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Office of Mental Health

Clinical Risk Management | Sentinel Events | Resources

Clinical Risk Management (CRM)

Office of Mental Health (OMH) operated and licensed providers must have an incident management system that protects the health and safety of consumers and improves quality of care. The CRM team works collaboratively with providers towards this goal. The primary risk reduction functions of the Clinical Risk Management unit are as follows:

Incident Management

A major component of CRM is the identification and management of adverse events (incidents). CRM reviews and follows up on serious incidents occurring in State operated and licensed programs each year. Follow up includes:

  • phone or e-mail inquiries
  • technical assistance
  • investigation reviews
  • on-site investigations and site visits

Training and OMH Correspondence to the Field

CRM conducts Special Investigator Training sessions in each region of the state for both State operated and State licensed programs on an annual basis.

Sentinel Events

CRM provides oversight and technical assistance through the process for reviewing sentinel events (unexpected occurrences involving death or serious physical injury, or risk thereof). CRM staff review and track root cause analyses and associated corrective action plans. The goal is to assure completion of a thorough and credible process which results in the implementation and monitoring of adequate and appropriate risk reduction strategies.

Special Investigations

Special Investigations are conducted by CRM in response to exceptionally serious incidents. The goal of an investigation is to determine and mitigate the underlying systemic factors associated with the adverse event.

Guidelines for Investigation of Significant Incidents in OMH Facilities

Resources

Alerts, Guidelines, Regulations, Incident Prevention and other Resources

 

Comments or questions about the information on this page can be directed to the Bureau of Inspection and Certification (BIC).