2019 -- H 5906

========

LC002195

========

     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

____________

A N   A C T

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

SEPSIS SCREENING PROTOCOLS

     

     Introduced By: Representatives Lyle, Newberry, Casimiro, Cortvriend, and Nardone

     Date Introduced: March 27, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

1

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

2

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

3

     23-17-65. Sepsis screening protocols.

4

     (a) Each licensed health care facility shall adopt, implement, and periodically update

5

evidence-based protocols for the early recognition and treatment of patients with sepsis, severe

6

sepsis, or septic shock (sepsis protocols) that are based on generally accepted standards of care.

7

Sepsis protocols must include components specific to the identification, care, and treatment of

8

adults and of children, and must clearly identify where and when components will differ for

9

adults and for children seeking treatment in the emergency department or as an inpatient. These

10

protocols must also include the following components:

11

     (1) A process for the screening and early recognition of patients with sepsis, severe

12

sepsis, or septic shock;

13

     (2) A process to identify and document individuals appropriate for treatment through

14

sepsis protocols, including explicit criteria defining those patients who should be excluded from

15

the protocols, such as patients with certain clinical conditions or who have elected palliative care;

16

     (3) Guidelines for hemodynamic support with explicit physiologic and treatment goals,

17

methodology for invasive or non-invasive hemodynamic monitoring, and time frame goals;

18

     (4) For infants and children, guidelines for fluid resuscitation consistent with current,

 

1

evidence-based guidelines for severe sepsis and septic shock with defined therapeutic goals for

2

children;

3

     (5) Identification of the infectious source and delivery of early broad spectrum antibiotics

4

with timely re-evaluation to adjust to narrow spectrum antibiotics targeted to identified infectious

5

sources; and

6

     (6) Criteria for use, based on accepted evidence of vasoactive agents.

7

     (b) Each licensed health care facility shall ensure that professional staff with direct

8

patient care responsibilities and, as appropriate, staff with indirect patient care responsibilities,

9

including, but not limited to, laboratory and pharmacy staff, are periodically trained to implement

10

the sepsis protocols required under subsection (a) of this section. The licensed health care facility

11

shall ensure updated training of staff if the licensed health care facility initiates substantive

12

changes to the sepsis protocols.

13

     (c) Each licensed health care facility shall be responsible for the collection and utilization

14

of quality measures related to the recognition and treatment of severe sepsis for purposes of

15

internal quality improvement.

16

      (d) The evidence-based protocols adopted under this section shall be provided to the

17

department upon the department's request.

18

     (e) Licensed health care facilities submitting sepsis data as required by the Center for

19

Medicare and Medicaid Services Hospital Inpatient Quality Reporting program as of fiscal year

20

2016 are presumed to meet the sepsis protocol requirements outlined in this section.

21

     (f) Subject to appropriation, the department of health shall:

22

     (1) Recommend evidence-based sepsis definitions and metrics that incorporate evidence-

23

based findings, including appropriate antibiotic stewardship, and that align with the National

24

Quality Forum, the Centers for Medicare and Medicaid Services, the Agency for Healthcare

25

Research and Quality, and The Joint Commission;

26

     (2) Establish and use a methodology for collecting, analyzing, and disclosing the

27

information collected under this section, including collection methods, formatting, and methods

28

and means for aggregate data release and dissemination;

29

     (3) Complete a digest of efforts and recommendations no later than twelve (12) months

30

after the effective date of this section; the digest may include Rhode Island-specific data, trends,

31

conditions, or other clinical factors; a summary shall be provided to the governor and general

32

assembly and shall be publicly available on the department's website; and

33

     (4) Consult and seek input and feedback prior to the proposal, publication, or issuance of

34

any guidance, methodologies, metrics, rulemaking, or any other information authorized under this

 

LC002195 - Page 2 of 4

1

section from statewide organizations representing hospitals, physicians, advanced practice nurses,

2

pharmacists, and long-term care facilities. Public and private hospitals, epidemiologists, infection

3

prevention professionals, health care informatics and health care data professionals, and academic

4

researchers may be consulted.

5

     If the department receives an appropriation and carries out the requirements of

6

subsections (f)(1), (f)(2), (f)(3), and (f)(4) of this section, then the department may adopt rules

7

concerning the collection of data from hospitals regarding sepsis and requiring that each hospital

8

shall be responsible for reporting to the department.

9

     Any publicly released hospital-specific information under this section is subject to data

10

provisions specified by the Rhode Island health care quality reporting program.

11

     (g) The department of health is hereby authorized to promulgate rules and regulations

12

necessary to implement the provisions of this section.

13

     SECTION 2. This act shall take effect upon passage.

========

LC002195

========

 

LC002195 - Page 3 of 4

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

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

SEPSIS SCREENING PROTOCOLS

***

1

     This act would require licensed health care facility medical staff to adopt, implement, and

2

periodically update evidence-based protocols for the early recognition and treatment of patients

3

with sepsis, severe sepsis and septic shock.

4

     This act would take effect upon passage.

========

LC002195

========

 

LC002195 - Page 4 of 4