy of the incident report to the QM Department at (336) 625-3661 to meet the 72-hour reporting requirement. Blank incident report forms may be obtained here.

If you are unable to access the incident reporting forms on the website, please call (336) 389-6148 or (336) 389-6358. Providers are required to enter incident reports in IRIS as soon as possible once the IRIS system is available or the reporting issue has been resolved.

Level III

Level III incidents must be verbally reported within 24 hours of learning of the incident, or sooner if possible.

Internal Review (formerly “peer review”) for LEVEL III Incidents

All Category A and B providers (except ICF-MR’s) are required to conduct an internal review team (formerly “peer review”) review of level III incidents that occur when the consumer is receiving a service or if the incident occurred on the provider’s premises.

ICF-MR’s are required to abide by federal regulations to ensure client protection, investigate incidents and take appropriate corrective action. (CFR 483.420)

Requirements for conducting an internal review may be accessed in APSM 30-1, Rules for MH/DD/SA Facilities and Services, 27G.0603(c). A copy of this manual may be obtained here:

27G.0603(c)

APSM30-1 Rules for MH/DD/SA Facilities and Services

How to Request the IRIS Incident Report Number

Providers should print a copy of the IRIS incident report number when entering/submitting incident reports and maintain a copy of the number for future access.

If a provider is unable get the incident report number, the LME can request the number be sent to the provider’s email address. However, the provider should never share the IRIS incident report number with the LME or any other persons or agencies not authorized to have access to this confidential consumer information.

To request the IRIS Incident Report Number, Guilford County providers should call (336) 389-6148 and providers in all other counties should call 336-389-6358 and have the following information available:

If the IRIS incident report number is unavailable, we will recommend that you re-enter the incident report in IRIS.

Please reference the Incident Response and Reporting Manual developed by the Department of Mental Health.

Incident Reporting Forms

Helpful Hints:

Useful Online Resources:

MANUALS

Division of MH/DD/SA — http://www.ncdhhs.gov/mhddsas/

IRIS Technical Manual — http://www.ncdhhs.gov/document/iris-resources

Incident Response and Reporting Manual — http://www.ncdhhs.gov/document/iris-resources

Rules for MH/DD/SA Facilities and Services — http://www.ncdhhs.gov/apsm-30-01-rules-mental-health-developmental-disabilities-and-substance-abuse-facilities-and

Confidentiality Rules — http://www.ncdhhs.gov/apsm-45-1-confidentiality-rules

Client Rights Rules — http://www.ncdhhs.gov/client-rights-rules-community-mental-health-developmental-disablities-and-substance-abuse-services

Record Management and Documentation Manual — https://www.ncdhhs.gov/divisions/mhddsas/reports/records-management-and-documentation-manual-rmdm

FORMS

(QM11) Quarterly Provider Incident Report (must be submitted within 10 days of the end of the quarter for providers that did not request a wavier) — http://www.ncdhhs.gov/document/iris-resources

Restrictive Intervention and Details Report form – See Client Rights Rules 27E.0401(e)(9) for details of required documentation — http://www.ncdhhs.gov/document/incident-response-improvement-system-iris-forms

Provider must meet the 72 hour reporting requirement even when IRIS is down or provider is having difficulty successfully submitting the report in IRIS. A blank copy of the Incident Reporting Form can be printed from the following website address:  http://www.ncdhhs.gov/document/incident-response-improvement-system-iris-forms