Senate Bill #773 (2019)

AN ACT RELATING TO HEALTH AND SAFETY - SEPSIS PROTOCOLS

Requires hospitals to adopt, implement, periodically update and submit to the director of health, evidence-based protocols for the early recognition and treatment of patients with sepsis and septic shock.

View latest version | View original version
View status on official RI website

Subscribe to email updates


Changes since original draft

  • 2019 – S 0773
  • 2019 – S 0773 SUBSTITUTE A AS AMENDED
  • ========
  • LC002138
  • LC002138/SUB A
  • ========
  • S T A T E O F R H O D E I S L A N D
  • S T A T E O F R H O D E I S L A N D
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2019
  • ____________
  • A N A C T
  • ____________
  • A N A C T
  • RELATING TO HEALTH AND SAFETY - SEPSIS PROTOCOLS
  • Introduced By: Senators Pearson, Lynch Prata, and McCaffrey
  • Date Introduced: April 04, 2019
  • Referred To: Senate Health & Human Services
  • It is enacted by the General Assembly as follows:
  • SECTION 1. Chapter 23-17 of the General Laws entitled "Licensing of Health-Care Facilities" is hereby amended by adding thereto the following sections:
  • SECTION 1. Chapter 23-17 of the General Laws entitled "Licensing of Health-Care Facilities" is hereby amended by adding thereto the following section:
  • 23-17-65. Protocols for the early recognition and treatment of patients with severe sepsis/septic shock.
  • (a) The licensing agency, with the advice of the health services council, shall require that the following patient care practices are implemented, shall monitor the hospital's compliance with these patient care practices, and shall take corrective action as necessary to attain compliance.
  • (b) Hospitals shall have in place evidence-based protocols for the early recognition and treatment of patients with severe sepsis/septic shock that are based on generally accepted standards of care.
  • 23-17-65.1. Hospital medical staff accountability - sepsis protocols.
  • (a) The medical staff shall be organized and accountable to the licensing agency for the quality of medical care provided to all patients. The medical staff shall adopt, implement, periodically update and submit to the director evidence-based protocols for the early recognition and treatment of patients with sepsis, severe sepsis, and septic shock ("sepsis protocols") that are based on generally accepted standards of care. Sepsis protocols must include components specific to the identification, care and treatment of adults and of children, and must clearly identify where and when components will differ for adults and for children. These protocols must include the following components:
  • (1) A process for the screening and early recognition of patients with sepsis, severe sepsis and septic shock;
  • (2) A process to identify and document individuals appropriate for treatment through severe sepsis protocols, including explicit criteria defining those patients who should be excluded from the protocols, such as patients with certain clinical conditions or who have elected palliative care;
  • (3) Guidelines for hemodynamic support with explicit physiologic and biomarker treatment goals, methodology for invasive or non-invasive hemodynamic monitoring, and timeframe goals;
  • (4) For infants and children, guidelines for fluid resuscitation with explicit timeframes for vascular access and fluid delivery, consistent with current evidence-based guidelines for severe sepsis and septic shock with defined therapeutic goals for children;
  • (5) A procedure for identification of infectious source and delivery of early antibiotics with timeframe goals; and
  • (6) Criteria for use, where appropriate, of an invasive protocol, and for use of vasoactive agents.
  • (b) The medical staff shall ensure that professional staff with direct patient care responsibilities and, as appropriate, staff with indirect patient care responsibilities, including, but not limited to, laboratory and pharmacy staff, are periodically trained to implement sepsis protocols required pursuant to this section. Medical staff shall ensure updated training when the hospital initiates substantive changes to the protocols.
  • (c) Hospitals shall submit sepsis protocols required pursuant to this section to the director for review on or before July 1, 2019. Hospitals must implement these protocols no later than forty-five (45) days after receipt of a letter from the director indicating that the proposed protocols have been reviewed and determined to be consistent with the criteria established herein. Hospitals must update protocols based on newly emerging evidence-based standards. Protocols are to be resubmitted at the request of the director, not more frequently than once every two (2) years unless the director identifies a hospital specific performance concern.
  • (d) 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 director. The 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.
  • (e) Hospitals shall submit data specified by the director to permit the director to develop risk-adjusted sepsis mortality rates in consultation with appropriate national, hospital and expert stakeholders.
  • (f) Data shall be reported annually, or more frequently at the request of the director, and shall be subject to audit at the discretion of the director.
  • (g) Definitions. For the purposes of this section, the following terms shall have the following meanings:
  • (1) "Sepsis" means a proven or suspected infection accompanied by a systemic inflammatory response;
  • (2) "Septic shock" means severe sepsis with persistent hypotension or cardiovascular organ dysfunction despite adequate IV fluid resuscitation; and
  • (3) "Severe sepsis" means sepsis plus at least one sign of hypoperfusion or organ dysfunction.
  • SECTION 2. This act shall take effect upon passage.
  • (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, 2020, the director 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) Beginning on February 1, 2021, the department of health shall not issue or renew a license unless the applicant is in compliance with this section.
  • SECTION 2. This act shall take effect upon passage.
  • ========
  • LC002138
  • LC002138/SUB A
  • ========
  • EXPLANATION
  • BY THE LEGISLATIVE COUNCIL
  • OF
  • A N A C T
  • RELATING TO HEALTH AND SAFETY - SEPSIS PROTOCOLS
  • ***
  • This act would require hospital medical staff to adopt, implement, periodically update and submit to the director of health, evidence-based protocols for the early recognition and treatment of patients with sepsis, severe sepsis and septic shock ("sepsis protocols", that are based on generally accepted standards of care).
  • This act would take effect upon passage. ======== LC002138 ========
  • This act would require hospital medical staff to adopt, implement, periodically update and submit to the director of health, evidence-based protocols for the early recognition and treatment of patients with sepsis and septic shock ("sepsis protocols" that are based on generally accepted standards of care).
  • This act would take effect upon passage. ======== LC002138/SUB A ========

Votes

NOTE: Electronic voting records are unofficial and may not be accurate. For an official vote tally, check the House or Senate Journal from the day of the vote.

Floor vote for Approval of Amendment

June 13, 2019 at 5:32pm
Yeas: 38 / Nays: 0 / Not voting: 0 / Recused: 0
Legislator Vote
Sen. Algiere Y
Sen. Archambault Y
Sen. Bell Y
Sen. Cano Y
Sen. Ciccone Y
Sen. Conley Y
Sen. Coyne Y
Sen. Crowley Y
Sen. Cruz Y
Sen. DiPalma Y
Sen. Euer Y
Sen. Felag Y
Sen. Gallo Y
Sen. Goldin Y
Sen. Goodwin Y
Sen. Lawson Y
Sen. Lombardi Y
Sen. Lombardo Y
Sen. Lynch Prata Y
Sen. McCaffrey Y
Sen. McKenney Y
Sen. Metts Y
Sen. Miller Y
Sen. Morgan Y
Sen. Murray Y
Sen. Nesselbush Y
Sen. Paolino Y
Sen. Pearson Y
Sen. Picard Y
Sen. Quezada Y
Sen. Raptakis Y
Sen. Rogers Y
Sen. Ruggerio Y
Sen. Satchell Y
Sen. Seveney Y
Sen. Sheehan Y
Sen. Sosnowski Y
Sen. Valverde Y

Floor vote for Passage as Amended

June 13, 2019 at 5:33pm
Yeas: 38 / Nays: 0 / Not voting: 0 / Recused: 0
Legislator Vote
Sen. Algiere Y
Sen. Archambault Y
Sen. Bell Y
Sen. Cano Y
Sen. Ciccone Y
Sen. Conley Y
Sen. Coyne Y
Sen. Crowley Y
Sen. Cruz Y
Sen. DiPalma Y
Sen. Euer Y
Sen. Felag Y
Sen. Gallo Y
Sen. Goldin Y
Sen. Goodwin Y
Sen. Lawson Y
Sen. Lombardi Y
Sen. Lombardo Y
Sen. Lynch Prata Y
Sen. McCaffrey Y
Sen. McKenney Y
Sen. Metts Y
Sen. Miller Y
Sen. Morgan Y
Sen. Murray Y
Sen. Nesselbush Y
Sen. Paolino Y
Sen. Pearson Y
Sen. Picard Y
Sen. Quezada Y
Sen. Raptakis Y
Sen. Rogers Y
Sen. Ruggerio Y
Sen. Satchell Y
Sen. Seveney Y
Sen. Sheehan Y
Sen. Sosnowski Y
Sen. Valverde Y