Definitions

Section 255.100  Definitions "Act" means the Hospital Report Card Act. "Actual nurse staffing assignment roster" means the nurse-patient assignment on each unit that reflects direct nursing services provided within a 24-hour time period to each patient, excluding any information that might identify a particular patient or nurse. "Acute care" means the treatment of a condition or disease for a short period of time in which a patient is treated for a brief but severe episode of illness with the goal of discharging the patient. "Appropriately trained" means has completed the orientation course for the job title as specified by the employing hospital. "Artificial life support" means a system that uses medical technology to aid, support, or replace a vital function of the body that has been seriously damaged. "Assigned" means that the registered professional nurse, licensed practical nurse, or other nursing personnel have responsibility for the provision of care to a particular patient within their scope of practice. "Assistive nursing personnel" means personnel assigned responsibility for the provision of nursing care to a particular patient within their scope of practice, other than registered professional nurses or licensed practical nurses. "Average daily census" means the average number of inpatients receiving service on any given 24-hour period beginning at midnight in each clinical service area of the hospital. (Section 10 of the Act) Average daily census shall be calculated as the sum of inpatients every day at midnight for the quarter, divided by the number of days in the quarter. "Average daily hours worked" means the total number of direct care nursing hours paid in the quarter per clinical service area, divided by the total number of calendar days in the quarter, to obtain the average number of worked hours per calendar day. "Behavioral health" means the clinical service areas in which inpatients are receiving care and treatment for mental illnesses, substance abuse disorders or dependence, co-occurring mental illness and substance abuse disorders, or organic brain disorders, such as Alzheimer's Disease or senile dementia with psychotic or depressive symptoms.  For the purposes of this Part, behavioral health clinical service areas do not include the following areas and their subcategories: critical care; maternal-child; medical-surgical; pediatrics; perioperative; and telemetry. "Clinical service area" means a grouping of clinical services by a generic class of various types or levels of support functions, equipment, care, or treatment provided to inpatients. Hospitals may have, but are not required to have, behavioral health, critical care, maternal-child care, medical-surgical, pediatrics, perioperative services, and telemetry. (Section 10 of the Act) These services shall be measured in patient day units.  "Perioperative" clinical service areas are defined in the definition of "perioperative" in this Part. "Critical care" means the clinical service areas organized, operated, and maintained to provide for monitoring and caring for patients with severe or potentially severe physiologic instability requiring technical support and often requiring artificial life support. "Critical care service area" means adult and pediatric critical care patient populations, but does not include intensive care newborn nursery services.  For the purposes of this Part, critical care clinical service areas do not include the following areas and their subcategories: behavioral health; maternal-child; medical-surgical; pediatrics; perioperative; and telemetry. "Current nursing staff schedules" means the prospective staffing schedules for each patient care unit, excluding any information that might identify a particular nurse, made in advance of a designated time frame, e.g., weekly, monthly or quarterly. "Department" means the Department of Public Health .  (Section 10 of the Act) "Direct-care nurse" and "direct-care nursing staff" include any registered nurse, licensed practical nurse, or assistive nursing personnel with direct responsibility to oversee or carry out medical regimens or nursing care for one or more patients . (Section 10 of the Act) "Direct patient care responsibilities" means the activities of direct care nurses and direct care assistive nursing personnel who are assigned to a patient or patients. "Direct supervision" means a situation in which an individual is responsible for directing the actions of another individual in the facility and is physically close enough to be readily available, if needed, by the supervised individual.  "Direct supervision" shall be conducted by a registered professional nurse. "Employee" means any full-time or part-time direct care nursing staff employee who works a regularly scheduled number of hours in a defined pay period.  Not included are direct care nursing staff who work on an as-needed basis and are not guaranteed work hours, including, but not limited to, casual, per diem, and registry personnel. "Full-time equivalent" means hospital-employed licensed nursing hours budgeted to work in a seven-day time period divided by 37.5, or in a 14-day time period divided by 75, or annually divided by 1950. "Indirect patient care responsibilities" means the activities of nurses, such as nurse managers, charge nurses, clinical nurse specialists and other ancillary licensed nursing personnel, when they are not assigned to direct patient care activities. "Hospital" means a health care facility licensed under the Hospital Licensing Act .  (Section 10 of the Act) "Hospital Quality Alliance" means the public-private collaboration that collects and reports hospital quality performance information and makes it available to consumers through Centers for Medicare and Medicaid Services (CMMS) information channels. "Inpatient" means a person admitted for at least one overnight stay to health facilities, usually hospitals, that provide board and room, for the purpose of observation, care, diagnosis or treatment. "Intensive Care Unit" or "ICU" means a hospital facility for provision of intensive nursing and medical care of critically ill patients, characterized by high quality and quantity of continuous nursing and medical supervision and by use of sophisticated monitoring and resuscitative equipment.  An ICU may be organized for the care of specific patient groups, e.g., neonatal or newborn ICU, neurological ICU, or pulmonary ICU. "Licensed nursing hours per inpatient day" means, for the quarter, the total number of productive hours worked by licensed nursing personnel with direct care responsibilities, divided by the total inpatient days. "Licensed practical nurse" or "LPN" means a person meeting the requirements for licensure by the Department of Financial and Professional Regulation as a licensed practical nurse pursuant to the Nurse Practice Act. "Maternal-child" means the clinical service areas that are designed, equipped, organized and operated in accordance with the requirements of the Hospital Licensing Act relating to the medical-surgical care of a patient prior to and during the act of giving birth to either a living child or a dead fetus and the continuing care of both patient and newborn infant.  For the purposes of this Part, intensive care newborn nursery services are included in maternal-child clinical service areas.  Maternal-child clinical service areas do not include the following clinical service areas and their subcategories:   behavioral health; critical care; medical-surgical; pediatrics; perioperative; and telemetry. "Medical-surgical" means the clinical service areas in which patients who require less care than that which is available in intensive care units or telemetry units have available 24-hour inpatient general medical services, post-surgical services, or both general medical and post-surgical services.  These units may include mixed patient populations of diverse diagnoses and diverse age groups.  For the purposes of this Part, medical-surgical clinical service areas do not include the following areas and their subcategories:  behavioral health; critical care; maternal-child; pediatrics; perioperative; and telemetry. "Nursing care"  means care that falls within the scope of practice set forth in the Nurse Practice Act or is otherwise encompassed within recognized professional standards of nursing practice, including assessment, nursing  diagnosis, planning, intervention, evaluation, and patient advocacy. (Section 10 of the Act) "Nursing hours per inpatient day" means, for the quarter, the total number of productive hours worked by registered nurses, licensed practical nurses, and assistive nursing personnel, in each case, with direct patient care responsibilities, divided by the total inpatient days. "Observation care" means those services furnished by a hospital on the hospital's premises, including use of a bed and at least periodic monitoring by a hospital's nursing or other staff, that are reasonable and necessary to evaluate an outpatient's condition or determine the need for a possible admission to the hospital as an inpatient.  In general, the duration of observation care services does not exceed 24 to 48 hours, depending on the hospital, physician and health plan. "Pediatrics" means the clinical service areas in acute care hospitals that are designed, equipped, organized and operated to render non-intensive care to the 0-17 age population performed at the direction of a physician on behalf of the patient by physicians, dentists, nurses, and other professional and technical personnel.  For the purposes of this Part, pediatric clinical service areas in acute care hospitals do not include the following areas and their subcategories:  behavioral health; critical care; maternal-child; medical-surgical; perioperative; and telemetry.  Pediatric hospitals may incorporate any or all of these clinical service areas in fulfilling their role of specialty treatment facilities for the medical care of infants, children, and adolescents.  Pediatric hospitals shall consider all care provided as pediatric without regard for where in the facility the service was rendered.  For patients in specialty pediatric hospitals, age requirements are extended to include those patients who, due to condition, care and treatment requirements, continue to be considered pediatric.  Clinical service area comparisons for pediatric hospitals shall follow the guidelines of national pediatric organizations.  An adult or specialty hospital operating a pediatric hospital within the larger hospital shall report using its National Provider Identifier and taxonomy codes to allow differentiation of nursing hours and more meaningful comparisons. "Perioperative" means the clinical service areas that are designed, equipped, organized and operated to provide care for inpatients during the preoperative, intraoperative and immediate postoperative periods of a hospital stay.  For the purposes of this Part, perioperative clinical service areas do not include the following areas and their subcategories:  behavioral health; critical care; maternal-child; medical-surgical; pediatrics; and telemetry. "Productive hours" means the actual work hours, exclusive of vacation, holidays, sick leave and any other absences, with the following inclusions and exclusions. Agency, per diem and registry RNs with direct patient care responsibility shall be included in the number of productive hours for the mandated reports. The number of productive hours for mandated reports shall not include nurse managers, charge nurses who are not assigned direct patient care responsibilities, or any other licensed nursing personnel who do not have a direct care patient assignment. The number of productive hours for mandated reports shall not include licensed nurses who are participating in orientation. "Registered professional nurse" or "RN" means a person meeting the requirements for licensure by the Department of Financial and Professional Regulation as a registered professional nurse pursuant to the provisions of the Nurse Practice Act. "Separated" means any licensed nursing employee who is permanently removed for any reason, including voluntary, involuntary or employee transfer, from the payroll allotted for a clinical service area. "Staffing levels" means the numerical nurse to patient ratio by licensed nurse classification within a nursing department or unit. (Section 10 of the Act) "Telemetry unit" means a unit organized, operated and maintained to provide care for and continuous cardiac monitoring of patients in a stable condition, having or suspected of having a cardiac condition or a disease requiring the electronic monitoring, recording, retrieval, and display of cardiac electrical signals.  "Telemetry unit" does not include fetal monitoring or fetal surveillance.  For the purposes of this Part, telemetry clinical service areas do not include the following areas and their subcategories:  behavioral health; critical care; maternal-child; medical-surgical; pediatrics; and perioperative care. "Technical support" means specialized equipment and/or personnel providing for invasive monitoring, telemetry, or mechanical ventilation, for the immediate amelioration or remediation of severe pathology. "Unit" means a functional division or area of a hospital in which nursing care is provided. (Section 10 of the Act)