Florida Senate - 2022 CS for CS for SB 718 By the Committees on Rules; and Health Policy; and Senator Bradley 595-03646-22 2022718c2 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 authorizing registered nurses to delegate to certified 23 nursing assistants and home health aides the 24 administration of certain medications to patients in 25 county detention facilities under certain 26 circumstances; revising the list of medications that a 27 registered nurse may delegate the administration of to 28 a certified nursing assistant or home health aide; 29 amending ss. 401.25 and 401.27, F.S.; conforming 30 cross-references; providing an effective date. 31 32 Be It Enacted by the Legislature of the State of Florida: 33 34 Section 1.Section 400.488, Florida Statutes, is amended to 35 read: 36 400.488Assistance with self-administration of medication 37 and with other tasks. 38 (1)For purposes of this section, the term: 39 (a)Informed consent means advising the patient, or the 40 patients surrogate, guardian, or attorney in fact, that the 41 patient may be receiving assistance with self-administration of 42 medication or other tasks from an unlicensed person. 43 (b)Unlicensed person means an individual not currently 44 licensed to practice nursing or medicine who is employed by or 45 under contract to a home health agency and who has received 46 training with respect to assisting with the self-administration 47 of medication or other tasks as provided by agency rule. 48 (2)Patients who are capable of self-administering their 49 own medications and performing other tasks without assistance 50 shall be encouraged and allowed to do so. However, an unlicensed 51 person may, consistent with a dispensed prescriptions label or 52 the package directions of an over-the-counter medication, assist 53 a patient whose condition is medically stable with the self 54 administration of routine, regularly scheduled medications that 55 are intended to be self-administered. An unlicensed person may 56 also provide assistance with other tasks specified in subsection 57 (6). Assistance with self-administration of medication or such 58 other tasks self-medication by an unlicensed person may occur 59 only upon a documented request by, and the written informed 60 consent of, a patient or the patients surrogate, guardian, or 61 attorney in fact. For purposes of this section, self 62 administered medications include both legend and over-the 63 counter oral dosage forms, topical dosage forms, transdermal 64 patches, and topical ophthalmic, otic, and nasal dosage forms, 65 including solutions, suspensions, sprays, inhalers, and 66 nebulizer treatments. 67 (3)Assistance with self-administration of medication 68 includes: 69 (a)Taking the medication, in its previously dispensed, 70 properly labeled container, from where it is stored and bringing 71 it to the patient. For purposes of this paragraph, an insulin 72 syringe that is prefilled with the proper dosage by a pharmacist 73 and an insulin pen that is prefilled by the manufacturer are 74 considered medications in previously dispensed, properly labeled 75 containers. 76 (b)In the presence of the patient, confirming that the 77 medication is intended for that patient, orally advising the 78 patient of the medication name and purpose, opening the 79 container, removing a prescribed amount of medication from the 80 container, and closing the container. 81 (c)Placing an oral dosage in the patients hand or placing 82 the dosage in another container and helping the patient by 83 lifting the container to his or her mouth. 84 (d)Applying topical medications, including routine 85 preventive skin care and applying and replacing bandages for 86 minor cuts and abrasions as provided by the agency in rule. 87 (e)Returning the medication container to proper storage. 88 (f)For nebulizer treatments, assisting with setting up and 89 cleaning the device in the presence of the patient, confirming 90 that the medication is intended for that patient, orally 91 advising the patient of the medication name and purpose, opening 92 the container, removing the prescribed amount for a single 93 treatment dose from a properly labeled container, and assisting 94 the patient with placing the dose into the medicine receptacle 95 or mouthpiece. 96 (g)Keeping a record of when a patient receives assistance 97 with self-administration under this section. 98 (g)Assisting with the use of a nebulizer, including 99 removing the cap of a nebulizer, opening the unit dose of 100 nebulizer solutions, and pouring the prescribed premeasured dose 101 of medication into the dispensing cup of the nebulizer. 102 (4)Assistance with self-administration of medication does 103 not include: 104 (a)Mixing, compounding, converting, or calculating 105 medication doses, except for measuring a prescribed amount of 106 liquid medication or breaking a scored tablet or crushing a 107 tablet as prescribed. 108 (b)The preparation of syringes for injection or the 109 administration of medications by any injectable route. 110 (c)Administration of medications through intermittent 111 positive pressure breathing machines or a nebulizer. 112 (d)Administration of medications by way of a tube inserted 113 in a cavity of the body. 114 (d)(e)Administration of parenteral preparations. 115 (e)(f)The use of irrigations or debriding agents used in 116 the treatment of a skin condition. 117 (f)(g)Assisting with rectal, urethral, or vaginal 118 preparations. 119 (g)(h)Assisting with medications ordered by the physician 120 or health care professional with prescriptive authority to be 121 given as needed, unless the order is written with specific 122 parameters that preclude independent judgment on the part of the 123 unlicensed person, and at the request of a competent patient. 124 (h)(i)Assisting with medications for which the time of 125 administration, the amount, the strength of dosage, the method 126 of administration, or the reason for administration requires 127 judgment or discretion on the part of the unlicensed person. 128 (5)Assistance with the self-administration of medication 129 by an unlicensed person as described in this section does not 130 constitute administration as defined in s. 465.003. 131 (6)Assistance with other tasks includes: 132 (a)Assisting with the use of a glucometer to perform 133 blood-glucose level checks. 134 (b)Assisting with putting on and taking off antiembolism 135 stockings. 136 (c)Assisting with applying and removing an oxygen cannula 137 but not with titrating the prescribed oxygen settings. 138 (d)Assisting with the use of a continuous positive airway 139 pressure device but not with titrating the prescribed setting of 140 the device. 141 (e)Assisting with measuring vital signs. 142 (f)Assisting with colostomy bags. 143 (7)(6)The agency may by rule establish procedures and 144 interpret terms as necessary to administer this section. 145 Section 2.Section 401.252, Florida Statutes, is amended to 146 read: 147 401.252Interfacility transfer. 148 (1)When conducting an interfacility transfer, a permitted 149 advanced life support ambulance must be occupied by at least two 150 persons: one patient attendant who is a certified paramedic, a 151 registered nurse authorized under subsection (2), or a licensed 152 physician; and one person who is a certified emergency medical 153 technician, a certified paramedic, a licensed physician, or an 154 ambulance driver who meets the driver requirements of s. 155 401.281. The person occupying the ambulance who has the highest 156 medical certification in this state is in charge of patient care 157 during the interfacility transfer. 158 (2)A licensed basic or advanced life support ambulance 159 service may conduct interfacility transfers in a permitted 160 ambulance, using a registered nurse in place of an emergency 161 medical technician or paramedic, if: 162 (a)The registered nurse holds a current certificate of 163 successful course completion in advanced cardiac life support; 164 (b)The physician in charge has granted permission for such 165 a transfer, has designated the level of service required for 166 such transfer, and has deemed the patient to be in such a 167 condition appropriate to this type of ambulance staffing; and 168 (c)The registered nurse operates within the scope of part 169 I of chapter 464. 170 (3)(2)A licensed basic or advanced life support service 171 may conduct interfacility transfers in a permitted ambulance if 172 the patients treating physician certifies that the transfer is 173 medically appropriate and the physician provides reasonable 174 transfer orders. An interfacility transfer must be conducted in 175 a permitted ambulance if it is determined that the patient 176 needs, or is likely to need, medical attention during transport. 177 If the emergency medical technician or paramedic believes the 178 level of patient care required during the transfer is beyond his 179 or her capability, the medical director, or his or her designee, 180 must be contacted for clearance prior to conducting the 181 transfer. If necessary, the medical director, or his or her 182 designee, shall attempt to contact the treating physician for 183 consultation to determine the appropriateness of the transfer. 184 (4)(3)Infants younger less than 28 days old or infants 185 weighing less than 5 kilograms, who require critical care 186 interfacility transport to a neonatal intensive care unit must, 187 shall be transported in a permitted advanced life support or 188 basic life support transport ambulance, or in a permitted 189 advanced life support or basic life support ambulance that is 190 recognized by the department as meeting designated criteria for 191 neonatal interfacility critical care transport. 192 Section 3.Section 429.256, Florida Statutes, is amended to 193 read: 194 429.256Assistance with self-administration of medication 195 and with other tasks. 196 (1)For the purposes of this section, the term: 197 (a)Informed consent means advising the resident, or the 198 residents surrogate, guardian, or attorney in fact, that an 199 assisted living facility is not required to have a licensed 200 nurse on staff, that the resident may be receiving assistance 201 with self-administration of medication or other tasks from an 202 unlicensed person, and that such assistance, if provided by an 203 unlicensed person, will or will not be overseen by a licensed 204 nurse. 205 (b)Unlicensed person means an individual not currently 206 licensed to practice nursing or medicine who is employed by or 207 under contract to an assisted living facility and who has 208 received training with respect to assisting with the self 209 administration of medication or other tasks in an assisted 210 living facility as provided under s. 429.52 prior to providing 211 such assistance as described in this section. 212 (2)Residents who are capable of self-administering their 213 own medications and performing other tasks without assistance 214 shall be encouraged and allowed to do so. However, an unlicensed 215 person may, consistent with a dispensed prescriptions label or 216 the package directions of an over-the-counter medication, assist 217 a resident whose condition is medically stable with the self 218 administration of routine, regularly scheduled medications that 219 are intended to be self-administered. An unlicensed person may 220 also provide assistance with other tasks specified in subsection 221 (6). Assistance with self-administration of medication or such 222 other tasks self-medication by an unlicensed person may occur 223 only upon a documented request by, and the written informed 224 consent of, a resident or the residents surrogate, guardian, or 225 attorney in fact. For the purposes of this section, self 226 administered medications include both legend and over-the 227 counter oral dosage forms, topical dosage forms, transdermal 228 patches, and topical ophthalmic, otic, and nasal dosage forms 229 including solutions, suspensions, sprays, and inhalers. 230 (3)Assistance with self-administration of medication 231 includes: 232 (a)Taking the medication, in its previously dispensed, 233 properly labeled container, including an insulin syringe that is 234 prefilled with the proper dosage by a pharmacist and an insulin 235 pen that is prefilled by the manufacturer, from where it is 236 stored, and bringing it to the resident. For purposes of this 237 paragraph, an insulin syringe that is prefilled with the proper 238 dosage by a pharmacist and an insulin pen that is prefilled by 239 the manufacturer are considered medications in previously 240 dispensed, properly labeled containers. 241 (b)In the presence of the resident, confirming that the 242 medication is intended for that resident, orally advising the 243 resident of the medication name and dosage, opening the 244 container, removing a prescribed amount of medication from the 245 container, and closing the container. The resident may sign a 246 written waiver to opt out of being orally advised of the 247 medication name and dosage. The waiver must identify all of the 248 medications intended for the resident, including names and 249 dosages of such medications, and must immediately be updated 250 each time the residents medications or dosages change. 251 (c)Placing an oral dosage in the residents hand or 252 placing the dosage in another container and helping the resident 253 by lifting the container to his or her mouth. 254 (d)Applying topical medications. 255 (e)Returning the medication container to proper storage. 256 (f)Keeping a record of when a resident receives assistance 257 with self-administration under this section. 258 (g)Assisting with the use of a nebulizer, including 259 removing the cap of a nebulizer, opening the unit dose of 260 nebulizer solution, and pouring the prescribed premeasured dose 261 of medication into the dispensing cup of the nebulizer. 262 (h)Using a glucometer to perform blood-glucose level 263 checks. 264 (i)Assisting with putting on and taking off antiembolism 265 stockings. 266 (j)Assisting with applying and removing an oxygen cannula 267 but not with titrating the prescribed oxygen settings. 268 (k)Assisting with the use of a continuous positive airway 269 pressure device but not with titrating the prescribed setting of 270 the device. 271 (l)Assisting with measuring vital signs. 272 (m)Assisting with colostomy bags. 273 (4)Assistance with self-administration of medication does 274 not include: 275 (a)Mixing, compounding, converting, or calculating 276 medication doses, except for measuring a prescribed amount of 277 liquid medication or breaking a scored tablet or crushing a 278 tablet as prescribed. 279 (b)The preparation of syringes for injection or the 280 administration of medications by any injectable route. 281 (c)Administration of medications by way of a tube inserted 282 in a cavity of the body. 283 (d)Administration of parenteral preparations. 284 (e)The use of irrigations or debriding agents used in the 285 treatment of a skin condition. 286 (f)Assisting with rectal, urethral, or vaginal 287 preparations. 288 (g)Assisting with medications ordered by the physician or 289 health care professional with prescriptive authority to be given 290 as needed, unless the order is written with specific 291 parameters that preclude independent judgment on the part of the 292 unlicensed person, and the resident requesting the medication is 293 aware of his or her need for the medication and understands the 294 purpose for taking the medication. 295 (h)Assisting with medications for which the time of 296 administration, the amount, the strength of dosage, the method 297 of administration, or the reason for administration requires 298 judgment or discretion on the part of the unlicensed person. 299 (5)Assistance with the self-administration of medication 300 by an unlicensed person as described in this section shall not 301 be considered administration as defined in s. 465.003. 302 (6)Assistance with other tasks includes: 303 (a)Assisting with the use of a glucometer to perform 304 blood-glucose level checks. 305 (b)Assisting with putting on and taking off antiembolism 306 stockings. 307 (c)Assisting with applying and removing an oxygen cannula 308 but not with titrating the prescribed oxygen settings. 309 (d)Assisting with the use of a continuous positive airway 310 pressure device but not with titrating the prescribed setting of 311 the device. 312 (e)Assisting with measuring vital signs. 313 (f)Assisting with colostomy bags. 314 (7)(6)The agency may by rule establish facility procedures 315 and interpret terms as necessary to implement this section. 316 Section 4.Subsection (2) of section 464.0156, Florida 317 Statutes, is amended to read: 318 464.0156Delegation of duties. 319 (2)A registered nurse may delegate to a certified nursing 320 assistant or a home health aide the administration of oral, 321 transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 322 topical prescription medications to a patient of a home health 323 agency or in a local county detention facility as defined in s. 324 951.23(1), if the certified nursing assistant or home health 325 aide meets the requirements of s. 464.2035 or s. 400.489, 326 respectively. A registered nurse may not delegate the 327 administration of any controlled substance listed in Schedule 328 II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s. 329 812, except for the administration of an insulin syringe that is 330 prefilled with the proper dosage by a pharmacist or an insulin 331 pen that is prefilled by the manufacturer. 332 Section 5.Subsection (7) of section 401.25, Florida 333 Statutes, is amended to read: 334 401.25Licensure as a basic life support or an advanced 335 life support service. 336 (7)(a)Each permitted basic life support ambulance not 337 specifically exempted from this part, when transporting a person 338 who is sick, injured, wounded, incapacitated, or helpless, must 339 be occupied by at least two persons: one patient attendant who 340 is a certified emergency medical technician, certified 341 paramedic, or licensed physician; and one ambulance driver who 342 meets the requirements of s. 401.281. This paragraph does not 343 apply to interfacility transfers governed by s. 401.252 s. 344 401.252(1). 345 (b)Each permitted advanced life support ambulance not 346 specifically exempted from this part, when transporting a person 347 who is sick, injured, wounded, incapacitated, or helpless, must 348 be occupied by at least two persons: one who is a certified 349 paramedic or licensed physician; and one who is a certified 350 emergency medical technician, certified paramedic, or licensed 351 physician who also meets the requirements of s. 401.281 for 352 drivers. The person with the highest medical certifications 353 shall be in charge of patient care. This paragraph does not 354 apply to interfacility transfers governed by s. 401.252 s. 355 401.252(1). 356 Section 6.Subsection (1) of section 401.27, Florida 357 Statutes, is amended to read: 358 401.27Personnel; standards and certification. 359 (1)Each permitted ambulance not specifically exempted from 360 this part, when transporting a person who is sick, injured, 361 wounded, incapacitated, or helpless, must be occupied by at 362 least two persons, one of whom must be a certified emergency 363 medical technician, certified paramedic, or licensed physician 364 and one of whom must be a driver who meets the requirements for 365 ambulance drivers. This subsection does not apply to 366 interfacility transfers governed by s. 401.252 s. 401.252(1). 367 Section 7.This act shall take effect July 1, 2022.