Code of Massachusetts Regulations
958 CMR - HEALTH POLICY COMMISSION
Title 958 CMR 8.00 - Patient Assignment Limits For Registered Nurses In Intensive Care Units In Acute Hospitals
Section 8.02 - Definitions

As used in 958 CMR 8.00 the following words mean:

Acuity Tool. A decision support tool using a method for assessing patient stability for the ICU Patient according to a defined set of indicators (including Clinical Indicators of Patient Stability and Indicators of Staff Nurse Workload), and used in the determination of a Patient Assignment.

Acute Hospital. The teaching hospital of the University of Massachusetts Medical School, any hospital licensed by the Department of Public Health pursuant to M.G.L. c. 111, § 51 or hospital operated by the Commonwealth, and which contains a majority of medical-surgical, pediatric, obstetric, and maternity beds as defined by the Department.

Clinical Indicators of Patient Stability. Indicators of ICU Patient stability related to the physiological status and clinical complexity and related scheduled procedures, medications and therapeutic supports appropriate to the ICU Patient population in the ICU in which the Acuity Tool will be deployed.

Commission. The Health Policy Commission established in M.G.L. c. 6D.

Critical Environmental Factors. Factors relevant to the particular ICU in which the Acuity Tool will be deployed that may affect the ability of Staff Nurses to care for one or two ICU Patients, such as: physical environment of the ICU, including visibility of patient/monitoring equipment; nursing skill mix, competency and familiarity with the ICU; availability of patient care equipment and technology; and availability of medical, ancillary and support staff in the ICU (e.g., physician, pharmacist, IV team/respiratory therapist, nurse practitioner, clinical nurse specialist, physician assistant, unit secretary, sitters, aides/technicians, staff to operate patient care equipment and technology, patient transport services, travel team/coverage).

Department. The Massachusetts Department of Public Health established in M.G.L. c. 17, § 1.

ICU Patient. A patient occupying a bed in an ICU.

Indicators of Staff Nurse Workload. Indicators of Staff Nurse workload associated with caring for the ICU Patient appropriate to the ICU Patient population in the ICU in which the Acuity Tool will be deployed, such as: patient age, including gestational age as applicable, and cognitive/functional ability; patient and family communication skills and cultural/linguistic characteristics; need for patient and family education; family and other support for the patient; need for care coordination; transitional care and discharge planning required for the patient.

Intensive Care Unit (ICU). A unit physically and identifiably separate from general routine and other patient care areas, in which are concentrated special equipment and skilled personnel for the care of critically ill inpatients requiring immediate and concentrated continuous care and observation, and which meets the Medicare requirements in 42 CFR 413.53(d) for intensive care type inpatient hospital units, licensed by the Department, and shall include intensive care unit, coronary care unit, burn unit, pediatric intensive care unit and neonatal intensive care unit, as defined in 105 CMR 130.020: Definitions, however named by the Acute Hospital, and any such unit in a hospital operated by the Commonwealth.

Nurse Manager. A nurse with management responsibility for nursing services for the ICU.

Patient Assignment. The assignment of a Staff Nurse to care for specified ICU Patient(s), consistent with the education, experience and demonstrated competence of the Staff Nurse, the needs of the ICU Patient(s), and the requirements of 958 CMR 8.00.

Registered Nurse. A nurse who meets the criteria for licensure under M.G.L. c. 112, § 74 and 244 CMR 8.00: Licensure Requirements, and who holds a valid license from the Massachusetts Board of Registration in Nursing to engage in the practice of nursing in Massachusetts as a Registered Nurse.

Shift. A designated period of work time within the ICU.

Staff Nurse. A Registered Nurse providing direct patient care in an ICU.