Glossary                                                                                              Updated March 2006

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Accreditation: Awarded to facilities, based upon an on-site visit and annual maintenance reports, that are in substantial compliance with the Standards for Health Services of the National Commission on Correctional Health Care as determined by its Accreditation Committee. Accreditation is considered ongoing unless other action is taken by the Accreditation Committee.

Annual Statistical Report: A compilation of information concerning the number of inmates receiving health services, by category of service, as well as other relevant information (e.g., operative procedures, referrals to specialists, ambulance services).

Chronic Care: Medical service rendered to a chronically ill patient. The goal is to maintain or restore a person’s normal functioning to the extent possible.

Chronic Disease: An illness or condition that affects an individual’s well-being for an extended interval, usually (at least) 6 months, and generally is not curable, but can be managed to provide optimum functioning within any limitations the condition imposes on the individual.

Clinical Encounter: Any interaction between a patient and health staff that involves a treatment and/or an exchange of confidential information.

Clinical Mortality Review: An assessment of the clinical care provided and the circumstances leading up to a death. Its purpose is to identify any areas of patient care or the system's policies and procedures that can be improved.

Clinically Ordered Restraint: Therapeutic intervention initiated by medical or mental health staff to use devices designed to safely limit a patient's mobility in a crisis due to physical or mental illness.

Clinically Ordered Seclusion: Therapeutic intervention initiated by medical or mental health staff to use rooms designed to safely limit a patient's mobility in a crisis due to physical or mental illness.

Continuous Quality Improvement (CQI):
   Basic CQI Program: Includes monitoring the fundamental aspects of the facility’s health care system (i.e., access to care, the intake process, continuity of care, emergency care and hospitalizations, and adverse patient occurrences including all deaths) at least annually. A basic CQI program also has monthly physician clinical chart reviews and an annual review of the CQI program’s effectiveness.
   Comprehensive CQI Program: Includes a multidisciplinary quality improvement committee, monitoring of the areas specified in the compliance indicators and an annual review of the effectiveness of the CQI program itself. In addition, the program includes an annual process quality improvement study and an outcome quality improvement study, and both studies identify areas in need of improvement and effect remedial actions or strategies.
   Multidisciplinary Quality Improvement Committee: A group of health staff from various disciplines (e.g., medicine, nursing, mental health, dentistry, health records, pharmacy, laboratory) that designs quality improvement monitoring activities, discusses the results and implements corrective action.
   Outcome Quality Improvement Studies: Examine whether expected outcomes of patient care were achieved.
   Process Quality Improvement Studies: Examine the effectiveness of the health care delivery process.

Critical Incident Debriefing: A process whereby individuals are provided an opportunity to express their thoughts and feelings about a critical incident (e.g., suicide, serious injury or death of a staff member or inmate), develop an understanding of critical stress symptoms and develop ways of dealing with those symptoms. Critical incident stress is a normal reaction to an abnormal event that causes individuals to experience unusually strong emotional reactions. Absent the opportunity for debriefing, critical incident stress has the potential for interfering with an individual’s ability to function now or some time in the future.

Custody Staff: Includes line security as well as correctional administration.

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Designated Mental Health Clinician: A psychiatrist, psychologist or psychiatric social worker who is responsible for clinical mental health issues when mental health services at the facility are under a different authority than the medical services.

Detoxification: Refers to the process by which an individual is gradually withdrawn from a drug by the administration of decreasing doses of the drug upon which the person is physiologically dependent, of one that is cross-tolerant to it or of one that has been demonstrated to be effective on the basis of medical research.

Disaster Plan: See Emergency Response Plan.

Discharge Planning: Refers to the process of providing sufficient medications and arranging for necessary follow-up health services prior to the inmate's release to the community.

Dispensing of Medication: Placing of one or more doses of a prescribed medication into containers that are correctly labeled to indicate the name of the patient, the contents of the container and all other vital information.

Documented Health Requests: These include such examples as the recording on the request slip of the action taken regarding triaging and the filing of such slips in the patient’s medical record, and the use of a log to record the request and its disposition.

Emergency Health Care (medical, dental and mental health): Care for an acute illness or unexpected health care needs that cannot be deferred until the next scheduled sick call or clinic.

Emergency Response Plan: The plan developed to respond to manmade or natural, internal or external disasters. Health aspects of an emergency plan, among other items, include the triaging process, outlining where care can be provided and laying out a backup plan.

Forensic Information: Physical or psychological data collected from an inmate that may be used against him or her in disciplinary or legal proceedings.

Formulary: A written list of prescription and nonprescription medications that are ordinarily available to authorized prescribers, including consultants, working for the facility.

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Health Administrator: A person who by virtue of education, experience or certification (e.g., MSN, MPH, MHA, FACHE, CCHP) is capable of assuming responsibility for arranging all levels of health care and ensuring quality and accessible health services for inmates.

Health Assessment: The process whereby the health status of an individual is evaluated, including questioning the patient regarding symptoms. The extent of the health assessment is defined by the responsible physician but should include at least the steps noted in prison or jail standard E-04.

Health Authority: The individual, governmental authority or health care contractor responsible for the facility’s health care services, including arrangements for all levels of health care and the ensuring of quality and accessibility of all health services provided to inmates.

Health Care: The sum of all actions, preventive and therapeutic, taken for the physical and mental well-being of a population. Health care includes medical, dental, mental health, nutrition and other ancillary services, as well as maintaining clean and safe environmental conditions.

Health Care Liaison: A person who generally carries out the following duties when health staff are not on site: reviewing receiving screening forms for follow-up attention; triaging nonemergency sick-call requests every 24 hours; facilitating sick call by having inmates and records available for the health provider; and helping to carry out providers’ orders regarding such matters as diet, housing, and work assignments. The health care liaison may be a correctional officer or other person without a health care license who is trained by the responsible physician in limited aspects of health care coordination.

Health Staff: All qualified health care professionals as well as administratiev and support staff (e.g., health record administrators, laboratory technicians, nursing and medical assistants, clerical workers).

Health-Trained Personnel: Individuals trained in limited aspects of health care, as determined by the responsible physician, and may include correctional officers and other nonhealth personnel.

Hospice Program: Delivers palliative care (medical care and support services aimed at providing comfort). Treatment is focused on symptom control and quality of life issues, rather than attempting to cure conditions.

Infirmary: An area within the health unit accommodating patients for a period of 24 hours or more, expressly set up and operated for the purpose of caring for patients who need skilled nursing care but are not in need of hospitalization or placement in a licensed nursing facility, and whose care cannot be managed safely in an outpatient setting. It is not the area itself, but the scope of care provided that makes the bed an infirmary bed.

Infirmary Care: Care provided to patients with an illness or diagnosis that requires daily monitoring, medication and/or therapy, or assistance with activities of daily living at a level needing skilled nursing intervention.

Informed Consent: The agreement by a patient to a treatment, examination or procedure after the patient receives the material facts about the nature, consequences and risks of the proposed treatment, examination or procedure; the alternatives to it; and the prognosis if the proposed treatment is not undertaken.

Initial Health Screening: See Receiving Screening.

Intrasystem Transfer: An inmate transferred from one facility to another in the same system, individuals returning from furlough or other individuals brought to the facility with an already established health record for their current incarceration.

Isolation: See Segregated Inmates.

Licensed Nursing Facility: A facility that provides long-term or rehabilitative care to patients with chronic physical or mental disabilities.

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Man-Down Drill: A simulated emergency affecting one individual who is in need of immediate medical intervention. It involves life-threatening situations commonly experienced in correctional settings.

Mass Disaster Drill: A simulated emergency involving multiple casualties that require triage by health staff. It frequently involves a natural disaster (e.g., tornado, flood, earthquake), an internal disaster (e.g., riot, arson, kitchen explosion) or external disaster (e.g., mass arrests, bomb threat, power outage).

Medical Diets: Special diets ordered for temporary or permanent health conditions that restrict the types, preparation and/or amounts of food. Examples include restricted calorie, low sodium, low fat, pureed, soft, liquid and nutritional supplementation diets.

Medical Restraints: See Clinically Ordered Restraint.

Medication:
   Accounting: The act of recording, summarizing, analyzing, verifying and reporting medication usage.
   Administration: The act in which a single dose of an identified drug is given to a patient.
   Dispensing: The placing of one or more doses of a prescribed medication into containers that are correctly labeled to indicate the name of the patient, the contents of the container and all other vital information.
   Disposal: (a) The destruction of medication on its expiration date or when retention is no longer necessary or suitable (e.g., upon the discharge of the patient from the facility), or (b) the provision of medication to the former inmate upon his or her discharge from the facility (in accordance with the continuity-of-care principle).
   Distribution: The system for delivering, storing and accounting for medications from the source of supply to the nursing station or point where they are administered to the patient.
   Forced Medications: Those given without the patient’s consent.
   Non-Legend Medications: Those medications that do not require a prescription by law or regulation, and are commonly referred to as over-the-counter drugs.
   Procuring: The act of ordering medications for the facility.

Mental Health Services: Includes the use of a variety of psychosocial and pharmacological therapies, either individual or group, including biological, psychological and social, to alleviate symptoms, attain appropriate functioning and prevent relapse.

Monitoring of Services: The process for ensuring that high quality health care services are being rendered in the facility by all providers. The monitoring is accomplished by on-site observation and review (e.g., study of inmates’ complaints about care; review of health records, pharmaceutical processes, standing orders and performance of care).

Mortality Review: See Clinical Mortality Review.

Nursing Assessment Protocols: Written instructions or guidelines that specify the steps to be taken in evaluating a patient's health status and providing interventions. Such protocols may include acceptable first-aid procedures for the identification and care of ailments that ordinarily would be treated by an individual with over-the-counter medications or through self-care. They also may address more serious symptoms such as chest pain, shortness of breath or intoxication. They provide a sequence of steps to be taken to evaluate and stabilize the patient until a clinician is contacted and orders are received for further care.

Observation Beds: Designated beds used for medical or mental observation for specific purposes, such as watching the patient's response to a change in medication regimen. In addition, patients can be placed in observation beds to prevent them from eating or drinking prior to a medical test that requires such restriction, to allow patients to recover from day surgeries or medical procedures, or to watch the general behavior of inmates whose mental stability appears questionable.

Opiates: Any preparation or derivative of opium, as well as "opioid," a synthetic narcotic that resembles an opioid in action but is not derived from opium.

Oral Care: Includes instruction in oral hygiene, examination and treatment of dental problems. Instruction in oral hygiene minimally includes information on plaque control and the proper brushing of teeth.

Oral Examination: Conducted by a dentist, this includes taking or reviewing the patient’s oral history, an extraoral head and neck examination, charting of teeth, and examination of the hard and soft tissue of the oral cavity with a mouth mirror, explorer and adequate illumination.

Oral Screening: Includes visual observation of the teeth and gums, and notation of any obvious or gross abnormalities requiring immediate referral to a dentist.

Oral Treatment: Includes the full range of services that in the supervising dentist's judgment are necessary for proper mastication and maintaining the inmate's health status.

Orientation:
   Basic Orientation: Provided on the first day of on-site employment, this includes information necessary for the health staff member (e.g., full-time, part-time, consultant, per diem) to function safely within the institution.
   In-Depth Orientation: Includes full familiarization with the health services delivery system at the facility, and focuses on the similarities as well as the differences between providing health care in the community and in a correctional setting.

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Policy: A facility’s official position on a particular issue related to an organization’s operations.

Position: A job filled by a specific staff member (e.g., medical records secretary, physician, chief nurse). A position has tasks that can usually be deferred until the staff member is available.

Post: A job defined by its location, time and duties that can be filled interchangeably by different staff (e.g., 7-3 infirmary nurse). Continuous coverage usually distinguishes a post from a position; a post has tasks that cannot usually be deferred.

Prescribing Provider: A licensed individual, such as an MD/DO, NP or PA, authorized to write prescriptions.

Preventive Maintenance: In the context of health promotion and disease prevention, includes the provision of individual or group health education and medical services, such as inoculations and immunizations provided to take advance measures against disease, and instruction in self-care for chronic conditions.

Primary Care Providers: All licensed practitioners providing the facility's primary care including medical physicians, psychiatrists, dentists, midlevel practitioners (i.e., nurse practitioners, physician assistants) and PhD-level psychologists.

Procedure: Describes in detail, sometimes in sequence, how a policy is to be carried out.

Providers' Clinic: Sick call held by physicians, nurse practitioners, physician assistants, dentists or mental health clinicians.

Psychiatric Personnel: Also known as psychiatric services staff, this may include psychiatrists, general family physicians with psychiatric orientation, psychologists, psychiatric nurses and social workers.

Psychological Autopsy: Sometimes referred to as a psychological reconstruction and usually conducted by a psychologist or other qualified mental health professional; a written reconstruction of an individual's life with emphasis on factors that may have contributed to the individual's death.

Qualified Health Care Professionals: Includes physicians, physician assistants, nurses, nurse practitioners, dentists, mental health professionals and others who by virtue of their education, credentials and experience are permitted by law to evaluate and care for patients.

Qualified Mental Health Professionals: Includes psychiatrists, psychologists, psychiatric social workers, psychiatric nurses and others who by virtue of their education, credentials and experience are permitted by law to evaluate and care for the mental health needs of patients.

Receiving Screening: A process of structured inquiry and observation of all inmates being admitted, designed to obtain immediate treatment for inmates who are in need of emergency health care, identify and meet ongoing current health needs, and isolate those with communicable diseases.

Responsible Physician: An designated MD or DO who has the final authority at a given facility regarding clinical issues.

Restraint: See Clinically Ordered Restraint.

Restricted Licenses: Licenses that have attached stipulations that must be followed. Different state licensing boards refer to these modified licenses by various names including temporary, probation, stipulated order or agreement, practice restriction, institutional, restricted, disciplinary, provisional, limited and conditional.

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Segregated Inmates: Those isolated from the general population and who receive services and activities apart from other inmates. Facilities may refer to inmates housed in such conditions as being in administrative segregation, protective custody, disciplinary segregation or a supermax tier.
   Extreme Isolation: Conditions of segregation in which inmates are seen by staff or other inmates fewer than three times a day.

Self-Medication: Permits responsible patients to carry and administer their own medications (e.g., "keep-on-person" programs).

Sick Call: The evaluation and treatment of an ambulatory patient in a clinical setting, either on or off site, by a qualified health care professional.

Special Needs Care: Care developed for patients with certain medical conditions that dictate a need for close medical supervision (e.g., seizure disorder, diabetes, potential suicide, pregnancy, chemical dependency, psychosis) or multidisciplinary care.

Specialty Care: Specialist-provided health care (e.g., nephrology, surgery, dermatology, orthopedics).

Staffing Plan: Lays out the full-time equivalent (FTE) staff coverage required for a facility, lists current incumbents and vacancies, and addresses how full coverage will be accomplished if all positions are not filled (e.g., use of agency, temporary or part-time staff). A staffing plan is a detailed schedule on which classifications of staff are assigned to Posts and Positions for the health care unit(s).

Statistical Reports: Summarize and monitor trends in the delivery of health care, including service volume; proportionality of service types; and incidence of certain illnesses, diseases and injuries targeted for risk management. These reports also are used for administrative planning for staffing, space and equipment needs, as well as a comparison of facilities.

Substantial Compliance: Defined as meeting all applicable Essential Standards and a minimum of 85 percent of the applicable Important Standards.

Training: See Orientation.

Transfer Screening: In the context of an Intrasystem Transfer, the review of an incoming inmate's health record or summary, by a qualified health professional, within 12 hours of arrival to ensure continuity of care.

Treatment Plan: A series of written statements specifying a patient's particular course of therapy and the roles of qualified health care professionals in carrying it out.

Treatment Protocols: Pre-established, physician-approved guidelines that specify the steps to be taken in appraising and managing a patient’s health condition. Treatment protocols do not include use of prescription medications.

Verification of Credentials: The process designated health staff use to verify the authenticity of required licenses or certification for the facility's qualified health care professionals.

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