S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6886
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               May 12, 2023
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law and the education law, in relation
   to standing orders for patient care in hospitals
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  The  public health law is amended by adding a new section
 2803-v-1 to read as follows:
   § 2803-V-1. STANDING ORDERS FOR PATIENT  CARE  IN  A  HOSPITAL.  1.  A
 HOSPITAL  MAY  ESTABLISH STANDING ORDERS FOR THE CARE OF PATIENTS, WHICH
 MAY AUTHORIZE AN ATTENDING NURSE TO  PROVIDE  SERVICES  AND  CARE  TO  A
 PATIENT.  NOTHING  CONTAINED  WITHIN THIS SECTION SHALL AFFECT OR IMPAIR
 THE VALIDITY OF SECTION TWENTY-EIGHT HUNDRED THREE-V OF THIS ARTICLE, AS
 ADDED BY CHAPTER THREE HUNDRED SIXTY-SIX OF THE  LAWS  OF  TWO  THOUSAND
 EIGHTEEN, AS IT RELATES TO STANDING ORDERS FOR THE CARE OF NEWBORNS IN A
 HOSPITAL.
   2. AS USED IN THIS SECTION, UNLESS THE CONTEXT CLEARLY REQUIRES OTHER-
 WISE:
   (A)  "ATTENDING PRACTITIONER" MEANS THE PHYSICIAN, NURSE PRACTITIONER,
 OR PHYSICIAN ASSISTANT ACTING WITHIN HIS OR HER LAWFUL SCOPE  AND  TERMS
 OF PRACTICE, ATTENDING A PATIENT IN A HOSPITAL.
   (B) "ATTENDING NURSE" MEANS A REGISTERED NURSE ATTENDING TO A PATIENT,
 ACTING WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE.
   (C)  "STANDING  ORDER" MEANS A NON-PATIENT SPECIFIC ORDER FOR THE CARE
 OF A PATIENT IN A HOSPITAL, AND SHALL INCLUDE THE FOLLOWING:
   (I) ELECTROCARDIOGRAMS FOR PATIENTS THAT MEET ACUTE  CARDIAC  SYNDROME
 CRITERIA AS DEFINED BY AMERICAN HEART ASSOCIATION GUIDELINES;
   (II)  POINT-OF-CARE  GLUCOSE  SCREENINGS  FOR  PATIENTS WITH SUSPECTED
 HYPOGLYCEMIA AS DEFINED IN AUTHORITATIVE NEUROLOGY CRITERIA  FOR  EVALU-
 ATION OF ACUTE MENTAL STATUS CHANGES;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10534-05-3
 S. 6886                             2
              

 
   (III)  SEPSIS LAB PANELS AND INTRAVENOUS ACCESS FOR PATIENTS THAT MEET
 SEVERE SEPSIS AND SEPTIC SHOCK CRITERIA AS DEFINED IN  THE  DEPARTMENT'S
 SEPSIS REGULATIONS;
   (IV)  PREGNANCY TESTS FOR PATIENTS WITH CHILDBEARING CAPACITY PRIOR TO
 UNDERGOING SELECT IMAGING STUDIES, OPERATIVE PROCEDURES, AND/OR ADMINIS-
 TRATION OF ANESTHETIC AGENTS;
   (V) COVID-19 VACCINES; AND
   (VI) AGE-RELATED CANCER SCREENING AS RECOMMENDED BY THE UNITED  STATES
 PREVENTION  SERVICES  TASKFORCE  INCLUDING  BUT NOT LIMITED TO PROVIDING
 STOOL TESTS TO SCREEN FOR COLORECTAL CANCER AND ORDERING OF MAMMOGRAMS.
   3. A STANDING ORDER MAY BE IMPLEMENTED IN THE CASE OF ANY PATIENT WHEN
 (A) DIRECTED BY THE ATTENDING PRACTITIONER, OR (B) IN THE ABSENCE  OF  A
 SPECIFIC  DIRECTION  BY  THE ATTENDING PRACTITIONER, THE ATTENDING NURSE
 DETERMINES, IN HIS OR HER PROFESSIONAL JUDGMENT, THAT  IMPLEMENTING  THE
 STANDING  ORDER FOR THE PATIENT IS CLINICALLY APPROPRIATE AND CONSISTENT
 WITH THE STANDING ORDER, THE HOSPITAL'S POLICIES  AND  APPLICABLE  REGU-
 LATIONS. THE STANDING ORDER SHALL NOT BE IMPLEMENTED IN A SPECIFIC SITU-
 ATION  WHERE  THE HOSPITAL'S POLICIES, THE STANDING ORDER, OR APPLICABLE
 REGULATIONS PROVIDE OTHERWISE.
   4. (A) A STANDING ORDER SHALL PROVIDE FOR THE CIRCUMSTANCES  IN  WHICH
 THE CONDITION OR CHANGE IN CONDITION OF THE PATIENT REQUIRES A DEPARTURE
 FROM THE TERMS OF THE STANDING ORDER.
   (B)  WHEN  AN  ATTENDING  NURSE  IMPLEMENTING A STANDING ORDER BECOMES
 AWARE OF CIRCUMSTANCES  THAT,  IN  HIS  OR  HER  PROFESSIONAL  JUDGMENT,
 REASONABLY  INDICATE  A  NEED  TO  DEPART FROM THE TERMS OF THE STANDING
 ORDER, HE OR SHE SHALL SO ADVISE THE  ATTENDING  PRACTITIONER.  IN  SUCH
 CIRCUMSTANCES,  IF THE ATTENDING NURSE DETERMINES, IN HIS OR HER PROFES-
 SIONAL JUDGMENT, THAT THE HEALTH OF THE PATIENT REQUIRES DEPARTING  FROM
 THE STANDING ORDER PRIOR TO RECEIVING DIRECTION FROM THE ATTENDING PRAC-
 TITIONER,  THE  ATTENDING  NURSE  MAY  DO SO, CONSISTENT WITH HIS OR HER
 LAWFUL SCOPE OF PRACTICE, THE HOSPITAL'S POLICIES AND  APPLICABLE  REGU-
 LATIONS.
   (C)  THE STANDING ORDER SHALL PROVIDE, INCLUDING THE TIMES AND MANNER,
 THAT AN ATTENDING PRACTITIONER SHALL REVIEW AND ACKNOWLEDGE  IN  WRITING
 THE  SERVICES  AND CARE PROVIDED TO THE PATIENT UNDER THE STANDING ORDER
 AND THE CONDITION OF THE PATIENT.
   5. (A) A STANDING ORDER MAY PROVIDE  FOR  CIRCUMSTANCES  IN  WHICH  IT
 SHALL NOT BE IMPLEMENTED, OR IMPLEMENTED ONLY AT THE ORDER OF AN ATTEND-
 ING PRACTITIONER.
   (B) A STANDING ORDER SHALL BE DATED, TIMED, AND AUTHENTICATED PROMPTLY
 IN  THE PATIENT'S MEDICAL RECORD BY THE ATTENDING PRACTITIONER ACTING IN
 ACCORDANCE WITH LAW, INCLUDING SCOPE-OF-PRACTICE  LAWS,  HOSPITAL  POLI-
 CIES, AND MEDICAL STAFF BYLAWS, RULES AND REGULATIONS.
   6. A STANDING ORDER MAY BE IMPLEMENTED ONLY IF THE IMPLEMENTING HOSPI-
 TAL:
   (A)  ESTABLISHES  THAT THE ORDER HAS BEEN REVIEWED AND APPROVED BY THE
 HOSPITAL'S MEDICAL STAFF AND NURSING AND PHARMACY LEADERSHIP, AND SIGNED
 BY A PHYSICIAN AFFILIATED WITH THE HOSPITAL;
   (B) DEMONSTRATES THAT THE ORDER IS CONSISTENT WITH  NATIONALLY  RECOG-
 NIZED EVIDENCE-BASED GUIDELINES; AND
   (C)  ENSURES  THAT  THE  PERIODIC  AND  REGULAR REVIEW OF THE ORDER IS
 CONDUCTED BY THE HOSPITAL'S MEDICAL STAFF AND NURSING AND PHARMACY LEAD-
 ERSHIP TO DETERMINE THE CONTINUING USEFULNESS AND SAFETY OF THE ORDER.
   7. A STANDING ORDER IS A MEDICAL REGIMEN; IT SHALL BE CONSISTENT  WITH
 THE LAWFUL SCOPE OF PRACTICE OF A REGISTERED NURSE.
 S. 6886                             3
 
   8.  THE  COMMISSIONER MAY MAKE REGULATIONS GOVERNING THE TERMS, PROCE-
 DURES AND IMPLEMENTATION OF STANDING ORDERS.
   §  2.    Section  6527 of the education law is amended by adding a new
 subdivision 12 to read as follows:
   12. A LICENSED PHYSICIAN MAY PRESCRIBE AND ORDER A NON-PATIENT SPECIF-
 IC STANDING ORDER FOR PATIENT CARE IN A HOSPITAL CONSISTENT WITH SECTION
 TWENTY-EIGHT HUNDRED THREE-V-1 OF THE PUBLIC HEALTH LAW.
   § 3. Section 6909 of the education law is amended by  adding  two  new
 subdivisions 12 and 13 to read as follows:
   12.  A  CERTIFIED NURSE PRACTITIONER MAY PRESCRIBE AND ORDER A NON-PA-
 TIENT SPECIFIC STANDING ORDER FOR PATIENT CARE IN A HOSPITAL  CONSISTENT
 WITH SECTION TWENTY-EIGHT HUNDRED THREE-V-1 OF THE PUBLIC HEALTH LAW.
   13.  A  REGISTERED NURSE MAY EXECUTE A STANDING ORDER FOR PATIENT CARE
 IN A HOSPITAL CONSISTENT WITH SECTION TWENTY-EIGHT HUNDRED THREE-V-1  OF
 THE  PUBLIC  HEALTH LAW.  THE COMMISSIONER MAY MAKE REGULATIONS RELATING
 TO IMPLEMENTATION OF THIS SUBDIVISION.
   § 4. This act shall take effect immediately.