2018 -- S 2403

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LC004540

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2018

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A N   A C T

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

     

     Introduced By: Senator Joshua Miller

     Date Introduced: February 15, 2018

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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

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

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     23-17-64. Relative to patient safety.

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     (a) Definitions. – As used in this section:

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

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

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

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or long-term care facilities.

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

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

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

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

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

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

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

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     (b) Maximum patient assignments.

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     (1) The maximum number of patients assigned to a registered nurse in a facility shall not

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exceed the limits enumerated in this section. However, nothing herein shall preclude a facility

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

 

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

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

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

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

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assignment of step-down/intermediate patients is three (3) except in a level one trauma hospital,

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in which instance the maximum patient assignment on a surgical step-down unit shall be two (2).

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

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

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PACU patients post anesthesia is two (2).

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

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

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anesthesia is two (2).

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     (6) In the emergency department:

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

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

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assesses that each patient's condition is stable;

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

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

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

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

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with maternal child care patients:

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

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

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

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

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

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

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(3) couplets;

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

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

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is stable; and

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

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

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patients is four (4) except that in all units with pediatric intensive care patients, the maximum

 

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patient assignment is one.

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

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patients is five (5), except that in all units with geriatric or intensive psychiatric patients the

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maximum patient assignment shall be four (4).

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     (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).

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

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

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

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transitional care patients is five (5).

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

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rehabilitation patients is five (5).

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

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     (c) Patient acuity system. Each facility shall develop a patient acuity system, to determine

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if the maximum number of patients that may be assigned to a unit's registered nurses on a

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particular shift should be lower than the limits specified in section (b) of this section, in which

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case that lower number will govern for the duration of that shift. The patient acuity system shall

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be written so as to be readily used and understood by registered nurses, and it shall consider the

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criteria including, but not limited to:

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     (1) The need for specialized equipment and technology;

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     (2) The intensity of nursing intervention required by the complexity of clinical nursing

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judgment needed to design, implement and evaluate patients nursing care plans consistent with

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professional standards of care;

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     (3) The skill mix of members of the health care workforce necessary to the delivery of

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quality care for each patient;

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     (4) The proximity of patients, the proximity and availability of other health care resources

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and facility design; and

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     (5) Patient and family communication skills and cultural/linguistic characteristics. A

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facility's patient acuity system shall, prior to implementation, be certified by the department of

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health, center for health facilities regulations, as meeting the above criteria, and the department of

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health may issue regulations governing such systems, including their content and implementation.

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     (d) Patient acuity system for technologists and therapists. Each facility shall develop a

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patient acuity system, to determine the maximum number of patients that may be assigned to a

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respiratory therapist or a diagnostic imaging technologist on a particular shift. The patient acuity

 

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system shall be written so as to be readily used and understood by technologists/therapists and it

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shall consider the criteria including, but not limited to:

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     (1) The need for specialized equipment and technology;

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     (2) The intensity of intervention required;

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     (3) The skill mix of members of the health care workforce necessary to the delivery of

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quality care for each patient;

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     (4) The proximity of patients, the proximity and availability of other health care resources

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and facility design; and

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     (5) Patient and family communication skills and cultural/linguistic characteristics. A

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facility's patient acuity system shall, prior to implementation, be certified by the department of

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health, division of facilities regulation as meeting the above criteria, and the department of health

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may issue regulations governing such systems, including their content and implementation.

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Nothing contained in this section shall be construed to prohibit, or at any time to have prohibited,

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a facility and labor union from agreeing in a collective bargaining agreement to fewer patients to

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be assigned to a respiratory therapist or diagnostic imaging technologist as designated by the

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patient acuity system.

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     (e) Enforcement. A facility's failure to adhere to the limits set by the act shall be reported

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by the department of health, division of facilities regulation to the attorney general for

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enforcement, for which the attorney general may bring a superior court action seeking injunctive

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relief and civil penalties. A separate and distinct violation, for which the facility shall be subject

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to a civil penalty of up to twenty-five thousand dollars ($25,000), shall be deemed to have been

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committed on each day during which any violation continues and written notice thereof by the

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department of health to the authority in charge of the facility is received. The requirements of this

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act, and its enforcement, shall be suspended during a state or nationally declared public health

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emergency.

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     (f) Collective bargaining. Nothing contained in this section shall be construed to prohibit,

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or at any time to have prohibited, a facility and labor union from agreeing in a collective

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bargaining agreement to fewer patients to be assigned to a registered nurse than the limits

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established by this section.

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     (g) Levels of workforce. The setting of nurses' patient assignment standards and nurses'

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patient limits for registered nurses shall not result in the under-staffing or reductions in staffing

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levels of the health care workforce.

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     (h) Severability. If any clause, sentence, paragraph, or part of this chapter or its

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application to any person or circumstances is, for any reason, adjudged by a court of competent

 

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jurisdiction to be invalid, that judgment shall not affect, impair, or invalidate the remainder of this

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chapter and the application of this chapter to other persons or circumstances, but shall be confined

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in its operation to the clause, sentence, paragraph, or part thereof directly involved in the

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controversy in which the judgment has been rendered and to the person or circumstances

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involved. It is declared to be the legislative intent that this chapter would have been adopted had

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the invalid provisions not been included.

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     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 establish limits on the maximum number of patients that may be assigned

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to a unit’s registered nurses in particular health care situations.

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     This act would take effect upon passage.

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