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A09950 Summary:

BILL NOA09950B
 
SAME ASSAME AS S08774-B
 
SPONSORGottfried
 
COSPNSRBraunstein, Englebright, Cahill, McDonald, D'Urso, Crouch, Thiele, Sepulveda, Seawright, Buchwald, Lifton, Dickens, Taylor, Jaffee, Niou, Lupardo, Barron, Zebrowski, Norris, Lawrence, Errigo, Montesano, Blake, Ortiz, Cook, Mosley, Lavine, Glick, Crespo, Bichotte, De La Rosa, Goodell, Rivera, Fahy, Rosenthal L, Espinal
 
MLTSPNSRDavila, Giglio, Hyndman
 
Add 2803-v, Pub Health L; amd 6909, Ed L
 
Authorizes hospitals to establish standing orders for the care of newborns in the hospital until the discharge of the newborn from the hospital following the birth, which may authorize an attending nurse to provide services and care to healthy newborns.
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A09950 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A9950B
 
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the public health law and the educa- tion law, in relation to hospital standing orders for the care of newborns   PURPOSE OR GENERAL IDEA OF BILL: To allow hospitals to establish non-patient specific orders for the care of healthy newborns by an attending registered nurse.   SUMMARY OF PROVISIONS: Section 1 creates a new section 2803-v in the public health law, author- izing hospitals to create standing orders for newborn care. Subdivision 1 authorizes a hospital to establish standing orders for the care of newborns. Subdivision 2 defines terms. Subdivision 3 provides that a standing order may be implemented either when directed by the attending practitioner, or when the attending nurse determines that implementing the standing order is clinically appropri- ate and consistent with the order, the hospital's policies, and applica- ble regulations. Subdivision 4 requires that a standing order provide for the circum- stances in which departure from the order is required, and that an attending nurse shall advise the attending practitioner if the nurse becomes aware of circumstances that reasonably indicate a need to depart from the standing order. The order must also provide that the attending practitioner shall review and acknowledge in writing the care provided under the standing order. Subdivision 5 allows a standing order to provide for circumstances in which it shall not be implemented or shall only be implemented at the order of an attending practitioner. A standing order shall also be dated, timed, and authenticated promptly in the patient's medical record by the attending practitioner. Subdivision 6 requires that in order to implement a standing order, a hospital must: establish that the order has been reviewed and approved by the hospital's medical staff and nursing and pharmacy leadership, and signed by a physician or midwife affiliated with the hospital; demon- strate that the order is consistent with nationally recognized evidence-based guidelines; and ensure that the hospital's medical staff and nursing and pharmacy leadership conduct periodic and regular reviews of the order to determine its continuing usefulness and safety. Subdivision 7 provides that a standing order is a medical regimen and shall be consistent with the lawful scope of practice of a registered nurse. Subdivision 8 allows the commissioner to make regulations governing the terms, procedures, and implementation of standing orders. Section 2 adds a new subdivision 9 to section 6909 of the education law to provide that a registered professional nurse may execute a standing order for newborn care in a hospital established under section 2803-v of the public health law. Section 3 is the effective date.   JUSTIFICATION: Until recently, it was common for hospitals to establish non-patient specific orders for the care of infants delivered within their facili- ties. These orders enabled registered nurses (RNs) to carry out standard procedures following deliveries of healthy babies, without a specific order from the attending obstetric or pediatric practitioner. They were initiated by the RN, were evidence-based, and included state-mandated treatments that must be performed within specified time limits for all healthy newborns, such as antibiotic eye prophylaxis, administration of vitamin K, and HIV and metabolic disorder testing. Such treatments and services are well within the scope of practice of a registered nurse. Since births often occur when the attending physician, nurse practition- er, physician assistant, or midwife is unavailable, an RN's ability to initiate the routine care of a healthy newborn is an important part of ensuring timely care. New York law authorizes "non-patient specific regimens" to allow RNs to do such things as administer certain treatments and tests, including immunizations and HIV tests, to patients without a patient-specific order from a physician for each individual. Since the law does not explicitly include standing orders for the care of healthy newborns, some authorities interpret hospital standing orders for newborn care to be illegal. The bill maintains the authority of the attending practitioner, the hospital, and Health Department regulations, and protects the role and scope of practice of RNs. This bill will allow hospitals to establish non-patient specific stand- ing orders for RNs to initiate upon the birth of a healthy newborn in their facility. Each hospital will establish the circumstances in which its order will and will not be implemented without a patient-specific order from the attending practitioner, and all orders will comply with an RN's scope of practice and all applicable regulations.   PRIOR LEGISLATIVE HISTORY: New bill.   FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None.   EFFECTIVE DATE: This act shall take effect one hundred twenty days after it shall become a law. Effective immediately, the commissioner may make regulations and take other actions reasonably necessary to implement this act on that date.
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A09950 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         9950--B
 
                   IN ASSEMBLY
 
                                    February 27, 2018
                                       ___________
 
        Introduced by M. of A. GOTTFRIED, BRAUNSTEIN, ENGLEBRIGHT, CAHILL, McDO-
          NALD,  D'URSO,  CROUCH,  THIELE, SEAWRIGHT, BUCHWALD, LIFTON, DICKENS,
          TAYLOR, JAFFEE, NIOU, LUPARDO, BARRON,  ZEBROWSKI,  NORRIS,  LAWRENCE,
          ERRIGO,  MONTESANO, BLAKE, ORTIZ, COOK, MOSLEY, LAVINE, GLICK, CRESPO,
          BICHOTTE, DE LA ROSA, GOODELL, RIVERA, FAHY -- Multi-Sponsored  by  --
          M.  of  A.  DAVILA,  GIGLIO,  HYNDMAN -- read once and referred to the
          Committee on Health -- reported and referred to the Committee on Codes
          -- committee discharged, bill amended, ordered  reprinted  as  amended
          and  recommitted  to  said  committee  -- reported and referred to the
          Committee on  Rules  --  Rules  Committee  discharged,  bill  amended,
          ordered reprinted as amended and recommitted to the Committee on Rules
 
        AN ACT to amend the public health law and the education law, in relation
          to hospital standing orders for the care of newborns
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. The public health law is amended by adding  a  new  section
     2  2803-v to read as follows:
     3    § 2803-v. Standing orders for newborn care in a hospital.  1. A hospi-
     4  tal may establish standing orders for the care of newborns in the hospi-
     5  tal  until  the discharge of the newborn from the hospital following the
     6  birth, which may authorize an attending nurse to  provide  services  and
     7  care to healthy newborns.
     8    2. As used in this section, unless the context clearly requires other-
     9  wise:
    10    (a) "Hospital" means a hospital that routinely provides perinatal care
    11  to newborns.
    12    (b)  "Attending practitioner" means the physician, nurse practitioner,
    13  physician assistant or midwife, acting within his or  her  lawful  scope
    14  and  terms  of  practice,  attending  the  birth  or postnatal care of a
    15  newborn in a hospital.
    16    (c) "Attending nurse" means a registered nurse attending the postnatal
    17  care of a newborn, acting within his or her lawful scope of practice.
    18    (d) "Standing order" means a non-patient specific order for  the  care
    19  of healthy newborns in the hospital, established under this section.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14792-04-8

        A. 9950--B                          2
 
     1    3. A standing order may be implemented in the case of any newborn when
     2  (a)  directed  by the attending practitioner, or (b) in the absence of a
     3  specific direction by the attending practitioner,  the  attending  nurse
     4  determines,  in  his or her professional judgment, that implementing the
     5  standing  order for the newborn is clinically appropriate and consistent
     6  with the standing order, the hospital's policies  and  applicable  regu-
     7  lations. The standing order shall not be implemented in a specific situ-
     8  ation  where  the hospital's policies, the standing order, or applicable
     9  regulations provide otherwise.
    10    4. (a) A standing order shall provide for the circumstances  in  which
    11  the  condition  or  change  in condition of the newborn or the newborn's
    12  mother, or other circumstances relating to providing services  and  care
    13  to the newborn, require departure from the terms of the standing order.
    14    (b)  Where  an  attending  nurse implementing a standing order becomes
    15  aware of circumstances  that,  in  his  or  her  professional  judgment,
    16  reasonably  indicate  a  need  to  depart from the terms of the standing
    17  order, he or she shall so advise the  attending  practitioner.  In  such
    18  circumstances,  if the attending nurse determines, in his or her profes-
    19  sional judgment, that the health of the newborn requires departing  from
    20  the standing order prior to receiving direction from the attending prac-
    21  titioner,  the  attending  nurse  may  do so, consistent with his or her
    22  lawful scope of practice, the hospital's policies and  applicable  regu-
    23  lations.
    24    (c)  The standing order shall provide, including the times and manner,
    25  that an attending practitioner shall review and acknowledge  in  writing
    26  the  services  and care provided to the newborn under the standing order
    27  and the condition of the newborn.
    28    5. (a) A standing order may provide  for  circumstances  in  which  it
    29  shall not be implemented, or implemented only at the order of an attend-
    30  ing practitioner, which may include but not be limited to:
    31    (i) lack of or inadequate prenatal care;
    32    (ii) a birth not attended by an attending practitioner;
    33    (iii) a birth not occurring in a hospital; or
    34    (iv) a premature or low birth weight birth.
    35    (b) A standing order shall be dated, timed, and authenticated promptly
    36  in  the patient's medical record by the attending practitioner acting in
    37  accordance with law, including scope-of-practice  laws,  hospital  poli-
    38  cies, and medical staff bylaws, rules and regulations.
    39    6. A standing order may be implemented only if the implementing hospi-
    40  tal:
    41    (a)  establishes  that the order has been reviewed and approved by the
    42  hospital's medical staff and nursing and pharmacy leadership, and signed
    43  by a physician affiliated with the hospital or, in the case of a midwif-
    44  ery birth center, by a midwife affiliated with the hospital;
    45    (b) demonstrates that the order is consistent with  nationally  recog-
    46  nized evidence-based guidelines; and
    47    (c)  ensures  that  the  periodic  and  regular review of the order is
    48  conducted by the hospital's medical staff and nursing and pharmacy lead-
    49  ership to determine the continuing usefulness and safety of the order.
    50    7. A standing order is a medical regimen; it shall be consistent  with
    51  the lawful scope of practice of a registered nurse.
    52    8.  The  commissioner may make regulations governing the terms, proce-
    53  dures and implementation of standing orders.
    54    § 2. Section 6909 of the education law is  amended  by  adding  a  new
    55  subdivision 9 to read as follows:

        A. 9950--B                          3
 
     1    9.  A  registered  professional nurse may execute a standing order for
     2  newborn care  in  a  hospital  established  under  section  twenty-eight
     3  hundred  three-v  of the public health law, as provided in that section.
     4  The commissioner may make regulations relating to implementation of this
     5  subdivision.
     6    § 3. This act shall take effect on the one hundred twentieth day after
     7  it  shall have become a law.  Effective immediately, the commissioner of
     8  health and the commissioner of education may make regulations  and  take
     9  other actions reasonably necessary to implement this act on that date.
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