2023 -- H 5869

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTHCARE FACILITIES

     Introduced By: Representatives DeSimone, Shekarchi, Slater, Hull, Kazarian, Cardillo,
and Biah

     Date Introduced: March 01, 2023

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

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

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

     23-17-66. Protocols for the early recognition and treatment of patients with

severe/septic shock.

     (a) For purposes of this section, the following words and terms shall have the following

meanings:

     (1) "Sepsis" means a life-threatening organ dysfunction caused by a dysregulated host

response to infection.

     (2) "Septic shock" means sepsis with persisting hypotension and having a serum lactate

level>2 mmol/L despite adequate volume resuscitation.

     (b) On or before February 1, 2024, the director of the department of health shall develop

in coordination with the Antimicrobial Stewardship and Environmental Cleaning task force, and

make available to health care practitioners, information on best practices for the treatment of

patients with sepsis and septic shock. The best practices shall be based on generally accepted

standards of care, including, but not limited to:

     (1) An evidence based screening tool that can be used at initial evaluation of adult and

pediatric patients in the emergency department;

     (2) An evidence based treatment protocol for adult and pediatric patients that includes time-

specific treatment goals;

     (3) Nurse-driven testing protocols to enable nurses to initiate care for patients with

suspected sepsis;

     (4) Incorporation of sepsis screening and treatment tools into the electronic health record

where possible;

     (5) Mechanisms to prompt escalation of care within the facility, and, when appropriate, to

stabilize and transfer to a facility able to provide a higher level of care;

     (6) Strategies for appropriate hand-offs and communication regarding the care of patients

with sepsis and for the reassessments of patients at regular intervals;

     (7) Hospital specific antibiotic guidelines for use in treating patients with sepsis and a

mechanism for reevaluating a patient’s antibiotic treatment based on culture results that provides

reassessment and de-escalation of antibiotic treatment when appropriate; and

     (8) Staff education on sepsis policies and procedures during the onboarding process and at

least annually and when new practice guidelines are published or existing standards are updated to

ensure that care reflects current standards of practice.

     (c) In order to enhance patient safety and protection, each hospital and freestanding

emergency-care facility licensed in the state shall implement policies and procedures in accordance

with the best practices issued by the department of health.

     (d) Collection and reporting of sepsis measures. Each hospital and freestanding emergency-

care facility licensed in the state shall be responsible for the collection of data and the reporting of

that data to the department annually, or more frequently at the request of the department, and shall

be subject to audit at the discretion of the department. Regarding the collection of the data:

     (1) The medical staff shall be responsible for the collection, use, and reporting of quality

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

improvement and hospital reporting to the department. Such measures shall include, but not be

limited to, data sufficient to evaluate each hospital’s adherence rate to its own sepsis protocols,

including adherence to timeframes and implementation of all protocol components for adults and

children.

     (2) Hospitals shall submit data specified by the department to permit the department to

develop risk-adjusted sepsis mortality rates in consultation with appropriate national, hospital and

expert stakeholders.

     (e) Beginning on July 1, 2024, the department shall not issue or renew a license unless the

applicant is in compliance with 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 HEALTHCARE FACILITIES

***

     This act would require the director of the department of health by February 1, 2024, to

develop in coordination with the Antimicrobial Stewardship and Environmental Cleaning task

force, and make available to health care practitioners, information on best practices for the

treatment of patients with sepsis and septic shock. Each hospital and freestanding emergency-care

facility would implement procedures and policies in accordance with this section. Beginning July

1, 2024, the department of health would not issue or renew a licensee unless the license is in

compliance with this section.

     This act would take effect upon passage.

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