Florida Senate - 2022 SB 718
By Senator Bradley
5-00716A-22 2022718__
1 A bill to be entitled
2 An act relating to patient care in health care
3 facilities; amending s. 400.488, F.S.; revising
4 provisions relating to medications and devices with
5 which unlicensed individuals may assist patients in
6 self-administration under certain circumstances;
7 amending s. 401.252, F.S.; specifying staffing
8 requirements for advanced life support ambulances
9 during interfacility transfers; providing that the
10 person occupying the ambulance who has the highest
11 medical certification in this state is in charge of
12 patient care during the transfer; amending s.
13 464.0156, F.S.; revising the list of medications that
14 a registered nurse may delegate the administration of
15 to a certified nursing assistant or home health aide;
16 amending ss. 401.25, 401.27, and 429.256, F.S.;
17 conforming provisions to changes made by the act;
18 providing an effective date.
19
20 Be It Enacted by the Legislature of the State of Florida:
21
22 Section 1. Subsections (2), (3), and (4) of section
23 400.488, Florida Statutes, are amended to read:
24 400.488 Assistance with self-administration of medication.—
25 (2) Patients who are capable of self-administering their
26 own medications without assistance must shall be encouraged and
27 allowed to do so. However, an unlicensed person may, consistent
28 with a dispensed prescription’s label or the package directions
29 of an over-the-counter medication, assist a patient whose
30 condition is medically stable with the self-administration of
31 routine, regularly scheduled medications that are intended to be
32 self-administered. Assistance with self-medication by an
33 unlicensed person may occur only upon a documented request by,
34 and the written informed consent of, a patient or the patient’s
35 surrogate, guardian, or attorney in fact. For purposes of this
36 section, self-administered medications include both legend and
37 over-the-counter oral dosage forms, topical dosage forms,
38 transdermal patches, and topical ophthalmic, otic, and nasal
39 dosage forms, including solutions, suspensions, sprays,
40 inhalers, and nebulizer treatments.
41 (3) Assistance with self-administration of medication
42 includes:
43 (a) Taking the medication, in its previously dispensed,
44 properly labeled container, from where it is stored and bringing
45 it to the patient. For purposes of this paragraph, an insulin
46 syringe that is prefilled with the proper dosage by a pharmacist
47 and an insulin pen that is prefilled by the manufacturer are
48 considered medications in previously dispensed, properly labeled
49 containers.
50 (b) In the presence of the patient, confirming that the
51 medication is intended for that patient, orally advising the
52 patient of the medication name and purpose, opening the
53 container, removing a prescribed amount of medication from the
54 container, and closing the container.
55 (c) Placing an oral dosage in the patient’s hand or placing
56 the dosage in another container and helping the patient by
57 lifting the container to his or her mouth.
58 (d) Applying topical medications, including routine
59 preventive skin care and applying and replacing bandages for
60 minor cuts and abrasions as provided by the agency in rule.
61 (e) Returning the medication container to proper storage.
62 (f) For nebulizer treatments, assisting with setting up and
63 cleaning the device in the presence of the patient, confirming
64 that the medication is intended for that patient, orally
65 advising the patient of the medication name and purpose, opening
66 the container, removing the prescribed amount for a single
67 treatment dose from a properly labeled container, and assisting
68 the patient with placing the dose into the medicine receptacle
69 or mouthpiece.
70 (g) Keeping a record of when a patient receives assistance
71 with self-administration under this section.
72 (g) Assisting with the use of a nebulizer, including
73 removing the cap of a nebulizer, opening the unit dose of
74 nebulizer solutions, and pouring the prescribed premeasured dose
75 of medication into the dispensing cup of the nebulizer.
76 (h) Using a glucometer to perform blood-glucose level
77 checks.
78 (i) Assisting with putting on and taking off antiembolism
79 stockings.
80 (j) Assisting with applying and removing an oxygen cannula
81 but not with titrating the prescribed oxygen settings.
82 (k) Assisting with the use of a continuous positive airway
83 pressure device but not with titrating the prescribed setting of
84 the device.
85 (l) Assisting with measuring vital signs.
86 (m) Assisting with colostomy bags.
87 (4) Assistance with self-administration does not include:
88 (a) Mixing, compounding, converting, or calculating
89 medication doses, except for measuring a prescribed amount of
90 liquid medication or breaking a scored tablet or crushing a
91 tablet as prescribed.
92 (b) The preparation of syringes for injection or the
93 administration of medications by any injectable route.
94 (c) Administration of medications through intermittent
95 positive pressure breathing machines or a nebulizer.
96 (d) Administration of medications by way of a tube inserted
97 in a cavity of the body.
98 (d)(e) Administration of parenteral preparations.
99 (e)(f) Irrigations or debriding agents used in the
100 treatment of a skin condition.
101 (f)(g) Rectal, urethral, or vaginal preparations.
102 (g)(h) Medications ordered by the physician or health care
103 professional with prescriptive authority to be given “as
104 needed,” unless the order is written with specific parameters
105 that preclude independent judgment on the part of the unlicensed
106 person, and at the request of a competent patient.
107 (h)(i) Medications for which the time of administration,
108 the amount, the strength of dosage, the method of
109 administration, or the reason for administration requires
110 judgment or discretion on the part of the unlicensed person.
111 Section 2. Section 401.252, Florida Statutes, is amended to
112 read:
113 401.252 Interfacility transfer.—
114 (1) When conducting an interfacility transfer, a permitted
115 advanced life support ambulance must be occupied by at least two
116 persons: one patient attendant who is a certified paramedic, a
117 registered nurse authorized under subsection (2), or a licensed
118 physician; and one who is a certified emergency medical
119 technician, a certified paramedic, a licensed physician, or an
120 ambulance driver who meets the driver requirements of s.
121 401.281. The person occupying the ambulance who has the highest
122 medical certification in this state is in charge of patient care
123 during the interfacility transfer.
124 (2) A licensed basic or advanced life support ambulance
125 service may conduct interfacility transfers in a permitted
126 ambulance, using a registered nurse in place of an emergency
127 medical technician or paramedic, if:
128 (a) The registered nurse holds a current certificate of
129 successful course completion in advanced cardiac life support;
130 (b) The physician in charge has granted permission for such
131 a transfer, has designated the level of service required for
132 such transfer, and has deemed the patient to be in such a
133 condition appropriate to this type of ambulance staffing; and
134 (c) The registered nurse operates within the scope of part
135 I of chapter 464.
136 (3)(2) A licensed basic or advanced life support service
137 may conduct interfacility transfers in a permitted ambulance if
138 the patient’s treating physician certifies that the transfer is
139 medically appropriate and the physician provides reasonable
140 transfer orders. An interfacility transfer must be conducted in
141 a permitted ambulance if it is determined that the patient
142 needs, or is likely to need, medical attention during transport.
143 If the emergency medical technician or paramedic believes the
144 level of patient care required during the transfer is beyond his
145 or her capability, the medical director, or his or her designee,
146 must be contacted for clearance prior to conducting the
147 transfer. If necessary, the medical director, or his or her
148 designee, shall attempt to contact the treating physician for
149 consultation to determine the appropriateness of the transfer.
150 (4)(3) Infants younger less than 28 days old or infants
151 weighing less than 5 kilograms, who require critical care
152 interfacility transport to a neonatal intensive care unit must,
153 shall be transported in a permitted advanced life support or
154 basic life support transport ambulance, or in a permitted
155 advanced life support or basic life support ambulance that is
156 recognized by the department as meeting designated criteria for
157 neonatal interfacility critical care transport.
158 Section 3. Subsection (2) of section 464.0156, Florida
159 Statutes, is amended to read:
160 464.0156 Delegation of duties.—
161 (2) A registered nurse may delegate to a certified nursing
162 assistant or a home health aide the administration of oral,
163 transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
164 topical prescription medications to a patient of a home health
165 agency, if the certified nursing assistant or home health aide
166 meets the requirements of s. 464.2035 or s. 400.489,
167 respectively. A registered nurse may not delegate the
168 administration of any controlled substance listed in Schedule
169 II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s.
170 812, except for the administration of an insulin syringe that is
171 prefilled with the proper dosage by a pharmacist or an insulin
172 pen that is prefilled by the manufacturer.
173 Section 4. Subsection (7) of section 401.25, Florida
174 Statutes, is amended to read:
175 401.25 Licensure as a basic life support or an advanced
176 life support service.—
177 (7)(a) Each permitted basic life support ambulance not
178 specifically exempted from this part, when transporting a person
179 who is sick, injured, wounded, incapacitated, or helpless, must
180 be occupied by at least two persons: one patient attendant who
181 is a certified emergency medical technician, certified
182 paramedic, or licensed physician; and one ambulance driver who
183 meets the requirements of s. 401.281. This paragraph does not
184 apply to interfacility transfers governed by s. 401.252 s.
185 401.252(1).
186 (b) Each permitted advanced life support ambulance not
187 specifically exempted from this part, when transporting a person
188 who is sick, injured, wounded, incapacitated, or helpless, must
189 be occupied by at least two persons: one who is a certified
190 paramedic or licensed physician; and one who is a certified
191 emergency medical technician, certified paramedic, or licensed
192 physician who also meets the requirements of s. 401.281 for
193 drivers. The person with the highest medical certifications
194 shall be in charge of patient care. This paragraph does not
195 apply to interfacility transfers governed by s. 401.252 s.
196 401.252(1).
197 Section 5. Subsection (1) of section 401.27, Florida
198 Statutes, is amended to read:
199 401.27 Personnel; standards and certification.—
200 (1) Each permitted ambulance not specifically exempted from
201 this part, when transporting a person who is sick, injured,
202 wounded, incapacitated, or helpless, must be occupied by at
203 least two persons, one of whom must be a certified emergency
204 medical technician, certified paramedic, or licensed physician
205 and one of whom must be a driver who meets the requirements for
206 ambulance drivers. This subsection does not apply to
207 interfacility transfers governed by s. 401.252 s. 401.252(1).
208 Section 6. Paragraph (a) of subsection (3) of section
209 429.256, Florida Statutes, is amended to read:
210 429.256 Assistance with self-administration of medication.—
211 (3) Assistance with self-administration of medication
212 includes:
213 (a) Taking the medication, in its previously dispensed,
214 properly labeled container, including an insulin syringe that is
215 prefilled with the proper dosage by a pharmacist and an insulin
216 pen that is prefilled by the manufacturer, from where it is
217 stored, and bringing it to the resident. For purposes of this
218 paragraph, an insulin syringe that is prefilled with the proper
219 dosage by a pharmacist and an insulin pen that is prefilled by
220 the manufacturer are considered medications in previously
221 dispensed, properly labeled containers.
222 Section 7. This act shall take effect July 1, 2022.