STATE OF NEW YORK ________________________________________________________________________ 6030--A 2023-2024 Regular Sessions IN ASSEMBLY March 30, 2023 ___________ Introduced by M. of A. PAULIN -- read once and referred to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law and the education law, in relation to standing orders for patient care in hospitals The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The public health law is amended by adding a new section 2 2803-v-1 to read as follows: 3 § 2803-v-1. Standing orders for patient care in a hospital. 1. A 4 hospital may establish standing orders for the care of patients, which 5 may authorize an attending nurse to provide services and care to a 6 patient. Notwithstanding this section, section twenty-eight hundred 7 three-v of this article, as added by chapter 366 of the laws of 2018, 8 shall apply in the case of standing orders for the care of newborns in 9 the hospital. 10 2. As used in this section, unless the context clearly requires other- 11 wise: 12 (a) "Hospital" means a hospital that routinely provides patient care. 13 (b) "Attending practitioner" means the physician, surgeon, nurse prac- 14 titioner, or physician assistant acting within his or her lawful scope 15 and terms of practice, attending a patient in a hospital. 16 (c) "Attending nurse" means a registered nurse attending to a patient, 17 acting within his or her lawful scope of practice. 18 (d) "Standing order" means a non-patient specific order for the care 19 of a patient in a hospital, established under this section. 20 3. Notwithstanding any other provision of law, a registered nurse may 21 administer the following procedures upon an order by a licensed physi- 22 cian or surgeon or an order by a nurse practitioner or physician assist- 23 ant: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10534-02-3
A. 6030--A 2 1 (a) Electrocardiograms for patients that meet Acute Cardiac Syndrome 2 criteria as defined by American Heart Association guidelines. 3 (b) Point-of-care glucose screenings for patients with suspected hypo- 4 glycemia as defined in authoritative neurology criteria for evaluation 5 of acute mental status changes. 6 (c) Sepsis lab panels and intravenous access for patients that meet 7 severe sepsis and septic shock criteria as defined in the department's 8 sepsis regulations. 9 (d) Pregnancy tests for patients with childbearing capacity prior to 10 undergoing select imaging studies, operative procedures, and/or adminis- 11 tration of anesthetic agents. 12 4. A standing order may be implemented in the case of any patient when 13 (a) directed by the attending practitioner, or (b) in the absence of a 14 specific direction by the attending practitioner, the attending nurse 15 determines, in his or her professional judgment, that implementing the 16 standing order for the patient is clinically appropriate and consistent 17 with the standing order, the hospital's policies and applicable regu- 18 lations. The standing order shall not be implemented in a specific situ- 19 ation where the hospital's policies, the standing order, or applicable 20 regulations provide otherwise. 21 5. (a) A standing order shall provide for the circumstances in which 22 the condition or change in condition of the patients requires a depar- 23 ture from the terms of the standing order. 24 (b) When an attending nurse implementing a standing order becomes 25 aware of circumstances that, in his or her professional judgment, 26 reasonably indicate a need to depart from the terms of the standing 27 order, he or she shall so advise the attending practitioner. In such 28 circumstances, if the attending nurse determines, in his or her profes- 29 sional judgment, that the health of the patient requires departing from 30 the standing order prior to receiving direction from the attending prac- 31 titioner, the attending nurse may do so, consistent with his or her 32 lawful scope of practice, the hospital's policies and applicable regu- 33 lations. 34 (c) The standing order shall provide, including the times and manner, 35 that an attending practitioner shall review and acknowledge in writing 36 the services and care provided to the patient under the standing order 37 and the condition of the patient. 38 6. (a) A standing order may provide for circumstances in which it 39 shall not be implemented, or implemented only at the order of an attend- 40 ing practitioner. 41 (b) A standing order shall be dated, timed, and authenticated promptly 42 in the patient's medical record by the attending practitioner acting in 43 accordance with law, including scope-of-practice laws, hospital poli- 44 cies, and medical staff bylaws, rules and regulations. 45 7. A standing order may be implemented only if the implementing hospi- 46 tal: 47 (a) establishes that the order has been reviewed and approved by the 48 hospital's medical staff and nursing and pharmacy leadership, and signed 49 by a physician affiliated with the hospital; 50 (b) demonstrates that the order is consistent with nationally recog- 51 nized evidence-based guidelines; and 52 (c) ensures that the periodic and regular review of the order is 53 conducted by the hospital's medical staff and nursing and pharmacy lead- 54 ership to determine the continuing usefulness and safety of the order. 55 8. A standing order is a medical regimen; it shall be consistent with 56 the lawful scope of practice of a registered nurse.
A. 6030--A 3 1 9. The commissioner may make regulations governing the terms, proce- 2 dures and implementation of standing orders. 3 § 2. Section 6909 of the education law is amended by adding a new 4 subdivision 11 to read as follows: 5 11. A registered nurse may execute a standing order for patient care 6 in a hospital established under section twenty-eight hundred three-v-1 7 of the public health law, as provided in that section. The commissioner 8 may make regulations relating to implementation of this subdivision. 9 § 3. This act shall take effect immediately.