With the law, An Act Relative to Patient Limits in All Hospital Intensive Care Units, critically ill patients in Massachusetts hospitals will be guaranteed safer care and closer monitoring from registered nurses as a new law goes into effect that sets safe patient limits for registered nurses who work in all the state’s hospital intensive care units. The law requires that no nurse can be assigned more than one patient or in certain circumstances, a maximum of two patients based on the assessment of the nurses on that unit. (The full text of the law can be found at the end of this story.)

The new law, An Act Relative to Patient Limits in All Hospital Intensive Care Units, was signed by Governor Deval Patrick on June 30 after passing with unanimous votes in the House and Senate becomes effective as of Sept. 29, 2014, 90 days following the signing.

“This is an important patient safety measure for the most critically ill patients providing them with one-on-one attention from their registered nurse when they need it most,” said Donna Kelly-Williams, RN, president of the Massachusetts Nurses Association/National Nurses United. “It is important for the public to be aware of this new measure as their health and safety in the hospital is directly related to the number of patients assigned to their nurse.”

To help educate the public about the new law, the MNA/NNU has launched a TV and radio ad campaign to alert the public about the law and to advise them to ask how many other patients their nurse is being assigned. (View TV ad | Listen to radio ad)

The law was passed in response to dozens of research studies that clearly show safe patient limits for nurses is the key to improving the care and safety of patients, leading to fewer patient complications, shorter hospital stays, lower readmission rates and higher patient satisfaction, while also saving millions of dollars due to these improved patient outcomes. In fact one study found that safe patient limits like those required under this new law, could reduce hospital acquired infections for ICU patients by 63 percent.

What the Law Does

• The new law applies to every type of intensive care unit in all the state’s hospitals, including medical intensive care units, surgical intensive care units, Coronary Care Units, neonatal intensive care units and pediatric intensive care units.

• The law sets a limit of one patient per nurse. A nurse can only take a second patient based on the assessment of the staff nurses on the unit and a soon to be developed acuity tool. The acuity tool will have standardized criteria to help determine the stability of the patients and all hospitals will be utilizing the same criteria. Until the acuity tool is developed, the staff nurses on the unit will determine if and when a second patient can be assigned, and if they can’t agree, then a supervisor or manager can be called in to help make the determination. In no instance and under no circumstances can an ICU nurse be assigned a third patient.

• The state’s Health Policy Commission (HPC) is regulating the implementation of the proposed law, including the formulation of the acuity tool, the method of public reporting of staffing compliance in hospital ICUs, and the identification of three to five patient safety quality indicators. The HPC has scheduled a Listening Session in Boston on Oct, 29 to gather testimony from nurses, hospitals and others to assist them in fleshing out the final regulations for the acuity criteria, reporting and compliance under the law and the quality indicators that will be measured

Law Sets Foundation for Expansion of Limits to Other Units

“This measure will protect the most critically ill patients and it breaks the decade-long logjam on Beacon Hill over the issue of establishing an enforceable maximum limit on the number of patients a nurse can care for at one time,” said Kelly-Williams. More importantly, it moves us closer to our ultimate goal, which is to extend safe patient limits beyond the ICUs to all other units of our hospitals to protect all patients.”

Having established a foundation for safe patient limits for intensive care units with the new law, the MNA/NNU plans to introduce legislation to extend patient limits to all other hospital units in the next legislative session.

The Commonwealth of Massachusetts

In the Year Two Thousand Fourteen

An Act relative to patient limits in all hospital intensive care units.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Chapter 111 of the General Laws is hereby amended by inserting after section 229 the following 2 sections:

Section 231. For the purposes of this section, the term “intensive care units” shall have the same meaning as defined in 105 CMR 130.020 and shall include intensive care units within a hospital operated by the commonwealth.

Notwithstanding any general or special law to the contrary, in all intensive care units the patient assignment for the registered nurse shall be 1:1 or 1:2 depending on the stability of the patient as assessed by the acuity tool and by the staff nurses in the unit, including the nurse manager or the nurse manager’s designee when needed to resolve a disagreement.

The acuity tool shall be developed or chosen by each hospital in consultation with the staff nurses and other appropriate medical staff and shall be certified by the department of public health. The health policy commission shall promulgate regulations governing the implementation and operation of this act including: the formulation of an acuity tool; the method of reporting to the public on staffing compliance in hospital intensive care units; and the identification of 3 to 5 related patient safety quality indicators, which shall be measured and reported by hospitals to the public.

From the archives of the Mass. Nurses Association.

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