BILL REQ. #:  H-1741.1 

Read first time 02/12/2007.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to improving safety in state hospitals; adding new sections to chapter 72.23 RCW; and creating new sections.

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

NEW SECTION.  Sec. 1   The legislature finds that the continuing number of assaults in state hospitals have made conditions for both patients and staff unacceptable. The legislature further finds that appropriate nurse staffing levels will result in improved patient and staff safety and a reduction in the number of workplace injuries. Therefore, to improve safety conditions in the state hospitals, the legislature intends that minimum patient assignment limits and nurse staffing ratios and other safety measures be implemented as an urgent public policy priority.

NEW SECTION.  Sec. 2   The definitions in this section apply throughout this section and sections 1 and 3 through 7 of this act unless the context clearly requires otherwise.
     (1) "Intensity" means the level of patient needs in terms of nursing care as determined by a registered nurse providing direct patient care, taking into account at least the following factors:
     (a) The severity and urgency of the patient's condition;
     (b) The complexity of either planning or providing, or both, the care required by the patient;
     (c) Scheduled or anticipated procedures or events, including those that necessitate increased frequency of assessment or intervention;
     (d) Age and cognitive and functional ability of the patient, including ability to perform self-care activities;
     (e) The availability of patient social supports including institutional, family, or community support;
     (f) The level of patient adherence or ability to comply with patient care;
     (g) Patient and family educational needs, including assessment of learning capabilities of patient and family;
     (h) Intactness of family unit, the availability of family to provide either emotional support or functional support, or both, and the ability of the family to participate in patient decision-making processes;
     (i) The communication skills of the patient; and
     (j) Other needs identified by the patient and by the registered nurse.
     (2) "Nursing personnel" means registered nurses, licensed practical nurses, and unlicensed assistive nursing personnel providing direct patient care.
     (3) "Patient" means the same as defined in RCW 72.23.010.
     (4) "Patient assignment limits" means the maximum number of patients that a hospital may assign to a registered nurse at any one time.
     (5) "Patient care unit" means any unit or area of a state hospital that provides patient care.
     (6) "Staffing committee" means the advisory committee on nurse staffing established by a state hospital under section 3 of this act.
     (7) "Staffing ratio" means the ratio of nursing personnel to the actual number of patients within a patient care unit.

NEW SECTION.  Sec. 3   By September 1, 2007, each state hospital must establish an advisory committee on nurse staffing. The staffing committee consists of nine members, at least five of whom must be registered nurses who provide direct patient care. The staffing committee shall:
     (1) Recommend patient assignment limits to be adopted by the department under section 4 of this act;
     (2) Recommend classifications of patient care units and appropriate staffing ratios to be adopted by the department under section 4 of this act;
     (3) Make recommendations to the state hospital and the safety committee regarding safe equipment and personal alarm system policies; and
     (4) Make other recommendations regarding the development and implementation of hospital staffing plans that the staffing committee deems necessary.

NEW SECTION.  Sec. 4   (1) By January 1, 2008, the department must establish, after considering the recommendations of the staffing committee:
     (a) Patient assignment limits by nurse classification. Patient assignment limits apply to individual registered nurse assignments, and may not be construed as establishing average assignments for a hospital or patient care unit. The limits apply at all times that a registered nurse is on duty, including times when other nurses are away from the unit, on a break, or otherwise not providing direct patient care; and
     (b) A staffing ratio for each patient care unit at a state hospital. In developing the staff ratios, the department must classify patient care units by staffing need according to the intensity of the patients needing the most intensive care within the unit. For those units with the highest level of staffing need, the staffing ratio must be at least 1.2 to 1. However, patients requiring one-on-one direct patient care must be given constant monitoring, and at no time may a nurse monitor more than one patient needing one-on-one care. In establishing staffing ratios, the department must consider the number of staff necessary to ensure that there is adequate response time to personal alarms.
     (2) The staffing ratio represents the maximum number of patients that may be assigned to any nursing personnel at any one time in that unit. "Assigned" means that the nurse has responsibility for the provision of care to a particular patient within his or her scope of practice. In implementing the staffing ratio:
     (a) The staff ratio may not be used in a manner that averages the number of patients and the total number of nursing personnel on the unit during any one shift or over any period of time;
     (b) Only licensed nurses who are providing direct patient care, are present in the unit, are awake and on duty, and have the necessary qualifications determined by the staffing committee to provide the necessary nursing services for clients admitted for care may be included in the ratios; and
     (c) The staffing ratio may not include nursing personnel who are engaged in activities other than direct patient care, including being on meal breaks or other statutorily mandated work breaks, on leave for vacation, sickness, or injury, or who are covering other patient units.
     (3) Regardless of the minimum staffing ratio, the facility must employ professional and other staff on all shifts in the number and with the qualifications to provide the necessary services for those patients admitted for care including, but not limited to, food service, maintenance, and janitorial services.
     (4) The department must post the staffing ratios in each patient care unit and update the posting each time any changes are made in staffing ratios. At least once every quarter, the department must publish on its web site the staffing ratios for each patient care unit of each state hospital. The publication must include the number of patients within each unit, the specific classification of each patient, and the specific titles of direct care staff assigned to such unit. The publication must also include a comparison of the current staffing ratios to the previous quarter's staffing ratios.
     (5) Nothing in this section may be construed to prevent a state hospital from raising the staffing levels due to the staffing need in each patient unit.

NEW SECTION.  Sec. 5   (1) Each state hospital must ensure that all nursing personnel are equipped with a properly functioning personal alarm at all times that the employee is on duty.
     (2) Each state hospital must establish, after considering the recommendations of the staffing and safety committees:
     (a) The frequency with which the personal alarms must be tested to ensure that the alarms: (i) Are in proper working order; and (ii) transmit signals from all areas of the patient care unit; and
     (b) A minimum response time within which a staff member with accident-incident training shall respond to an activated alarm.

NEW SECTION.  Sec. 6   (1) Each state hospital must provide staff with protective safety equipment. The state hospital must determine:
     (a) The types of equipment needed;
     (b) The proper locations to store the equipment;
     (c) The quantities of equipment necessary to ensure that all staff are equipped with or have easy access to personal protective equipment; and
     (d) Policies on the effective use of the equipment.
     (2) All direct care workforce must receive training on the use of the equipment, which shall:
     (a) Take place during an employee's regularly scheduled work hours; and
     (b) Include instruction on how and when to use the equipment.
     (3) Each state hospital must examine the types of equipment and furniture that are frequently used by patients in assaults on other patients, staff, or self. The state hospital must examine alternatives that may include, but are not limited to:
     (a) The purchase of new equipment and furniture that does not have the same potential to inflict injury; and
     (b) Securing equipment and furniture so that it may not be used to inflict injury.
     (4) The state hospital must consider the recommendations of the staffing and safety committees in fulfilling its obligations under this section.

NEW SECTION.  Sec. 7   Each member of the state hospital safety committee shall receive accident-incident training. The safety committee shall determine the number of additional nursing personnel who must have accident-incident training in order to ensure that the staff can adequately respond to incidents involving patient or staff safety.

NEW SECTION.  Sec. 8   The department of social and health services shall adopt rules necessary to implement this act.

NEW SECTION.  Sec. 9   Sections 2 through 7 of this act are each added to chapter 72.23 RCW.