New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 37 - COMMUNITY MENTAL HEALTH SERVICES ACT › Subchapter 9 - QUALITY ASSURANCE › Section 10:37-9.3 - Definitions

Current through Register Vol. 56, No. 14, July 15, 2024
The words and terms in this subchapter shall have the
				  following meanings, unless the context clearly indicates otherwise:
"Adverse medication reactions" means any response to a drug
				  that is unintended, occurring at doses used for prophylaxis, diagnosis or
				  therapy, which demonstrates a deviation from the expected pharmaceutical,
				  therapeutic or chemical action of the drug. Minor adverse medication reactions
				  result in a need for an antidote or therapy. Moderate adverse medication
				  reactions require a change in drug therapy and/or specific treatment. Severe
				  adverse medication reactions are potentially life threatening, cause permanent
				  damage or require intensive medical care.
"Appropriate(ness)" means the right treatment in the right
				  amount/frequency, to the right patient at the right time by the right staff
				  performed the right way.
"Division" means the Division of Mental Health and
				  Hospitals.
"Drug usage evaluation" means a criteria-based, ongoing,
				  planned and systematic process for monitoring and evaluating the prophylactic,
				  therapeutic, and empiric use of drugs to assure that they are provided
				  appropriately, safely and effectively.
"Follow-up" means reassessment of a problem at an appropriate
				  interval to determine whether proposed solutions have been implemented and have
				  remained effective.
"High risk" means any activity or intervention that could
				  result in serious consequences or could deprive clients of substantial benefit,
				  including providing care that is not indicated, or failing to provide care that
				  is indicated.
"High volume" means an aspect of care which occurs frequently
				  or affects large numbers of clients.
"Incident" means an unexpected event that places a client(s)
				  or staff member(s) at risk.
"Indicator" means a defined, measurable, objective dimension
				  of the quality and appropriateness of care which is based on current knowledge
				  and clinical experience. Indicators are structures of care (for example,
				  resources), processes of care (for example, procedures, techniques), or
				  outcomes of care (for example, failure to improve).
"Infection control" means a program that includes the
				  surveillance, prevention and control of infections.
"Justification for continued service(s)" means a
				  determination, based on objective clinical criteria, that a client continues to
				  require a specific service(s) or level of care.
"Length of stay review" means the point in treatment, on a
				  timeline, at which a case should be reviewed to determine that the clinical
				  needs of the client are being met and that proper utilization of resources is
				  occurring.
"Life safety" means structures and activities related to
				  provision of a safe, secure physical environment.
"Problem prone" means an aspect of care that has tended, in
				  the past, to produce problems for clients and/or staff.
"Provider agency (PA)" means an agency contracted with,
				  licensed by or funded by, the Division to provide specific, direct mental
				  health services to clients.
"Quality assurance (QA)" means a program or set of activities
				  designed to monitor, evaluate and improve care or services provided in order to
				  enhance the health of clients and the effective use of resources.
"Quantitative review" means a review of a clinical record for
				  timely completion of required documentation.
"QA oversight" means the function of ensuring implementation
				  of the QA program and resolution of identified issues, but not necessarily
				  carrying out monitoring and evaluation activities or corrective actions. This
				  can be done by an existing committee or a separate committee established
				  specifically for this purpose.
"Representative sample" means a selected subset of a larger
				  group which exemplifies the characteristics of that group (that is, a
				  cross-section).
"Risk management" means clinical and administrative
				  activities designed to detect, prevent or reduce risks that could impair client
				  care or client, staff or visitor comfort or safety.
"Routine/ongoing monitoring" means collecting and organizing
				  data continuously according to a predetermined frequency; to check or
				  observe.
"Sample size" means a number of cases or observations
				  selected from a population for a specific sample (that is, a subset).
"Special case review" means clinical evaluation of and
				  recommendations about the treatment of a difficult or high risk case by
				  practicing mental health professionals (peers, supervisors, consultants) to the
				  treating mental health professional(s).
"Thresholds for evaluation" means a pre-established level
				  (number, percentage or proportion) in cumulative data that will trigger more
				  intensive evaluation to determine whether an actual problem or opportunity to
				  improve care exists (for example, 90 percent, one half, two out of six).
"Trend" means a recognizable pattern of occurrences; a
				  straight line or other statistical curve showing the tendency of some function
				  to increase or decrease over a period of time.
"Utilization review (UR)" means the process of using
				  predefined criteria to evaluate the necessity of admissions and continued stays
				  and whether clients are receiving the services best suited to their needs. UR
				  monitors services to determine that an agency's services are necessary and cost
				  effective, and that resources are efficiently utilized.