2023 -- H 5869

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LC002395

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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:

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

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

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

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severe/septic shock.

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

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meanings:

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

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response to infection.

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

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level>2 mmol/L despite adequate volume resuscitation.

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

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

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

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

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standards of care, including, but not limited to:

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

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pediatric patients in the emergency department;

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

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specific treatment goals;

 

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

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suspected sepsis;

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

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where possible;

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

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

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

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

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

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

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

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

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

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ensure that care reflects current standards of practice.

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

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

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with the best practices issued by the department of health.

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

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

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

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

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

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

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

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

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

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children.

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

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

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expert stakeholders.

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

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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

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

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develop in coordination with the Antimicrobial Stewardship and Environmental Cleaning task

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

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

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

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

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compliance with this section.

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     This act would take effect upon passage.

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