63M-2.002. Definitions

(1) Adverse Drug Events: an illness or injury resulting from a medical intervention related to a drug.

(2) Authority for Evaluation and Treatment (AET): Form HS 002, that when signed by a parent or legal guardian, gives the Department the authority to assume responsibility for the provision of routine mental and physical healthcare to a youth within its physical custody.

(3) Cheeking: a term used to describe patients who hide their medications in their cheek or under their tongue to prevent swallowing them.

(4) Chief Probation Officer (CPO) – The department employee who is responsible for managing community-based program operations and staff within each of Florida’s twenty judicial circuits.

(5) Chronic medical condition: any illness, disability or condition that is permanent or persists longer than six months, with the exception of allergies, hearing/speech/visual impairment, Developmental Disability, or Mental Retardation.

(6) Clinical responsibility: the oversight of the medical care of all youth within a department facility. This includes the overall clinical direction, policies, and protocols for the medical services provided.

(7) Community Provider: a Health Care Provider outside of the department commitment system.

(8) Comprehensive Physical Assessment (CPA) (HS 007): a comprehensive physical assessment (exam) performed by a physician (MD), osteopathic physician (DO), physician’s assistant (PA), or advanced registered nurse practitioner (ARNP). The purpose of this assessment is the establishment of a data point, which is used to facilitate the following:

(a) Identification and treatment of acute, chronic, and functional medical and dental problems;

(b) Promotion of growth and development;

(c) Prevention of communicable diseases; and

(d) Provision of health education.

(9) Controlled Substances: all substances defined as “Controlled” in Section 893.03, F.S.

(10) Core Health Profile: a section of the individual health care record, which contains standardized forms that are filed in designated sub-sections of the Individual Health Care Record (IHCR).

(11) Corrective action: refers to an analysis of the problem’s root cause with a subsequent adjustment in the system in order to prevent future mistakes from taking place.

(12) Designated Health Authority (DHA): The DHA shall be a Physician (MD) who holds an active, unrestricted license under Chapter 458, F.S., or an osteopathic Physician (DO) who holds an active, unrestricted license under Chapter 459, F.S., and meets all requirements for practice in the State of Florida. The Physician must be either Board Certified in Pediatrics, Family Practice or Internal Medicine (with experience in adolescent health) or Board-Eligible and have prior experience in treating the primary health care needs of adolescents. A Psychiatrist who holds an unrestricted license under Chapter 458 or 459, F.S., may serve as the DHA of a facility that provides specialized mental health services, as long as the Psychiatrist has current experience in medically treating the physical health care needs of adolescents. The DHA shall be either a state employed or contracted Physician accountable for ensuring the delivery of administrative, managerial and medical oversight of the facility health care system. Corporate physicians, who do not perform clinical/administrative duties on-site, shall not be the Designated Health Authority. The DHA shall ultimately be responsible for the provision of necessary and appropriate health care to youth in the care of a detention center or residential commitment program.

(13) Detention Center: a temporary hardware-secure state-operated, county or municipal facility for juveniles, which compares to a jail in the adult system.

(14) Episodic care: the health care component intended to provide medical services in response to unexpected illnesses, accidents or conditions that require immediate attention or an immediate professional assessment to determine their severity. Episodic care also includes responses to those complaints that can result in severe pain or suffering, even if the youth’s life does not appear to be in danger.

(15) Facility: for the purposes of this chapter, a Detention Center or Residential Commitment Program.

(16) Facility Management System (FMS): The computer based system used by state-operated juvenile detention centers as the primary source of documentation and reporting for facility operations. Forms and reports generated by FMS are considered to be both the official and original documentation for the area concerned.

(17) Facility Operating Procedures: facility/program-specific procedures implemented as guidelines for providing care to youth.

(18) Facility Superintendent: the person responsible for the operation of a designated regional juvenile detention center.

(19) First Aid: any one-time treatment, and follow-up visit for the purpose of observation, of minor injuries such as cuts, scratches, first degree burns and splinters. Ointments, salves, antiseptics, and dressings to minor injuries are considered to be first aid.

(20) Five Rights of Medication Administration: these five rights are specifically defined as:

(a) Right Youth;

(b) Right Medication;

(c) Right Route;

(d) Right Dosage;

(e) Right Time.

(21) Health-Related History (HRH) (HS 014): the form required to document a standardized, comprehensive medical and health-related questionnaire.

(22) Heat Index: The temperature the body feels when heat and humidity are combined.

(23) Individual Health Care Record (IHCR): The permanent departmental file containing the unified cumulative hard-copy collection of clinical records, histories, assessments, treatments, diagnostic tests which relate to a youth’s medical, mental health, substance abuse, Developmental Disability, behavioral health and dental health which have been obtained to facilitate care or document care provided while the youth is in a detention center and residential commitment program.

(24) Juvenile Assessment Center: Section 985.135, F.S. establishes juvenile justice assessment centers which are designed to serve as a point of intake and screening for juveniles referred to the Department.

(25) Juvenile Justice Information System (JJIS): The department’s electronic information system used to gather and store information on youths having contact with the department.

(26) Juvenile Probation Officer (JPO): A person meeting the definition in Section 985.03(30), F.S., and Rule 63D-8.001, F.A.C.

(27) Licensed Health Care Professional: for the purposes of this chapter, a Registered Nurse (RN), Licensed Practical Nurse (LPN), and an Advanced Registered Nurse Practitioner (ARNP) licensed under Chapter 464, F.S.; a Medical Doctor (MD), and a Physician Assistant (PA) licensed under Chapter 458, F.S.; an Osteopathic Physician (DO) licensed under Chapter 459, F.S.; and a Dentist (DMD, DDS) licensed by Chapter 466, F.S.

(28) Medical Grade: One of five (5) categories or grades that can be assigned to a youth as part of the medical classification system. The specific Medical Grades are defined as follows:

(a) Medical Grade 1:

1. Youth has no identified chronic health conditions; and

2. Youth has no serious, chronic infectious, communicable disease; and

3. Youth has no periodic monitoring requirements.

(b) Medical Grade 2:

1. Youth has only one chronic condition, which has not required medical/nursing intervention within the last 12 months (except for routine periodic evaluations at the intervals required in this rule); and

2. Youth has no serious, chronic, infectious communicable disease (youth may or may not be prescribed oral medications); and

3. Youth being treated with prescription medication greater than 30 days.

(c) Medical Grade 3:

1. Youth has been diagnosed with two or more chronic conditions (regardless of the actual or expected need for medical/nursing intervention); or

2. Youth has been diagnosed with a serious chronic, infectious communicable disease; or

3. Youth requires nursing/medical intervention and/or evaluation no more frequently than once every 30 days (youth may or may not be prescribed oral medications).

(d) Medical Grade 4:

1. Youth is physically disabled (visual, hearing, mobility); or

2. Youth is prescribed parenteral medications (medications which are administered by injection); or

3. Youth requires nursing/medical intervention and/or evaluation at a frequency greater than once every 30 days; or

4. Youth is pregnant or is within six weeks post-birth; or

5. Youth is receiving anti-tuberculosis medications.

(e) Medical Grade 5:  Youth is prescribed any medication for diagnosed mental and/or emotional disorders.

(29) Methicillin-Resistant Staphylococcus Aureus (MRSA): MRSA infection is an infection with a strain of Staphylococcus aureus bacteria that is resistant to antibiotics known as beta-lactams. These antibiotics include methicillin, amoxicillin, and penicillin.

(30) Non-licensed: For the purposes of this rule, persons who do not hold a medical or nursing licensure from the Division of Health Quality Assurance of the Department of Health but who function in an assistive role to registered nurses or licensed practical nurses in the provision of patient care services through delegated tasks or activities. These delegated tasks or activities shall be provided under the clinical supervision of a nurse or higher licensure level.

(31) Periodic Evaluation: a follow-up focused medical evaluation for youth by a physician (MD), osteopathic physician (DO), advanced registered nurse practitioner (ARNP) or physician’s assistant (PA) for youth with chronic conditions or communicable diseases, at specified time intervals.

(32) Over-The Counter medications (OTCs): Any drug that routinely does not require a prescription.

(33) Perpetual Inventory: A dose-by-dose inventory process for the daily distribution of prescribed medication and sharps. Sharps are to be counted as each sharp is utilized and disposed of.

(34) Practitioner’s Orders: Prescribed and authorized treatments and medications written for implementation by duly licensed practitioners authorized by their respective practice acts to do so. For the purposes of this rule, the term refers to orders written by Physicians, Physician Assistants, Advanced Registered Nurse Practitioners, and Dentists.

(35) Probation: An individualized program in which the freedom of the child is limited and the child is restricted to non-institutional quarters or restricted to the child’s home in lieu of commitment to the custody of the department as per Rule 63D-8.001, F.A.C.

(36) Program Director: The on-site administrator of a Residential Commitment Program, whether state or privately operated, who is accountable for the on-site operation of the program.

(37) Progress Note: Interdisciplinary documentation of medical and mental health care encounters that explain the forward course of action, events and time of any health care activity.

(38) Protective Action Response – Department-approved verbal and physical intervention techniques and application of mechanical restraints used in accordance with the DJJ Administrative Rules 63H-1.001-1.016, F.A.C., the Protective Action Response Escalation Matrix, and PAR training curricula.

(39) Residential Commitment Program: A low-risk, moderate-risk, high-risk, or maximum-risk residential delinquency program for committed youth.

(40) Restricted Housing: All situations involving segregation, isolation, or separation of a youth for any reason, including disciplinary, medical or mental health reasons. Thus, this term includes disciplinary confinement, room restriction, secure observation, controlled observation, or any other form of housing which is separate from that of the general population.

(41) Service agreements: Written agreements that are utilized on a routine basis by providers who render health care services, and whose provision of services is rendered without a contractual agreement with the department.

(42) Sharp: Any object routinely used in medical procedures, including but not limited to, hypodermic needles, scalpels, blades, broken glass, broken capillary tubes, breakable culture dish, and exposed ends of dental wires.

(43) Sick Call: The official method for a youth to request health care services for an illness or injury. This is the health care delivery system component intended to provide care in response to complaints of illness or injury of a non-emergent nature but which require some form of assessment and/or decision-making.

(44) Significant Change: Any increase or decrease in dosage beyond a small increment or beyond the normal dosage range for youths of similar age.

(45) Transitional Health Care Planning: the process of planning and information exchange to maintain continuity of care for a youth who is discharged, released to the community from a facility, or transferred between facilities.

(46) Treatment Protocols: the precise and detailed plan for a course of medical treatment developed by the Designated Health Authority that describes a patient's treatment regimen; a detailed plan for the delivery of health care treatment, procedures, tests, medications and dosages. These treatment protocols are limited in scope and responsibility depending upon whether the protocol is written for implementation by licensure level or non-licensed direct care staff.

(47) Working Inventory: Inventory that is permitted to be kept in an area outside of regular stock for immediate access by nursing staff, including but not limited to, syringes, needles, phlebotomy equipment, suture kits, and all other potentially dangerous sharps and other devices.

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS. History–New 3-16-14.