2023 -- H 5869 SUBSTITUTE A

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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

sepsis/severe sepsis/septic shock.

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

meanings:

     (1) "Sepsis" means a known or suspected infection with at least two (2) or more system

inflammatory response syndrome (SIRS) criteria as developed by American College of Chest

Physicians/Society of Critical Care Medicine (1991).

     (2) "Severe sepsis" means a known or suspected infection with at least two (2) or more

SIRS criteria and sepsis-related tissue hypoperfusion or organ dysfunction.

     (3) "Septic shock" means sepsis-induced hypotension persisting despite adequate

intravenous (IV) fluid resuscitation and/or evidence of tissue hypoperfusion.

     (b) On or before February 1, 2024, to the extent allowable by available state and federal

funding, the director of the department of health shall in coordination with the department of

health's Antimicrobial Stewardship and Environmental Cleaning task force, make available to

hospitals, urgent care facilities, freestanding emergency rooms, pediatric practices and EMS

agencies, 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 these settings;

     (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 these settings, 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 licensed in the state shall

establish a multi-disciplinary committee to implement policies, procedures and staff education in

accordance with the best practices issued by the department of health.

     (1) The multi-disciplinary committee at each hospital 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. 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.

     (d) Contingent upon the availability of funding, the department of health shall offer

continuing education credits and other educational opportunities such as provider briefings for

pediatricians and EMS agencies on the early recognition and treatment of patients with sepsis.

     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.

     This act would take effect upon passage.

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