Florida Senate - 2022                       CS for CS for SB 718
       
       
        
       By the Committees on Rules; and Health Policy; and Senator
       Bradley
       
       
       
       
       595-03646-22                                           2022718c2
    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         authorizing registered nurses to delegate to certified
   23         nursing assistants and home health aides the
   24         administration of certain medications to patients in
   25         county detention facilities under certain
   26         circumstances; revising the list of medications that a
   27         registered nurse may delegate the administration of to
   28         a certified nursing assistant or home health aide;
   29         amending ss. 401.25 and 401.27, F.S.; conforming
   30         cross-references; providing an effective date.
   31          
   32  Be It Enacted by the Legislature of the State of Florida:
   33  
   34         Section 1. Section 400.488, Florida Statutes, is amended to
   35  read:
   36         400.488 Assistance with self-administration of medication
   37  and with other tasks.—
   38         (1) For purposes of this section, the term:
   39         (a) “Informed consent” means advising the patient, or the
   40  patient’s surrogate, guardian, or attorney in fact, that the
   41  patient may be receiving assistance with self-administration of
   42  medication or other tasks from an unlicensed person.
   43         (b) “Unlicensed person” means an individual not currently
   44  licensed to practice nursing or medicine who is employed by or
   45  under contract to a home health agency and who has received
   46  training with respect to assisting with the self-administration
   47  of medication or other tasks as provided by agency rule.
   48         (2) Patients who are capable of self-administering their
   49  own medications and performing other tasks without assistance
   50  shall be encouraged and allowed to do so. However, an unlicensed
   51  person may, consistent with a dispensed prescription’s label or
   52  the package directions of an over-the-counter medication, assist
   53  a patient whose condition is medically stable with the self
   54  administration of routine, regularly scheduled medications that
   55  are intended to be self-administered. An unlicensed person may
   56  also provide assistance with other tasks specified in subsection
   57  (6). Assistance with self-administration of medication or such
   58  other tasks self-medication by an unlicensed person may occur
   59  only upon a documented request by, and the written informed
   60  consent of, a patient or the patient’s surrogate, guardian, or
   61  attorney in fact. For purposes of this section, self
   62  administered medications include both legend and over-the
   63  counter oral dosage forms, topical dosage forms, transdermal
   64  patches, and topical ophthalmic, otic, and nasal dosage forms,
   65  including solutions, suspensions, sprays, inhalers, and
   66  nebulizer treatments.
   67         (3) Assistance with self-administration of medication
   68  includes:
   69         (a) Taking the medication, in its previously dispensed,
   70  properly labeled container, from where it is stored and bringing
   71  it to the patient. For purposes of this paragraph, an insulin
   72  syringe that is prefilled with the proper dosage by a pharmacist
   73  and an insulin pen that is prefilled by the manufacturer are
   74  considered medications in previously dispensed, properly labeled
   75  containers.
   76         (b) In the presence of the patient, confirming that the
   77  medication is intended for that patient, orally advising the
   78  patient of the medication name and purpose, opening the
   79  container, removing a prescribed amount of medication from the
   80  container, and closing the container.
   81         (c) Placing an oral dosage in the patient’s hand or placing
   82  the dosage in another container and helping the patient by
   83  lifting the container to his or her mouth.
   84         (d) Applying topical medications, including routine
   85  preventive skin care and applying and replacing bandages for
   86  minor cuts and abrasions as provided by the agency in rule.
   87         (e) Returning the medication container to proper storage.
   88         (f) For nebulizer treatments, assisting with setting up and
   89  cleaning the device in the presence of the patient, confirming
   90  that the medication is intended for that patient, orally
   91  advising the patient of the medication name and purpose, opening
   92  the container, removing the prescribed amount for a single
   93  treatment dose from a properly labeled container, and assisting
   94  the patient with placing the dose into the medicine receptacle
   95  or mouthpiece.
   96         (g) Keeping a record of when a patient receives assistance
   97  with self-administration under this section.
   98         (g)Assisting with the use of a nebulizer, including
   99  removing the cap of a nebulizer, opening the unit dose of
  100  nebulizer solutions, and pouring the prescribed premeasured dose
  101  of medication into the dispensing cup of the nebulizer.
  102         (4) Assistance with self-administration of medication does
  103  not include:
  104         (a) Mixing, compounding, converting, or calculating
  105  medication doses, except for measuring a prescribed amount of
  106  liquid medication or breaking a scored tablet or crushing a
  107  tablet as prescribed.
  108         (b) The preparation of syringes for injection or the
  109  administration of medications by any injectable route.
  110         (c) Administration of medications through intermittent
  111  positive pressure breathing machines or a nebulizer.
  112         (d) Administration of medications by way of a tube inserted
  113  in a cavity of the body.
  114         (d)(e) Administration of parenteral preparations.
  115         (e)(f)The use of irrigations or debriding agents used in
  116  the treatment of a skin condition.
  117         (f)(g)Assisting with rectal, urethral, or vaginal
  118  preparations.
  119         (g)(h)Assisting with medications ordered by the physician
  120  or health care professional with prescriptive authority to be
  121  given “as needed,” unless the order is written with specific
  122  parameters that preclude independent judgment on the part of the
  123  unlicensed person, and at the request of a competent patient.
  124         (h)(i)Assisting with medications for which the time of
  125  administration, the amount, the strength of dosage, the method
  126  of administration, or the reason for administration requires
  127  judgment or discretion on the part of the unlicensed person.
  128         (5) Assistance with the self-administration of medication
  129  by an unlicensed person as described in this section does not
  130  constitute administration as defined in s. 465.003.
  131         (6)Assistance with other tasks includes:
  132         (a)Assisting with the use of a glucometer to perform
  133  blood-glucose level checks.
  134         (b)Assisting with putting on and taking off antiembolism
  135  stockings.
  136         (c)Assisting with applying and removing an oxygen cannula
  137  but not with titrating the prescribed oxygen settings.
  138         (d)Assisting with the use of a continuous positive airway
  139  pressure device but not with titrating the prescribed setting of
  140  the device.
  141         (e)Assisting with measuring vital signs.
  142         (f)Assisting with colostomy bags.
  143         (7)(6) The agency may by rule establish procedures and
  144  interpret terms as necessary to administer this section.
  145         Section 2. Section 401.252, Florida Statutes, is amended to
  146  read:
  147         401.252 Interfacility transfer.—
  148         (1) When conducting an interfacility transfer, a permitted
  149  advanced life support ambulance must be occupied by at least two
  150  persons: one patient attendant who is a certified paramedic, a
  151  registered nurse authorized under subsection (2), or a licensed
  152  physician; and one person who is a certified emergency medical
  153  technician, a certified paramedic, a licensed physician, or an
  154  ambulance driver who meets the driver requirements of s.
  155  401.281. The person occupying the ambulance who has the highest
  156  medical certification in this state is in charge of patient care
  157  during the interfacility transfer.
  158         (2) A licensed basic or advanced life support ambulance
  159  service may conduct interfacility transfers in a permitted
  160  ambulance, using a registered nurse in place of an emergency
  161  medical technician or paramedic, if:
  162         (a) The registered nurse holds a current certificate of
  163  successful course completion in advanced cardiac life support;
  164         (b) The physician in charge has granted permission for such
  165  a transfer, has designated the level of service required for
  166  such transfer, and has deemed the patient to be in such a
  167  condition appropriate to this type of ambulance staffing; and
  168         (c) The registered nurse operates within the scope of part
  169  I of chapter 464.
  170         (3)(2) A licensed basic or advanced life support service
  171  may conduct interfacility transfers in a permitted ambulance if
  172  the patient’s treating physician certifies that the transfer is
  173  medically appropriate and the physician provides reasonable
  174  transfer orders. An interfacility transfer must be conducted in
  175  a permitted ambulance if it is determined that the patient
  176  needs, or is likely to need, medical attention during transport.
  177  If the emergency medical technician or paramedic believes the
  178  level of patient care required during the transfer is beyond his
  179  or her capability, the medical director, or his or her designee,
  180  must be contacted for clearance prior to conducting the
  181  transfer. If necessary, the medical director, or his or her
  182  designee, shall attempt to contact the treating physician for
  183  consultation to determine the appropriateness of the transfer.
  184         (4)(3) Infants younger less than 28 days old or infants
  185  weighing less than 5 kilograms, who require critical care
  186  interfacility transport to a neonatal intensive care unit must,
  187  shall be transported in a permitted advanced life support or
  188  basic life support transport ambulance, or in a permitted
  189  advanced life support or basic life support ambulance that is
  190  recognized by the department as meeting designated criteria for
  191  neonatal interfacility critical care transport.
  192         Section 3. Section 429.256, Florida Statutes, is amended to
  193  read:
  194         429.256 Assistance with self-administration of medication
  195  and with other tasks.—
  196         (1) For the purposes of this section, the term:
  197         (a) “Informed consent” means advising the resident, or the
  198  resident’s surrogate, guardian, or attorney in fact, that an
  199  assisted living facility is not required to have a licensed
  200  nurse on staff, that the resident may be receiving assistance
  201  with self-administration of medication or other tasks from an
  202  unlicensed person, and that such assistance, if provided by an
  203  unlicensed person, will or will not be overseen by a licensed
  204  nurse.
  205         (b) “Unlicensed person” means an individual not currently
  206  licensed to practice nursing or medicine who is employed by or
  207  under contract to an assisted living facility and who has
  208  received training with respect to assisting with the self
  209  administration of medication or other tasks in an assisted
  210  living facility as provided under s. 429.52 prior to providing
  211  such assistance as described in this section.
  212         (2) Residents who are capable of self-administering their
  213  own medications and performing other tasks without assistance
  214  shall be encouraged and allowed to do so. However, an unlicensed
  215  person may, consistent with a dispensed prescription’s label or
  216  the package directions of an over-the-counter medication, assist
  217  a resident whose condition is medically stable with the self
  218  administration of routine, regularly scheduled medications that
  219  are intended to be self-administered. An unlicensed person may
  220  also provide assistance with other tasks specified in subsection
  221  (6). Assistance with self-administration of medication or such
  222  other tasks self-medication by an unlicensed person may occur
  223  only upon a documented request by, and the written informed
  224  consent of, a resident or the resident’s surrogate, guardian, or
  225  attorney in fact. For the purposes of this section, self
  226  administered medications include both legend and over-the
  227  counter oral dosage forms, topical dosage forms, transdermal
  228  patches, and topical ophthalmic, otic, and nasal dosage forms
  229  including solutions, suspensions, sprays, and inhalers.
  230         (3) Assistance with self-administration of medication
  231  includes:
  232         (a) Taking the medication, in its previously dispensed,
  233  properly labeled container, including an insulin syringe that is
  234  prefilled with the proper dosage by a pharmacist and an insulin
  235  pen that is prefilled by the manufacturer, from where it is
  236  stored, and bringing it to the resident. For purposes of this
  237  paragraph, an insulin syringe that is prefilled with the proper
  238  dosage by a pharmacist and an insulin pen that is prefilled by
  239  the manufacturer are considered medications in previously
  240  dispensed, properly labeled containers.
  241         (b) In the presence of the resident, confirming that the
  242  medication is intended for that resident, orally advising the
  243  resident of the medication name and dosage, opening the
  244  container, removing a prescribed amount of medication from the
  245  container, and closing the container. The resident may sign a
  246  written waiver to opt out of being orally advised of the
  247  medication name and dosage. The waiver must identify all of the
  248  medications intended for the resident, including names and
  249  dosages of such medications, and must immediately be updated
  250  each time the resident’s medications or dosages change.
  251         (c) Placing an oral dosage in the resident’s hand or
  252  placing the dosage in another container and helping the resident
  253  by lifting the container to his or her mouth.
  254         (d) Applying topical medications.
  255         (e) Returning the medication container to proper storage.
  256         (f) Keeping a record of when a resident receives assistance
  257  with self-administration under this section.
  258         (g) Assisting with the use of a nebulizer, including
  259  removing the cap of a nebulizer, opening the unit dose of
  260  nebulizer solution, and pouring the prescribed premeasured dose
  261  of medication into the dispensing cup of the nebulizer.
  262         (h)Using a glucometer to perform blood-glucose level
  263  checks.
  264         (i)Assisting with putting on and taking off antiembolism
  265  stockings.
  266         (j)Assisting with applying and removing an oxygen cannula
  267  but not with titrating the prescribed oxygen settings.
  268         (k)Assisting with the use of a continuous positive airway
  269  pressure device but not with titrating the prescribed setting of
  270  the device.
  271         (l)Assisting with measuring vital signs.
  272         (m)Assisting with colostomy bags.
  273         (4) Assistance with self-administration of medication does
  274  not include:
  275         (a) Mixing, compounding, converting, or calculating
  276  medication doses, except for measuring a prescribed amount of
  277  liquid medication or breaking a scored tablet or crushing a
  278  tablet as prescribed.
  279         (b) The preparation of syringes for injection or the
  280  administration of medications by any injectable route.
  281         (c) Administration of medications by way of a tube inserted
  282  in a cavity of the body.
  283         (d) Administration of parenteral preparations.
  284         (e) The use of irrigations or debriding agents used in the
  285  treatment of a skin condition.
  286         (f) Assisting with rectal, urethral, or vaginal
  287  preparations.
  288         (g) Assisting with medications ordered by the physician or
  289  health care professional with prescriptive authority to be given
  290  “as needed,” unless the order is written with specific
  291  parameters that preclude independent judgment on the part of the
  292  unlicensed person, and the resident requesting the medication is
  293  aware of his or her need for the medication and understands the
  294  purpose for taking the medication.
  295         (h) Assisting with medications for which the time of
  296  administration, the amount, the strength of dosage, the method
  297  of administration, or the reason for administration requires
  298  judgment or discretion on the part of the unlicensed person.
  299         (5) Assistance with the self-administration of medication
  300  by an unlicensed person as described in this section shall not
  301  be considered administration as defined in s. 465.003.
  302         (6)Assistance with other tasks includes:
  303         (a)Assisting with the use of a glucometer to perform
  304  blood-glucose level checks.
  305         (b)Assisting with putting on and taking off antiembolism
  306  stockings.
  307         (c)Assisting with applying and removing an oxygen cannula
  308  but not with titrating the prescribed oxygen settings.
  309         (d)Assisting with the use of a continuous positive airway
  310  pressure device but not with titrating the prescribed setting of
  311  the device.
  312         (e)Assisting with measuring vital signs.
  313         (f)Assisting with colostomy bags.
  314         (7)(6) The agency may by rule establish facility procedures
  315  and interpret terms as necessary to implement this section.
  316         Section 4. Subsection (2) of section 464.0156, Florida
  317  Statutes, is amended to read:
  318         464.0156 Delegation of duties.—
  319         (2) A registered nurse may delegate to a certified nursing
  320  assistant or a home health aide the administration of oral,
  321  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  322  topical prescription medications to a patient of a home health
  323  agency or in a local county detention facility as defined in s.
  324  951.23(1), if the certified nursing assistant or home health
  325  aide meets the requirements of s. 464.2035 or s. 400.489,
  326  respectively. A registered nurse may not delegate the
  327  administration of any controlled substance listed in Schedule
  328  II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s.
  329  812, except for the administration of an insulin syringe that is
  330  prefilled with the proper dosage by a pharmacist or an insulin
  331  pen that is prefilled by the manufacturer.
  332         Section 5. Subsection (7) of section 401.25, Florida
  333  Statutes, is amended to read:
  334         401.25 Licensure as a basic life support or an advanced
  335  life support service.—
  336         (7)(a) Each permitted basic life support ambulance not
  337  specifically exempted from this part, when transporting a person
  338  who is sick, injured, wounded, incapacitated, or helpless, must
  339  be occupied by at least two persons: one patient attendant who
  340  is a certified emergency medical technician, certified
  341  paramedic, or licensed physician; and one ambulance driver who
  342  meets the requirements of s. 401.281. This paragraph does not
  343  apply to interfacility transfers governed by s. 401.252 s.
  344  401.252(1).
  345         (b) Each permitted advanced life support ambulance not
  346  specifically exempted from this part, when transporting a person
  347  who is sick, injured, wounded, incapacitated, or helpless, must
  348  be occupied by at least two persons: one who is a certified
  349  paramedic or licensed physician; and one who is a certified
  350  emergency medical technician, certified paramedic, or licensed
  351  physician who also meets the requirements of s. 401.281 for
  352  drivers. The person with the highest medical certifications
  353  shall be in charge of patient care. This paragraph does not
  354  apply to interfacility transfers governed by s. 401.252 s.
  355  401.252(1).
  356         Section 6. Subsection (1) of section 401.27, Florida
  357  Statutes, is amended to read:
  358         401.27 Personnel; standards and certification.—
  359         (1) Each permitted ambulance not specifically exempted from
  360  this part, when transporting a person who is sick, injured,
  361  wounded, incapacitated, or helpless, must be occupied by at
  362  least two persons, one of whom must be a certified emergency
  363  medical technician, certified paramedic, or licensed physician
  364  and one of whom must be a driver who meets the requirements for
  365  ambulance drivers. This subsection does not apply to
  366  interfacility transfers governed by s. 401.252 s. 401.252(1).
  367         Section 7. This act shall take effect July 1, 2022.