2015 -- H 5506

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LC001506

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTH CARE FACILITIES

     Introduced By: Representatives Gallison, Bennett, Casey, Edwards, and Canario

     Date Introduced: February 12, 2015

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 23-17 of the General Laws entitled "Licensing of Health Care

Facilities" is hereby amended by adding thereto the following section:

     23-17-63. Relative to patient safety. – (a) Definitions. – As used in this chapter:

     (1) "Facility" means any licensed private or state-owned and state-operated general acute

care hospital, an acute psychiatric hospital, an acute care specialty hospital, or any acute care unit

within a state operated health care facility. This definition shall not include rehabilitation facilities

or long-term care facilities.

     (2) "Nursing care" means care which falls within the scope of practice as defined in § 5-

34-3 or is otherwise encompassed within recognized standards of nursing practice, including

assessment, nursing diagnosis, planning, intervention, evaluation and patient advocacy.

     (3) "Health care workforce" means personnel employed by or contracted to work at a

facility that have an effect upon the delivery of quality care to patients, including, but not limited

to, registered nurses, licensed practical nurses, unlicensed assistive personnel, service,

maintenance, clerical, professional and technical workers, or other health care workers.

     (b)(1) The maximum number of patients assigned to a registered nurse in a facility shall

not exceed the limits enumerated in this section. However, nothing shall preclude a facility from

assigning fewer patients to a registered nurse than the limits enumerated in this section.

     (2) In all units with intensive care patients and in all units with critical care patients, the

maximum patient assignment is one patient. A registered nurse in such units may accept a second

intensive care or critical care patient if that nurse assesses that each patient's condition is stable.

     (3) In all units with step-down/intermediate care patients, the maximum patient

assignment of step-down/intermediate patients is three (3).

     (4) In all units will post anesthesia care (PACU) patients, the maximum patient

assignment of PACU patients under anesthesia is one. The maximum patient assignment of

PACU patients post anesthesia is two (2).

     (5) In all units with operating room (OR) patients, the maximum patient assignment of

OR patients under anesthesia is one. The maximum patient assignment of OR patients post

anesthesia is two (2).

     (6) In the emergency department:

     (i) The maximum patient assignment of critical unstable or intensive care patients is one.

     (ii) A registered nurse may accept a second critical or intensive care patient if that nurse

assesses that each patient's condition is stable.

     (iii) The maximum patient assignment of critical stable patients is two (2).

     (iv) The maximum patient assignment of urgent stable patients is three (3).

     (v) The maximum patient assignment of non-urgent stable patients is four (4).

     (7) As used in this subsection, "couplet" means one mother and one baby. In all units

with maternal child care patients:

     (i) The maximum patient assignment of active labor patients is one patient.

     (ii) The maximum patient assignment during birth is one nurse responsible for the mother

and, for each baby, one nurse whose sole responsibility is the baby.

     (iii) The maximum patient assignment of immediate postpartum patients is one couplet,

and in the case of multiple births, one nurse for each additional baby.

     (iv) The maximum patient assignment of postpartum patients is six (6) patients or three

(3) couplets.

     (v) The maximum patient assignment of intermediate care babies is three (3) babies. The

nurse may accept a fourth intermediate care baby if the nurse assesses that each baby's condition

is stable.

     (vi) The maximum patient assignment of well-baby patients is six (6) babies.

     (8) In all units with pediatric patients, the maximum patient assignment of pediatric

patients is four (4):

     (9) In all units with psychiatric patients, the maximum patient assignment of psychiatric

patients is five (5).

     (10) In all units with medical, surgical and telemetry patients, the maximum patient

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assignment of medical, surgical and telemetry patients is four (4).

     (11) In all units with observational/outpatient treatment patients, the maximum patient

assignment of observational/outpatient treatment patients is four (4).

     (12) In all units with transitional care patients the maximum patient assignment of

transitional care patients is five (5).

     (13) In all units with rehabilitation patients, the maximum patient assignment of

rehabilitation patients is five (5).

     (14) In any unit not otherwise listed, the maximum patient assignment is four (4).

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTH CARE FACILITIES

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     This act would specify the maximum number of patients assigned to a registered nurse in

various facilities.

     This act would take effect upon passage.

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