Chapter
353
2006 -- S 2760 SUBSTITUTE A
Enacted 07/07/06
A N A
C T
RELATING TO HEALTH AND
SAFETY -- SAFE PATIENT HANDLING LEGISLATION
Introduced By: Senators
Sosnowski, Lanzi, Perry, Paiva-Weed, and Pichardo
Date Introduced: February
14, 2006
It is
enacted by the General Assembly as follows:
SECTION
1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is
hereby
amended
by adding thereto the following chapter:
CHAPTER 80
SAFE PATIENT HANDLING ACT OF 2006
23-80-1.
Short title. – (a) This chapter shall be known and may be cited as
the "Safe
Patient
Handling Act of 2006."
23-80-2.
Legislative findings. – (a) Patients are at greater risk of injury,
including skin
tears,
falls, and musculoskeletal injuries, when being lifted, transferred, or
repositioned manually.
(b)
Safe patient handling can reduce skin tears suffered by patients by threefold,
and can
significantly
reduce other injuries to patients as well.
(c)
Health care workers lead the nation in work-related musculoskeletal disorders.
Between
thirty-eight percent (38%) and fifty percent (50%) of nurses and other health
care
workers
will suffer a work-related back injury during their career. Forty-four percent
(44%) of
these
workers will be unable to return to their pre-injury position.
(d)
Research indicates that nurses lift an estimated 1.8 tons per shift.
Eighty-three percent
(83%)
of nurses work in spite of back pain, and sixty percent (60%) of nurses fear a
disabling
back
injury. Twelve percent (12%) to thirty-nine percent (39%) of nurses not yet
disabled are
considering
leaving nursing due to back pain and injuries.
(e)
Safe patient handling reduces injuries and costs. In nine (9) case studies
evaluating the
impact
of lifting equipment, injuries decreased sixty percent (60%) to ninety-five
percent (95%),
Workers'
Compensation costs dropped by ninety-five percent (95%), and absenteeism due to
lifting
and handling was reduced by ninety-eight percent (98%).
SECTION
2. Chapter 23-17 of the General Laws entitled "Licensing of Health Care
Facilities"
is hereby amended by adding thereto the following section:
23-17-59.
Safe patient handling. – (1) Definitions. - As used in this chapter:
(a)
"Safe patient handling" means the use of engineering controls,
transfer aids, or
assistive
devices whenever feasible and appropriate instead of manual lifting to perform
the acts
of
lifting, transferring, and/or repositioning health care patients and residents.
(b)
"Safe patient handling policy" means protocols established to
implement safe patient
handling.
(c)
"Health care facility" means a hospital or a nursing facility.
(d)
"Lift team" means health care facility employees specially trained to
perform patient
lifts,
transfers, and repositioning in accordance with safe patient handling policy.
(e)
"Musculoskeletal disorders" means conditions that involve the nerves,
tendons,
muscles,
and supporting structures of the body.
(2)
Licensure requirements. - Each licensed health care facility shall comply with
the
following
as a condition of licensure:
(a)
Each licensed health care facility shall establish a safe patient handling
committee,
which
shall be chaired by a professional nurse or other appropriate licensed health
care
professional.
A health care facility may utilize any appropriately configured committee to
perform
the responsibilities of this section. At least half of the members of the
committee shall be
hourly,
non-managerial employees who provide direct patient care.
(b)
By July 1, 2007, each licensed health care facility shall develop a written
safe patient
handling
program, with input from the safe patient handling committee, to prevent
musculoskeletal
disorders among health care workers and injuries to patients. As part of this
program,
each licensed health care facility shall:
(i)
By July 1, 2008, implement a safe patient handling policy for all shifts and
units of the
facility
that will achieve the maximum reasonable reduction of manual lifting,
transferring, and
repositioning
of all or most of a patient's weight, except in emergency, life-threatening, or
otherwise
exceptional circumstances;
(ii)
Conduct a patient handling hazard assessment. This assessment should consider
such
variables
as patient-handling tasks, types of nursing units, patient populations, and the
physical
environment
of patient care areas;
(iii)
Develop a process to identify the appropriate use of the safe patient handling
policy
based
on the patient's physical and mental condition, the patient's choice, and the
availability of
lifting
equipment or lift teams. The policy shall include a means to address
circumstances under
which
it would be medically contraindicated to use lifting or transfer aids or
assistive devices for
particular
patients;
(iv)
Designate and train a registered nurse or other appropriate licensed health
care
professional
to serve as an expert resource, and train all clinical staff on safe patient
handling
policies,
equipment, and devices before implementation, and at least annually or as
changes are
made
to the safe patient handling policies, equipment and/or devices being used;
(v)
Conduct an annual performance evaluation of the safe patient handling with the
results
of the evaluation reported to the safe patient handling committee or other
appropriately
designated
committee. The evaluation shall determine the extent to which implementation of
the
program
has resulted in a reduction in musculoskeletal disorder claims and days of lost
work
attributable
to musculoskeletal disorder caused by patient handling, and include
recommendations
to
increase the program's effectiveness; and
(vi)
Submit an annual report to the safe patient handling committee of the facility,
which
shall
be made available to the public upon request, on activities related to the
identification,
assessment,
development, and evaluation of strategies to control risk of injury to
patients, nurses
and
other health care workers associated with the lifting, transferring, repositioning,
or movement
of a
patient.
(c)
Nothing in this section precludes lift team members from performing other
duties as
assigned
during their shift.
(d)
An employee may, in accordance with established facility protocols, report to
the
committee,
as soon as possible, after being required to perform a patient handling
activity that
he/she
believes in good faith exposed the patient and/or employee to an unacceptable
risk of
injury.
Such employee reporting shall not be cause for discipline or be subject to
other adverse
consequences
by his/her employer. These reportable incidents shall be included in the
facility's
annual
performance evaluation.
SECTION
3. Section 23-15-4 of the General Laws in Chapter 23-15 entitled
"Determination
of Need for New Health Care Equipment and New Institutional Health
Services"
is
hereby amended to read as follows:
23-15-4.
Review and approval of new health care equipment and new institutional
health
services. -- (a) No health care
provider or health care facility shall develop or offer new
health
care equipment or new institutional health services in Rhode Island, the
magnitude of
which
exceeds the limits defined by this chapter, without prior review by the health
services
council
and approval by the state agency; except that review by the health services
council may
be
waived in the case of expeditious reviews conducted in accordance with section
23-15-5, and
except
that health maintenance organizations which fulfill criteria to be established
in rules and
regulations
promulgated by the state agency with the advice of the health services council
shall be
exempted
from the review and approval requirement established in this section upon
approval by
the state
agency of an application for exemption from the review and approval requirement
established
in this section which contain any information that the state agency may require
to
determine
if the health maintenance organization meets the criteria.
(b) No approval shall be made without an adequate demonstration of need by the
applicant
at the time and place and under the circumstances proposed, nor shall the
approval be
made
without a determination that a proposal for which need has been demonstrated is
also
affordable
by the people of the state.
(c) No approval of new institutional health services for the provision of
health services to
inpatients
shall be granted unless the written findings required in accordance with
section 23-15-
6(b)(6)
are made.
(d) Applications for determination of need shall be filed with the state agency
on a date
fixed by
the state agency together with plans and specifications and any other
appropriate data
and
information that the state agency shall require by regulation, and shall be
considered in
relation
to each other no less than once a year. A duplicate copy of each application
together with
all
supporting documentation shall be kept on file by the state agency as a public
record.
(e) The health services council shall consider, but shall not be limited to,
the following in
conducting
reviews and determining need:
(1) The relationship of the proposal to state health plans that may be
formulated by the
state
agency;
(2) The impact of approval or denial of the proposal on the future viability of
the
applicant
and of the providers of health services to a significant proportion of the
population
served
or proposed to be served by the applicant;
(3) The need that the population to be served by the proposed equipment or
services has
for the
equipment or services;
(4) The availability of alternative, less costly, or more effective methods of
providing
services
or equipment, including economies or improvements in service that could be
derived
from
feasible cooperative or shared services;
(5) The immediate and long term financial feasibility of the proposal, as well
as the
probable
impact of the proposal on the cost of, and charges for, health services of the applicant;
(6) The relationship of the services proposed to be provided to the existing
health care
system
of the state;
(7) The impact of the proposal on the quality of health care in the state and
in the
population
area to be served by the applicant;
(8) The availability of funds for capital and operating needs for the provision
of the
services
or equipment proposed to be offered;
(9) The cost of financing the proposal including the reasonableness of the
interest rate,
the period
of borrowing, and the equity of the applicant in the proposed new institutional
health
service
or new equipment;
(10) The relationship, including the organizational relationship of the
services or
equipment
proposed, to ancillary or support services;
(11) Special needs and circumstances of those entities which provide a
substantial
portion
of their services or resources, or both, to individuals not residing within the
state;
(12) Special needs of entities such as medical and other health professional
schools,
multidisciplinary
clinics, and specialty centers; also, the special needs for and availability of
osteopathic
facilities and services within the state;
(13) In the case of a construction project:
(i) The costs and methods of the proposed construction, and
(ii) The probable impact of the construction project reviewed on the costs of
providing
health
services by the person proposing the construction project; and
(iii)
The proposed availability and use of safe patient handling equipment in the new
or
renovated
space to be constructed.
(14)
Those appropriate considerations that may be established in rules and
regulations
promulgated
by the state agency with the advice of the health services council;
(15) The potential of the proposal to demonstrate or provide one or more
innovative
approaches
or methods for attaining a more cost effective and/or efficient health care
system;
(16) The relationship of the proposal to the need indicated in any requests for
proposals
issued
by the state agency;
(17) The input of the community to be served by the proposed equipment and
services
and the people
of the neighborhoods close to the health care facility who are impacted by the
proposal;
(18) The relationship of the proposal to any long-range capital improvement
plan of the
health
care facility applicant.
(f) In conducting its review, the health services council shall perform the
following:
(1) Within one hundred and fifteen (115) days after initiating its review,
which must be
commenced
no later than thirty-one (31) days after the filing of an application, the
health services
council
shall determine as to each proposal whether the applicant has demonstrated need
at the
time and
place and under the circumstances proposed, and in doing so may apply the
criteria and
standards
set forth in subsection (e) of this section; provided however, that a
determination of
need
shall not alone be sufficient to warrant a recommendation to the state agency
that a proposal
should
be approved. The director shall render his or her decision within five (5) days
of the
determination
of the health services council.
(2) Prior to the conclusion of its review in accordance with section
23-15-6(e), the health
services
council shall evaluate each proposal for which a determination of need has been
established
in relation to other proposals, comparing proposals with each other, whether
similar
or not,
establishing priorities among the proposals for which need has been determined,
and
taking
into consideration the criteria and standards relating to relative need and
affordability as
set forth
in subsection (e) of this section and section 23-15-6(f).
(3) At the conclusion of its review, the health services council shall make
recommendations
to the state agency relative to approval or denial of the new institutional
health
services
or new health care equipment proposed; provided that:
(i) The health services council shall recommend approval of only those
proposals found
to be
affordable in accordance with the provisions of section 23-15-6(f); and
(ii) If the state agency proposes to render a decision that is contrary to the
recommendation
of the health services council, the state agency must render its reasons for
doing
so in
writing.
(g) Approval of new institutional health services or new health care equipment by
the
state
agency shall be subject to conditions that may be prescribed by rules and
regulations
developed
by the state agency with the advice of the health services council, but those
conditions
must
relate to the considerations enumerated in subsection (e) and to considerations
that may be
established
in regulations in accordance with subsection (e)(14).
(h) The offering or developing of new institutional health services or health
care
equipment
by a health care facility without prior review by the health services council
and
approval
by the state agency shall be grounds for the imposition of licensure sanctions
on the
facility,
including denial, suspension, revocation, or curtailment or for imposition of
any
monetary
fines that may be statutorily permitted by virtue of individual health care
facility
licensing
statutes.
(i) No government agency and no hospital or medical service corporation
organized
under
the laws of the state shall reimburse any health care facility or health care
provider for the
costs
associated with offering or developing new institutional health services or new
health care
equipment
unless the health care facility or health care provider has received the
approval of the
state
agency in accordance with this chapter. Government agencies and hospital and
medical
service
corporations organized under the laws of the state shall, during budget
negotiations, hold
health
care facilities and health care providers accountable to operating efficiencies
claimed or
projected
in proposals which receive the approval of the state agency in accordance with
this
chapter.
(j) In addition, the state agency shall not make grants to, enter into
contracts with, or
recommend
approval of the use of federal or state funds by any health care facility or
health care
provider
which proceeds with the offering or developing of new institutional health
services or
new
health care equipment after disapproval by the state agency.
SECTION
4. This act shall take effect on January 1, 2007.
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LC01138/SUB A/2
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