Chapter 335
2023 -- H 5869 SUBSTITUTE A
Enacted 06/24/2023

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

It is enacted by the General Assembly as follows:
     SECTION 1. Chapter 23-17 of the General Laws entitled "Licensing of Healthcare
Facilities" is hereby amended by adding thereto the following section:
     23-17-66. Protocols for the early recognition and treatment of patients with
sepsis/severe sepsis/septic shock.
     (a) For purposes of this section, the following words and terms shall have the following
meanings:
     (1) "Sepsis" means a known or suspected infection with at least two (2) or more system
inflammatory response syndrome (SIRS) criteria as developed by American College of Chest
Physicians/Society of Critical Care Medicine (1991).
     (2) "Severe sepsis" means a known or suspected infection with at least two (2) or more
SIRS criteria and sepsis-related tissue hypoperfusion or organ dysfunction.
     (3) "Septic shock" means sepsis-induced hypotension persisting despite adequate
intravenous (IV) fluid resuscitation and/or evidence of tissue hypoperfusion.
     (b) On or before February 1, 2024, to the extent allowable by available state and federal
funding, the director of the department of health shall in coordination with the department of
health's Antimicrobial Stewardship and Environmental Cleaning task force, make available to
hospitals, urgent care facilities, freestanding emergency rooms, pediatric practices, and EMS
agencies, 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 these settings;
     (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 these settings, 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 licensed in the state shall
establish a multi-disciplinary committee to implement policies, procedures, and staff education in
accordance with the best practices issued by the department of health.
     (1) The multi-disciplinary committee at each hospital 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. Such 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.
     (d) Contingent upon the availability of funding, the department of health shall offer
continuing education credits and other educational opportunities such as provider briefings for
pediatricians and EMS agencies on the early recognition and treatment of patients with sepsis.
     SECTION 2. This act shall take effect upon passage.
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LC002395/SUB A/2
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