Florida Senate - 2022                              CS for SB 718
       
       
        
       By the Committee on Health Policy; and Senator Bradley
       
       
       
       
       
       588-02345-22                                           2022718c1
    1                        A bill to be entitled                      
    2         An act relating to the provision of health care;
    3         amending s. 400.488, F.S.; revising the definitions of
    4         the terms “informed consent” and “unlicensed person”;
    5         authorizing unlicensed persons to assist patients with
    6         other specified tasks; revising provisions relating to
    7         medications and devices with which unlicensed persons
    8         may assist patients in self-administration under
    9         certain circumstances; amending s. 401.252, F.S.;
   10         specifying staffing requirements for advanced life
   11         support ambulances during interfacility transfers;
   12         providing that the person occupying the ambulance who
   13         has the highest medical certification in this state is
   14         in charge of patient care during the transfer;
   15         amending s. 429.256, F.S.; revising the definitions of
   16         the terms “informed consent” and “unlicensed person”;
   17         authorizing unlicensed persons to assist patients with
   18         other specified tasks; revising provisions relating to
   19         medications and devices with which unlicensed persons
   20         may assist patients in self-administration under
   21         certain circumstances; amending s. 464.0156, F.S.;
   22         revising the list of medications that a registered
   23         nurse may delegate the administration of to a
   24         certified nursing assistant or home health aide;
   25         amending ss. 401.25 and 401.27, F.S.; conforming
   26         cross-references; providing an effective date.
   27          
   28  Be It Enacted by the Legislature of the State of Florida:
   29  
   30         Section 1. Section 400.488, Florida Statutes, is amended to
   31  read:
   32         400.488 Assistance with self-administration of medication
   33  and with other tasks.—
   34         (1) For purposes of this section, the term:
   35         (a) “Informed consent” means advising the patient, or the
   36  patient’s surrogate, guardian, or attorney in fact, that the
   37  patient may be receiving assistance with self-administration of
   38  medication or other tasks from an unlicensed person.
   39         (b) “Unlicensed person” means an individual not currently
   40  licensed to practice nursing or medicine who is employed by or
   41  under contract to a home health agency and who has received
   42  training with respect to assisting with the self-administration
   43  of medication or other tasks as provided by agency rule.
   44         (2) Patients who are capable of self-administering their
   45  own medications and performing other tasks without assistance
   46  shall be encouraged and allowed to do so. However, an unlicensed
   47  person may, consistent with a dispensed prescription’s label or
   48  the package directions of an over-the-counter medication, assist
   49  a patient whose condition is medically stable with the self
   50  administration of routine, regularly scheduled medications that
   51  are intended to be self-administered. An unlicensed person may
   52  also provide assistance with other tasks specified in subsection
   53  (6). Assistance with self-administration of medication or such
   54  other tasks self-medication by an unlicensed person may occur
   55  only upon a documented request by, and the written informed
   56  consent of, a patient or the patient’s surrogate, guardian, or
   57  attorney in fact. For purposes of this section, self
   58  administered medications include both legend and over-the
   59  counter oral dosage forms, topical dosage forms, transdermal
   60  patches, and topical ophthalmic, otic, and nasal dosage forms,
   61  including solutions, suspensions, sprays, inhalers, and
   62  nebulizer treatments.
   63         (3) Assistance with self-administration of medication
   64  includes:
   65         (a) Taking the medication, in its previously dispensed,
   66  properly labeled container, from where it is stored and bringing
   67  it to the patient. For purposes of this paragraph, an insulin
   68  syringe that is prefilled with the proper dosage by a pharmacist
   69  and an insulin pen that is prefilled by the manufacturer are
   70  considered medications in previously dispensed, properly labeled
   71  containers.
   72         (b) In the presence of the patient, confirming that the
   73  medication is intended for that patient, orally advising the
   74  patient of the medication name and purpose, opening the
   75  container, removing a prescribed amount of medication from the
   76  container, and closing the container.
   77         (c) Placing an oral dosage in the patient’s hand or placing
   78  the dosage in another container and helping the patient by
   79  lifting the container to his or her mouth.
   80         (d) Applying topical medications, including routine
   81  preventive skin care and applying and replacing bandages for
   82  minor cuts and abrasions as provided by the agency in rule.
   83         (e) Returning the medication container to proper storage.
   84         (f) For nebulizer treatments, assisting with setting up and
   85  cleaning the device in the presence of the patient, confirming
   86  that the medication is intended for that patient, orally
   87  advising the patient of the medication name and purpose, opening
   88  the container, removing the prescribed amount for a single
   89  treatment dose from a properly labeled container, and assisting
   90  the patient with placing the dose into the medicine receptacle
   91  or mouthpiece.
   92         (g) Keeping a record of when a patient receives assistance
   93  with self-administration under this section.
   94         (g)Assisting with the use of a nebulizer, including
   95  removing the cap of a nebulizer, opening the unit dose of
   96  nebulizer solutions, and pouring the prescribed premeasured dose
   97  of medication into the dispensing cup of the nebulizer.
   98         (4) Assistance with self-administration of medication does
   99  not include:
  100         (a) Mixing, compounding, converting, or calculating
  101  medication doses, except for measuring a prescribed amount of
  102  liquid medication or breaking a scored tablet or crushing a
  103  tablet as prescribed.
  104         (b) The preparation of syringes for injection or the
  105  administration of medications by any injectable route.
  106         (c) Administration of medications through intermittent
  107  positive pressure breathing machines or a nebulizer.
  108         (d) Administration of medications by way of a tube inserted
  109  in a cavity of the body.
  110         (d)(e) Administration of parenteral preparations.
  111         (e)(f)The use of irrigations or debriding agents used in
  112  the treatment of a skin condition.
  113         (f)(g)Assisting with rectal, urethral, or vaginal
  114  preparations.
  115         (g)(h)Assisting with medications ordered by the physician
  116  or health care professional with prescriptive authority to be
  117  given “as needed,” unless the order is written with specific
  118  parameters that preclude independent judgment on the part of the
  119  unlicensed person, and at the request of a competent patient.
  120         (h)(i)Assisting with medications for which the time of
  121  administration, the amount, the strength of dosage, the method
  122  of administration, or the reason for administration requires
  123  judgment or discretion on the part of the unlicensed person.
  124         (5) Assistance with the self-administration of medication
  125  by an unlicensed person as described in this section does not
  126  constitute administration as defined in s. 465.003.
  127         (6)Assistance with other tasks includes:
  128         (a)Assisting with the use of a glucometer to perform
  129  blood-glucose level checks.
  130         (b)Assisting with putting on and taking off antiembolism
  131  stockings.
  132         (c)Assisting with applying and removing an oxygen cannula
  133  but not with titrating the prescribed oxygen settings.
  134         (d)Assisting with the use of a continuous positive airway
  135  pressure device but not with titrating the prescribed setting of
  136  the device.
  137         (e)Assisting with measuring vital signs.
  138         (f)Assisting with colostomy bags.
  139         (7)(6) The agency may by rule establish procedures and
  140  interpret terms as necessary to administer this section.
  141         Section 2. Section 401.252, Florida Statutes, is amended to
  142  read:
  143         401.252 Interfacility transfer.—
  144         (1) When conducting an interfacility transfer, a permitted
  145  advanced life support ambulance must be occupied by at least two
  146  persons: one patient attendant who is a certified paramedic, a
  147  registered nurse authorized under subsection (2), or a licensed
  148  physician; and one person who is a certified emergency medical
  149  technician, a certified paramedic, a licensed physician, or an
  150  ambulance driver who meets the driver requirements of s.
  151  401.281. The person occupying the ambulance who has the highest
  152  medical certification in this state is in charge of patient care
  153  during the interfacility transfer.
  154         (2) A licensed basic or advanced life support ambulance
  155  service may conduct interfacility transfers in a permitted
  156  ambulance, using a registered nurse in place of an emergency
  157  medical technician or paramedic, if:
  158         (a) The registered nurse holds a current certificate of
  159  successful course completion in advanced cardiac life support;
  160         (b) The physician in charge has granted permission for such
  161  a transfer, has designated the level of service required for
  162  such transfer, and has deemed the patient to be in such a
  163  condition appropriate to this type of ambulance staffing; and
  164         (c) The registered nurse operates within the scope of part
  165  I of chapter 464.
  166         (3)(2) A licensed basic or advanced life support service
  167  may conduct interfacility transfers in a permitted ambulance if
  168  the patient’s treating physician certifies that the transfer is
  169  medically appropriate and the physician provides reasonable
  170  transfer orders. An interfacility transfer must be conducted in
  171  a permitted ambulance if it is determined that the patient
  172  needs, or is likely to need, medical attention during transport.
  173  If the emergency medical technician or paramedic believes the
  174  level of patient care required during the transfer is beyond his
  175  or her capability, the medical director, or his or her designee,
  176  must be contacted for clearance prior to conducting the
  177  transfer. If necessary, the medical director, or his or her
  178  designee, shall attempt to contact the treating physician for
  179  consultation to determine the appropriateness of the transfer.
  180         (4)(3) Infants younger less than 28 days old or infants
  181  weighing less than 5 kilograms, who require critical care
  182  interfacility transport to a neonatal intensive care unit must,
  183  shall be transported in a permitted advanced life support or
  184  basic life support transport ambulance, or in a permitted
  185  advanced life support or basic life support ambulance that is
  186  recognized by the department as meeting designated criteria for
  187  neonatal interfacility critical care transport.
  188         Section 3. Section 429.256, Florida Statutes, is amended to
  189  read:
  190         429.256 Assistance with self-administration of medication
  191  and with other tasks.—
  192         (1) For the purposes of this section, the term:
  193         (a) “Informed consent” means advising the resident, or the
  194  resident’s surrogate, guardian, or attorney in fact, that an
  195  assisted living facility is not required to have a licensed
  196  nurse on staff, that the resident may be receiving assistance
  197  with self-administration of medication or other tasks from an
  198  unlicensed person, and that such assistance, if provided by an
  199  unlicensed person, will or will not be overseen by a licensed
  200  nurse.
  201         (b) “Unlicensed person” means an individual not currently
  202  licensed to practice nursing or medicine who is employed by or
  203  under contract to an assisted living facility and who has
  204  received training with respect to assisting with the self
  205  administration of medication or other tasks in an assisted
  206  living facility as provided under s. 429.52 prior to providing
  207  such assistance as described in this section.
  208         (2) Residents who are capable of self-administering their
  209  own medications and performing other tasks without assistance
  210  shall be encouraged and allowed to do so. However, an unlicensed
  211  person may, consistent with a dispensed prescription’s label or
  212  the package directions of an over-the-counter medication, assist
  213  a resident whose condition is medically stable with the self
  214  administration of routine, regularly scheduled medications that
  215  are intended to be self-administered. An unlicensed person may
  216  also provide assistance with other tasks specified in subsection
  217  (6). Assistance with self-administration of medication or such
  218  other tasks self-medication by an unlicensed person may occur
  219  only upon a documented request by, and the written informed
  220  consent of, a resident or the resident’s surrogate, guardian, or
  221  attorney in fact. For the purposes of this section, self
  222  administered medications include both legend and over-the
  223  counter oral dosage forms, topical dosage forms, transdermal
  224  patches, and topical ophthalmic, otic, and nasal dosage forms
  225  including solutions, suspensions, sprays, and inhalers.
  226         (3) Assistance with self-administration of medication
  227  includes:
  228         (a) Taking the medication, in its previously dispensed,
  229  properly labeled container, including an insulin syringe that is
  230  prefilled with the proper dosage by a pharmacist and an insulin
  231  pen that is prefilled by the manufacturer, from where it is
  232  stored, and bringing it to the resident. For purposes of this
  233  paragraph, an insulin syringe that is prefilled with the proper
  234  dosage by a pharmacist and an insulin pen that is prefilled by
  235  the manufacturer are considered medications in previously
  236  dispensed, properly labeled containers.
  237         (b) In the presence of the resident, confirming that the
  238  medication is intended for that resident, orally advising the
  239  resident of the medication name and dosage, opening the
  240  container, removing a prescribed amount of medication from the
  241  container, and closing the container. The resident may sign a
  242  written waiver to opt out of being orally advised of the
  243  medication name and dosage. The waiver must identify all of the
  244  medications intended for the resident, including names and
  245  dosages of such medications, and must immediately be updated
  246  each time the resident’s medications or dosages change.
  247         (c) Placing an oral dosage in the resident’s hand or
  248  placing the dosage in another container and helping the resident
  249  by lifting the container to his or her mouth.
  250         (d) Applying topical medications.
  251         (e) Returning the medication container to proper storage.
  252         (f) Keeping a record of when a resident receives assistance
  253  with self-administration under this section.
  254         (g) Assisting with the use of a nebulizer, including
  255  removing the cap of a nebulizer, opening the unit dose of
  256  nebulizer solution, and pouring the prescribed premeasured dose
  257  of medication into the dispensing cup of the nebulizer.
  258         (h)Using a glucometer to perform blood-glucose level
  259  checks.
  260         (i)Assisting with putting on and taking off antiembolism
  261  stockings.
  262         (j)Assisting with applying and removing an oxygen cannula
  263  but not with titrating the prescribed oxygen settings.
  264         (k)Assisting with the use of a continuous positive airway
  265  pressure device but not with titrating the prescribed setting of
  266  the device.
  267         (l)Assisting with measuring vital signs.
  268         (m)Assisting with colostomy bags.
  269         (4) Assistance with self-administration of medication does
  270  not include:
  271         (a) Mixing, compounding, converting, or calculating
  272  medication doses, except for measuring a prescribed amount of
  273  liquid medication or breaking a scored tablet or crushing a
  274  tablet as prescribed.
  275         (b) The preparation of syringes for injection or the
  276  administration of medications by any injectable route.
  277         (c) Administration of medications by way of a tube inserted
  278  in a cavity of the body.
  279         (d) Administration of parenteral preparations.
  280         (e) The use of irrigations or debriding agents used in the
  281  treatment of a skin condition.
  282         (f) Assisting with rectal, urethral, or vaginal
  283  preparations.
  284         (g) Assisting with medications ordered by the physician or
  285  health care professional with prescriptive authority to be given
  286  “as needed,” unless the order is written with specific
  287  parameters that preclude independent judgment on the part of the
  288  unlicensed person, and the resident requesting the medication is
  289  aware of his or her need for the medication and understands the
  290  purpose for taking the medication.
  291         (h) Assisting with medications for which the time of
  292  administration, the amount, the strength of dosage, the method
  293  of administration, or the reason for administration requires
  294  judgment or discretion on the part of the unlicensed person.
  295         (5) Assistance with the self-administration of medication
  296  by an unlicensed person as described in this section shall not
  297  be considered administration as defined in s. 465.003.
  298         (6)Assistance with other tasks includes:
  299         (a)Assisting with the use of a glucometer to perform
  300  blood-glucose level checks.
  301         (b)Assisting with putting on and taking off antiembolism
  302  stockings.
  303         (c)Assisting with applying and removing an oxygen cannula
  304  but not with titrating the prescribed oxygen settings.
  305         (d)Assisting with the use of a continuous positive airway
  306  pressure device but not with titrating the prescribed setting of
  307  the device.
  308         (e)Assisting with measuring vital signs.
  309         (f)Assisting with colostomy bags.
  310         (7)(6) The agency may by rule establish facility procedures
  311  and interpret terms as necessary to implement this section.
  312         Section 4. Subsection (2) of section 464.0156, Florida
  313  Statutes, is amended to read:
  314         464.0156 Delegation of duties.—
  315         (2) A registered nurse may delegate to a certified nursing
  316  assistant or a home health aide the administration of oral,
  317  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  318  topical prescription medications to a patient of a home health
  319  agency, if the certified nursing assistant or home health aide
  320  meets the requirements of s. 464.2035 or s. 400.489,
  321  respectively. A registered nurse may not delegate the
  322  administration of any controlled substance listed in Schedule
  323  II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s.
  324  812, except for the administration of an insulin syringe that is
  325  prefilled with the proper dosage by a pharmacist or an insulin
  326  pen that is prefilled by the manufacturer.
  327         Section 5. Subsection (7) of section 401.25, Florida
  328  Statutes, is amended to read:
  329         401.25 Licensure as a basic life support or an advanced
  330  life support service.—
  331         (7)(a) Each permitted basic life support ambulance not
  332  specifically exempted from this part, when transporting a person
  333  who is sick, injured, wounded, incapacitated, or helpless, must
  334  be occupied by at least two persons: one patient attendant who
  335  is a certified emergency medical technician, certified
  336  paramedic, or licensed physician; and one ambulance driver who
  337  meets the requirements of s. 401.281. This paragraph does not
  338  apply to interfacility transfers governed by s. 401.252 s.
  339  401.252(1).
  340         (b) Each permitted advanced life support ambulance not
  341  specifically exempted from this part, when transporting a person
  342  who is sick, injured, wounded, incapacitated, or helpless, must
  343  be occupied by at least two persons: one who is a certified
  344  paramedic or licensed physician; and one who is a certified
  345  emergency medical technician, certified paramedic, or licensed
  346  physician who also meets the requirements of s. 401.281 for
  347  drivers. The person with the highest medical certifications
  348  shall be in charge of patient care. This paragraph does not
  349  apply to interfacility transfers governed by s. 401.252 s.
  350  401.252(1).
  351         Section 6. Subsection (1) of section 401.27, Florida
  352  Statutes, is amended to read:
  353         401.27 Personnel; standards and certification.—
  354         (1) Each permitted ambulance not specifically exempted from
  355  this part, when transporting a person who is sick, injured,
  356  wounded, incapacitated, or helpless, must be occupied by at
  357  least two persons, one of whom must be a certified emergency
  358  medical technician, certified paramedic, or licensed physician
  359  and one of whom must be a driver who meets the requirements for
  360  ambulance drivers. This subsection does not apply to
  361  interfacility transfers governed by s. 401.252 s. 401.252(1).
  362         Section 7. This act shall take effect July 1, 2022.