Rhode Island § 23-17-66 - Licensing of Healthcare Facilities

§ 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.