S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6030--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 30, 2023
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on  Health -- committee discharged, bill amended, ordered reprinted as
   amended and recommitted to said committee
 
 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.  NOTWITHSTANDING  THIS  SECTION,  SECTION  TWENTY-EIGHT HUNDRED
 THREE-V OF THIS ARTICLE, AS ADDED BY CHAPTER 366 OF THE  LAWS  OF  2018,
 SHALL  APPLY  IN THE CASE OF STANDING ORDERS FOR THE CARE OF NEWBORNS IN
 THE HOSPITAL.
   2. AS USED IN THIS SECTION, UNLESS THE CONTEXT CLEARLY REQUIRES OTHER-
 WISE:
   (A) "HOSPITAL" MEANS A HOSPITAL THAT ROUTINELY PROVIDES PATIENT CARE.
   (B) "ATTENDING PRACTITIONER" MEANS THE PHYSICIAN, SURGEON, NURSE PRAC-
 TITIONER, OR PHYSICIAN ASSISTANT ACTING WITHIN HIS OR HER  LAWFUL  SCOPE
 AND TERMS OF PRACTICE, ATTENDING A PATIENT IN A HOSPITAL.
   (C) "ATTENDING NURSE" MEANS A REGISTERED NURSE ATTENDING TO A PATIENT,
 ACTING WITHIN HIS OR HER LAWFUL SCOPE OF PRACTICE.
   (D)  "STANDING  ORDER" MEANS A NON-PATIENT SPECIFIC ORDER FOR THE CARE
 OF A PATIENT IN A HOSPITAL, ESTABLISHED UNDER THIS SECTION.
   3. NOTWITHSTANDING ANY OTHER PROVISION OF LAW, A REGISTERED NURSE  MAY
 ADMINISTER  THE  FOLLOWING PROCEDURES UPON AN ORDER BY A LICENSED PHYSI-
 CIAN OR SURGEON OR AN ORDER BY A NURSE PRACTITIONER OR PHYSICIAN ASSIST-
 ANT:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10534-02-3
 A. 6030--A                          2
              

 
   (A) ELECTROCARDIOGRAMS FOR PATIENTS THAT MEET ACUTE  CARDIAC  SYNDROME
 CRITERIA AS DEFINED BY AMERICAN HEART ASSOCIATION GUIDELINES.
   (B) POINT-OF-CARE GLUCOSE SCREENINGS FOR PATIENTS WITH SUSPECTED HYPO-
 GLYCEMIA  AS  DEFINED IN AUTHORITATIVE NEUROLOGY CRITERIA FOR EVALUATION
 OF ACUTE MENTAL STATUS CHANGES.
   (C) SEPSIS LAB PANELS AND INTRAVENOUS ACCESS FOR  PATIENTS  THAT  MEET
 SEVERE  SEPSIS  AND SEPTIC SHOCK CRITERIA AS DEFINED IN THE DEPARTMENT'S
 SEPSIS REGULATIONS.
   (D) PREGNANCY TESTS FOR PATIENTS WITH CHILDBEARING CAPACITY  PRIOR  TO
 UNDERGOING SELECT IMAGING STUDIES, OPERATIVE PROCEDURES, AND/OR ADMINIS-
 TRATION OF ANESTHETIC AGENTS.
   4. 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.
   5.  (A)  A STANDING ORDER SHALL PROVIDE FOR THE CIRCUMSTANCES IN WHICH
 THE CONDITION OR CHANGE IN CONDITION OF THE PATIENTS REQUIRES  A  DEPAR-
 TURE 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.
   6. (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.
   7. 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.
   8. A STANDING ORDER IS A MEDICAL REGIMEN; IT SHALL BE CONSISTENT  WITH
 THE LAWFUL SCOPE OF PRACTICE OF A REGISTERED NURSE.
 A. 6030--A                          3
 
   9.  THE  COMMISSIONER MAY MAKE REGULATIONS GOVERNING THE TERMS, PROCE-
 DURES AND IMPLEMENTATION OF STANDING ORDERS.
   §  2.  Section  6909  of  the education law is amended by adding a new
 subdivision 11 to read as follows:
   11. A REGISTERED NURSE MAY EXECUTE A STANDING ORDER FOR  PATIENT  CARE
 IN  A  HOSPITAL ESTABLISHED UNDER SECTION TWENTY-EIGHT HUNDRED THREE-V-1
 OF THE PUBLIC HEALTH LAW, AS PROVIDED IN THAT SECTION. THE  COMMISSIONER
 MAY MAKE REGULATIONS RELATING TO IMPLEMENTATION OF THIS SUBDIVISION.
   § 3. This act shall take effect immediately.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6030--B
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 30, 2023
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on  Health -- committee discharged, bill amended, ordered reprinted as
   amended and recommitted to said committee -- again reported from  said
   committee  with amendments, ordered reprinted as amended and recommit-
   ted to said committee

 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;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10534-04-3
 A. 6030--B                          2
              

 
   (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;
   (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.
 A. 6030--B                          3
 
   7. A STANDING ORDER IS A MEDICAL REGIMEN; IT SHALL BE CONSISTENT  WITH
 THE LAWFUL SCOPE OF PRACTICE OF A REGISTERED NURSE.
   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.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6030--C
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 30, 2023
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on  Health -- committee discharged, bill amended, ordered reprinted as
   amended and recommitted to said committee -- again reported from  said
   committee  with amendments, ordered reprinted as amended and recommit-
   ted to said committee --  again  reported  from  said  committee  with
   amendments,  ordered  reprinted  as  amended  and  recommitted to said
   committee
 
 AN ACT to amend the education law, in relation to  non-patient  specific
   orders a registered professional nurse may perform
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 4 of section  6909  of  the  education  law  is
 amended  by  adding four new paragraphs (i), (j), (k) and (l) to read as
 follows:
   (I) ADMINISTERING ELECTROCARDIOGRAM TESTS TO DETECT SIGNS AND SYMPTOMS
 OF ACUTE CORONARY SYNDROME.
   (J) ADMINISTERING POINT-OF-CARE BLOOD GLUCOSE TESTS TO EVALUATE  ACUTE
 MENTAL STATUS CHANGES IN PERSONS WITH SUSPECTED HYPOGLYCEMIA.
   (K)  ADMINISTERING  TESTS  AND  INTRAVENOUS LINES TO PERSONS THAT MEET
 SEVERE SEPSIS AND SEPTIC SHOCK CRITERIA.
   (L) ADMINISTERING TESTS TO DETERMINE PREGNANCY.
   § 2. Subdivision 6 of section 6527 of the education law is amended  by
 adding four new paragraphs (i), (j), (k) and (l) to read as follows:
   (I) ADMINISTERING ELECTROCARDIOGRAM TESTS TO DETECT SIGNS AND SYMPTOMS
 OF ACUTE CORONARY SYNDROME.
   (J)  ADMINISTERING POINT-OF-CARE BLOOD GLUCOSE TESTS TO EVALUATE ACUTE
 MENTAL STATUS CHANGES IN PERSONS WITH SUSPECTED HYPOGLYCEMIA.
   (K) ADMINISTERING TESTS AND INTRAVENOUS LINES  TO  PERSONS  THAT  MEET
 SEVERE SEPSIS AND SEPTIC SHOCK CRITERIA.
   (L) ADMINISTERING TESTS TO DETERMINE PREGNANCY.
   § 3. This act shall take effect immediately.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10534-06-3