Bill Text: HI SB917 | 2012 | Regular Session | Introduced

Hawaii Senate Bill 917 (Prior Session Legislation)

Introduced

Bill Title: Preterm Births; Nurse Coordinator; Task Force; Appropriation

Spectrum: Partisan Bill (Democrat 8-0)

Status: (Introduced - Dead) 2011-12-01 - Carried over to 2012 Regular Session. [SB917 Detail]

Download: Hawaii-2012-SB917-Introduced.html

THE SENATE	S.B. NO.	917
TWENTY-SIXTH LEGISLATURE, 2011
STATE OF HAWAII

A BILL FOR AN ACT

relating to health.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that preterm birth is the leading cause of deaths among newborns, accounting for twenty-four per cent of infant deaths in the first month of life. One out of every eight babies born in Hawaii is the result of a premature or preterm birth, defined in this Act as a birth that occurs at less than thirty-seven weeks of gestation. As of 2008, 12.8 per cent of babies in Hawaii were born prematurely. Late preterm births, which occur between thirty-four and thirty-six weeks of gestation, account for much of the increase in premature births in the past decade, accounting for seventy per cent of premature births. The rate of births by cesarean delivery has also risen from more than eighteen per cent in 1999 to twenty-six per cent in 2006.

The legislature finds that premature babies may suffer life-long effects, including cerebral palsy, mental retardation, chronic lung disease, and vision and hearing loss, and late preterm infants have a higher incidence of morbidity and mortality in comparison to full term infants. The annual estimated cost of premature births and their associated effects was over $26,200,000,000 in 2005 in the United States.

The legislature finds that while there are risk factors that may indicate the need for a premature birth, including a prior premature birth, spontaneous abortion, low pre-pregnancy weight, and the use of alcohol, tobacco, or other drugs during pregnancy, these risk factors account for only about one-third of all preterm births.

The legislature finds that work has already begun, both nationally and locally, to reduce elective inductions and preterm cesarean deliveries. The American College of Obstetricians and Gynecologists (ACOG) guidelines call for the confirmation of thirty-nine weeks of gestation for single births prior to the elective, or non-medically indicated, induction of labor under most circumstances. The ACOG has promoted multiple strategies to reduce the rate of premature births, including delaying non-medically indicated inductions and cesarean deliveries until thirty-nine weeks of gestation. Additionally, the national Healthy People 2020 draft objective on preterm births, retained from the Healthy People 2010 objective on preterm births, is to decrease the proportion of births that are premature to 7.6 per cent, with no more than 1.1 per cent of all births being very preterm, or less than thirty-two weeks of gestation.

In California, the March of Dimes Foundation, California Maternal Quality Care Collaborative, and California Department of Public Health collaboratively developed a toolkit titled "Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age" to help disseminate and determine best practices for the prevention of early deliveries and to determine the most effective strategies for supporting California health care providers in implementing those practices.

In Hawaii, the legislature adopted house concurrent resolution no. 215, S.D. 1, during the 2009 regular session to request the department of health to review and assess the policies and procedures implemented by hospitals to reduce elective cesarean sections and inductions of labor. In response to the resolution, the department of health convened a workgroup to review and assess the criteria used by hospitals and physicians for medical indications to elective preterm inductions or cesarean sections and the policies and procedures implemented by hospitals to reduce elective cesarean sections and inductions of labor. The workgroup collected data through surveys of hospitals and physicians in the State. Through the survey data, the workgroup found some variation in the guidelines used by the hospitals in the State regarding guidelines for elective inductions and preterm cesarean deliveries, wide variation in the awareness of hospitals to changes in the rates of elective inductions and preterm cesarean deliveries performed among hospitals in the State, and a general lack of training opportunities relating to elective inductions and preterm cesarean deliveries.

Despite efforts to reduce preterm births, there remains a need for standardized guidelines and procedures among hospitals in Hawaii that are current with accepted best practices and guidelines, better awareness of the risks of elective inductions and preterm cesarean deliveries, and increased training opportunities among hospital personnel relating to elective inductions and preterm cesarean deliveries. The legislature believes that the department of health is the appropriate agency to lead efforts in meeting these needs.

The purpose of this Act is to require the department of health to establish a quality assurance nurse coordinator and a task force to lead efforts to reduce elective inductions and preterm cesarean deliveries in the State.

SECTION 2. Chapter 321, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part . PRETERM BIRTHS

§321‑ Definitions. As used in this part:

"Department" means the department of health.

"Director" means the director of health.

"Elective induction" means an induction of labor that is non-medically indicated.

"Preterm" means occurring at less than thirty-seven weeks of gestation.

§321‑ Quality assurance nurse coordinator. (a) There is established in the department of health a quality assurance nurse coordinator position. The position may be appointed by the director, in consultation with the division chief of the family health services division of the department of health, in accordance with chapter 76. The quality assurance nurse coordinator shall coordinate all activities relating to the development of policies and procedures for reducing the rate of elective inductions and preterm cesarean deliveries performed in the State.

(b) No later than January 1, 2012, the quality assurance nurse coordinator shall develop and maintain current interdisciplinary best practices training materials and a learning collaboration model for practitioners, physicians, staff, and registrars of hospitals, community health centers, and other institutions, as necessary, in the State.

(c) Upon the approval by the director of the training materials and learning collaboration model developed by the quality assurance nurse coordinator pursuant to subsection (b), the quality assurance nurse coordinator shall provide training to practitioners, physicians, staff, and registrars of hospitals, community health centers, and other institutions, as necessary, in the State. The quality assurance nurse coordinator shall also coordinate training efforts within the State to ensure that all hospitals with obstetric units adopt standardized best practices with regard to elective induction and preterm cesarean deliveries."

SECTION 3. (a) The director of health shall convene a preterm birth task force within the department of health to collaborate with the John A. Burns school of medicine, the department of human services, and representatives of health plan providers in the State to develop best practices recommended by the quality assurance nurse coordinator established pursuant to this Act, the American College of Obstetricians and Gynecologists, or the Institute for Healthcare Improvement.

(b) The task force shall consist of the following members:

(1) One representative of the family health services division of the department of health to be appointed by the director of health;

(2) One representative of the March of Dimes Foundation;

(3) One representative of the Healthcare Association of Hawaii;

(4) One representative of the Med-Quest division of the department of human services to be appointed by the director of human services;

(5) One representative of the Healthy Mothers, Healthy Babies Coalition of Hawaii; and

(6) Two physicians specializing in obstetrics or gynecology, one to be appointed by the president of the senate and one to be appointed by the speaker of the house of representatives.

(1) Review laws and rules governing the licensure of hospitals in the State and determine whether amendments should be made to those laws and rules to require that all hospitals with obstetric units develop standardized policies that are consistent and current with American College of Obstetricians and Gynecologists guidelines or other best practices for reducing elective inductions and preterm cesarean deliveries;

(2) Develop and implement a public awareness campaign to educate the public on the risks of elective inductions or preterm cesarean deliveries and track data on the effectiveness of the campaign;

(3) Use trends and other information obtained through public health records and birth certificates to examine other issues that may be related to elective inductions of labor and preterm cesarean sections; and

(4) Track data relating to the rate of preterm births and the effect of changes in the rate of preterm births on infant morbidity and mortality.

(d) The task force shall submit a report to the legislature on its findings and recommendations, including proposed legislation, no later than twenty days prior to the convening of the regular session of 2012 and every fifth regular session thereafter.

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $158,000 or so much thereof as may be necessary for fiscal year 2011-2012 and the same sum or so much thereof as may be necessary for fiscal year 2012-2013 for the establishment of one full-time quality assurance nurse coordinator position within the department of health.

The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 5. This Act shall take effect on July 1, 2011.

INTRODUCED BY:	_____________________________

Report Title:

Preterm Births; Nurse Coordinator; Task Force; Appropriation

Description:

Establishes a quality assurance nurse coordinator and task force within the department of health to coordinate policies and procedures, increase awareness, and provide training to various health care providers to reduce elective preterm births in the State. Appropriates funds for the quality assurance nurse coordinator position.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.