Fla. Admin. Code Ann. R. 63M-2.002 - Definitions

The following definitions shall be used for the department's acceptable health care treatment services for youth in Detention and Residential facilities.

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

(2) Assigned Custodian: Individual assigned by the parent/guardian to make healthcare decisions for the youth, as evidenced by a lawful power of attorney under chapter 709, F.S., or a surrogate designation under chapter 765, F.S.

(3) 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.

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

(5) Chief Probation Officer (CPO) - The department employee who is responsible for managing community-based program operations, including department staff and contracted providers, within each of Florida's twenty judicial circuits.

(6) Chronic medical condition: Any illness, disability or condition that is permanent or has persisted longer than six months, or has exacerbated within the past six months, causing subsequent treatment/evaluation, apart from allergies. This may include uncorrected or uncompensated hearing/speech/visual impairment, but excludes Developmental Disability, or Intellectual Disability.

(7) 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.

(8) Community Provider: A Health Care Provider outside of the department commitment system.

(9) 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 practice registered nurse (APRN). 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.

(10) Controlled Substances: All substances defined as "Controlled" in Chapter 893, F.S.

(11) 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).

(12) 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.

(13) Designated Health Authority (DHA): The DHA shall be a Physician (MD) who holds an active, unrestricted license under chapter 458, F.S., an osteopathic Physician (DO) who holds an active, unrestricted license under Chapter 459, F.S., or an Advanced Practice Registered Nurse (APRN), who has qualifications in Autonomous Practice, who holds an active, unrestricted license under Chapter 464, F.S., and meets all requirements for practice in the State of Florida. The Autonomous APRN may not serve as the DHA of programs with complex medical beds. The Physician must be either Board Certified in Pediatrics, Family Practice, Emergency Medicine, or Internal Medicine (with experience in adolescent health) or Board-Eligible and have prior experience in treating the primary health care needs of adolescents. The Autonomous Practice APRN must have experience with Pediatrics, Emergency Care, Family Practice, or Internal Medicine (with experience in adolescent health). The DHA shall be either a state employed or contracted clinician accountable for ensuring the delivery of administrative, managerial and medical oversight of the facility health care system. Corporate clinicians, who do not perform clinical/administrative duties onsite, 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.

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

(15) Electronic Medical Record/Electronic Health Record (EMR/EHR): The EMR and EHR definition can be used interchangeably for this Rule. Electronic Health Record is a department electronic system to maintain and securely access youth(s) Individual Health Care Record to meet federal and state regulations and to allow oversight and confidential access remotely or on site to the youth(s) health information.

(16) 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.

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

(18) 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 both the official and original documentation for the area concerned.

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

(20) Facility Superintendent/ Major: The person responsible for the operation of a designated juvenile detention center.

(21) 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.

(22) Five Rights of Medication Administration: These five rights are specifically defined as:

(a) Right Youth;

(b) Right Medication;

(c) Right Route;

(d) Right Dosage; and

(e) Right Time.

(23) Focused Note: A chronological progress note in SOAP note (Subjective, Objective, Assessment and Plan) format which documents the review of the prior CPA and documents any discrepancy or changes to the current assessment noted in the CPA and outlines any plan to address the findings when youth return to DJJ programming.

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

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

(26) Individual Health Care Record (IHCR): The permanent departmental file containing the unified cumulative electronic and 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.

(27) Juvenile Assessment Center: Chapter 985, 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.

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

(29) Juvenile Probation Officer (JPO): A person meeting the definition in Chapter 985, F.S., and Chapter 63D-13, F.A.C.

(30) Licensed Health Care Professional: For the purposes of this rule, a Registered Nurse (RN), Licensed Practical Nurse (LPN), and an Advanced Practice Registered Nurse (APRN) 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 under Chapter 466, F.S.

(31) 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. This medical grade shall be the only grade assigned in consideration of mental health disorders.

(32) 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.

(33) Non-licensed: For the purposes of this rule, persons who do not hold a medical or nursing licensure recognized as active in the state of Florida 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 Registered Nurse or higher licensure level.

(34) Over-The-Counter medications (OTCs): OTC medications are defined as medications that are safe and effective for use by the general public without seeking treatment by a health professional and can be provided to youth utilizing health care and non-health care protocols within manufacturers recommendations.

(35) 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.

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

(37) 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 or given verbally by Physicians, Physician Assistants, Advanced Practice Registered Nurses, and Dentists.

(38) 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 Chapter 63D-13, F.A.C.

(39) Program Director/Facility Administrator: The onsite administrator of a Residential Commitment Program, whether state or privately operated, who is accountable for the onsite operation of the program.

(40) 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.

(41) Protective Action Response(PAR)/Right Interaction (RI) - The department approved verbal, physical, and mechanical intervention curriculum used in accordance with Chapter 63H-3, F.A.C.

(42) Psychiatric APRN: A licensed advanced practice registered nurse who has a master's degree or a doctorate in psychiatric nursing and two years post-master's clinical experience under the supervision of a psychiatrist. A licensed and certified psychiatric Advanced Practice Registered Nurse (APRN) under Chapter 464, F.S., with a master's degree or doctorate in psychiatric nursing or mental health nursing and two years post-master's clinical experience in pediatric or adolescent psychiatric treatment under the supervision of a psychiatrist would meet this definition as specified in section 394.455, F.S.

(43) Psychiatric Services: Within this rule refers to provision of psychiatric evaluations, prescribing psychotropic medications and monitoring psychotropic medications rendered by a psychiatrist or Psychiatric Advanced Practice Registered Nurse (APRN).

(44) Psychiatrist: A physician licensed pursuant to Chapter 458 or 459, F.S. who is board certified in Child and Adolescent Psychiatry or Psychiatry by the American Board of Psychiatry and Neurology or has completed a training program in Psychiatry approved by the American Board of Psychiatry and Neurology for entrance into its certifying examination. A Psychiatrist, who is board certified in Forensic Psychiatry by the American Board of Psychiatry and Neurology, or the American Board of Forensic Psychiatry, may provide services in DJJ facilities or programs but must have prior experience and training in psychiatric treatment with children or adolescents.

(45) Psychotropic Medication: Medications capable of affecting the mind, emotions and behavior that are used to treat mental illness. The medications, include, but are not limited to the following major categories: antipsychotics, antidepressants, antianxiety drugs, mood stabilizers, and stimulants.

(46) Residential Commitment Program: As defined in Chapter 985, F.S., the level of programming and security provided by programs that service the supervision, custody, care, and treatment needs of committed youth.

(47) Restricted Housing: All situations involving segregation, isolation, or separation of a youth for any reason, including disciplinary, medical or mental health reasons, or any other form of housing which separates youth from that of the general population.

(48) 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.

(49) Sharp: Any object routinely used in medical procedures, including but not limited to, hypodermic needles, scalpels, blades, sutures, instruments with or without blunt ends, and dental equipment.

(50) Shift-to-Shift Inventory: An inventory of controlled substances that shall be conducted with each shift change, ending shift or new shift, prior to the administration of any controlled substance. It shall be conducted with one oncoming and one off-going staff responsible for the access/administration of controlled substances. If nursing staff shifts do not correspond with other nursing staff, then a non-licensed staff shall observe and witness the counting of all controlled substances in the instance where the nurse comes on shift and when the nurse goes off shift for the day.

(51) 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.

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

(53) Subjective, Objective, Assessment, Plan (SOAP): The medical documentation note format nationally recognized as universal documentation for all medical documentation to be used within the Individual Healthcare Record.

(54) 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.

(55) Treatment Protocols: The precise and detailed plan for a course of medical treatment developed by the Designated Health Authority/designee 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.

(56) Working Inventory: Inventory of stock medications, syringes, needles, phlebotomy equipment, suture kits, and other potentially dangerous sharps that is permitted to be kept in an area for immediate access by nursing and trained non-licensed staff, which is separately tracked for use from the larger quantities stored in a secured area accessible only by licensed staff.

Notes

Fla. Admin. Code Ann. R. 63M-2.002

Rulemaking Authority 985.64(2) FS. Law Implemented 985.64(2), 985.145, 985.18 FS.

New 3-16-14, Amended by Florida Register Volume 51, Number 014, January 22, 2025 effective 2/5/2025.

New 3-16-14.