Definitions

(1) Abuse. The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish. (2) Adult. An individual who has capacity and is at least 18 years of age. (3) Advance Directive. An individual instruction or a written statement relating to the subsequent provision of health care for the individual, including, but not limited to, a living will or a durable power of attorney for health care. (4) Agent. An individual designated in an advance directive for health care to make a health care decision for the individual granting the power. (5) Anticoagulant. A medication or medical technique to prevent or slow down coagulation and clotting. (6) Anticoagulation. The process of inhibiting the blood clotting mechanism by the administration of certain drugs. (7) Artificial Kidney. An apparatus which removes metabolic wastes or other poisons from the body when the natural kidneys are not functioning properly. This apparatus may be referred to as a kidney dialyzer. (8) Board. The Tennessee Board for Licensing Health Care Facilities. (9) Capacity. An individual’s ability to understand the significant benefits, risks, and alternatives to proposed health care and to make and communicate a health care decision. These regulations do not affect the right of a patient to make health care decisions while having the capacity to do so. A patient shall be presumed to have capacity to make a health care decision, to give or revoke an advance directive, and to designate or disqualify a surrogate. Any person who challenges the capacity of a patient shall have the burden of proving lack of capacity. (10) Cardiopulmonary Resuscitation (CPR). The administering of any means or device to restore or support cardiopulmonary functions in a patient, whether by mechanical devices, chest compressions, mouth-to-mouth resuscitation, cardiac massage, tracheal intubation, manual or mechanical ventilations or respirations, defibrillation, the administration of drugs and/or STANDARDS FOR END STAGE RENAL DIALYSIS CLINICS CHAPTER 0720-33 chemical agents intended to restore cardiac and/or respiratory functions in a patient where cardiac or respiratory arrest has occurred or is believed to be imminent. (11) Chronic Hemodialysis. Hemodialysis over a long period of time, usually to the extent of the patient’s life or organ transplant. (12) Commissioner. The Commissioner of the Tennessee Department of Health or his or her authorized representative. (13) Competent. A patient who has capacity. (14) Department. The Tennessee Department of Health. (15) Designated Physician. A physician designated by an individual or the individual’s agent, guardian, or surrogate, to have primary responsibility for the individual’s health care or, in the absence of a designation or if the designated physician is not reasonably available, a physician who undertakes such responsibility. (16) Dialysis. A process by which substances are removed from a patient’s body by diffusion and convection from one fluid compartment to another across a semipermeable membrane. The two types of dialysis that are currently in common use are hemodialysis and peritoneal dialysis. (17) Dialysis technician. An individual who is not a registered nurse or physician and who provides dialysis care under the direct supervision of a registered nurse or physician. If unlicensed, this individual may also be known as a patient care technician, dialysis assistant or dialysis technician. (18) Dietitian. A person currently licensed as such by the Tennessee Board of Dietitian/Nutritionist Examiners or exempted from licensure by T.C.A. § 63-25-104 and having at least one (1) year of experience in clinical nutrition. (19) Do-Not-Resuscitate Order (DNR). A written order, other than a POST, not to resuscitate a patient in cardiac or respiratory arrest in accordance with accepted medical practices. (20) Emancipated Minor. Any minor who is or has been married or has by court order or otherwise been freed from the care, custody and control of the minor’s parents. (21) Emergency Responder. A paid or volunteer firefighter, law enforcement officer, or other public safety official or volunteer acting within the scope of his or her proper function under law or rendering emergency care at the scene of an emergency. (22) End-Stage Renal Disease (ESRD). That stage of renal impairment that is or appears irreversible and permanent, and requires a regular course of dialysis or kidney transplantation to maintain life. (23) Guardian. A judicially appointed guardian or conservator having authority to make a health care decision for an individual. (24) Hazardous Waste. Materials whose handling, use, storage, and disposal are governed by local, state or federal regulations. (25) Health Care. Any care, treatment, service or procedure to maintain, diagnose, treat, or otherwise affect an individual’s physical or mental condition, and includes medical care as defined in T.C.A. § 32-11-103(5). STANDARDS FOR END STAGE RENAL DIALYSIS CLINICS CHAPTER 0720-33 (26) Health Care Decision. Consent, refusal of consent or withdrawal of consent to health care. (27) Health Care Decision-Maker. In the case of a patient who lacks capacity, the patient’s health care decision-maker is one of the following: the patient’s health care agent as specified in an advance directive, the patient’s court-appointed guardian or conservator with health care decision-making authority, the patient’s surrogate as determined pursuant to Rule 0720-33- .13 or T.C.A. § 33-3-220, the designated physician pursuant to these rules or in the case of a minor child, the person having custody or legal guardianship. (28) Health Care Institution. A health care institution as defined in T.C.A. § 68-11-1602. (29) Health Care Provider. A person who is licensed, certified or otherwise authorized or permitted by the laws of this state to administer health care in the ordinary course of business or practice of a profession. (30) Home dialysis. Dialysis performed by a trained patient on him or herself or by a trained designated caregiver on the patient at the patient’s home with little or no professional assistance. (31) Home dialysis training. A training program that teaches dialysis patients and patient caregivers to perform home dialysis. (32) Hospital. Any institution, place, building or agency represented and held out to the general public as ready, willing and able to furnish care, accommodations, facilities and equipment for the use, in connection with the services of a physician or dentist, of one (1) or more nonrelated persons who may be suffering from deformity, injury or disease or from any other condition for which nursing, medical or surgical services would be appropriate for care, diagnosis or treatment. (33) Hospitalization. The reception and care of any person for a continuous period longer than twenty-four (24) hours, for the purpose of giving advice, diagnosis, nursing service or treatment bearing on the physical health of such person, and maternity care involving labor and delivery for any period of time. (34) Incompetent. A patient who has been adjudicated incompetent by a court of competent jurisdiction and has not been restored to legal capacity. (35) Individual Instruction. An individual’s direction concerning a health care decision for the individual. (36) Infectious Waste. Solid or liquid wastes which contain pathogens with sufficient virulence and quantity such that exposure to the waste by a susceptible host could result in an infectious disease. (37) Licensed Practical Nurse. A person currently licensed as such by the Tennessee Board of Nursing. (38) Licensee. The person or entity to whom the license is issued. The licensee is held responsible for compliance with all rules and regulations. (39) Life Threatening or Serious Injury. Injury requiring the patient to undergo significant additional diagnostic or treatment measures. (40) Medical Director. A physician who: (1) Is board eligible or board certified in nephrology, internal medicine or pediatrics by a professional board, and has at least 12 months of experience or training in the care of patients at ESRD facilities; or (2) During the 5-year STANDARDS FOR END STAGE RENAL DIALYSIS CLINICS CHAPTER 0720-33 period prior to September 1, 1976, served for at least 12 months as director of a dialysis or transplantation program; and worked within the field of kidney dialysis for at least 12 months in the past 5 years. However, in the areas where a physician who meets the definition in paragraph (1) or (2) of this definition is not available to direct a dialysis facility, another physician may direct the facility, subject to the approval of the Department. (41) Medical Emergency. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the patient’s health in serious jeopardy, serious impairment to bodily functions or serious dysfunction of any bodily organ or part. (42) Medical Record. Medical histories, records, reports, summaries, diagnoses, prognoses, records of treatment and medication ordered and given, entries, x-rays, radiology interpretations and other written, electronic, or graphic data prepared, kept, made or maintained in a facility that pertains to confinement or services rendered to patients. (43) Medically Inappropriate Treatment. Resuscitation efforts that cannot be expected either to restore cardiac or respiratory function to the patient or other medical or surgical treatments to achieve the expressed goals of the informed patient. In the case of the incompetent patient, the patient’s representative expresses the goals of the patient. (44) Misappropriation of Patient/Resident Property. The deliberate misplacement, exploitation or wrongful, temporary or permanent use of an individual’s belongings or money without the individual’s consent. (45) Neglect. The failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness; however, the withholding of authorization for or provision of medical care to any terminally ill person who has executed an irrevocable living will in accordance with the Tennessee Right to Natural Death Law, or other applicable state law, if the provision of such medical care would conflict with the terms of the living will, shall not be deemed “neglect” for purposes of these rules. (46) NFPA. The National Fire Protection Association. (47) Nurse Manager. A Registered Nurse who is employed full-time in a renal dialysis clinic, is currently licensed as such by the Tennessee Board of Nursing, and (1) has at least 12 months of experience in clinical nursing, and an additional 6 months of experience in nursing care of the patient with permanent kidney failure or undergoing kidney transplantation, including training in and experience with the dialysis process; or (2) Has at least 18 months of experience in nursing care of the patient on maintenance dialysis, or in nursing care of the patient with a kidney transplant, including training in and experience with the dialysis process. If the Nurse Manager is in charge of self-care dialysis training, at least 3 months of the total required ESRD experience must be in training patients in self-care. (48) Nurse Practitioner/Clinical Nurse Specialist. A person currently licensed as a registered nurse by the Tennessee Board of Nursing and certified by the American Academy of Nurse Practitioners, the American Nurses Credentialing Center as a nurse practitioner or holds a certification as clinical nurse specialist from the Tennessee Board of Nursing. (49) Nursing Personnel. Licensed nurses and certified nurse aides, who provide nursing care. (50) On-Duty/On-Site. A staff person who is on the facility’s premises and has the obligation to carry out any job responsibilities designated in his/her job description. (51) On-Site. A staff person who is on the facility’s premises but is only required to be on duty during an emergency. STANDARDS FOR END STAGE RENAL DIALYSIS CLINICS CHAPTER 0720-33 (52) Patient Care Plan. A written document prepared by the interdisciplinary team for a patient receiving end stage renal disease services. (53) Person. An individual, corporation, estate, trust, partnership, association, joint venture, government, governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. (54) Personally Informing. A communication by any effective means from the patient directly to a health care provider. (55) Physician. An individual authorized to practice medicine or osteopathy under Tennessee Code Annotated, Title 63, Chapters 6 or 9. (56) Physician Assistant. A person who has graduated from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant, has passed the Physician Assistant National Certifying Examination, and is currently licensed in Tennessee as a physician assistant under Title 63, Chapter 19. (57) Physician Orders for Scope of Treatment or POST. Written orders that: (a) Are on a form approved by the Board for Licensing Health Care Facilities; (b) Apply regardless of the treatment setting and that are signed as required herein by the patient’s physician, physician assistant, nurse practitioner, or clinical nurse specialist; and (c) 1. Specify whether, in the event the patient suffers cardiac or respiratory arrest, cardiopulmonary resuscitation should or should not be attempted; 2. Specify other medical interventions that are to be provided or withheld; or 3. Specify both 1. and 2. (58) Power of Attorney for Health Care. The designation of an agent to make health care decisions for the individual granting the power under T.C.A. Title 34, Chapter 6, Part 2. (59) Qualified Emergency Medical Service Personnel. Includes, but shall not be limited to, emergency medical technicians, paramedics, or other emergency services personnel, providers, or entities acting within the usual course of their professions, and other emergency responders. (60) Reasonably Available. Readily able to be contacted without undue effort and willing and able to act in a timely manner considering the urgency of the patient’s health care needs. Such availability shall include, but not be limited to, availability by telephone. (61) Referring Physician. The physician who refers the patient to the renal dialysis clinic for treatment. (62) Renal Dialysis Clinic. Any institution, facility, place or building devoted to the provision of renal dialysis on an outpatient basis to persons diagnosed with end stage renal disease. (63) Registered Nurse. A person currently licensed as such by the Tennessee Board of Nursing. (64) Shall or Must. Compliance is mandatory. STANDARDS FOR END STAGE RENAL DIALYSIS CLINICS CHAPTER 0720-33 (65) Social Worker. A person who is licensed by the Tennessee Board of Social Worker Certification and Licensure, if applicable, and (1) Has completed a course of study with specialization in clinical practice at, and holds a masters degree from, a graduate school of social work accredited by the Council on Social Work Education; or (2) Has served for at least 2 years as a social worker, 1 year of which was in a dialysis unit or transplantation program and has established a consultative relationship with a social worker who qualifies in paragraph (1) of this definition. (66) State. A state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, or a territory or insular possession subject to the jurisdiction of the United States. (67) Supervising Health Care Provider. The designated physician or, if there is no designated physician or the designated physician is not reasonably available, the health care provider who has undertaken primary responsibility for an individual’s health care. (68) Surrogate. An individual, other than a patient’s agent or guardian, authorized to make a health care decision for the patient. (69) Survey. An on-site examination by the Department to determine compliance with state and federal regulations. (70) Treating Health Care Provider. A health care provider who at the time is directly or indirectly involved in providing health care to the patient. (71) Treating Physician. The physician selected by or assigned to the patient and who has the primary responsibility for the treatment and care of the patient. Where more than one physician shares such responsibility, any such physician may be deemed to be the “treating physician.” (72) Water Treatment. The process of treating water used for dialysis purposes in order to maintain a continuous water supply that meets AAMI (Association for the Advancement of Medical Instrumentation) standards.