BILL REQ. #:  H-0724.2 

Read first time 01/31/2003.   Referred to Committee on Health Care.

     AN ACT Relating to the Washington state patient safety act; adding new sections to chapter 70.41 RCW; creating a new section; and prescribing penalties.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   A new section is added to chapter 70.41 RCW to read as follows:
     Current health services research continues to demonstrate that higher numbers of registered nurses available to care for patients in acute care hospitals lead to better patient outcomes with less morbidity and mortality and fewer complications. Moreover, improvements in safety of staff, job satisfaction, and reduction of workplace injuries have also been directly linked to higher registered nurse staffing levels. Therefore, to safeguard the public and support registered nurses, licensed practical nurses, and unlicensed assistive personnel, the legislature finds, as a matter of public policy, that development and implementation of staffing plans for nursing services are essential to ensure that the classifications, skills, experiences, and numbers of health care professionals providing direct patient care are sufficient to meet the needs of patients.

NEW SECTION.  Sec. 2   A new section is added to chapter 70.41 RCW to read as follows:
     The definitions in this section apply throughout sections 1 through 7 of this act unless the context clearly requires otherwise.
     (1) "Staffing committee" means a committee established by the hospital with at least one-half of its members who are registered nurses currently providing direct patient care. If registered nurses are represented by a collective bargaining representative, the registered nurse representatives must be selected by the collective bargaining representative. Participation in the committee must be considered a part of the employee's regularly scheduled workweek.
     (2) "Patient care unit" means any unit of the hospital that provides patient care.
     (3) "Intensity" means the level of patient needs as determined by a registered nurse providing direct patient care taking into account at least the following factors:
     (a) Severity and urgency of the patient's admitting condition;
     (b) Scheduled procedures;
     (c) Patient's ability to meet health care requisites;
     (d) Patient's availability of social supports;
     (e) Age and functional ability of the patient;
     (f) Communications skills of the patient; and
     (g) Other needs identified by the patient and by the registered nurse.
     (4) "Skill mix" means the number of registered nurses, licensed practical nurses, and unlicensed assistive personnel providing direct patient care.

NEW SECTION.  Sec. 3   A new section is added to chapter 70.41 RCW to read as follows:
     (1) Each hospital in the state shall develop and implement a staffing plan for nursing services. The plan must be reviewed and updated annually and filed with the department. The written staffing plan must:
     (a) Set the minimum number and skill mix of registered nurses, licensed practical nurses, and unlicensed assistive personnel required in each patient care unit in the hospital;
     (b) Be based on at least the following criteria on each patient care unit:
     (i) Census, including activity such as patient discharges, admissions, and transfers;
     (ii) Level of intensity of all patients and nature of the care to be delivered on each shift;
     (iii) Skill mix, experience, and specialty certification or training of those providing the care;
     (iv) The need for specialized or intensive equipment; and
     (v) The architecture and geography of the patient care unit;
     (c) Include appropriate limits on the use of agency and traveling nurses;
     (d) Be consistent with the scopes of practice for registered nurses and licensed practical nurses and the authorized duties of unlicensed assistive personnel;
     (e) Include adequate staffing to provide for staff time off, illnesses, meal and break time, and educational, health, and other leaves;
     (f) Include a semiannual process for internal review by the staffing committee that ensures compliance with the staffing plan, provides for the review of incidents and staff concerns, and tracks staffing patterns, number of patients, and their acuity.
     (2) The staffing plan must not diminish existing standards in law, rules, or the terms of an applicable collective bargaining agreement.
     (3) Each hospital shall staff each patient care unit in accordance with its staffing plan. Shift-to-shift adjustments in staffing levels required by the plan may be made only if based upon assessment by a registered nurse providing direct patient care on the patient care unit.
     (4) Each hospital shall post the staffing plan for that patient care unit as required by this section on each patient care unit in the facility.
     (5) Each hospital shall collaborate with its staffing committee in the development and implementation of its staffing plan.
     (6) No hospital shall retaliate against or intimidate any employee for performing any duties or responsibilities in connection with participation on the staffing committee.
     (7) No hospital shall retaliate against or intimidate any employee who notifies the staffing committee, the hospital administration, or the department that any schedule fails to meet with the posted staffing plan, or that the hospital has failed to develop or implement a staffing plan consistent with sections 1 through 7 of this act.

NEW SECTION.  Sec. 4   A new section is added to chapter 70.41 RCW to read as follows:
     (1) Hospitals shall maintain accurate daily records showing:
     (a) The number of patients present in each patient care unit at the end of each standard shift within the facility;
     (b) The number of admissions, discharges, transfers, and observation patients in each patient care unit and each shift; and
     (c) The number of registered nurses, licensed practical nurses, and unlicensed assistive personnel providing direct patient care in each patient care unit and shift within the facility.
     (2) All records required to be kept under this section must be maintained for a period of seven years.
     (3) Hospitals shall maintain and post a list of qualified, on-call nursing staff and nursing services that may be called to provide replacement staff in the event of sickness, vacations, vacancies, and other absences of nursing staff and that provides a sufficient number of replacement staff for the hospital on a regular basis.
     (4) All records required to be kept under this section must be available upon request to the department and to the staffing committee.

NEW SECTION.  Sec. 5   A new section is added to chapter 70.41 RCW to read as follows:
     Semiannually, hospitals shall collect and submit to the department information regarding nurse staffing. Such information must include the following nursing-sensitive quality indicators established by the American nurses association:
     (1) The percentage mix of registered nurses, licensed practical nurses, and unlicensed assistive personnel caring for patients as a total of all nursing care hours on each unit;
     (2) The total nursing care hours provided per patient day on each unit;
     (3) The rates of pressure ulcers relative to the number of patients;
     (4) The rate of patient falls per one thousand patient days; and
     (5) Nurse staff satisfaction as determined by scaled responses to a uniform series of questions.

NEW SECTION.  Sec. 6   A new section is added to chapter 70.41 RCW to read as follows:
     (1) The department shall investigate complaints of violations of sections 1 through 5 of this act. The department may impose civil penalties or suspend or revoke a license of a hospital for violation of any provision of sections 1 through 5 of this act. A civil penalty imposed under this section may not exceed five thousand dollars. Each violation of a nursing staff plan must be considered a separate violation.
     (2) The department shall maintain for public inspection records of any civil penalties, administrative actions, or license suspensions or revocations imposed on hospitals under this section.
     (3) The department shall conduct an annual random audit of not less than ten percent of all hospitals in this state solely to verify compliance with the requirements of sections 1 through 5 of this act. Surveys made by private accrediting organizations may not be used in lieu of the audit required under this subsection. The department shall compile and maintain for public inspection an annual report of the audit conducted under this subsection.
     (4) The department shall establish rules as necessary to implement sections 1 through 7 of this act.

NEW SECTION.  Sec. 7   A new section is added to chapter 70.41 RCW to read as follows:
     Any costs associated with the administration of sections 1 through 6 of this act must be paid through hospital licensure fees.

NEW SECTION.  Sec. 8   This act may be known and cited as the Washington state patient safety act.