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

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.