On-Demand Webinar: Resident-to-Resident Altercations-Resident-to-Resident Altercations

Video Transcription

Video Summary

The webinar addresses how nursing facility leadership should respond and investigate resident-to-resident altercations, which sometimes may be abuse cases. After immediate safety and medical needs are managed, a thorough investigation is essential to maintain quality of care, meet survey requirements, and mitigate litigation risks. The presenter introduces a five-step investigation process: purpose, plan, investigate, analyze, and follow-up.<br /><br />Key steps include notifying appropriate parties per federal and state guidelines, reviewing medical records, staffing, policies, and incident reports, and conducting comprehensive interviews with involved residents, staff, visitors, and witnesses. Investigators must remain unbiased, use open-ended questions, and document interviews meticulously.<br /><br />Analysis involves root cause analysis (RCA) to identify system-related issues, using tools like fishbone diagrams and the five whys method. Corrective actions should aim for strong or intermediate interventions that change systems or processes, rather than weak actions like only training or increased checks.<br /><br />The session uses a case study of two dementia-unit residents, Arthur and Stanley, whose altercation stemmed from increased wandering due to missed medication and emotional distress from grief. The investigation revealed systemic issues such as medication authorization process failures and implemented solutions including creating a "post office" activity, updating protocols, and providing psychiatric services.<br /><br />The presenter emphasizes documentation's importance for potential litigation and survey compliance, confidentiality during interviews, and continuous quality improvement via QAPI committees. Resources such as investigation checklists and RCA guides are provided to enhance facility readiness to handle these incidents effectively.

Keywords

nursing facility leadership

resident-to-resident altercations

abuse investigation

five-step investigation process

root cause analysis

fishbone diagram

corrective actions

dementia unit case study

documentation and compliance

quality improvement QAPI