Massachusetts General Hospital Patient Care Services
Excellence Every Day


click here

PCS Home Page Nursing Chaplaincy Institute for Patient Care Occupational Therapy Orthotics & Prosthetics Physical Therapy Respiratory Care Services Social Service Speech Language & Swallowing Disorders Clinical Resources MGH Internal Access Only


Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.
Collaborative Governance Magnet Recognition Regulatory Readiness Innovation Units

Other Topics: Anticoagulation | CAUTI | Central Lines | Downtime (internal access only)

Ethics | Evidence-Based Practice | Fall Prevention | Pain | Patient Education/Health Literacy | Patient Experience
Practice Alerts & Updates (internal access only) | Pressure Injuries | Process Improvement | Professional Development
SUD | Workplace Violence (internal access only) | EED Home

eCare Tips for Nurses

(internal access only)

Glossary of Terms

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
Accountable Care Organization (ACO)
An accountable care organization is a group of health care providers (e.g. primary care physicians, specialists and hospitals) that have entered into a formal arrangement to assume collective responsibility for the cost and quality of care of a specific group of patients and that receive financial incentives to improve the quality and efficiency of health care.

An associate chief nurse (ACN) is a member of the nursing executive leadership team who is responsible for ensuring that competent and compassionate patient care is uniformly provided to patients in inpatient, ambulatory and community settings through development, implementation and evaluation of policies, programs and services consistent with the hospital’s mission and department’s vision and philosophy.  Actively participates in the development of the Department’s strategic plan and provides direction and support to the unit leadership triad toward attainment of short- and long-term goals and objectives.

The American Hospital Association is a national organization, founded in 1898, that represents and serves all types of hospitals, health care networks, and their patients and communities. The AHA provides education for health care leaders and is a source of information on health care issues and trends. Through representation and advocacy activities, the AHA ensures that members' perspectives and needs are heard and addressed in national health policy development, legislative and regulatory debates, and judicial matters. Our advocacy efforts include the legislative and executive branches and include the legislative and regulatory arenas. Nearly 5,000 hospitals, health care systems, networks, other providers of care and 37,000 individual members come together to form the AHA.

Perception of innocuous stimuli (light touch, warmth) as pain

The American Nurses Association (ANA) is the only full-service professional organization representing the nation's 2.9-million registered nurses (RNs) through its 54-constituent member associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

American Nurses Credentialing Center

The Agency for Healthcare Research and Quality (AHRQ) is the nation's lead federal agency for research on health care quality, costs, outcomes and patient safety. AHRQ is the health services research arm of the U.S. Department of Health and Human Services (HHS), complementing the biomedical research mission of its sister agency, the National Institutes of Health. The agency is home to research centers that specialize in major areas of health care research, including: clinical practice and technology assessment, health care organization and delivery systems, and primary care. AHRQ is a major source of funding and technical assistance for health services research and research training at leading U.S. universities and other institutions. As a science partner, the agency works with the public and private sectors to build the knowledge base for what works—and does not work—in health and health care and to translate this knowledge into everyday practice and policy-making.

Drug used to prevent clot formation or to prevent a clot that has formed from enlarging. Anticoagulant drugs inhibit clot formation by blocking the action of clotting factors or platelets. Anticoagulant drugs fall into three groups: inhibitors of clotting factor synthesis, inhibitors of thrombin and antiplatelet drugs. The FreeDictionary (accessed Dec. 2, 2014)

Assistive Device
A technical aid, communication device or medical aid modified or customized, that is used to increase, maintain or improve the functional abilities of people with disabilities. Assistive technology can include mobility devices such as walkers and wheelchairs, as well as hardware, software and peripherals that assist people with disabilities in accessing computers or other information technologies. For example:

  • people with limited hand function may use a keyboard with large keys or a special mouse to operate a computer
  • people who are blind may use software that reads text on the screen in a computer-generated voice
  • people with low vision may use software that enlarges screen content
  • people who are deaf may use a video
  • or people with speech impairments may use a device that speaks out loud as they enter text via a keyboard

return to top uparrow

way for hospitals and doctors to analyze quality data, both internally and against data from other hospitals and doctors, to identify best practices of care and improve quality

Brain Death
Death by brain criteria is defined under Massachusetts state law as the total and irreversible cessation of spontaneous brain functions, in which further attempts of resuscitation or continued supportive maintenance would not be successful in restoring such function. Stated more simply, brain death is the irreversible loss of all function of the brain, including the brainstem. A patient determined to be brain dead is legally and clinically dead. (MGH Policy on Brain Death, 2.1)

return to top uparrow

Coordinated Bed Efficiency Dashboard System (CBEDS) is teh electronic bed management system that enhances patient throughput with real-time display and communication of bed and patient status.

Centers for Disease Control and Prevention is one of the major operating components of the Department of Health and Human Services. Its mission is to collaborate to create the expertise, information, and tools that people and communities need to protect their health – through health promotion, prevention of disease, injury and disability, and preparedness for new health threats.

he Centers for Medicare and Medicaid Services (CMS) is a federal agency within the US Department of Health and Human Services. CMS administers the Medicare program and works in partnership with state governments to administer Medicaid and other programs. CMS’ mission is to make sure beneficiaries are aware of services for which they are eligible, and that services are provided in an effective manner.

In order for a health care organization to participate in and receive payment from Medicare or Medicaid programs, it must comply with standards called Conditions of Participation (CoP’s). In lieu of conducting surveys to monitor compliance, CMS accepts findings of accrediting agencies such as The Joint Commission and grants them “deemed” status. CMS does, from time to time, conduct their own survey to validate the findings of the accrediting agencies.

Central Line
A central line is an intravascular catheter that terminates at or close to the heart in a large blood vessel. A central line can be used to give fluids, antibiotics, medical treatments such as chemotherapy, and liquid food if a patient is unable to eat or digest food normally. Central lines are also sometimes called central venous lines or central venous catheters. Examples of central lines are PICCs (peripherally-inserted central catheter), Hickman catheters (tunneled catheter), and Port-A Caths (implanted port).

Central line days
The total number of days a central line is in place for patients in surgical, intensive care, and certain other hospital units. In units where this is monitored, the count is performed at the same time each day. Each patient with one or more central lines at the time the count is performed is counted as one central line day. 

An antiseptic agent with topical antibacterial activity. Chlorhexidine is positively charged and reacts with the negatively charged microbial cell surface, thereby destroying the integrity of the cell membrane. Subsequently, chlorhexidine penetrates into the cell and causes leakage of intracellular components leading to cell death. Since gram positive bacteria are more negatively charged, they are more sensitive to this agent.

Central Line-Associated Bloodstream infection (CLABSI). When a patient gets a bloodstream infection after having a central line put in and the bloodstream infection is not related to an infection in another part of the body it’s considered a CLABSI.   According to the Centers for Disease Control and Prevention (CDC), an estimated 248,000 CLABSIs occur in U.S. hospitals each year.  These bloodstream infections often lead to longer hospital stays, higher costs, and an increased risk of dying.  CLABSIs can be prevented through proper insertion and care of the central line.

The Clinical Nurse Specialist (CNS) is a master's-prepared nurse with an area of specialization who promotes competent, compassionate and professional nursing care for patients/families across the continuum through direct patient care and by influencing nursing personnel and systems to facilitate expert care.  The role includes patient care, teaching, consultation and research and is the clinical arm of the unit leadership triad.

return to top uparrow

Data collection
The acquisition of health care information or facts based upon patient and consumer race, ethnicity and language. Data Collection provides health care providers with the ability to perform benchmarking measures on health care systems to determine areas where improvement is needed in providing care.

Disparities in care are differences in the delivery of health care, access to health care services and medical outcomes based on ethnicity, geography, gender and other factors that do not include socioeconomic status or insurance coverage. Understanding and eliminating the causes of health care disparities is an ongoing effort of many groups and organizations.

The Department of Nursing (DON) – The clinical departments and programs of Patient Care Services (PCS) that are within the discipline of nursing.

The Department of Public Health (DPH) is a state agency within Massachusetts Health and Human Services (HHS). DPH has several bureaus and programs that strive to promote the health and well being of all people in the Commonwealth and to ensure that safe, effective; high-quality care is provided in all settings. HHS administers Medicaid (Mass Health Program) which is the second largest insurer in the state. DPH ensures that hospitals comply with Center for Medicare and Medicaid Services standards in order to receive payment through Mass Health. DPH does not routinely conduct comprehensive on-site surveys, but does conduct surveys related to specific programs such as Transplant and Infection Control. DPH may also choose to conduct a review of a specific patient’s care triggered by hospital self-report of a serious incident or by a patient/family complaint

Dreyfus Model of Skill Acquisition
Based on the work of Drs. Hubert and Stuart Dreyfus, both professors at the University of California at Berkeley. This is a situational model of skill acquisition. It is the development of skilled know how. The model states that a person passes through five stages of qualitatively different perceptions of his/her task and/or mode of decision-making as his/her skill improves. It is neither expected nor possible for all individuals to proceed in a linear fashion. Skill according to this model is based on innate ability, experience and environment.

return to top uparrow

Electronic Health Record (EHR)
The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates and streamlines the clinician's workflow. The EHR has the ability to generate a complete record of a clinical patient encounter - as well as supporting other care-related activities directly or indirectly via interface - including evidence-based decision support, quality management, and outcomes reporting.

Evidence-Based Practice (EBP)
Evidence-based practice (EBP) is a method of clinical decision making used by many healthcare disciplines. The term was first defined by Dr. Sackett from McMaster University in Canada in the early 1990s. EBP takes into account the best available information, or evidence, along with the clinical expertise of the healthcare practitioners and the values and preferences of the patient to determine the best treatment for an individual.

Excellence Every Day
At Massachusetts General Hospital, Excellence Every Day means striving to provide the best possible care to every patient and family in every moment of every day.  It is our philosophy and our commitment.  Our efforts to achieve Excellence Every Day include validation by external regulatory agencies in the form of on site surveys and through our designation as a Magnet hospital.  We are all focused upon meeting the needs of patients and creating systems that support the highest level of quality and safety.

MGH EED site
PCS EED Portal

return to top uparrow

Friction is defined as the resistance to motion in a parallel direction relative to the common boundary of two surfaces (NPUAP, 2007.) Friction is one of the two most common etiologies of superficial, top-down Stage 2 ulcers. The mechanism of injury associated with friction is abrasion of the epidermis, which is often caused by dragging the patient up in the bed or from one surface to another. Strategies to prevent friction injury include: 1) using the ceiling lift to reposition the patient, regardless of body habitus, 2) covering bony prominences with dressings (e.g. Mepilex Border Sacrum) that have slippery outer layer which decreases resistance, 3) moisturizing skin with cream containing silicon which decreases resistance (may complicate adherence of dressings with silicon at borders.

return to top uparrow

l Consumer Assessment of Healthcare Providers and Systems (H-CAHPS or CAHPS Hospital Survey) is a standardized survey instrument and data collection methodology for measuring patients' perspectives of hospital care. While many hospitals collect information on patient satisfaction, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals. H-CAHPS is a core set of questions that can be combined with customized, hospital-specific items to produce information that complements the data hospitals currently collect to support improvements in internal customer service and quality-related activities.

Health Care Proxy
This term refers to the form-not the person. The preferred form of advance directive in Massachusetts under Massachusetts General Laws Chapter 201D Health Care Proxies. The form appoints a health care agent (the person) to make health care decisions for the patient if he/she loses the capacity to make their own decisions.This legal document does not require an attorney to fill out. It must be signed in front of two adult witnesses who are not the appointed agent. In some states this document is called a Durable Power of Attorney for Health Care.

Health Literacy
The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.  — Healthy People 2010, U.S. Department of Health and Human Services

Hidden/ Invisible Disabilities
Those disabilities that can not be directly identified through observation. They can include cognitive, chronic health, and psychological disabilities. These Disabilities can sometimes or always limit daily activities, range from mild challenges to severe limitations and vary from person to person - Invisible Disabilities Association - IDA

Generally seeing a person in a wheelchair, wearing a hearing aid, or carrying a white cane tells us a person may be disabled. But what about people with invisible disabilities, such as chronic pain, renal failure, diabetes, or sleep disorder? They are often accused of faking or imagining their disabilities. These symptoms can occur due to chronic illness, injury, birth disorders, etc. and are not always obvious to the onlooker.

A phenomenon of a heightened perception of and response to pain.

-- Primary Hyperalgesia:  An exaggerated pain response  (primary hyperalgesia). 

-- Secondary Hyperalgesia:  The extension of an area of hyperalgesia to adjacent body parts so that an uncomfortable stimulus applied near injured tissue evokes an exaggerated pain response.

return to top uparrow

Inflammatory Pain
Pain associated with illness or injury without direct nerve damage. 

The Institute for Healthcare Improvement (IHI) is an independent nonprofit organization helping to lead the improvement of health care throughout the world. Founded in 1991 and based in Cambridge, Mass., IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action.

“Innovation in service delivery and organization is a novel set of behaviors, routines and ways of working that are directed at improving health outcomes, administrative efficiency, cost effectiveness of users’ experience and are implemented by planned and coordinated actions.” (Greenholgh, 2005)

The Institute of Medicine (IOM) is a nonprofit organization and honorific membership organization that works outside the framework of government to ensure scientifically informed analysis and independent guidance on matters of biomedical science, medicine and health. The Institute provides unbiased, evidence-based and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society and the public at large. IOM's book on quality and safety, Crossing the Quality Chasm: A New Health System for the 21st Century, partially funded by the Robert Wood Johnson Foundation, reported that a huge divide exists between the care we should receive and the care that we get. Crossing the Quality Chasm introduces the notion that health care needs to take a page from industry and use its engineering improvement methods to aim for top quality, efficiency and safety. The report lays out six goals that would become akin to a mantra for the quality improvement movement: care should be "safe, effective, patient-centered, timely, efficient and equitable." IOM's 2003 landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care demonstrates the reality and effect of health disparities and quality-of-care differences for persons of racial and ethnic minorities.

return to top uparrow

Formerly called the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), The Joint Commission (TJC) is a private, nonprofit organization that evaluates and accredits hospitals and other health care organizations providing home care, behavioral health care, ambulatory care and long-term care services. The State and Federal government recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicare and Medicaid reimbursement. Surveys are unannounced and typically follow a tri-annual cycle. Joint Commission surveys are unannounced and occur 18 to 36 months after the previous full survey.

return to top uparrow

Maximum Sterile Barrier
Technique used to minimize potential for infection during procedures. For central line insertion at MGH, this requires: hat and mask for everyone in room, sterile gloves & sterile gown for all operators, and full body drape (head to toe).

Moral distress
Moral distress has been defined as physical and/or emotional suffering that is experienced when internal or external constraints prevent a person from taking the action that one believes is right (Pendry, 2007)." (From OJIN Vol 15 - 2010No3 Sept 2010 Vol 15  No. 3, Sept 2010 "Creating Workplace Environments that Support Moral Courage," by Cynthia Ann LaSala MS, RN and Dana Bjarnason, PhD, RN, NE-BC)

"Nursing care today is provided in very complex environments. This complexity can lead to moral distress and the need to demonstrate moral courage. Moral courage involves the willingness to speak out and do that which is right in the face of forces that would lead a person to act in some other way."(Iseminger, K., (September 30, 2010) "Overview and Summary: Moral Courage Amid Moral Distress: Strategies for Action" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Overview and Summary.)

return to top uparrow

The National Database of Nursing Quality Indicators (NDNQI) is a proprietary database of the American Nurses Association (ANA). The database collects and evaluates unit-specific data from hospitals in the United States. Participating hospitals receive unit-based comparative data reports to use for quality improvement purposes.

Neuropathic Pain
Abnormal pain secondary to nerve illness or injury. 

Never Events
Never Events are medical mistakes that should never occur under any circumstance.

National Patient Safety Foundation

Nursing Sensitive Indicators (NSIs)
such as falls and pressure injurys, are those aspects of patient care for which there is empirical evidence linking nursing interventions to improved outcomes. link to Caring Headlines article

return to top uparrow

For scientific and clinical purposes, the International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage". Because of the Subjective Nature of pain,  The most commonly cited definition is by Margo McCaffery: "'Pain is whatever the experiencing person says it is, existing whenever he (the experiencing person) says it does.”

Patient fall (NDNQI definition)
A patient fall is a sudden unintentional descent, with or without injury that results in the patient coming to rest on the floor, on or against some other surface.

Performance Improvement
Performance Improvement is the concept of measuring the output of a particular process or procedure, then modifying the process or procedure to increase the output, increase efficiency, or increase the effectiveness of the process or procedure.

Pressure Injury
A pressure injury is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A  number of contributing or confounding factors are associated with formation of pressure ulcers. (National pressure injury Advisory Panel, 2011)

Process Improvement
Process Improvement is a methodology that seeks to engage front line staff in the problem solving process. Process Improvement can involve clinical, as well as administrative functions and may occur in emergency rooms, inpatient settings, ambulatory practices or other hospital operational areas.

return to top uparrow

Quality indicator
A quality indicator is an agreed-upon process or outcome measure that is used to determine the level of quality achieved. A measurable variable (or characteristic) that can be used to determine the degree of adherence to a standard or achievement of quality goals.

Quality measures
Quality measures are mechanisms used to assign a quantity to quality of care by comparison to a criterion.

return to top uparrow

Rapid cycle change
Rapid cycle change is a quality-improvement method that identifies, implements and measures changes made to improve a process or a system. At the onset, the team sets an outcome measure based on the system's goals. Improvement occurs through small, rapid PDSA (Plan, Do, Study, Act) cycles to advance practice change. This model requires targeting a specific area to change; planning changes on the basis of sound science, theory and evidence; piloting several changes with small patient groups; measuring the effects of changes; and acting according to the data. The fundamental concept of rapid-cycle improvement is that health care processes—once defined, in place and in effect—should be continually improved by instituting a constant cycle of innovations or improvements.

Research is a scientific process that seeks to validate, refine and extend existing knowledge and generate new knowledge that directly influences the work of a discipline or group. .Nursing research focuses on the development, validation, testing and refinement of knowledge that advances nursing science and informs professional practice to improve patient care.

Per The Joint Commission, in its broadest sense, restraint is the direct application of physical force to a patient with or without the patient's permission to restrict his or her freedom of movement.

Revised Professional Practice Environment Survey (RPPE)
Revised Professional Practice Environment Survey (RPPE) is an instrument designed to measure nursing and a multidisciplinary work forces perceptions of and satisfaction with the professional practice environment.

return to top uparrow

Sentinel event
A sentinel event is any unexpected event in a health care setting that causes death or serious injury to a patient and is not related to the natural course of the patient's illness.

Service animal
A service animal is defined by the Americans with Disabilities Act (ADA) as a dog that is individually trained to do work or perform tasks for a person with a disability. If they meet this definition, animals are considered service animals under the ADA regardless of whether they have been licensed or certified by a state or local government. All entities must permit service animals to accompany people with disabilities in all areas where members of the public are allowed to go. People with disabilities who use service animals cannot be isolated from other patrons, treated less favorably than other patrons, or charged fees that are not charged to other patrons without animals. Allergies and fear of dogs are not valid reasons for denying access or refusing service to people using service animals.

Some examples of tasks that service dogs provide include: Guiding people who are blind, alerting people who are deaf or hard of hearing, pulling a wheelchair, alerting and protecting a person who is having a seizure, reminding a person with mental illness to take prescribed  medications  and calming a person  with post traumatic Stress Disorder (PTSD) during an anxiety attack.

Individuals with mental disabilities who use service animals that are trained to perform a specific task are protected by the ADA. The rule permits the use of trained miniature horses as alternatives to dogs, subject to certain limitations.
Dogs that are not trained to perform tasks that mitigate the effects of a disability, including dogs that are used purely for emotional support, are not service animals.

Skin Failure
An [ unavoidable ] event in which the skin and underlying tissue dies due to hypoperfusion [ as a consequence of ] concurrent severe dysfunction or failure of other organ systems (Langemo & Brown, 2006).” Skin failure may occur simultaneously, but must be differentiated from, pressure injuries (PI) prior to labeling and reporting skin discoloration, necrosis, or a cavitary wound as a PI. “Failing skin” increases susceptibility to the forces of pressure and shear (White-Chu & Langemo, 2015). However, PI occur as a result of unrelieved pressure, usually over a bony prominence or under a medical device, with resultant tissue deformation, ischemia and necrosis (Delmore, Cox, Rolnitsky,, 2015). PI may occur in healthy persons as well as those with coexisting illness. In contrast, skin failure “mirrors” critical illness manifested by hemodynamic instability and / or major organ compromise. Peripheral arterial disease, mechanical ventilation greater than 72 hours, respiratory failure, liver failure, and severe sepsis / septic shock have been shown to be significant and independent predictors of acute skin failure in critically-ill patients (Delmore, 2015).

Delmore B, Cox J, Rolnitsky L, Chu A, Stolfi A. Differentiating a pressure ulcer from acute skin failure in the adult critical care patient. Adv Skin Wound Care 2015; 28: 514-524.
Langemo D, Brown G. Skin fails too: acute, chronic, and end-stage skin failure. Adv Skin Wound Care 2006; 19:206-2011
White-Chu E, Langemo D. Skin failure: Identifying and managing an underrecognized condition. Annals of long term care.

return to top uparrow

Tissue Plasminogen Activator
Also called tPA. An enzyme made in the body that helps dissolve blood clots. A form of tPA is made in the laboratory to treat blood clots in central lines, heart attacks, strokes, and clots in the lungs. Tissue plasminogen activator may be instilled into the catheter of central lines when a blood clot in the catheter is suspected.

Transparency is the process of collecting and reporting health care cost, performance and quality data in a format that can be accessed by the public and is intended to improve the delivery of services and ultimately improve the health care system as a whole.

return to top uparrow

Work flow
Work flow is a repeatable pattern of activity enabled by the organization of resources, defined roles, and information into a process that can be documented and learned. Improvements in work flow for health care providers will lessen the burden of providing health care and will lead to greater quality health care overall.

return to top uparrow

Excellence Every Day represents an MGH commitment to providing the highest quality, safest care that meets or exceeds all standards set by the hospital and external organizations.
If you have questions or suggestions related to the EED portal, please contact Jess Beaham at (617) 726-3109 or via email at

updated 3/3/15
return to top

Home | Chaplaincy | Excellence Every Day Portal | Institute for Patient Care | Nursing | Occupational Therapy | Orthotics & Prosthetics | Physical Therapy

Respiratory Care | Social Service | Nursing | Speech Language Swallowing Disorders | Clinical Resources | Search PCS | Contact PCS

MGH Home Page | MGH Intranet | MassGeneral Hospital for Children | Partners Healthcare

Massachusetts General Hospital 55 Fruit Street, Boston MA 02114 / (617) 726-2000 / TDD: 617-724-8800