2023 -- H 5869
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S TATE OF RHODE IS LAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2023
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A N A C T
RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTHCARE FACILITIES
Introduced By: Representatives DeSimone, Shekarchi, Slater, Hull, Kazarian, Cardillo,
and Biah
Date Introduced: March 01, 2023
Referred To: House Health & Human Services
It is enacted by the General Assembly as follows:
SECTION 1. Chapter 23-17 of the General Laws entitled "Licensing of Healthcare 1
Facilities" is hereby amended by adding thereto the following section: 2
23-17-66. Protocols for the early recognition and treatment of patients with 3
severe/septic shock. 4
(a) For purposes of this section, the following words and terms shall have the following 5
meanings: 6
(1) "Sepsis" means a life-threatening organ dysfunction caused by a dysregulated host 7
response to infection. 8
(2) "Septic shock" means sepsis with persisting hypotension and having a serum lactate 9
level>2 mmol/L despite adequate volume resuscitation. 10
(b) On or before February 1, 2024, the director of the department of health shall develop 11
in coordination with the Antimicrobial Stewardship and Environmental Cleaning task force, and 12
make available to health care practitioners, information on best practices for the treatment of 13
patients with sepsis and septic shock. The best practices shall be based on generally accepted 14
standards of care, including, but not limited to: 15
(1) An evidence based screening tool that can be used at initial evaluation of adult and 16
pediatric patients in the emergency department; 17
(2) An evidence based treatment protocol for adult and pediatric patients that includes time-18
specific treatment goals; 19
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(3) Nurse-driven testing protocols to enable nurses to initiate care for patients with 1
suspected sepsis; 2
(4) Incorporation of sepsis screening and treatment tools into the electronic health record 3
where possible; 4
(5) Mechanisms to prompt escalation of care within the facility, and, when appropriate, to 5
stabilize and transfer to a facility able to provide a higher level of care; 6
(6) Strategies for appropriate hand-offs and communication regarding the care of patients 7
with sepsis and for the reassessments of patients at regular intervals; 8
(7) Hospital specific antibiotic guidelines for use in treating patients with sepsis and a 9
mechanism for reevaluating a patient’s antibiotic treatment based on culture results that provides 10
reassessment and de-escalation of antibiotic treatment when appropriate; and 11
(8) Staff education on sepsis policies and procedures during the onboarding process and at 12
least annually and when new practice guidelines are published or existing standards are updated to 13
ensure that care reflects current standards of practice. 14
(c) In order to enhance patient safety and protection, each hospital and freestanding 15
emergency-care facility licensed in the state shall implement policies and procedures in accordance 16
with the best practices issued by the department of health. 17
(d) Collection and reporting of sepsis measures. Each hospital and freestanding emergency-18
care facility licensed in the state shall be responsible for the collection of data and the reporting of 19
that data to the department annually, or more frequently at the request of the department, and shall 20
be subject to audit at the discretion of the department. Regarding the collection of the data: 21
(1) The medical staff shall be responsible for the collection, use, and reporting of quality 22
measures related to the recognition and treatment of severe sepsis for purposes of internal quality 23
improvement and hospital reporting to the department. Such measures shall include, but not be 24
limited to, data sufficient to evaluate each hospital’s adherence rate to its own sepsis protocols, 25
including adherence to timeframes and implementation of all protocol components for adults and 26
children. 27
(2) Hospitals shall submit data specified by the department to permit the department to 28
develop risk-adjusted sepsis mortality rates in consultation with appropriate national, hospital and 29
expert stakeholders. 30
(e) Beginning on July 1, 2024, the department shall not issue or renew a license unless the 31
applicant is in compliance with this section. 32
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SECTION 2. This act shall take effect upon passage. 1
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EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTHCARE FACILITIES
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This act would require the director of the department of health by February 1, 2024, to 1
develop in coordination with the Antimicrobial Stewardship and Environmental Cleaning task 2
force, and make available to health care practitioners, information on best practices for the 3
treatment of patients with sepsis and septic shock. Each hospital and freestanding emergency-care 4
facility would implement procedures and policies in accordance with this section. Beginning July 5
1, 2024, the department of health would not issue or renew a licensee unless the license is in 6
compliance with this section. 7
This act would take effect upon passage. 8
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