GUIDELINES. under THE PRIVATE HOSPITALS AND MEDICAL CLINICS ACT (1980) AND REGULATIONS (1991) MINISTRY OF HEALTH SINGAPORE

Transcription

1 GUIDELINES uner THE PRIVATE HOSPITALS AND MEDICAL CLINICS ACT (1980) AND REGULATIONS (1991) MINISTRY OF HEALTH SINGAPORE

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4 GUIDELINES FOR PRIVATE HOSPITALS, MEDICAL CLINICS AND CLINICAL LABORATORIES uner the Privte Hospitls n Meil Clinis At (1980) n Privte Hospitls n Meil Clinis Regultions (1991) Issue y Diretor of Meil Servies Ministry of Helth

5 First Eition (Jn 1993) 1 Otoer 2007 Singpore

6 Contents Contents i Forewor iii Chpter 1 - Introution 1 Chpter 2 - Applition Forms 3 Chpter 3 - Generl Guielines 7 Chpter 4 - Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) 11 Chpter 5 - Speifi Guielines for Nursing Homes 31 Chpter 6 - Speifi Guielines for Mternity Homes 43 Chpter 7 - Speifi Guielines for Meil Clinis 57 Chpter 8 - Speifi Guielines for Clinil Lortories 61 6

7 Forewor The Privte Hospitls n Meil Clinis (PHMC) At n the Regultions uner the At will ome into opertion on 1 Jn 93. These Guielines re to ssist the liensee n the mngement of privte hospitls, meil linis n linil lortories in omplying with the requirements uner the PHMC At n its Regultions, n other iretives tht my e issue from time to time y the Diretor of Meil Servies. They over the pplition proess, generl requirements n requirements speifi to types of helth re estlishments. We hope tht these Guielines will serve s useful n prtil hnook for ll helth re estlishments on the stnrs require for operting privte hospitls, meil linis n linil lortories. DR KWA SOON BEE PERMANENT SECRETARY (HEALTH)/ DIRECTOR OF MEDICAL SERVICES Jnury Ot 07 7

8 Chpter 1 - Introution 1.1 The Privte Hospitls n Meil Clinis At 1980 n Regultions 1991 regulte n govern the ministrtion n mngement of ll privte hospitls, meil linis n linil lortories in Singpore. 1.2 All persons who wish to operte privte hospitl, meil lini or linil lortory must pply for liene from the Diretor of Meil Servies (herefter lle the Diretor) n ensure tht they omply with the ove legisltion. It is lso their responsiility to keep themselves informe of n to oserve ll other relevnt sttutory requirements. 1.3 Uner the Regultions, it is mntory for the liensees to omply with ny guielines whih re issue from time to time y the Diretor, suh s those pulishe in these Guielines. These Guielines esrie the minimum stnrs whih must e estlishe n mintine in orer to seure liensing from the Diretor. Any liene issue my lso e sujet to other terms n onitions s speifie y the Diretor. 1.4 Referene to the pproprite Regultion is given in these Guielines for onveniene. Unless otherwise stte, ny referene to meil prtitioner shll inlue entist. Unless otherwise stte, privte hospitls inlue nursing n mternity homes. 1.5 Liensees n prospetive pplints requiring ny itionl informtion shoul ontt the Exeutive Offier, Meil Auit & Areittion Unit t telephone numer Copies of the At n the Regultions re ville from the Singpore Ntionl Printers. 8

9 Chpter 2 - Applition Forms 2.1 Applition for liene must e me on the Applition Form s speifie on the First Sheule of the Regultions issue y the Diretor n sumitte with ll relevnt supporting ouments to the Diretor. 2.2 The Applition Form shll e typewritten. Where the spe provie is insuffiient, n pplint my furnish the informtion on seprte sheet of pper, whih shll lso e typewritten. Applints shll ensure tht omplete n urte informtion is given in the Applition Form. The Diretor reserves the right to rejet inomplete pplition forms. 2.3 In the Applition Form, plese note the following: Nme n ress of the premises refer to tht of the privte hospitl, meil lini or linil lortory. Dte of first estlishment refers to the te when the helth re estlishment ommene opertions. Approvl from the Plnning Deprtment, Ministry of Ntionl Development must e otine y ll privte hospitls n linil lortories in Singpore efore ommenement of opertions. If pplile, sumit photoopy of the "Notie of Grnt of Written Permission" from the Chief Plnner, Urn Reevelopment Authority, Ministry of Ntionl Development. This setion is not pplile to meil lini in Housing Development Bor (HDB) estte. Clerne from the Singpore Fire Sfety Bureu, Ministry of Home Affirs must e otine for premises ontrolle y HDB. Plese sumit photoopy of the Approvl from the Builing Control Deprtment of HDB. For non-hdb premises, sumit photoopy of 9

10 10 Applition Forms either the "Temporry Ouption Liene" or the "Certifite of Sttutory Completion" s soon s it is issue y the Puli Works Deprtment. e The relevnt professionl registrtion numer shll ompny the nmes of ll professionls tht re mentione in the Applition Form, for exmple, the nmes of otors shll e ompnie y their Meil Counil Registrtion Numer. 2.4 FORM A shll e omplete y those intening to set up n operte privte hospitl, inluing mternity or nursing home. For privte hospitls with linil lortory, Qulity Assurne Mnul for the linil lortory must e sumitte together with the pplition. If itionl Speilise Servies s set out in the Seon Sheule of the Regultions re intene susequent to the pplition, the liensee must sumit n pplition to the Diretor together with supporting ouments. 2.5 FORM B shll e omplete y those intening to set up n operte lini proviing meil n/or entl servies. If itionl Speilise Servies s set out in the Thir Sheule of the Regultions re intene susequent to the pplition, the liensee must sumit n pplition to the Diretor together with supporting ouments. 2.6 FORM C shll e omplete y those intening to set up n operte linil lortory. A Qulity Assurne Mnul must e sumitte t the time of pplition for liene.

11 Chpter 3 - Generl Guielines Duties n responsiilities of persons who mnge privte hospitl, meil lini or linil lortory (Regultion 9) 3.1 Any person who mnges privte hospitl, meil lini or linil lortory shll, where pplile: t ll times exerise lose personl supervision of the premises n the persons employe therein n use ll orers n iretions of the meil prtitioner in hrge of the ptients to e fithfully n iligently rrie out; keep n mintin ll mterils, equipment n pplines neessry for the proper ignosis, re or tretment of ptients or running of the servies n shll provie ny itionl equipment n pplines s my e irete y the Diretor from time to time; ept for mission into the privte hospitl (exluing nursing homes) only those ptients reommene y registere meil prtitioner; e responsile for the mintenne of the stnrs of prtie eptle to the Diretor; e e responsile for the notifition for ny ptient with or suspete to hve notifile isese, s require uner the Infetious Diseses At. Duty of mnger of privte hospitl (Regultion 10) 3.2 Further to proviing informtion on the estimte totl ill for perio of hospitlistion, privte hospitls (exluing nursing n mternity homes) shll lso mke ville to ptients prior to mission, omprtive informtion on the verge ill size per y t government n privte hospitls. 11

12 12 Generl Guielines 3.3 The hospitls re to vise ptients using Meisve of the estimte mount of Meisve whih n e use. 3.4 Where professionl fees re hrge seprtely from the hospitlistion hrges for the privte hospitls, the meil prtitioner in hrge of the ptient shll mke ville n estimte of the professionl fees whih re likely to e inurre uring his sty. Stff Reors 3.5 Every privte hospitl, meil lini or linil lortory shll keep reors of ll persons engge in mngement or helth re servies, with the following prtiulrs: nme, sex, te of irth, ientity r/pssport numer n ress; qulifitions n uties; te(s) of employment. Clenliness n Hygiene 3.6 The internl finishes of the premises shll e of suh mterils whih will permit esy wshing n lening. 3.7 Every prt of the premises shll e mintine t ll times in len n snitry onition n in goo stte of repir. Lighting n ventiltion 3.8 Aequte lighting n ventiltion for the premises shll e provie. Design

13 Generl Guielines Ais to filitte the movement of users of the premises (for exmple, lifts, rmps n hnrils) shll e ville where pproprite. Disposl of infetious n wste mterils 3.10 Every privte hospitl, meil lini or linil lortory shll ensure tht ll infetious n wste mterils shll e properly isinfete n ispose of in orne with lws suh s those ministere y the Ministry of Environment n the Ministry of Helth, n ny other existing lws. Guielines for prevention of trnsmission of Humn Immunoefiieny Virus n other infetious iseses 3.11 Every privte hospitl, meil lini or linil lortory shll omply with ny guielines tht my e issue from time to time y the Diretor on the prevention of trnsmission of Humn Immunoefiieny Virus n other infetious iseses.

14 Chpter 4 - Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) Meil Reors (Regultion 11) 4.1 The prtiulrs whih must e inlue in the ptient's registrtion reor shll e the following: ptient's nme, ientity r/irth ertifite/pssport numer, sex, te of irth, ethni group n resientil ress; nme n ress of the meil prtitioner(s) proviing the re n tretment or requesting investigtions; tes n times of onsulttion, mission, investigtions, ishrge or eth. 4.2 The meil reor of eh ptient shll inlue: e f g h i the mission form; the ptient's meil history, n ny referrl ouments; linil finings n progress notes; meition, nursing re, tretment n iet notes; reor of llergies n other ftors requiring speil onsiertion, if ny; reports of ll lortory tests performe; reors of ll Xry n other investigtions performe; onsent forms, where pplile; ishrge sttement whih summrises the signifint finings n 14

15 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) 15 events of the ptient's sty, onition on ishrge n reommentions n rrngements for future re. 4.3 Where surgil proeure hs een performe, the following shll lso e inlue: the nestheti reor, inluing preopertive ssessment; the opertion report, inluing preopertive n post-opertive ignosis, esription of finings, tehnique use n tissue remove or ltere; n if tissue or oy flui ws remove, the histopthology report. 4.4 Where there is mternity servie, the following prtiulrs shll lso e inlue: e f the lour reor: te n time of elivery n whether the result ws liveirth, stillirth or ortion; sex, weight n height of the neworn, irumferene of he n onition of neworn t irth; nme(s) of person(s) ttening to the ptient uring elivery; onition of mother n neworn on ishrge; nme, ress n reltionship of the person who reeive the neworn from the privte hospitl on ishrge. 4.5 All meil reors shll e urte, suffiiently etile, legile, urrent, seure, omplete n onfientil n orgnise to enle: the meil prtitioner responsile for the ptient to provie ontinuing re to the ptient, to etermine lter wht the ptient's onition ws t speifi time, n to review the ignosti n

16 16 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) therpeuti proeures performe n the ptient's response to tretment; nother meil prtitioner to rener n opinion fter n exmintion of the ptient n review of the meil reor; nother meil prtitioner to ssume the re of the ptient t ny time; the retrievl of pertinent informtion require for utilistion review n qulity ssurne tivities. 4.6 All originl inptient n outptient hospitl meil reors shll e retine for n pproprite length of time. Filities 4.7 Ptients of ifferent sex shll not e llowe to oupy the sme room, exept: for ptients in n intensive re unit, high epeneny re, reovery room or oservtion room; for hilren uner twelve yers of ge, who shll e ommote in wr seprte from ults; for newly elivere ies n their mothers. 4.8 Every room or wr oupie or intene to e oupie y ptient shll hve t lest the following: suitle hospitl e, mttress, pillow, hir n loker fility for every ptient; equte lighting n ventiltion; e sreening filities, where neessry; ptient-to-nurse ommunition system.

17 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) There shll e equte n properly mintine snitry filities for ptients A privte hospitl with mternity servies shll e provie with: Suitle rooms with emergeny light n power supply, oxygen n sution filities n wsh sin to e use exlusively s irth rooms; n Seprte milk preprtion res suitly site n equippe, outsie of whih no fees for infnts my e prepre Be spe provision shll e suffiient: to ensure the omfort n sfety of ptients; to prevent isese trnsmission; n to llow proper tretment of the ptients. Opertion Thetre Filities (Regultion 15) 4.12 Opertion thetre filities shll e: Lrge enough to ommote ll personnel, fittings n equipment n to llow ll proeures n movements to e rrie out in omfort n sfety; Provie with emergeny lighting n power supply; Provie with post-nestheti reovery res with filities for the elivery of oxygen n negtive pressure sution Aeptle levels of sterility shll e mintine for the opertion thetre, ssoite filities n opertive equipment. Intensive Cre Unit (Regultion 16)

18 18 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) 4.14 The Intensive Cre Unit shll e provie with filities for: the elivery of oxygen n negtive pressure sution; the ontinuous respirtory n ri support of the ptient; n ri efirilltion with synhronistion. Trnsport rrngements 4.15 Every privte hospitl shll estlish rrngements wherey ptient n e trnsporte to other helth re estlishments for meil tretment Where privte hospitl intens to provie servie wherey ill persons n e trnsporte, it shll hve mulnes whih must e ppropritely ientifie, properly equippe n meet ll other relevnt existing requirements. Linen Servie 4.17 Linen shll e: equtely supplie n pproprite to the purposes of the premises; len n hnge s neessry n t pproprite intervls; effetively lunere with resonle preutions tken to prevent its ontmintion therefter; ppropritely lunere if it omes into ontt with ptients with potentilly infetious iseses. Bloo Servies (Regultion 20) 4.18 The Bloo Servies provie y privte hospitl must omply with the relevnt guielines for Speilise Servies uner Sheules Two n Three.

19 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) 19 Dieteti Servies (Regultion 21) 4.19 Persons involve in the preprtion n provision of foo in privte hospitls shll omply with the sme requirements s for foohnlers engge in the sle of foo In prtiulr, the following preutions shll e tken: ll foo hnlers shll oserve proper personl hygiene n hve regulr n pproprite helth sreening; the foo provie shll e properly store n hnle; foo wstes shll e properly ispose in mnner tht oes not rete nuisne or reeing ple for pests or otherwise permit the trnsmission of isese; there must e proper snittion proeures for lensing n mintenne of equipment n work res Premises n filities for preprtion n serving of foo must similrly meet with ll requirements s for premises involve in the sle of foo.

20 20 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) Clinil Lortory Servies (Regultion 23) 4.22 The Qulity Assurne Mnul of the lortory shll e sumitte together with the pplition form for the liene. The formt of the Qulity Assurne Mnul shll inlue the following: e Philosophy n Ojetives The linil lortory shll provie high qulity linil lortory n ignosti servies. The linil lortory is expete to hieve lose n informe reltionship with the meil prtitioners in respet of the servies provie, with prtiulr referene to the esy n rpi ess to results, t, opinion n vie. Orgnistion, Aministrtion n Reors The linil lortory shll hve urrent written orgnistionl hrt, n uties n responsiilities for ll lssifitions of personnel. There shll e effetive methos for ommunition to ensure prompt n relile reporting. There shll e pproprite reor storge n retrievl. Stffing n Diretion The linil lortory shll e irete y meil prtitioner or sientifi stff qulifie to ssume professionl, orgnistionl, n ministrtive responsiility for the filities, n for the servies renere. There shll e suffiient personnel who hve equte qulifitions n experiene to supervise n onut the work of the lortories. Filities n Equipment There shll e suffiient spe, equipment n supplies within ll lortories to perform the require volume of work professionlly n ministrtively n with ury, preision, effiieny n sfety. Poliies n Proeures The linil lortory shll hve te, written poliies n proeures se upon urrent knowlege n

21 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) 21 priniples. f g Stff Development & Eutionl Progrmmes There shll e pproprite ontinuing professionl eution progrmmes. Qulity Assurne n Evlution There shll e n overll linil lortory qulity ssurne progrmme whih shll inlue internl n externl proeures y whih the prtie n stnrs of the linil lortory re ssesse n y whih the reliility n meil usefulness of linil lortory t re emonstrte. These proeures shll provie mehnism to enle the t otine from the evlutions to e use effetively for the ongoing improvements of the servie, in terms of its efine ims n ojetives A "trine person" in the Regultions refers to ny person who stisfies one of the following requirements: registere Meil Prtitioner who i hols postgrute qulifition in ny pthology sujet, inluing histopthology, ytology, miroiology, immunology, hemtology, immunohemtology n iohemistry, OR ii hs t lest five yers of pprove experiene in linil lortory eptle to the Ministry of Helth Lortory Bor. A person with meil egree or si egree in relevnt Siene sujet eptle to the Ministry of Helth Lortory Bor, n five yers relevnt working experiene in linil lortory eptle to the Ministry of Helth Lortory Bor. A egree in meil lortory tehnology eptle to the Ministry of Helth Lortory Bor n 3 yers relevnt working experiene in linil lortory eptle to the Ministry of Helth Lortory Bor.

22 22 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) e A pss in the Deprtmentl Qulifying Exmintions of the Ministry of Helth or iplom in meil lortory tehnology eptle to the Ministry of Helth Lortory Bor n 3 yers relevnt working experiene in linil lortory eptle to the Ministry of Helth Lortory Bor. Registrtion s qulifie lortory tehnologist in the relevnt isipline y the Ministry of Helth Lortory Bor se on equivlent qulifitions n experiene. Meil Servies (Regultion 24) 4.24 The meil stff shll e properly orgnise to provie linil servies to ptients, to represent the professionl nees of the meil stff n to ensure full involvement of the stff in qulity ontrol of ptient re. Nursing Servies (Regultion 25) 4.25 The nursing eprtment (or servie) shll e irete y n ministrtor who is registere nurse with the pproprite qulifitions n experiene. In the nurse ministrtor's sene, registere nurse who is suitly qulifie shll e uthorise to t in her ple The nursing eprtment shll hve: A written orgnistionl pln tht elinetes lines of uthority, ountility n ommunition; Written poliies n proeures to guie the provision of nursing re; n Written jo esriptions for ll tegories of nursing stff speifying the funtions, responsiilities n speifi qulifitions of eh position.

23 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) The hospitl nursing eprtment shll e responsile for: The professionl onut n prties of its nurses; n The nursing re n relte uties when nursing stuents re proviing re within ptient re unit Nurse stffing shll e suh tht: The rtio of the nursing stff to ptient is not less thn 1 to 1.5. The perentge of Registere Nurses of the totl nursing stff s require y this rtio is not less thn 60%. The reminer my inlue enrolle nurses, miwives n nursing ies. A suffiient numer of registere nurses re on uty t ll times to give ptients the nursing re tht requires the jugement n speilise skills of registere nurse In the se of psyhitri n onvlesent hospitls, the rtio of nursing stff n helth ttennts to ptients shll not e less thn: 1 : 2.5 for ute mission ptients, with t lest 60% omprising registere nurses; 1 : 3 for short-sty ptients, with t lest 60% omprising registere nurses; 1 : 4 for long-sty, geritri, rehilittion n onvlesent ptients, with t lest 40% omprising registere nurses; n 1 : 5 for mentlly retre n hroni sik ptients, with t lest 40% omprising registere nurses The ove guielines on stffing estlishment my e moifie in ny mnner s the Diretor thinks fit epening on the use of the privte hospitl.

24 24 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) 4.31 Nursing stff orgnistion shll e suh tht: e f Approprite ministrtion of nursing servies is provie on ll shifts. A registere nurse is on uty t ll times in the wr or unit to pln, supervise n evlute ll nursing re. The ptient re ssignment is ommensurte with the qulifitions of eh nursing stff, the ientifie nursing nees of the ptient n the presrie meil regime. A registere nurse is responsile for the sfe ustoy, reoring, ministrtion, hnling n isposl of ontrolle rugs. A registere nurse with pproprite speilise skills is on uty t ll times where speilise nursing re is require. There is prompt reognition of ny untowr hnge in ptient's onition to filitte pproprite interventions The nursing eprtment shll mintin high nursing stnrs, n: Tke ll resonle mesures to provie optiml qulity re. Ensure tht the nursing re provie to ptients is in orne with the pprove stnrs of nursing prtie. Ensure tht registere nurse ssesses eh ptient's nees n prolems within the perio estlishe y the nursing eprtment following mission. Hve estlishe stnrs of nursing re n mehnisms for evluting suh re to monitor the qulity of nursing re provie The registere nurse shll e responsile for eh ptient's nursing re pln. The following requirements must e met: The nursing re plns shll e oumente in orne with the

25 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) 25 pprove stnrs of nursing prtie. The nursing tions shll e rrie out oring to the re pln n the ptient's response shll e reore. Continuous evlution of ptient shll e performe to etermine the ptient's urrent helth sttus The nursing stff shll prtiipte in ontinuing eution to mintin n upgre their urrent ompeteny There shll e n ongoing Nursing Qulity Assurne Progrmme to monitor n evlute the qulity n ppropriteness of nursing re. Drugs, et (Regultion 27) 4.36 Every privte hospitl shll mintin: storge of ll ntiseptis, rugs for externl use n isinfetnts seprte from internl n injetle meition; n equte supply of meiinl prouts n pproprite reors of suh prouts; mens of ientifying the signtures of ll meil prtitioners uthorise to use the phrmeutil servies for presriptions. Qulity Assurne (Regultion 29) 4.37 There shll e Qulity Assurne Progrmme to ensure qulity ptient re through ojetive n systemti monitoring, evlution, ientifition of prolems n tion to improve the level n ppropriteness of suh re The following re essentil omponents of the Qulity Assurne Progrmme. The privte hospitl shll estlish n give full support to Qulity

26 26 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) Assurne Committee, n hospitl-wie qulity ssurne progrmme; There shll e written pln for the Qulity Assurne Progrmme esriing its ojetives, orgnistion, mehnisms n sope; The sope of the Qulity Assurne Progrmme shll inlue monthly oumente review of ll eths, n ll tissues remove t opertions for isese; The privte hospitl shll ensure tht links re estlishe etween the progrmme, mngement n the linil spets of ptient re to ensure tht the neessry tions re tken to remey ientifie efiienies The privte hospitl shll sumit to the Diretor qurterly reports of the finings, reommentions, tions tken n results of tions tken on: voile eths; n tissues remove t opertion ut reporte s norml The privte hospitl shll ensure tht the Qulity Assurne Progrmme is evlute t lest yerly, n revise if neessry. Equipment (Regultion 30) 4.41 Every privte hospitl shll ensure tht proeures re rwn up regring the proper use, re n mintenne of ll equipment use in the privte hospitl n shll omply with estlishe or reommene proeures Every piee of equipment use in ny enosopi, opertive or invsive proeure shll e renere sterile y the pproprite proeure.

27 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) 27 Infetion Control (Regultion 31) 4.43 There shll e n tive hospitl-wie infetion ontrol progrmme with mesures evelope to prevent, ientify n ontrol infetions quire in or rought into the privte hospitl. This shll inlue the following: e f g There is system for reporting, evluting n mintining t on the iniene n trens of infetions mong ptients n personnel; An Infetion Control Committee shll e estlishe. Infetion Control stff shll e ppointe, trine n uthorise to rry out suh monitoring n ontrol tivities; Infetion Control tivities shll e oumente, n pertinent finings ommunite to hospitl mngement for follow-up tion, n use in the privte hospitl's eution progrmmes; There shll e written poliies, proeures n guielines for: i septi n isoltion tehniques, ii snittion proeures, iii presriing of ntiiotis in the hospitl; The privte hospitl shll estlish system: i to etet n lert pproprite uthorities out outreks of infetious isese mong its ptients or stff; n ii to prevent n ontrol suh n outrek. The privte hospitl shll ensure tht its infetion ontrol poliies n proeures re evlute regulrly n on ontinuing sis All new employees shll e orientte regring the progrmme; 4.44 The Diretor shll e informe immeitely of: Any ptient or stff with notifile isese,

28 28 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) Outreks of hospitl-quire infetions. Avertising (Regultion 32) 4.45 The purpose of vertising y privte hospitl shll e to inform the puli out the types n nture of servies whih re ville. Flse or misleing sttements out the privte hospitl or other helth re estlishments or proviers re uneptle n unethil. The vertisements shll onform to the Avertising Stnrs Assoition of Singpore (ASAS) Coe of Avertising Prties n ny guielines s issue y the Diretor The informtion whih my e islose in vertisements re: Generl etils, inluing nme, ress, hours of servie, hrges, ontt person (y esigntion only); Aommotion filities, inluing lsses of ommotion, numer of es per lss, osts, moe of pyment, n filities tthe (for exmple, throom, television, telephone); Professionl servies (for exmple, Aient & Emergeny, Surgil, Ostetri & Gyneology, Psyhitry); Speil filities (for exmple, Amulne, Coronry Cre Unit, Dignosti Servies) Mention of the following is prohiite in vertisements: Servies whih re not owne y the privte hospitl; Comprison, either iret or y implition, etween the servies, filities or employees of one privte hospitl n nother; The use of superltives in esriing the filities n servies of the privte hospitl n lims of prominene or uniqueness; Any mention of nmes of otors or of the personl skills or servies of

29 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) 29 iniviul otors ssoite with the privte hospitl; e f Testimonils of iniviuls or ptients; n Sles promotions Avertising y privte hospitl my e in ny mei in Singpore ut shll e restrine, voiing full pge or lengthy vertisements n too frequent vertising All vertisements must e sumitte to the Diretor for pprovl prior to use Privte hospitls whih vertise in other ountries must omply with ll requirements in the ountries onerne. Fire preutions (Regultion 33) 4.51 The preutions ginst the risk of fire shll inlue the following spets: estlishing fire evution pln; provision of equte mens of espe in the event of fire n ensuring tht ll fire espe pssges n stirses re ler of ostrution t ll times; mking equte rrngements for eteting, ontining n extinguishing fire, for the giving of wrnings n for the evution of ll persons in the privte hospitl in the event of fire; e f mintenne of fire preutions n fire fighting equipment; mking rrngements to seure y mens of regulr fire rills n prties tht ll stff in the privte hospitl n so fr s prtile, ptients know the proeure to e followe in the se of fire, inluing the proeure for sving life; onuting fire rills perioilly n mintining reor of ll fire

30 30 Speifi Guielines for Privte Hospitls (exluing mternity n nursing homes) rills; n g isplying onspiuously in the premises noties of the proeures to e followe in the event of fire.

31 Chpter 5 - Speifi Guielines for Nursing Homes Meil Reors (Regultion 11) 5.1 The prtiulrs whih must e inlue in the ptient's registrtion reor shll e the following: ptient's nme, ientity r/irth ertifite/pssport numer, sex, te of irth, ethni group, resientil ress n ontt numer of the next of kin; tes n times of onsulttion, mission, ishrge or eth. 5.2 The meil reor of eh ptient shll inlue informtion on the following: e f the mission; the ptient's meil onition, n ny referrl ouments; meition; nursing re; progress; llergies n other ftors requiring speil onsiertion, if ny. 5.3 All meil reors shll e urte, legile, suffiiently etile, urrent, seure, omplete n onfientil n orgnise to enle: ontinuity of meil n nursing re to e provie to the ptient; the trnsfer of meil n nursing re to the pproprite fility when neessry; ny meil prtitioner involve in the re of ptient i to provie ontinuing re to the ptient, 31

32 32 Speifi Guielines for Nursing Homes ii iii iv to etermine lter wht the ptient's onition ws t speifi time, n rener n opinion fter n exmintion of the ptient n review of the meil reor; to review ny investigtions n tretment performe n the ptient's response to tretment; to ssume the re of the ptient t ny time. 5.4 All originl meil reors shll e retine for n pproprite length of time. Filities 5.5 Ptients of ifferent sex shll not e llowe to oupy the sme room. 5.6 Every room or wr oupie or intene to e oupie y ptient shll hve t lest the following: suitle e, mttress, pillow, hir n loker fility for every ptient; equte lighting n ventiltion; e sreening filities, where neessry; n effetive system for ptient-to-nurse ommunition. 5.7 There shll e equte n properly mintine snitry filities for ptients. 5.8 Be spe provision shll e suffiient: to ensure the omfort n sfety of ptients; to prevent isese trnsmission; n to llow proper tretment of the ptients. 5.9 A nursing home shll provie: reretionl filities for ptients;

33 Speifi Guielines for Nursing Homes 33 ouptionl therpy n physiotherpy for ptients, where neessry; n ounselling servies for ptients, where neessry. Trnsport rrngements 5.10 Every nursing home shll estlish rrngements wherey ptient n e trnsporte to other helth re estlishments for meil tretment s neessry Where irumstnes eyon the ontrol of the nursing home prevent the rrivl of meil prtitioner within hlf n hour of ll, these rrngements must e use in timely mnner to trnsport the ill ptient to the relevnt helth re estlishment for tretment Where nursing home intens to provie servie wherey ill persons n e trnsporte, it shll hve mulnes whih must e ppropritely ientifie, properly equippe n meet ll other relevnt existing requirements. Linen Servie 5.13 Linen shll e: equtely supplie n pproprite to the purposes of the premises; len n hnge s neessry n t pproprite intervls; effetively lunere with resonle preutions tken to prevent its ontmintion therefter; ppropritely lunere if it omes into ontt with ptients. Dieteti Servies (Regultion 21)

34 34 Speifi Guielines for Nursing Homes 5.14 Persons involve in the preprtion n provision of foo in nursing homes shll omply with the sme requirements s for foohnlers engge in the sle of foo In prtiulr, the following preutions shll e tken: ll foo hnlers shll oserve proper personl hygiene n hve regulr n pproprite helth sreening; the foo provie shll e properly store n hnle; foo wstes shll e properly ispose in mnner tht oes not rete nuisne or reeing ple for pests or otherwise permit the trnsmission of isese; there must e proper snittion proeures for lensing n mintenne of equipment n work res Premises n filities for preprtion n serving of foo must similrly meet with ll requirements s for premises involve in the sle of foo. Nursing Servies (Regultion 25) 5.17 The nursing eprtment (or servie) shll e irete y n ministrtor who is registere nurse with the pproprite qulifitions n experiene. In the nurse ministrtor's sene, registere nurse who is suitly qulifie shll e uthorise to t in her ple The nursing eprtment shll hve: A written orgnistionl pln tht elinetes lines of uthority, ountility n ommunition; Written poliies n proeures to guie the provision of nursing re; n

35 Speifi Guielines for Nursing Homes 35 Written jo esriptions for ll tegories of nursing stff speifying the funtions, responsiilities n speifi qulifitions of eh position The nursing eprtment shll e responsile for the professionl onut n prties of its nurses The numer n omposition of re stff shll e suffiient to provie equte re to the resients n in orne to stnrs set out y the Diretor. The guielines on stffing estlishment my e moifie in ny mnner s the Diretor thinks fit epening on the use of the nursing home. There shll preferly e t lest one registere nurse onttle t ll times Nursing stff orgnistion shll e suh tht: Approprite ministrtion of nursing servies is provie on ll shifts. The ptient re ssignment is ommensurte with the qulifitions of eh nursing stff, the ientifie nursing nees of the ptient n the presrie meil regime. A registere nurse is responsile for the sfe ustoy, reoring, ministrtion, hnling n isposl of ontrolle rugs. There is prompt reognition of ny untowr hnge in ptient's onition to filitte pproprite interventions The nursing eprtment shll mintin high nursing stnrs, n: Tke ll resonle mesures to provie optiml qulity re. Ensure tht the nursing re provie to ptients is in orne with the pprove stnrs of nursing prtie. Ensure tht registere nurse ssesses eh ptient's nees n prolems within the perio estlishe y the nursing eprtment following mission.

36 36 Speifi Guielines for Nursing Homes 5.23 The registere nurse shll e responsile for eh ptient's nursing re pln. The following requirements must e met: The nursing re plns shll e oumente in orne with the pprove stnrs of nursing prtie. The nursing tions shll e rrie out oring to the re pln n the ptient's response shll e reore. Continuous evlution of ptient shll e performe to etermine the ptient's urrent helth sttus The nursing stff shll prtiipte in ontinuing eution to mintin n upgre their urrent ompeteny There shll e n ongoing qulity ssurne progrmme to monitor n evlute the qulity n ppropriteness of nursing re. Drugs, et (Regultion 27) 5.26 Every nursing home shll mintin: storge of ll ntiseptis, rugs for externl use n isinfetnts seprtely from internl n injetle meition; n equte supply of meiinl prouts n pproprite reors of suh prouts. Qulity Assurne (Regultion 29) 5.27 The Qulity Assurne Progrmme shll inlue the following tivities: infetion ontrol review; n review of eths, ients, injuries n ptient sfety.

37 Speifi Guielines for Nursing Homes The nursing home shll set out stnrs for the re it provies, to help ientify prolems n provie opportunities to improve suh re The finings, reommentions, tions tken n results of tions tken in the Qulity Assurne Progrmme shll e oumente n reporte to the Diretor nnully The Diretor shll e informe monthly s to the numer n iniviul nture of serious mishps n ients ourring mong ptients The nursing home shll ensure tht the Qulity Assurne Progrmme is evlute t lest yerly, n revise if neessry. Infetion Control (Regultion 31) 5.32 Every nursing home shll hve written poliies, proeures or guielines for: septi n isoltion tehniques; n snittion proeures The nursing home shll estlish system to etet n lert pproprite uthorities out outreks of infetious isese mongst its ptients or stff, n pln to prevent n ontrol suh n outrek The nursing home shll ensure tht its infetion ontrol poliies n proeures re evlute regulrly n on ontinuing sis All new employees shll e orientte regring the progrmme The Diretor shll e informe immeitely whenever ny ptient or stff ontrts notifile isese. Avertising (Regultion 32)

38 38 Speifi Guielines for Nursing Homes 5.37 The purpose of vertising y nursing home shll e to inform the puli out the types n nture of servies whih they hve ville. Flse or misleing sttements out the nursing home, other helth re estlishments or proviers re uneptle n unethil. The vertisements shll onform to the Avertising Stnrs Assoition of Singpore (ASAS) Coe of Avertising Prties n ny guielines issue y the Diretor The informtion whih my e islose in vertisements re: Generl etils, inluing nme, ress, hours of servie, hrges, ontt person (y esigntion only); Aommotion filities, inluing lsses of ommotion, numer of es per lss, osts, moe of pyment, n filities tthe (for exmple, throom, TV, telephone); Speil filities (for exmple, mulne servie) Mention of the following is prohiite in vertisements: e f Servies whih re not owne y the nursing home; Comprison, either iret or y implition, etween the servies, filities or employees of one nursing home n nother; The use of superltives in esriing the filities n servies of the nursing home, n lims of prominene or uniqueness; Any mention of nmes of otors or of the personl skills or servies of iniviul otors ssoite with the nursing home; Testimonils of iniviuls or ptients; n Sles promotions Avertising y nursing home my e in ny mei ut shll e restrine,

39 Speifi Guielines for Nursing Homes 39 voiing full pge or lengthy vertisements n too frequent vertising All vertisements must e sumitte to the Diretor for pprovl prior to use. Fire preutions (Regultion 33) 5.42 The preutions ginst the risk of fire shll inlue: estlishing fire evution pln; provision of equte mens of espe in the event of fire n ensuring tht ll fire espe pssges n stirses re ler of ostrution t ll times; mking equte rrngements for eteting, ontining n extinguishing fire, for the giving of wrnings n for the evution of ll persons in the nursing home in the event of fire; e f g mintenne of fire preutions n fire fighting equipment; mking rrngements to seure y mens of regulr fire rills n prties tht ll stff in the nursing home n so fr s prtile, ptients know the proeure to e followe in the se of fire, inluing the proeure for sving life; onuting fire rills perioilly n mintining reor of ll fire rills; n isplying onspiuously in the premises noties of the proeures to e followe in the event of fire.

40 Chpter 6 - Speifi Guielines for Mternity Homes Meil Reors (Regultion 11) 6.1 The prtiulrs whih must e inlue in the ptient's registrtion reor shll e the following: ptient's nme, ientity r/irth ertifite/pssport numer, sex, te of irth, ethni group, resientil ress n ontt numer of next of kin; nme n ress of the meil prtitioner(s) proviing the re n tretment or requesting investigtions; tes n times of onsulttion, mission, investigtions, ishrge or eth. 6.2 The meil reor of eh ptient shll inlue: e f g h i the mission form; the ptient's meil history, n ny referrl ouments; linil finings; meition reors; nursing re reors, tretment n iet sheets; progress notes; reor of llergies n other ftors requiring speil onsiertion, if ny; reports of lortory tests performe; reports of Xry n other investigtions performe; 40

41 Speifi Guielines for Mternity Homes 41 j k onsent forms, where pplile; ishrge sttement whih summrises the signifint finings n events of the ptient's sty, onition on ishrge n reommentions n rrngements for future re. 6.3 The following prtiulrs shll lso e inlue: e f the lour reor; te n time of elivery n whether the result ws live-irth, stillirth or ortion; sex, weight n height of the neworn, irumferene of he n onition of neworn t irth; nme(s) of person(s) ttening to the ptient uring elivery; onition of mother n neworn on ishrge; nme n ress of the person who reeive the neworn from the mternity home on ishrge. 6.4 All meil reors shll e urte, suffiiently etile, legile, urrent, seure, omplete n onfientil n orgnise to enle: the meil prtitioner responsile for the ptient to provie ontinuing re to the ptient, to etermine lter wht the ptient's onition ws t speifi time, n to review the ignosti n therpeuti proeures performe n the ptient's response to tretment; nother meil prtitioner to rener n opinion fter n exmintion of the ptient n review of the meil reor; nother meil prtitioner to ssume the re of the ptient t ny time;

42 42 Speifi Guielines for Mternity Homes the retrievl of pertinent informtion require for utilistion review n qulity ssurne tivities. 6.5 All originl inptient n outptient meil reors shll e retine for n pproprite length of time. Filities 6.6 Every room or wr oupie or intene to e oupie y ptient shll hve t lest the following: suitle hospitl e, mttress, pillow, hir n loker fility for every ptient; equte lighting n ventiltion; e sreening filities, where neessry; ptient-to-nurse ommunition system. 6.7 There shll e equte n properly mintine snitry filities for ptients. 6.8 A mternity home shll e provie with: Suitle rooms with emergeny light n power supply, oxygen n sution filities n wsh sin to e use exlusively s irth rooms; n Seprte milk preprtion res suitly site n equippe, outsie of whih no fees for infnts my e prepre. 6.9 Be spe provision shll e suffiient: to ensure the omfort n sfety of ptients; to prevent isese trnsmission; n to llow proper tretment of the ptients.

43 Speifi Guielines for Mternity Homes 43 Trnsport rrngements 6.10 Every mternity hospitl shll estlish rrngements wherey ptient n e trnsporte to other helth re estlishments for meil tretment s neessry Where mternity home intens to provie servie wherey ill persons n e trnsporte, it shll hve mulnes whih must e ppropritely ientifie, properly equippe n meet ll other relevnt existing requirements. Linen Servie 6.12 Linen shll e: equtely supplie n pproprite to the purposes of the premises; len n hnge s neessry n t pproprite intervls; effetively lunere with resonle preutions tken to prevent its ontmintion therefter; ppropritely lunere if it omes into ontt with ptients. Bloo Servies (Regultion 20) 6.13 The Bloo Servies provie y ny mternity home must omply with Regultion 20 n the relevnt guielines for Speilise Servies uner Sheules Two n Three. Dieteti Servies (Regultion 21) 6.14 Persons involve in the preprtion n provision of foo in mternity homes shll omply with the sme requirements s for foohnlers engge in the

44 44 Speifi Guielines for Mternity Homes sle of foo In prtiulr, the following preutions shll e tken: ll foo hnlers shll oserve proper personl hygiene n hve regulr n pproprite helth sreening; the foo provie shll e properly store n hnle; foo wstes shll e properly ispose in mnner tht oes not rete nuisne or reeing ple for pests or otherwise permit the trnsmission of isese; there must e proper snittion proeures for lensing n mintenne of equipment n work res Premises n filities for preprtion n serving of foo must similrly meet with ll requirements s for premises involve in the sle of foo. Nursing Servies (Regultion 25) 6.17 The nursing eprtment (or servie) shll e irete y n ministrtor who is registere nurse with the pproprite qulifitions n experiene. In the nurse ministrtor's sene, registere nurse who is suitly qulifie shll e uthorise to t in her ple The nursing eprtment shll hve: A written orgnistionl pln tht elinetes lines of uthority, ountility n ommunition; Written poliies n proeures to guie the provision of nursing re; n Written jo esriptions for ll tegories of nursing stff speifying the funtions, responsiilities n speifi qulifitions of eh position.

45 Speifi Guielines for Mternity Homes The nursing eprtment shll e responsile for the professionl onut n prties of its nurses Nurse stffing shll e suh tht: The rtio of the nursing stff to e is not less thn 1 to 5 ptients. At lest 60% of nursing stff re registere miwives, inluing registere nurses with miwifery qulifitions. There is t lest one miwife on uty t ll times The ove guielines on stffing estlishment my e moifie in ny mnner s the Diretor thinks fit epening on the use of the mternity home Nursing stff orgnistion shll e suh tht: Approprite ministrtion of nursing servies is provie on ll shifts. The ptient re ssignment is ommensurte with the qulifitions of eh nursing stff, the ientifie nursing nees of the ptient n the presrie meil regime. A registere nurse is responsile for the sfe ustoy, reoring, ministrtion, hnling n isposl of ontrolle rugs. There is prompt reognition of ny untowr hnge in ptient's onition to filitte pproprite interventions The nursing eprtment shll mintin high nursing stnrs, n: Tke ll resonle mesures to provie optiml qulity re. Ensure tht the nursing re provie to ptients is in orne with the pprove stnrs of nursing prtie. Ensure tht registere nurse ssesses eh ptient's nees n prolems within the perio estlishe y the nursing eprtment

46 46 Speifi Guielines for Mternity Homes following mission. Hve estlishe stnrs of nursing re n mehnisms for evluting suh re to monitor the qulity of nursing re provie The registere nurse shll e responsile for eh ptient's nursing re pln. The following requirements must e met: The nursing re plns shll e oumente in orne with the pprove stnrs of nursing prtie. The nursing tions shll e rrie out oring to the re pln n the ptient's response shll e reore. Continuous evlution of ptient shll e performe to etermine the ptient's urrent helth sttus The nursing stff shll prtiipte in ontinuing eution to mintin n upgre their urrent ompeteny There shll e n ongoing Nursing Qulity Assurne Progrmme to monitor n evlute the qulity n ppropriteness of nursing re. Drugs, et (Regultion 27) 6.27 Every mternity home shll mintin: storge of ll ntiseptis, rugs for externl use n isinfetnts seprte from internl n injetle meition; n equte supply of pproprite meiinl prouts n pproprite reors of suh prouts. Qulity Assurne (Regultion 29) 6.28 There shll e Qulity Assurne Progrmme whih shll inlue the

47 Speifi Guielines for Mternity Homes 47 following tivities: infetion ontrol review; n review of eths, ients, injuries n ptient sfety The mternity home shll set out stnrs for the re it provies, to help ientify prolems n provie opportunities to improve suh re The finings, reommentions, tions tken n results of tions tken in the Qulity Assurne Progrmme shll e oumente n reporte to the Diretor nnully The Diretor shll e informe monthly s to the numer n iniviul nture of serious mishps n ients ourring mong ptients The mternity home shll ensure tht the Qulity Assurne Progrmme is evlute t lest yerly, n revise if neessry. Equipment (Regultion 30) 6.33 Every mternity home shll ensure tht proeures re rwn up regring the proper use, re n mintenne of ll equipment use in the mternity home n shll omply with estlishe or reommene proeures Every piee of equipment use in ny invsive proeure shll e renere sterile y the pproprite proeure. Infetion Control (Regultion 31) 6.35 Every mternity home shll hve written poliies, proeures or guielines for: septi n isoltion tehniques; n snittion proeures.

48 48 Speifi Guielines for Mternity Homes 6.36 The mternity home shll estlish system to etet n lert pproprite uthorities out outreks of infetious isese mongst its ptients or stff, n pln to prevent n ontrol suh n outrek The mternity home shll ensure tht its infetion ontrol poliies n proeures re evlute regulrly n on ontinuing sis All new employees shll e orientte regring the progrmme The Diretor shll e informe immeitely whenever ny ptient or stff ontrts notifile isese. Avertising (Regultion 32) 6.40 The purpose of vertising y mternity home shll e to inform the puli out the types n nture of servies whih they hve ville. Flse or misleing sttements out the mternity home or other helth re estlishments or proviers re uneptle n unethil. The vertisements shll onform to the Avertising Stnrs Assoition of Singpore (ASAS) Coe of Avertising Prties n other guielines issue y the Diretor The informtion whih my e islose in vertisements re: Generl etils, inluing nme, ress, hours of servie, hrges, ontt person (y esigntion only); Aommotion filities, inluing lsses of ommotion, numer of es per lss, osts, moe of pyment, n filities tthe (for exmple, throom, TV, telephone); Speil filities (for exmple, mulne servie) Mention of the following is prohiite in vertisements:

49 Speifi Guielines for Mternity Homes 49 e f Servies whih re not owne y the mternity home; Comprison, either iret or y implition, etween the servies, filities or employees of one mternity home n nother; The use of superltives in esriing the filities n servies of the mternity home n lims of prominene or uniqueness; Any mention of nmes of otors or of the personl skills or servies of iniviul otors ssoite with the mternity home; Testimonils of iniviuls or ptients; n Sles promotions Avertising y mternity home my e in ny mei ut shll e restrine, voiing full pge or lengthy vertisements n too frequent vertising All vertisements must e sumitte to the Diretor for pprovl prior to use. Fire preutions (Regultion 33) 6.45 The preutions ginst the risk of fire shll inlue: estlishing fire evution pln; provision of equte mens of espe in the event of fire n ensuring tht ll fire espe pssges n stirses re ler of ostrution t ll times; mking equte rrngements for eteting, ontining n extinguishing fire, for the giving of wrnings n for the evution of ll persons in the mternity home in the event of fire; e mintenne of fire preutions n fire fighting equipment; mking rrngements to seure y mens of regulr fire rills n prties tht ll stff in the mternity home n so fr s prtile,

50 50 Speifi Guielines for Mternity Homes ptients know the proeure to e followe in the se of fire, inluing the proeure for sving life; f g onuting fire rills perioilly n mintining reor of ll fire rills; n isplying onspiuously in the premises noties of the proeures to e followe in the event of fire.

51 Chpter 7 - Speifi Guielines for Meil Clinis Meil Reors (Regultion 11) 7.1 Every meil lini shll mintin ptient's register, linil notes of onsulttion, investigtion n tretment given. 7.2 The prtiulrs to e inlue in the ptient's registrtion reors shll e the following: ptient's nme, ientity r/irth ertifite/pssport, numer, sex, te of irth, ethni group n resientil ress; nme n ress of the meil prtitioner(s) proviing the re n tretment; te n time of onsulttion. 7.3 The meil reor of ptient shll inlue: e f g h the registrtion reor; the ptient's meil history, n ny referrl oument; linil finings; presription reor; tretment reor; reor of llergies n other ftors requiring speil onsiertion, if ny; reports of ll lortory tests performe; reports of ll Xry n other investigtions performe; 51