HF 2510 (LSB 5670YH (1) 89)

HOUSE FILE 2510

BY  JAMES

A BILL FOR

An Act relating to hospital practices including those involving sepsis protocols and the rights of a parent of a minor patient. 
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  SHORT TITLE.  This Act shall be known as “Adam’s Law”.
    Sec. 2.  NEW SECTION.  135B.36  Sepsis protocols.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Sepsis” means a proven or suspected infection accompanied by a systemic inflammatory response. 
   b.  “Septic shock” means severe sepsis with persistent hypotension or cardiovascular organ dysfunction despite adequate intravenous fluid resuscitation.
   c.  “Severe sepsis” means sepsis with the addition of at least one sign of hypoperfusion or organ dysfunction. 
   2.  A hospital shall adopt, implement, and periodically update, in accordance with this section, evidence-based protocols for the early recognition and treatment of patients with sepsis, severe sepsis, and septic shock that are based on generally accepted standards of care. Sepsis protocols shall include components specific to the identification, care, and treatment of adults and of children, and shall clearly differentiate the components applicable to adults and children. The sepsis protocols shall include all of the following components:
   a.  A process for the screening and early recognition of patients with sepsis, severe sepsis, and septic shock.
   b.  A process to identify and document patients appropriate for treatment through severe sepsis protocols, including explicit criteria defining those patients who should be excluded from the protocols, such as patients with certain clinical conditions or patients who have elected palliative care.
   c.  Guidelines for hemodynamic support with explicit physiologic and biomarker treatment goals, methodology for invasive or noninvasive hemodynamic monitoring, and time frame goals.
   d.  For infants and children, guidelines for fluid resuscitation with explicit time frames for vascular access and fluid delivery consistent with current, evidence-based guidelines for severe sepsis and septic shock with defined therapeutic goals for children.
   e.  A procedure for identification of the source of infection and delivery of early antibiotics with time frame goals.
   f.  Criteria for use, when appropriate, of an invasive protocol and for use of vasoactive agents. 
   3.  A hospital shall ensure that professional staff with direct patient care responsibilities and, as appropriate, staff with indirect patient care responsibilities, including but not limited to laboratory and pharmacy staff, are periodically trained to implement the sepsis protocols specified in this section. The hospital shall ensure that sepsis training is updated following the initiation of substantive changes to the protocols.
   4.  A hospital shall update sepsis protocols specified under this section based on newly emerging evidence-based standards. 
   5.  Following initial approval, sepsis protocols required under this section shall be submitted to the department at the request of the department not more frequently than every two years, unless the department requires submission more frequently based on hospital-specific performance concerns identified by the department.
   6.  A hospital shall collect, use, and report quality measurement data related to the recognition and treatment of severe sepsis for purposes of internal quality improvement and data reporting as required by the department. Quality measurement data shall include but is not limited to data sufficient to evaluate each hospital’s adherence rate to the hospital’s own sepsis protocols, including adherence to time frames and implementation of all protocol components for adults and children.
   a.  Hospitals shall submit the required quality measurement data to enable the department to develop risk-adjusted sepsis mortality rates in consultation with appropriate national, hospital, and expert stakeholders. 
   b.  Hospitals shall submit quality measurement data to the department as specified by the department on an annual basis, or more frequently at the request of the department, and such data shall be subject to audit at the discretion of the department.
    Sec. 3.  NEW SECTION.  135B.37  Bill of rights for parent of a minor patient.
   1.  For the purposes of this section:
   a.  “Critical value results” means the results of laboratory or other diagnostic tests that suggest a life-threatening or otherwise significant condition requiring immediate medical attention.
   b.  “Minor patient” means an individual receiving hospital emergency department or inpatient care who is a minor as described in section 599.1.
   c.  “Parent” means a parent, guardian, or other person with legal authority to make health care decisions on behalf of a minor patient. 
   2.  A hospital shall post in a conspicuous place and provide a minor patient’s parent with a written copy of the information specified in this section. The information shall be known as the “parent’s bill of rights for a minor patient” and shall advise that, at a minimum, and subject to laws and regulations governing privacy and confidentiality, in connection with every hospital admission or emergency room visit of a minor patient, all of the following shall apply:
   a.  The hospital must ask each minor patient or the minor patient’s parent, as appropriate, for the name of the minor patient’s primary care provider, if known, and shall document such information in the minor patient’s medical record.
   b.  The hospital shall admit minor patients only to the extent consistent with the hospital’s ability to provide qualified staff, space, and the size-appropriate equipment necessary for the unique needs of minor patients.
   c.  To the extent possible given a minor patient’s health and safety, the hospital shall allow at least one parent to remain with the minor patient at all times.
   d.  The results of all tests completed during a minor patient’s hospital admission or emergency room visit shall be reviewed by a physician, physician assistant, or nurse practitioner who is familiar with the minor patient’s presenting condition.
   e.  A minor patient shall not be discharged from the hospital or the emergency room until the results of any tests that could reasonably be expected to yield critical value results are reviewed by a physician, physician assistant, or nurse practitioner and are communicated to the minor patient and the minor patient’s parent, as appropriate.
   f.  A minor patient shall not be discharged from the hospital or the emergency room until the minor patient’s discharge plan is provided in writing and verbally communicated to the minor patient and the minor patient’s parent, as appropriate. The discharge plan shall identify critical value results of tests ordered during the minor patient’s hospital admission or emergency room visit and shall specify any other tests that have not yet been concluded.
   g.  The communication of critical value results and the discussion of the discharge plan shall be accomplished in a manner that reasonably assures that a minor patient and the minor patient’s parent, as appropriate, understand the health information provided in order to make appropriate health decisions.
   h.  A hospital shall provide all laboratory results to a minor patient’s primary care provider, if known.
   i.  A minor patient and the minor patient’s parent, as appropriate, may request information about the diagnosis, possible diagnoses that were considered during the episode of care, and complications that could develop, as well as information about any contact made with the minor patient’s primary care provider.
   j.  Upon discharge from the hospital or emergency room, a hospital shall provide a minor patient and the minor patient’s parent, as appropriate, with a telephone number that the minor patient and the minor patient’s parent may call for advice if complications or questions arise.
    Sec. 4.  INITIAL SEPSIS PROTOCOLS —— SUBMISSION TO DEPARTMENT AND IMPLEMENTATION.  A hospital subject to section 135B.36, as enacted in this Act, shall submit initial sepsis protocols to the department of inspections and appeals for review and approval by October 1, 2022. Within forty-five days of receipt of approval of the protocols from the department, a hospital shall implement the sepsis protocols consistent with section 135B.36, as enacted in this Act.
    Sec. 5.  CODE EDITOR DIRECTIVE.
   1.  The Code editor shall designate section 135B.36, as enacted in this Act, as a new subchapter within chapter 135B, entitled “Sepsis Protocols”.
   2.  The Code editor shall designate section 135B.37, as enacted in this Act, as a new subchapter within chapter 135B, entitled “Parent’s Bill of Rights for a Minor Patient”.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to protocols required of hospitals relating to sepsis and minor patients.
   The bill provides that the short title of the bill is “Adam’s Law”.
   The bill requires hospitals to adopt, implement, periodically update, and submit to the department of inspections and appeals (DIA) for review and approval, evidence-based protocols for the early recognition and treatment of patients with sepsis, severe sepsis, and septic shock, which protocols are based on generally accepted standards of care. The protocols shall include components, specified in the bill, that are specific to the identification, care, and treatment of adults and of children, and shall clearly identify the differences in the components applicable to adults and children. The bill requires hospitals to ensure that professional staff with direct patient care responsibilities and, as appropriate, staff with indirect patient care responsibilities are periodically trained to implement the sepsis protocols and to update the training following substantive changes to the protocols. The bill requires hospitals to submit the required sepsis protocols to DIA at the request of the department not more frequently than every two years, following initial approval, unless DIA requires submission more frequently based on hospital-specific performance concerns identified by DIA. The bill requires hospitals to collect, use, and report quality measurement data related to the recognition and treatment of severe sepsis for purposes of internal quality improvement and data reporting to DIA. The data submitted to DIA are for the purposes of development by DIA of risk-adjusted sepsis mortality rates in consultation with appropriate national, hospital, and expert stakeholders. Hospitals are required to submit the data to DIA as specified by DIA, annually, or more frequently at the request of the department. The data are subject to audit at the discretion of DIA.
   The bill requires hospitals to submit initial sepsis protocols to DIA for review and approval by October 1, 2022, and requires hospitals to implement the protocols within 45 days of receipt of approval of the protocols from DIA. 
   The bill also requires hospitals to provide parents of minor patients with a written copy of information specified in the bill as the “parent’s bill of rights for a minor patient”. The information provided is to advise that, subject to laws and regulations governing privacy and confidentiality, in connection with every hospital admission or emergency room visit of a minor patient, a hospital must comply with certain requirements. The requirements include that the hospital must ask each minor patient or the minor patient’s parent, as appropriate, for the name of the minor patient’s primary care provider, if known, and shall document such information in the minor patient’s medical record; the hospital shall admit minor patients only to the extent consistent with the hospital’s ability to meet the unique needs of minor patients; to the extent possible given a minor patient’s health and safety, the hospital shall allow at least one parent to remain with the minor patient at all times; the results of all tests completed during a minor patient’s admission or visit shall be reviewed by a physician, physician assistant, or nurse practitioner who is familiar with the minor patient’s presenting condition; a minor patient shall not be discharged until the results of any tests that could reasonably be expected to yield critical value results are reviewed by a physician, physician assistant, or nurse practitioner and are communicated to the minor patient and the minor patient’s parent, as appropriate; a minor patient shall not be discharged until the minor patient’s discharge plan is provided in writing and verbally communicated to the minor patient and the minor patient’s parent, as appropriate; the communication of critical value results and the discussion of the discharge plan shall be accomplished in a manner that reasonably assures that a minor patient and the minor patient’s parent, as appropriate, understand the health information provided in order to make appropriate health decisions; a hospital shall provide all laboratory results to a minor patient’s primary care provider, if known; a minor patient and the minor patient’s parent, as appropriate, may request information about the diagnosis, possible diagnoses that were considered during the episode of care, and complications that could develop, as well as information about any contact made with a minor patient’s primary care provider; and upon discharge, a hospital shall provide a minor patient and the minor patient’s parent, as appropriate, with a telephone number that the minor patient and the minor patient’s parent may call for advice if complications or questions arise. The bill defines “minor patient” as an individual receiving hospital emergency department or inpatient care who has not reached majority as specified in Code section 599.1 and “parent” as a parent, guardian, or other person with legal authority to make health care decisions on behalf of a minor patient.