2020 -- H 7470

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2020

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A N   A C T

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

SEPSIS SCREENING PROTOCOLS

     

     Introduced By: Representatives Lyle, and Shekarchi

     Date Introduced: February 06, 2020

     Referred To: House Health, Education & Welfare

     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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     23-17-65. Sepsis screening protocols.

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

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

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

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

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

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

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protocols must also include the following components:

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

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sepsis, or septic shock;

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

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

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

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

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

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

 

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

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children;

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

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

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sources; and

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

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

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

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

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

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

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changes to the sepsis protocols.

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

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

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internal quality improvement.

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

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department upon the department's request.

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

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

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

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

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

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

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

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Research and Quality, and The Joint Commission;

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

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

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and means for aggregate data release and dissemination;

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

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

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

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

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

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

 

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

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

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

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researchers may be consulted.

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

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

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

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shall be responsible for reporting to the department.

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

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

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

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necessary to implement the provisions of this section.

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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 --

SEPSIS SCREENING PROTOCOLS

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

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

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with sepsis, severe sepsis and septic shock.

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     This act would take effect upon passage.

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