Florida Senate - 2022 CS for SB 718 By the Committee on Health Policy; and Senator Bradley 588-02345-22 2022718c1 1 A bill to be entitled 2 An act relating to the provision of health care; 3 amending s. 400.488, F.S.; revising the definitions of 4 the terms informed consent and unlicensed person; 5 authorizing unlicensed persons to assist patients with 6 other specified tasks; revising provisions relating to 7 medications and devices with which unlicensed persons 8 may assist patients in self-administration under 9 certain circumstances; amending s. 401.252, F.S.; 10 specifying staffing requirements for advanced life 11 support ambulances during interfacility transfers; 12 providing that the person occupying the ambulance who 13 has the highest medical certification in this state is 14 in charge of patient care during the transfer; 15 amending s. 429.256, F.S.; revising the definitions of 16 the terms informed consent and unlicensed person; 17 authorizing unlicensed persons to assist patients with 18 other specified tasks; revising provisions relating to 19 medications and devices with which unlicensed persons 20 may assist patients in self-administration under 21 certain circumstances; amending s. 464.0156, F.S.; 22 revising the list of medications that a registered 23 nurse may delegate the administration of to a 24 certified nursing assistant or home health aide; 25 amending ss. 401.25 and 401.27, F.S.; conforming 26 cross-references; providing an effective date. 27 28 Be It Enacted by the Legislature of the State of Florida: 29 30 Section 1.Section 400.488, Florida Statutes, is amended to 31 read: 32 400.488Assistance with self-administration of medication 33 and with other tasks. 34 (1)For purposes of this section, the term: 35 (a)Informed consent means advising the patient, or the 36 patients surrogate, guardian, or attorney in fact, that the 37 patient may be receiving assistance with self-administration of 38 medication or other tasks from an unlicensed person. 39 (b)Unlicensed person means an individual not currently 40 licensed to practice nursing or medicine who is employed by or 41 under contract to a home health agency and who has received 42 training with respect to assisting with the self-administration 43 of medication or other tasks as provided by agency rule. 44 (2)Patients who are capable of self-administering their 45 own medications and performing other tasks without assistance 46 shall be encouraged and allowed to do so. However, an unlicensed 47 person may, consistent with a dispensed prescriptions label or 48 the package directions of an over-the-counter medication, assist 49 a patient whose condition is medically stable with the self 50 administration of routine, regularly scheduled medications that 51 are intended to be self-administered. An unlicensed person may 52 also provide assistance with other tasks specified in subsection 53 (6). Assistance with self-administration of medication or such 54 other tasks self-medication by an unlicensed person may occur 55 only upon a documented request by, and the written informed 56 consent of, a patient or the patients surrogate, guardian, or 57 attorney in fact. For purposes of this section, self 58 administered medications include both legend and over-the 59 counter oral dosage forms, topical dosage forms, transdermal 60 patches, and topical ophthalmic, otic, and nasal dosage forms, 61 including solutions, suspensions, sprays, inhalers, and 62 nebulizer treatments. 63 (3)Assistance with self-administration of medication 64 includes: 65 (a)Taking the medication, in its previously dispensed, 66 properly labeled container, from where it is stored and bringing 67 it to the patient. For purposes of this paragraph, an insulin 68 syringe that is prefilled with the proper dosage by a pharmacist 69 and an insulin pen that is prefilled by the manufacturer are 70 considered medications in previously dispensed, properly labeled 71 containers. 72 (b)In the presence of the patient, confirming that the 73 medication is intended for that patient, orally advising the 74 patient of the medication name and purpose, opening the 75 container, removing a prescribed amount of medication from the 76 container, and closing the container. 77 (c)Placing an oral dosage in the patients hand or placing 78 the dosage in another container and helping the patient by 79 lifting the container to his or her mouth. 80 (d)Applying topical medications, including routine 81 preventive skin care and applying and replacing bandages for 82 minor cuts and abrasions as provided by the agency in rule. 83 (e)Returning the medication container to proper storage. 84 (f)For nebulizer treatments, assisting with setting up and 85 cleaning the device in the presence of the patient, confirming 86 that the medication is intended for that patient, orally 87 advising the patient of the medication name and purpose, opening 88 the container, removing the prescribed amount for a single 89 treatment dose from a properly labeled container, and assisting 90 the patient with placing the dose into the medicine receptacle 91 or mouthpiece. 92 (g)Keeping a record of when a patient receives assistance 93 with self-administration under this section. 94 (g)Assisting with the use of a nebulizer, including 95 removing the cap of a nebulizer, opening the unit dose of 96 nebulizer solutions, and pouring the prescribed premeasured dose 97 of medication into the dispensing cup of the nebulizer. 98 (4)Assistance with self-administration of medication does 99 not include: 100 (a)Mixing, compounding, converting, or calculating 101 medication doses, except for measuring a prescribed amount of 102 liquid medication or breaking a scored tablet or crushing a 103 tablet as prescribed. 104 (b)The preparation of syringes for injection or the 105 administration of medications by any injectable route. 106 (c)Administration of medications through intermittent 107 positive pressure breathing machines or a nebulizer. 108 (d)Administration of medications by way of a tube inserted 109 in a cavity of the body. 110 (d)(e)Administration of parenteral preparations. 111 (e)(f)The use of irrigations or debriding agents used in 112 the treatment of a skin condition. 113 (f)(g)Assisting with rectal, urethral, or vaginal 114 preparations. 115 (g)(h)Assisting with medications ordered by the physician 116 or health care professional with prescriptive authority to be 117 given as needed, unless the order is written with specific 118 parameters that preclude independent judgment on the part of the 119 unlicensed person, and at the request of a competent patient. 120 (h)(i)Assisting with medications for which the time of 121 administration, the amount, the strength of dosage, the method 122 of administration, or the reason for administration requires 123 judgment or discretion on the part of the unlicensed person. 124 (5)Assistance with the self-administration of medication 125 by an unlicensed person as described in this section does not 126 constitute administration as defined in s. 465.003. 127 (6)Assistance with other tasks includes: 128 (a)Assisting with the use of a glucometer to perform 129 blood-glucose level checks. 130 (b)Assisting with putting on and taking off antiembolism 131 stockings. 132 (c)Assisting with applying and removing an oxygen cannula 133 but not with titrating the prescribed oxygen settings. 134 (d)Assisting with the use of a continuous positive airway 135 pressure device but not with titrating the prescribed setting of 136 the device. 137 (e)Assisting with measuring vital signs. 138 (f)Assisting with colostomy bags. 139 (7)(6)The agency may by rule establish procedures and 140 interpret terms as necessary to administer this section. 141 Section 2.Section 401.252, Florida Statutes, is amended to 142 read: 143 401.252Interfacility transfer. 144 (1)When conducting an interfacility transfer, a permitted 145 advanced life support ambulance must be occupied by at least two 146 persons: one patient attendant who is a certified paramedic, a 147 registered nurse authorized under subsection (2), or a licensed 148 physician; and one person who is a certified emergency medical 149 technician, a certified paramedic, a licensed physician, or an 150 ambulance driver who meets the driver requirements of s. 151 401.281. The person occupying the ambulance who has the highest 152 medical certification in this state is in charge of patient care 153 during the interfacility transfer. 154 (2)A licensed basic or advanced life support ambulance 155 service may conduct interfacility transfers in a permitted 156 ambulance, using a registered nurse in place of an emergency 157 medical technician or paramedic, if: 158 (a)The registered nurse holds a current certificate of 159 successful course completion in advanced cardiac life support; 160 (b)The physician in charge has granted permission for such 161 a transfer, has designated the level of service required for 162 such transfer, and has deemed the patient to be in such a 163 condition appropriate to this type of ambulance staffing; and 164 (c)The registered nurse operates within the scope of part 165 I of chapter 464. 166 (3)(2)A licensed basic or advanced life support service 167 may conduct interfacility transfers in a permitted ambulance if 168 the patients treating physician certifies that the transfer is 169 medically appropriate and the physician provides reasonable 170 transfer orders. An interfacility transfer must be conducted in 171 a permitted ambulance if it is determined that the patient 172 needs, or is likely to need, medical attention during transport. 173 If the emergency medical technician or paramedic believes the 174 level of patient care required during the transfer is beyond his 175 or her capability, the medical director, or his or her designee, 176 must be contacted for clearance prior to conducting the 177 transfer. If necessary, the medical director, or his or her 178 designee, shall attempt to contact the treating physician for 179 consultation to determine the appropriateness of the transfer. 180 (4)(3)Infants younger less than 28 days old or infants 181 weighing less than 5 kilograms, who require critical care 182 interfacility transport to a neonatal intensive care unit must, 183 shall be transported in a permitted advanced life support or 184 basic life support transport ambulance, or in a permitted 185 advanced life support or basic life support ambulance that is 186 recognized by the department as meeting designated criteria for 187 neonatal interfacility critical care transport. 188 Section 3.Section 429.256, Florida Statutes, is amended to 189 read: 190 429.256Assistance with self-administration of medication 191 and with other tasks. 192 (1)For the purposes of this section, the term: 193 (a)Informed consent means advising the resident, or the 194 residents surrogate, guardian, or attorney in fact, that an 195 assisted living facility is not required to have a licensed 196 nurse on staff, that the resident may be receiving assistance 197 with self-administration of medication or other tasks from an 198 unlicensed person, and that such assistance, if provided by an 199 unlicensed person, will or will not be overseen by a licensed 200 nurse. 201 (b)Unlicensed person means an individual not currently 202 licensed to practice nursing or medicine who is employed by or 203 under contract to an assisted living facility and who has 204 received training with respect to assisting with the self 205 administration of medication or other tasks in an assisted 206 living facility as provided under s. 429.52 prior to providing 207 such assistance as described in this section. 208 (2)Residents who are capable of self-administering their 209 own medications and performing other tasks without assistance 210 shall be encouraged and allowed to do so. However, an unlicensed 211 person may, consistent with a dispensed prescriptions label or 212 the package directions of an over-the-counter medication, assist 213 a resident whose condition is medically stable with the self 214 administration of routine, regularly scheduled medications that 215 are intended to be self-administered. An unlicensed person may 216 also provide assistance with other tasks specified in subsection 217 (6). Assistance with self-administration of medication or such 218 other tasks self-medication by an unlicensed person may occur 219 only upon a documented request by, and the written informed 220 consent of, a resident or the residents surrogate, guardian, or 221 attorney in fact. For the purposes of this section, self 222 administered medications include both legend and over-the 223 counter oral dosage forms, topical dosage forms, transdermal 224 patches, and topical ophthalmic, otic, and nasal dosage forms 225 including solutions, suspensions, sprays, and inhalers. 226 (3)Assistance with self-administration of medication 227 includes: 228 (a)Taking the medication, in its previously dispensed, 229 properly labeled container, including an insulin syringe that is 230 prefilled with the proper dosage by a pharmacist and an insulin 231 pen that is prefilled by the manufacturer, from where it is 232 stored, and bringing it to the resident. For purposes of this 233 paragraph, an insulin syringe that is prefilled with the proper 234 dosage by a pharmacist and an insulin pen that is prefilled by 235 the manufacturer are considered medications in previously 236 dispensed, properly labeled containers. 237 (b)In the presence of the resident, confirming that the 238 medication is intended for that resident, orally advising the 239 resident of the medication name and dosage, opening the 240 container, removing a prescribed amount of medication from the 241 container, and closing the container. The resident may sign a 242 written waiver to opt out of being orally advised of the 243 medication name and dosage. The waiver must identify all of the 244 medications intended for the resident, including names and 245 dosages of such medications, and must immediately be updated 246 each time the residents medications or dosages change. 247 (c)Placing an oral dosage in the residents hand or 248 placing the dosage in another container and helping the resident 249 by lifting the container to his or her mouth. 250 (d)Applying topical medications. 251 (e)Returning the medication container to proper storage. 252 (f)Keeping a record of when a resident receives assistance 253 with self-administration under this section. 254 (g)Assisting with the use of a nebulizer, including 255 removing the cap of a nebulizer, opening the unit dose of 256 nebulizer solution, and pouring the prescribed premeasured dose 257 of medication into the dispensing cup of the nebulizer. 258 (h)Using a glucometer to perform blood-glucose level 259 checks. 260 (i)Assisting with putting on and taking off antiembolism 261 stockings. 262 (j)Assisting with applying and removing an oxygen cannula 263 but not with titrating the prescribed oxygen settings. 264 (k)Assisting with the use of a continuous positive airway 265 pressure device but not with titrating the prescribed setting of 266 the device. 267 (l)Assisting with measuring vital signs. 268 (m)Assisting with colostomy bags. 269 (4)Assistance with self-administration of medication does 270 not include: 271 (a)Mixing, compounding, converting, or calculating 272 medication doses, except for measuring a prescribed amount of 273 liquid medication or breaking a scored tablet or crushing a 274 tablet as prescribed. 275 (b)The preparation of syringes for injection or the 276 administration of medications by any injectable route. 277 (c)Administration of medications by way of a tube inserted 278 in a cavity of the body. 279 (d)Administration of parenteral preparations. 280 (e)The use of irrigations or debriding agents used in the 281 treatment of a skin condition. 282 (f)Assisting with rectal, urethral, or vaginal 283 preparations. 284 (g)Assisting with medications ordered by the physician or 285 health care professional with prescriptive authority to be given 286 as needed, unless the order is written with specific 287 parameters that preclude independent judgment on the part of the 288 unlicensed person, and the resident requesting the medication is 289 aware of his or her need for the medication and understands the 290 purpose for taking the medication. 291 (h)Assisting with medications for which the time of 292 administration, the amount, the strength of dosage, the method 293 of administration, or the reason for administration requires 294 judgment or discretion on the part of the unlicensed person. 295 (5)Assistance with the self-administration of medication 296 by an unlicensed person as described in this section shall not 297 be considered administration as defined in s. 465.003. 298 (6)Assistance with other tasks includes: 299 (a)Assisting with the use of a glucometer to perform 300 blood-glucose level checks. 301 (b)Assisting with putting on and taking off antiembolism 302 stockings. 303 (c)Assisting with applying and removing an oxygen cannula 304 but not with titrating the prescribed oxygen settings. 305 (d)Assisting with the use of a continuous positive airway 306 pressure device but not with titrating the prescribed setting of 307 the device. 308 (e)Assisting with measuring vital signs. 309 (f)Assisting with colostomy bags. 310 (7)(6)The agency may by rule establish facility procedures 311 and interpret terms as necessary to implement this section. 312 Section 4.Subsection (2) of section 464.0156, Florida 313 Statutes, is amended to read: 314 464.0156Delegation of duties. 315 (2)A registered nurse may delegate to a certified nursing 316 assistant or a home health aide the administration of oral, 317 transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 318 topical prescription medications to a patient of a home health 319 agency, if the certified nursing assistant or home health aide 320 meets the requirements of s. 464.2035 or s. 400.489, 321 respectively. A registered nurse may not delegate the 322 administration of any controlled substance listed in Schedule 323 II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s. 324 812, except for the administration of an insulin syringe that is 325 prefilled with the proper dosage by a pharmacist or an insulin 326 pen that is prefilled by the manufacturer. 327 Section 5.Subsection (7) of section 401.25, Florida 328 Statutes, is amended to read: 329 401.25Licensure as a basic life support or an advanced 330 life support service. 331 (7)(a)Each permitted basic life support ambulance not 332 specifically exempted from this part, when transporting a person 333 who is sick, injured, wounded, incapacitated, or helpless, must 334 be occupied by at least two persons: one patient attendant who 335 is a certified emergency medical technician, certified 336 paramedic, or licensed physician; and one ambulance driver who 337 meets the requirements of s. 401.281. This paragraph does not 338 apply to interfacility transfers governed by s. 401.252 s. 339 401.252(1). 340 (b)Each permitted advanced life support ambulance not 341 specifically exempted from this part, when transporting a person 342 who is sick, injured, wounded, incapacitated, or helpless, must 343 be occupied by at least two persons: one who is a certified 344 paramedic or licensed physician; and one who is a certified 345 emergency medical technician, certified paramedic, or licensed 346 physician who also meets the requirements of s. 401.281 for 347 drivers. The person with the highest medical certifications 348 shall be in charge of patient care. This paragraph does not 349 apply to interfacility transfers governed by s. 401.252 s. 350 401.252(1). 351 Section 6.Subsection (1) of section 401.27, Florida 352 Statutes, is amended to read: 353 401.27Personnel; standards and certification. 354 (1)Each permitted ambulance not specifically exempted from 355 this part, when transporting a person who is sick, injured, 356 wounded, incapacitated, or helpless, must be occupied by at 357 least two persons, one of whom must be a certified emergency 358 medical technician, certified paramedic, or licensed physician 359 and one of whom must be a driver who meets the requirements for 360 ambulance drivers. This subsection does not apply to 361 interfacility transfers governed by s. 401.252 s. 401.252(1). 362 Section 7.This act shall take effect July 1, 2022.