New Hampshire Code of Administrative Rules
He - Department of Health and Human Services
Subtitle He-P - Former Division of Public Health Services
Chapter He-P 800 - RESIDENTIAL CARE AND HEALTH FACILITY RULES
Part He-P 802 - RULES FOR HOSPITALS
Section He-P 802.03 - Definitions

(a) "Abuse" means any one of the following:

(b) "Activities of daily living (ADL)" means basic daily routine tasks such as eating, transferring, toileting, bathing, dressing, and medication management.

(c) "Addition" means an increase in the building area, aggregate floor area, building height, or number of stories of a structure.

(d) "Administer" means an act whereby one or more doses of a medication is instilled into the body, applied to the body of, or otherwise given to a person for immediate consumption or use by an individual authorized by law, pursuant to RSA 318-B and RSA 326-B.

(e) "Administrator" means the person responsible for the management of the licensed premises and who reports to and is accountable to the governing body.

(f) "Admission" means the point in time when a patient has been accepted by a licensee for the provision of services. This term also includes "admitted".

(g) "Advance directive" means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term "advance directive" includes living wills, durable powers of attorney for health care, or surrogate decision maker in accordance with RSA 137-J.

(h) "Adverse event" means a consequence of care that results in an undesired outcome which may or may not have been preventable, and which is listed in RSA 151:38.

(i) "Affiliated or related parties" means companies or individuals that serve as operators, landlords, management companies or advisors, real estate or consulting companies, members of limited liability companies, administrative services companies, lenders and companies providing financial guarantees, and captive or affiliated insurance companies.

(j) "Agent" means an adult to whom authority to make health care decisions is delegated under an activated durable power of attorney for health care executed in accordance with RSA 137-J, or a surrogate decision maker identified under RSA 137-J:34-37.

(k) "Applicant" means an individual, agency, partnership, corporation, government entity, association, or other legal entity seeking a license to operate a hospital pursuant to RSA 151:2, I(a) or provide a special health care service pursuant to RSA 151:2-e.

(l) "Area of non-compliance" means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151, He-P 802, or other applicable federal or state requirements.

(m) "Cardiac catheterization laboratory services" mean those cardiac catheterization procedures that are performed in a cardiac catheterization laboratory, including diagnostic and interventional cardiac catheterization procedures.

(n) "Care plan or treatment plan" means a documented guide developed by the licensee, in consultation with personnel, the patient, and the patient's guardian or agent, if any, as a result of the assessment process for the provision of care and services.

(o) "Change of ownership" means a change in the controlling interest of an established hospital or provider of special health care services to any individual, agency, partnership, corporation, government entity, association, or other legal entity.

(p) "Chemical restraint" means a drug or medication that is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition.

(q) "Commissioner" means the commissioner of the department of health and human services or his or her designee.

(r) "Critical access hospital (CAH)" means a hospital that has been so designated by the state in which it is located and has been surveyed by the state survey agency or by Centers for Medicare and Medicaid Services (CMS) pursuant to 42 CFR Subpart F § 485.606.

(s) "Critical incident stress management (CISM)" means an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem. Its purpose is to enable people to return to their daily routine more quickly and with less likelihood of experiencing post-traumatic stress disorder.

(t) "Days" means calendar days unless otherwise specified in the rule.

(u) "Deficiency" means any action, failure to act, or other set of circumstances that cause a licensee to be out of compliance with RSA 151 or He-P 802.

(v) "Demonstrated competency" means the ability of the employee to demonstrate to an evaluator that he or she is able to complete the required task in a way that reflects the minimum standard including, but not limited to, a certificate of completion of course material or a post-test to the training provided.

(w) "Department" means the department of health and human services, at 129 Pleasant St, Concord, NH 03301.

(x) "Direct care" means hands on care or services to a patient, including but not limited to medical, nursing, psychological, or rehabilitative treatments.

(y) "Directed plan of correction" means a plan developed and written by the department that specifies the actions the licensee must take to correct identified deficiencies.

(z) "Dietitian" means a person who is licensed under RSA 326-H.

(aa) "Do not resuscitate order (DNR order)" means an order, signed by a licensed provider, that in the event of an actual or imminent cardiac or respiratory arrest, chest compression, and ventricular defibrillation will not be performed, the patient will not be intubated or manually ventilated, and there will be no administration of resuscitation drugs. This term also includes "do not attempt resuscitation order (DNAR order)".

(ab) "Elopement" means an event in which a patient who is cognitively, physically, mentally, emotionally, or chemically impaired wanders away, walks away, runs away, escapes, or otherwise leaves the facility unsupervised, unnoticed, or prior to their scheduled discharge.

(ac) "Emergency" means an unexpected occurrence or set of circumstances, which require immediate remedial attention.

(ad) "Emergency plan" means a document outlining the responsibilities of personnel in an emergency.

(ae) "Emergency psychiatric services" means those services available on a 24-hour basis when a patient needs immediate treatment for psychiatric health concerns.

(af) "Emergency services" means those services rendered in accordance with RSA 151:2-g and includes emergency medical treatment of both physical and behavioral health concerns.

(ag) "Employee" means anyone employed by the licensee and for whom the licensee has direct supervisory authority.

(ah) "Equipment" means "any plumbing, heating, electrical, ventilating, air-conditioning, refrigerating, and fire protection equipment, and any elevators, dumbwaiters, escalators, boilers, pressure vessels, or other mechanical facilities or installations related to building services. This term includes fixtures.

(ai) "Exploitation" means the illegal use of a patient's person or property for another person's profit or advantage, or the breach of a fiduciary relationship through the use of a person or person's property for any purpose not in the proper and lawful execution of a trust, including, but not limited to, situations where a person obtains money, property, or services from a patient through the use of undue influence, harassment, duress, deception, or fraud.

(aj) "Facility" means "facility" as defined in RSA 151:19, II, including the part of the hospital where special health care services are rendered in accordance with RSA 151:2-e.

(ak) "Freestanding hospital emergency facility (FHEF)" means a hospital geographically separate from the parent hospital, which is owned or operated, directly or indirectly, by the parent hospital and which provides emergency acute care identical to those services provided by the parent hospital.

(al) "Governing body" means a group of designated person(s) functioning as a governing body that appoints the administrator and is legally responsible for establishing and implementing policies regarding management and operation of the facility.

(am) "Guardian" means a person appointed in accordance with RSA 463, RSA 464-A or the laws of another state, to make informed decisions relative to the patient's health care and other personal needs.

(an) "Hospital" means "hospital" as defined in RSA 151:2, I(a).

(ao) "Incident Command System (ICS)" means a standardized on-scene emergency management system specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents.

(ap) "Independent contractor" means an individual or business entity working under the supervision of the licensee but not employed by the licensee.

(aq) "Infectious waste" means those items specified by Env-Sw 904.

(ar) "Informed consent" means the decision by a person, his or her guardian or agent, or surrogate decision-maker, to agree to a proposed course of treatment, after the person, his or her guardian or agent, or surrogate decision-maker has received full disclosure of the facts, including information about the risks and benefits of the treatment and available alternatives, needed to make the decision competently.

(as) "Inspection" means the process followed by the department to determine an applicant's or a licensee's compliance with RSA 151 and He-P 802 or to respond to allegations pursuant to RSA 151:6, of non-compliance with RSA 151 and He-P 802.

(at) "License" means the document issued by the department to an applicant, at the start of operation as a hospital or provider of special health care services which authorizes operation of a hospital or special health care services in accordance with RSA 151 and He-P 802, and includes the name of the licensee, the name of the business, the physical address, the license category, the effective date, and license number.

(au) "License certificate" means the document issued by the department to an applicant or licensee that contains the information on a license, and includes the name of the administrator, the type(s) of services authorized, and the number of beds for which the hospital is licensed.

(av) "Licensed practitioner" means:

(aw) "Licensed premises" means the building, or portion thereof, that comprises the physical location that the department has approved for the licensee to conduct operations in accordance with its license.

(ax) "Licensee" means any person or legal entity to which a license has been issued pursuant to RSA 151.

(ay) "Life safety code" means the National Fire Protection Association (NFPA) 101, as adopted pursuant to RSA 153:1, VI-a and amended in Saf-FMO 300 by the fire marshal with the board of fire control, pursuant to RSA 153:5.

(az) "Locked unit" means a locked, secured, or alarmed hospital or units within a hospital, or anklets, bracelets or similar devices that cause a door to close automatically and lock when approached, thereby preventing a patient from freely exiting the hospital or unit within.

(ba) "Medical director" means a physician licensed in New Hampshire pursuant to RSA 329, who is responsible for the implementation of patient care policies and the coordination of medical care in the hospital.

(bb) "Medical staff" means those physicians and other licensed practitioners permitted by law and licensee policies to provide patient care services independently within their scope of practice.

(bc) "Medication" means a substance available with or without a prescription, which is used as a curative, remedial, or palliative, supportive substance.

(bd) "Megavoltage radiation therapy equipment" means therapeutic equipment having a minimum power rating in excess of one MeV which utilizes directed beams of ionizing radiation to kill cancerous tissues. The term includes, but is not limited to, Cobalt-60 and linear accelerator machines.

(be) "Modification" means the reconfiguration of any space, the addition, relocation, or elimination of any door or window, the addition or elimination of load-bearing elements, the reconfiguration or extension of any system, or the installation of any additional equipment. This term does not include repair or replacement of interior finishes.

(bf) "Neglect" means an act or omission which results or could result in the deprivation of essential services or supports necessary to maintain the minimum mental, emotional, or physical health and safety of any patient. For the purposes of this definition, minimum means that the hospital provides stabilizing treatment to all patients until the patient has been physically transferred from the hospital.

(bg) "Nursing care" means the provision or oversight of a patient's physical, mental, or emotional condition or diagnosis by a nurse, that if not monitored on a routine basis by a nurse, would or could result in physical or mental harm to a patient.

(bh) "Open heart surgery (OHS)" means open surgical procedures on the heart muscle, valves, coronary arteries, or other heart structures, including coronary artery bypass graft surgery.

(bi) "Orders" means an electronic or written document, or a verbal direction, by a licensed practitioner for medications, treatments, recommendations, and referrals, and signed by the licensed practitioner using terms such as authorized by, authenticated by, approved by, reviewed by, or any other term that denotes approval by the licensed practitioner.

(bj) "Owner" means a person or organization who has controlling interest in the hospital.

(bk) "Parent hospital" means the hospital which owns and operates a freestanding hospital emergency facility.

(bl) "Patient" means any person admitted to or in any way receiving care, services, or both from a hospital licensed in accordance with RSA 151 and He-P 802.

(bm) "Patient record" means a separate file maintained for each person receiving care and services by the licensee, which includes all documentation required by RSA 151 and He-P 802 and all documentation as required by other federal and state requirements.

(bn) "Patient rights" means the privileges and responsibilities possessed by each patient pursuant to RSA 151:21.

(bo) "Performance-based design" means a flexible, informed design approach that allows for design freedom while specifically addressing fire and life safety concerns of a specific building project, and that makes use of computer fire models or other fire engineering calculation methodologies, such as timed egress studies, to help assess if proposed fire safety solutions meet fire safety goals under specific conditions.

(bp) "Personal care" means personal care services that are non-medical, hands-on services provided to a patient including, but not limited to, assistance with activities of daily living such as grooming, toileting, eating, dressing, bathing, getting into or out of a bed or chair, walking, or reminding the patient to take medications.

(bq) "Personnel" means an individual who is employed by, a volunteer of, or an independent contractor of the hospital who provides services to patients.

(br) "Physical restraint" means the use of hands-on or other physically applied technique to physically limit a patient's freedom of movement, such as forced escorts, holding, prone restraints, or other containment techniques. This term does not include orthopedic appliances.

(bs) "Physician" means medical doctor or doctor of osteopathy currently licensed in the state of New Hampshire pursuant to RSA 329.

(bt) "Plan of correction (POC)" means a plan developed and written by the licensee, which specifies the actions that will be taken to correct identified deficiencies with applicable rules or codes identified at the time of a clinical or life safety code inspection conducted pursuant to RSA 151:6-a or during the course of a complaint investigation conducted pursuant to RSA 151:6.

(bu) "Primary interventional cardiac catheterization" means those catheter-based procedures that involve modification of the coronary arterial system under emergency conditions.

(bv) "Pro re nata (PRN) medication" means medication administered as circumstances might require in accordance with licensed practitioner's orders.

(bw) "Procedure" means a licensee's written, standardized method of performing duties and providing services.

(bx) "Protective care" means the provision of patient monitoring services, including but not limited to:

(by) "Psychiatric hospital" means a:

(bz) "Qualified personnel" means personnel that have been trained and have demonstrated competency to adequately perform the tasks which they are assigned, such as nursing staff, clinical staff, housekeeping staff trained in infection control, and kitchen staff trained in food safety protocols.

(ca) "Radiographic images" means x-rays or other images which are either on film, paper, or stored electronically.

(cb) "Reconstruction" means the reconfiguration of a space that affects an exit or a corridor shared by more than one occupant space, or the reconfiguration of a space such that the rehabilitation work area is not permitted to be occupied because existing means of egress and fire protection systems, or their equivalent, are not in place or continuously maintained.

(cc) "Renovation" means the replacement in kind or strengthening of building elements, or upgrading of building elements, material, equipment, or fixtures, without involving the reconfiguration of spaces.

(cd) "Rehabilitation hospital" means a:

(ce) "Repair" means the patching, restoration, or painting of materials, elements, equipment, or fixtures for the purpose of maintaining such materials, elements, equipment, or fixtures in good or sound condition.

(cf) "Service" means a specific activity performed by the licensee, either directly or indirectly, to benefit or assist a patient, such as dietary, laboratory, nursing, or surgery.

(cg) "Special health care service" means cardiac catheterization laboratory services, open heart surgery, or treatment using megavoltage radiation therapy equipment.

(ch) "Swing beds" means beds within a hospital or critical access hospital participating in Medicare that are approved by the CMS for the provision of a skilled level of care.

(ci) "Volunteer" means an unpaid person who assists with the provision of services such as personal care services, food services, entertainment, or activities, and who does not provide direct care or assist with direct care. This term does not include visitors or those persons who provide religious services.