keperluan perubatan klinikkesihatan

PANDUAN PENYEDIAAN KLINIK KESIHATAN

BUKU �A�

KEPERLUAN PERUBATANKLINIKKESIHATAN(SEMUAJENIS)

UNTUKRANCANGAN MALAYSIA KELAPAN

BAHAGIANPEMBANGUNANKESIHATANKELUARGAKEMENTERIANKESIHATANMALAYSIA

2003

Disediakan olehBAHAGIANPEMBANGUNANKESIHATANKELUARGA

Dengan Kerjasama

JABATAN KESIHATAN AWAMBAHAGIANPERANCANGANDANPEMBANGUNANBAHAGIANKESIHATANPERGIGIANBAHAGIANPERKHIDMATANFARMASIBAHAGIANPERKHIDMATANKEJURUTERAANJABATAN-JABATANKESIHATANNEGERISertaJABATAN KERJA RAYA MALAYSIA

DATO� DRNARIMAH BINTI AWINPengarah Pembangunan Kesihatan KeluargaKementerian Kesihatan MalaysiaOktober 2003

PRAKATA

Buku �Keperluan Perubatan Klinik Kesihatan� ini adalah hasil usaha berterusan oleh anggota daripada beberapabahagian dalam Kementerian Kesihatan Malaysia serta Jabatan Kerja Raya Malaysia dan Jabatan-jabatanKesihatan Negeri sepanjang 1999-2001.

Usaha ini mengambil masa yang agak panjang kerana ia melalui pelbagai peringkat: penyediaan draf, kelulusandasar dan pemurnian. Proses penyediaan draf melibatkan bengkel-bengkel di Kuala Lumpur, Kuching danKota Kinabalu yang menghasilkan cadangan penyediaan klinik kesihatan pelbagai jenis, dengan spesifikasikhusus diberi untuk memenuhi keperluan di Sabah dan Sarawak. Seterusnya, draf dibentang dalam mesyuaratpengurusan peringkat Jabatan Kesihatan Awam dan Kementerian Kesihatan. Draf berkenaan dikemaskiniberdasarkan ulasan bahagian-bahagian dan negeri-negeri. Setelah itu, kertas dasar dibentang kepadaJawatankuasa Dasar Kementerian Kesihatan. Setelah diluluskan, interaksi dengan Jabatan Kerja Raya bermula;dokumen ini dimurnikan melalui siri mesyuarat dan lawatan-lawatan. Hasilnya ialah yang kita tatapi ini.

Adalah sukar untuk mengejar kemajuan dan keperluan masa depan, dalam masa yang sama menangani�jurang teknologi� yang masih berlaku dalam negara. Ketika menyediakan dokumen ini, pihak KementerianKesihatan berusaha untuk memastikan keperluan baru seperti pengembangan skop perkhidmatan penjagaankesihatan primer (meliputi kesihatan keluarga, kawalan penyakit dan pergigian) serta kemajuan teknologiperubatan dan maklumat dan komunikasi dipenuhi. Dalam masa yang sama, masalah sedia ada sepertiperolehan tanah, perbandaran dan kemampuan kemudahan pengangkutan dan perhubungan di luar bandarjuga diambil kira. Tumpuan diberi kepada meningkatkan kualiti perkhidmatan, mengoptimumkan penggunaansumber manusia, teknologi dan peralatan serta mencapai kepuasan pelanggan.

Tahniah diucapkan kepada semua anggota yang terlibat menyediakan dokumen ini. Saya percaya buku iniakan menjadi bahan yang penting dan bermakna dalam melakar sistem kesihatan negara menuju Wawasan2020 dan merealisasikan Wawasan Untuk Kesihatan

(i)

PENDAHULUAN

Keperluan Perubatan (Medical Brief of Requirement) adalah dokumen penting dalam merancangpembangunan prasarana kesihatan seperti klinik kesihatan, klinik desa dan hospital. Dokumen ini, apabiladigabungkan dengan dokumen keperluan kejuruteraan dan sebagainya, akanmenjadi Brief of Requirementyang lengkap dan dijadikan panduan untuk merekabentuk sesuatu bangunan kemudahan kesihatan.

Buku �Keperluan Perubatan� ini mengandungi kumpulan Kertas Dasar mengenai penyediaan danpengoperasian klinik kesihatan serta �Keperluan Perubatan� bagi semua jenis klinik kesihatan. Pembukuanini bertujuan agar ia digunakan oleh Pegawai-Pegawai Kesihatan Daerah/Bahagian/Kawasan khususnyauntuk:

1. Dijadikan templat bagi menyediakan dokumen �Keperluan Perubatan� lengkap bagimemohon projek pembangunan klinik kesihatan;

2. Rujukan ketika berunding dengan pakar perunding bagi merekabentuk bangunan klinikkesihatan yang dibangunkan secara �turn-key� atau �PMC�

3. Rujukan ketika memantau pembangunan projek;4. Panduan ketika merancang penggunaan bangunan klinik kesihatan secara optimum;

dan5. Rujukan ketikamenjalankan kajian pembangunan projek, seperti Penilaian Penggunaan

Kemudahan (Post-Occupancy Evaluation).

Buku ini perlu sentiasa berada dalam simpanan Pegawai Pembangunan, Pegawai Kesihatan Daerah danPegawai Y/M klinik kesihatan.

Cawangan Penjagaan Kesihatan PrimerBahagian Pembangunan Kesihatan KeluargaKementerian Kesihatan Malaysia

(ii)

KANDUNGAN

Prakata i

Pendahuluan ii

Kertas Dasar: 1-14Polisi Operasi dan Ringkasan KeperluanPerubatan bagi Klinik Kesihatan danKlinik Desa dalam Rancangan MalaysiaKelapan

Keperluan Perubatan:

Klinik Kesihatan Jenis 1 15-52




Klinik Kesihatan Jenis 4S 165-200



Senarai Peserta Bengkel Penyediaan/penyumbang 249-251

Penghargaan 252

WAWASANUNTUKKESIHATAN

Malaysia akan menjadi sebuah Negara terdiri daripada individu, keluarga dan masyarakat yangsihat melalui sistem kesihatan yang adil dan saksama, cekap, mampu disedia dan diperolehi,berteknologi sesuai, serasi pelanggan dan bersesuaian dengan persekitaran. Sistem ini jugaakan mengutamakan kualiti, inovasi, promosi kesihatan, hormat kepada kemuliaan insan sertamenggalakkan tanggungjawab individu dan penyertaan masyarakat ke arah peningkatan mutukehidupan.

MISI KEMENTERIANKESIHATAN

Misi Kementerian Kesihatan adalah untuk mewujudkan penglibatan dan penyertaanmasyarakatuntuk kesihatan bagi merangsang dan memudahkan rakyat untuk:

· Mencapai sepenuh kemampuan mereka dalam kesihatan· Menghargai kesihatan sebagai aset yang bernilai· Mengambil sikap positif meningkatkan lagi dan mengekalkan status kesihatan untuk

menikmati kualiti hidup yang lebih bermutu.

Kertas Dasar JDPKK 1/2001

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Lampiran 2

CADANGANPELAKSANAANITUNTUKKLINIKKESIHATAN

A. PENGENALAN

Penggunaan teknologi maklumat (IT) dalam meningkatkan kualiti penyampaian perkhidmatankesihatan kepada individu dan masyarakat adalah merupakan teras utama dalam cadanganpembangunan klinik-klinik kesihatan kerajaan pada masa depan. IT akan dimanfaatkan sebagai alat(enablers) bagi mewujudkan satu rangkaian maklumat bersepadu bagi membolehkan pemberirawatan/pengamal (care provider) menyampaikan perkhidmatan yang efektif, manakala pihakpengurusan di klinik, daerah, negeri dan pusat akan dapat mengawal kos perkhidmatan di sampingmeningkatkan keupayaan pengawasan operasi dalam kawasan yang dipertanggungjawabkan. Pihakpengurusan juga akan menjadi lebih responsif dalam mengesan dan mengambil tindakan terhadapisu-isu kesihatan masyarakat dengan adanya kemudahan menganalisis data-data.

Dokumen ini akan menghuraikan dengan lebih lanjut cadangan penggunaan IT bagi klinik-klinikkesihatan yang akan dibina. Skop cadangan ini merangkumi aspek-aspek perancangan,pembangunan, latihan, pentauliahan dan penyelenggaraan sistem IT.

B. MATLAMAT

Cadangan penggunaan IT bagi klinik-klinik kesihatan jenis 1�6S yang akan dibina mempunyaimatlamat-matlamat seperti berikut:

� Sistem yang akan dibekalkan boleh menjadi pemangkin dalam mencapai wawasan kesihatannegara untuk mewujudkan individu, keluarga dan masyarakat Malaysia yang sihat.

� Membolehkan penyampaian perkhidmatan kesihatan secara holistik dengan memberikeutamaan kepada aspek-aspek wellness, promosi kesihatan dan pencegahan penyakit disamping perkhidmatan kuratif dan rehabilitatif.

� Mewujudkan satu mekanisma bagi meningkatkan kesedaran individu dan masyarakat untukturut serta dan bertanggungjawab ke atas kesihatan masing-masing.

� Menggunakan teknologi-teknologi terkini yang bersesuaian dan berkongsi sumber bagimengelakkan kos penyelenggaraan yang tinggi.

� Mewujudkan rangkaian maklumat yang membolehkan individu, masyarakat, pemberi rawatan/pengamal, pengurusan klinik, pejabat kesihatan dan kementerian memainkan perananmasing-masing dengan lebih efektif.

C. FAKTOR-FAKTORYANGMEMPENGARUHIPEMILIHANSISTEM

Dalam memilih struktur dan kandungan sistem IT untuk kegunaan klinik-klinik kesihatan, beberapafaktor diambilkira bagi memastikan keberkesanan sistem tersebut untuk menepati kehendakpengguna:

1. Peningkatan Kos Perkhidmatan Kesihatan

Peningkatan kos dalam memberi perkhidmatan kesihatan adalah antara faktor utama yangmendesak penilaian semula kaedah penyampaian perkhidmatan kesihatan. Peningkatanjangkahayat (life expectancy) rakyat Malaysia akan memerlukan penambahan perbelanjaanbagi memelihara kesihatan warga tua yang lebih terdedah kepada penyakit-penyakit kronik.Kadar insidens penyakit-penyakit kadiovaskular, kanser, kecederaan akibat kemalangan,penyakit-penyakit yang berkaitan dengan perubahan cara hidup semakin meningkat. Semuaini memerlukan lebih banyak usaha pencegahan dan pendidikan di peringkat kesihatanprimer bagi mengawal kos pembiayaan kuratif yang mahal di hospital.


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2. Pendidikan Kesihatan

Pendidikan kesihatan adalah amat penting bagi meningkatkan kesedaran individu danmasyarakat untuk bertanggungjawab terhadap kesihatan masing-masing. Selain daripadamembantu ke arah pencegahan, ia juga boleh mengurangkan kadar lawatan ke klinik atauhospital yang dikira tidak perlu apabila pelanggan/pesakit mudah mendapat maklumatmengenai keadaan/masalah yang dihadapi.

3. Maklumat Kesihatan

Kemudahan mendapatkan maklumat kesihatan seseorang pelanggan adalah amat pentingbagi pemberi rawatan menentukan jenis rawatan yang sesuai. Rekod kesihatan yang lengkap,mudah diperolehi walau di klinik mana pun pelanggan itu pergi akan dapat memastikankesinambungan rawatan (continuity of care) diperolehi.

4. Pengkongsian Maklumat

Fungsi klinik sebagai saluran perkhidmatan kesihatan utama yang berdepan denganmasyarakat akan menjadi lebih berkesan sekiranya kewujudannya dalam rangkaian unit-unit kesihatan lain seperti klinik-klinik berhampiran dan pejabat kesihatan negeri dan daerahdapat dimantapkan. Pertukaran maklumat, mendapatkan maklumbalas, mendapatkanmaklumat-maklumat penyelidikan, protokol-protokol kesihatan atau kempen-kempenkemasyarakatan adalah antara perkara-perkara yang dapat dilakukan dengan lebih berkesanmelalui penggunaan IT.

5. Fungsi Pejabat Kesihatan

Dengan adanya maklumat lengkap dari klinik-klinik kesihatan, petugas di pejabat kesihatanakan dapat menjalankan tugas-tugas pengawasan dan pentadbiran dengan lebih berkesan.Analisis dapat dibuat bagi menilai tahap kesihatan sesuatu kawasan serta faktor-faktorpenyebabnya. Pihak berkuasa juga akan menjadi lebih proaktif dalam mengawal ataumenghadapi kemungkinan sesuatu wabak penyakit.

Penilaian dan kawalan kualiti perkhidmatan sesuatu klinik akan juga dapat dibuat denganlebih berkesan dengan adanya data-data yang membolehkan perbandingan indicator-indikator perkhidmatan.

6. Kos Pembiayaan Perlengkapan IT

Kos pembiayaan bagi melengkapkan klinik-klinik kesihatan dengan peralatan IT masih tinggi.Ini bukan sahaja melibatkan kos pemasangan peralatan tetapi juga kos latihan danpenyelenggaraan. Kekurangan tenaga mahir bagi memberi perkhidmatan sokongan jugamenyebabkan pelaksanaan IT sehingga kini dilakukan secara kecil-kecilan. Pendekatanyang lebih sesuai diperlukan dalam melaksanaan satu sistem IT bersepadu untukmemperolehi pulangan yang optiimum.

D. CADANGANKONSEP IT

D.1 Rangkaian Sistem Maklumat

Konsep pelaksanaan IT untuk klinik-klinik kesihatan dalam skop cadangan ini akanditumpukan kepada pembanguan satu infrastruktur rangkaian sistem maklumat elektronikyang melibatkan klinik-klinik dan pejabat-pejabat kesihatan DAERAH berhampiran. Pejabatkesihatan DAERAH akan dijadikan pangkalan atau �hub� yang memberi perkhidmatan sistemmaklumat kepada klinik-klinik dibawah pengawasannya. Klinik-klinik tersebut akandihubungkan dengan hub tersebut melalui rangkaian telekomunikasi �leased line�. Pengguna


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sistem diklinik akan menggunakan stesen kerja (�workstation�) yang dihubungkan denganpangkalan data (database) dan sistem pemprosesan maklumat yang ditempatkan di hubtersebut.

Pejabat-pejabat kesihatan DAERAH atau hub-hub tersebut akan juga dihubungkan antarasatu sana lain bagi membentuk rangkaian sistem maklumat kesihatan yang lebih besar diperingkat negeri. Dengan kemudahan ini pihak pentadbir kesihatan di peringkat negeri danibu pejabat kementerian kesihatan akan dapat mengakses maklumat-maklumat pentingdengan lebih cepat untuk dianalisis bagi tujuan pengawasan atau kajian tertentu.

Dengan konsep ini, pejabat-pejabat kesihatan daerah akan berfungsi sebagai pusat IT bagiklinik-klinik di bawah pengawasannya. Peralatan-peralatan IT seperti pelayan atau �server�,pangkalan data dan alat-alat komunikasi data akan ditempatkan di sebuah bilik khas dipejabat tersebut. Sistem maklumat yang digunakan akan dipasang pada komputer tersebut.Sistem ini akan digunakan oleh pengguna pengguna di klinik-klinik dan di pejabat kesihatanmelalui rangkaian komunikasi dalaman (LAN) dan luaran (WAN) yang akan disediakan.

Pengguna pengguna sistem di klinik pula akan dilengkapi dengan stesen kerja (�workstation�).Klinik-klinik tersebut akan dilengkapi dengan satu rangkaian komunikasi dalaman yangseterusnya dihubungkan melalui �leased line� ke pusat IT di pejabat kesihatan.

D.2 Sistem Maklumat

Sistem yang dicadangkan akan memberi penekanan kepada aspek-aspek klinikal danpengurusan di peringkat individu, masyarakat dan pengurusan kesihatan. Pelaksanaanrekod kesihatan elektronik atau �electronic medical record� (EMR) bagi setiap pelanggan danrekod-rekod kesihatan sesuatu kawasan akan menjadi asas penting dalam membangunkanpangkalan data kesihatan yang lengkap. Sistem itu juga akan membantu penyelarasanpengurusan kewangan dan sumber manusia. Aspek pendidikan IT untuk individu danmasyarakat akan juga diberikan tumpuan.

Sistem maklumat yang dicadangkan terbahagi kepada dua bahagian. Bahagian pertamameliputi sistem maklumat untuk kegunaan klinik. Sistem ini akan memberi penekananterhadap aspek klinikal pelanggan dan bersesuaian dengan skop perkhidmatan yangdisediakan. Satu bahagian lagi akan memenuhi keperluan pentadbiran dan fungsi�inspektorat� pejabat kesihatan. Pengawasan kesihatan, analisis data kesihatan danpentadbiran kewangan dan sumber manusia bagi kawasan berkenaan merupakan fungsiutama sistem tersebut.

Sistem untuk kegunaan klinik-klinik akan mengandungi fungsi-fungsi seperti berikut:

� Pendaftaran� Temujanji� Saringan (triage)� Pentadbiran rekod perubatan� Sistem giliran (queue)� Kos mikro dan bil� Dokumen dan rekod klinikal� Rekod ibu mengadung dan kanak kanak� Pengurusan permintaan (�order management�)� Pengurusan unit pergigian� Pengurusan farmasi� Pengurusan makmal� Pengurusan pengimejan diagnostik� Perkhidmatan kesihatan sekolah� Perkhidmatan rawatan / penjagaan di rumah� Pusat bersalin alternatif� Sistem automasi pejabat


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Klinik juga akan dilengkapi dengan sistem automasi pejabat yang meliputi kemudahan melelektronik dan perisian-perisian pejabat yang lain. Laluan ke internet juga akan dibekalkantetapi penggunaannya akan bergantung kepada polisi sekuriti yang akan ditentukan kemudian.

� Pendidikan kesihatan

Satu lama web (homepage) akan disediakan sebagai saluran maklumat kesihatan kepadamasyarakat. Untuk tujuan ini �kiosk penerangan� akan dipasang di setiap klinik untukkegunaan orang ramai. Laman itu juga dapat diakses melalui komputer peribadi di rumah/pejabat. Dengan ini klinik-klinik kesihatan akan juga memainkan peranan dalammeningkatkan kesedaran IT masyarakat setempat.

Sistem yang digunakan diperingkat pejabat kesihatan pula akan mengandungi fungsi fungsiberikut:

� Inspektorat kesihatan� Laporan-laporan stastik� Pengurusan kewangan� Pengurusan sumber manusia� Pentadbiran am� Sistem automasi pejabat (seperti diatas)

Di peringkat klinik, skrin-skrin bagi kegunaan kemasukan data (data entry) akan disediakanbagi fungsi-fungsi di atas.

Sistem IT yang dicadangkan akan menggunakan teknologi semasa dan berdasarkan kepadakonsep sistem terbuka (open system). Bagi kemudahan pengguna, sistem yang dibekalkanakan mempunyai ciri-ciri berkenaan:

� �Look and feel� yang konsisten� GUI (Graphical User Interface) dan penggunaan tetikus dan set-set data yang siap

sedia bagi mengurangkan keperluan menaip.� Multimedia� Kebolehan pemprosesan teks dan gambar yang canggih� Sistem keselamatan (security) bagi mengelakkan penggunaan yang tidak diperakui.

Perisian hadapan yang dilihat oleh pengguna akan berasaskan Windows yang merupakanteknologi yang lazim kepada pengguna-pengguna komputer. Bagi mereka yang pernahmenggunakan komputer, ini akan memudahkan penerima terhadap sistem tersebut. Latihanakan memberi kepada mereka yang baru pertama kali menggunakan komputer.

Komputer pemprosesan utama (pelayan atau server) yang mengawal sistem maklumatakan menggunakan sistem operasi Windows NT. Sistem ini diakui tahan lasak bagi kerja�kerja pemprosesan yang intensif dan merupakan satu sistem standard � sistem masa kini.Pangkalan data yang akan digunakan adalah berasaskan sistem SQL yang diterima sebagaisistem terbuka.

Penggunaan teknologi berasaskan Internet akan diberi keutamaan. Selain laman web sistemmaklumat yang dibekal akan menggunakan komponen komponenteknologi internet yang terkini. Rangkaian komunikasi akan menggunakan lakaran ( design)dan protokol�protokol yang standard. Penggunaan switched network dan protokol ethernetbagi rangkaian dalaman (local area network) dapat menjamin kesesuaian jangka panjangmanakala rangkaian yang menghubungkan klinik-klinik dan pusat IT pejabat-pejabat kesihatanakan menggunakan protokol ISDN atau FRAME RELAY.

D.3 Teknologi


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E. SKOPPEMBEKALANDANPELAKSANAAN

E.1 Skop Pembekalan

Pihak kontraktor akan menyediakan perisian, peralatan IT dan rangkaian dalaman (localarea network) bagi setiap pejabat kesihatan daerah dan klinik-klinik yang di bawah bidangkuasa pejabat berkenaan. Dengan erti kata lain, pejabat kesihatan daerah yang mempunyaiklinik yang terlibat dalam skop cadangan ini akan dilengkapi sebagai pusat IT. Pejabatkesihatan negeri tidak termasuk dalam skop pembekalan ini.

Peralatan untuk membolehkan komunikasi data (contohnya switch) melalui rangkaian luaran(wide area network) akan dibekalkan. Pihak kontraktor akan menguruskan penyediaanrangkaian luaran melalui leased line dengan pembekal perkhidmatan berkenaan danmembiayai kos sewa dan lain lain kos berkaitan pada tahun pertama operasi.Kementerian Kesihatan adalah bertanggungjawab untuk membiayai kos tersebut pada tahun-tahun seterusnya.

Pihak kontraktor juga bertanggungjawab untuk melaksanakan keseluruhan sistem sepertiyang dihuraikan di bawah.

E.2 Skop Pelaksanaan

Skop pelaksanaan sistem IT bagi klinik-klinik dalam cadangan ini akan meliputi aspek-aspek berikut:

� PerancanganPerancangan terperinci terhadap setiap aspek pelaksanaan akan dijalankan bagimemastikan pembekalan sistem IT tersebut menepati kehendak dan dapat diterimaoleh pengguna.

� Rekabentuk (design)Rekabentuk teknikal secara terperinci bagi menentukan penggunaan teknologisecara optimum.

� PembangunanIni melibatkan penyesuaian sistem maklumat dengan keperluan pengguna sertakerja-kerja pemasangan rangkaian dan perkakasan berkaitan.

� LatihanLatihan merangkumi penggunaan sistem maklumat dan pengurusan sistem untukpengguna-pengguna dan pentadbir sistem yang dilantik.

� PentauliahanPemasangan dan penyediaan sistem untuk penggunaan secara �live�.

� Penyelenggaraan dan sokonganPenyelengaraan dan sokongan terhadap sistem IT yang dibekal akan dilaksanakanuntuk jangkamasa yang dipersetujui.


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F. STRATEGIPELAKSANAN

Untuk memastikan kejayaan pelaksanaan sistem IT yang dicadangkan, beberapa strategi akandigunakan:

� Meningkatkan kesedaran ITKesedaran IT di kalangan bakal-bakal pengguna sistem adalah penting bagi memudahkanpenerimaan mereka. Latihan penggunaan sistem akan lebih lancar apabila pengguna telahbiasa dengan IT. Oleh demikian siri latihan asas IT akan dilaksanakan seiring dengan kerja-kerja pembangunan sistem. Konsep buddy di mana rakan sekerja membimbing rakan yang lainakan digunapakai bagi tujuan ini.

� Mengenal pasti pengguna ulung (champion)Beberapa champion akan dikenalpasti dan dilatih untuk menjadi model dan rujukan penggunapengguna yang lain. Adanya individu individu ini di kalangan mereka akan memberikan galakanuntuk menerima penggunaan sistem IT tersebut.

� Piawaian proses dan polisi kerjaProses dan polisi kerja klinik klinik kesihatan akan dikenalpasti dan diselaraskan untukmenyeragamkan pelaksanaan sistem IT.

� Lokasi projek perintisPelaksanaan yang pertama akan dijadikan lokasi contoh. Pelaksanaan berikutnya akanmenggunakan kaedah duplikasi bagi menyeragamkan sistem dan untuk mengurangkan kospenyelenggaraan jangka panjang.

� Pemusatan sumber sokongan dan penyelengaraanSumber sokongan dan penyelenggaraan akan dipusatkan di pejabat-pejabat kesihatan negeri.Kaedah-kaedah sokongan menerusi rangkaian akan digunakan. Ini akan dapat mengurangkankos keperluan tenaga mahir di setiap klinik.

G. KESIMPULAN

Pelaksanaan sistem rangkaian maklumat elektronik antara klinik-klinik dan pejabat-pejabat kesihatanadalah kaedah yang sesuai bagi memodenkan sistem perkhidmatan kesihatan awam di Malaysia.Faeadah yang bakal diperolehi dari perkongsian dan pertukaran maklumat serta penjagaan berterusanbagi pelanggan melalui rekod kesihatan elektronik lengkap akan menyediakan klinik-klinik dan pejabat-pejabat kesihatan turut serta dalam insiatif-insiatif kerajaan dalam penggunaan IT di bidang perubatan.

Disediakan Oleh :Bahagian Pembangunan Kesihatan Keluarga, danPusat Teknologi MaklumatKementerian Kesihatan Malaysia


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KK1Keperluan Perubatan

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KEPERLUAN PERUBATAN

KLINIK KESIHATAN JENIS 1

UNTUKRANCANGANMALAYSIAKE-8


April 2001

KK1 Keperluan Perubatan

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NOTA:JENIS-JENISKLINIKKESIHATAN(KK)

A) KKJENIS1 >�� 800KEDATANGANSEHARIB) KK JENIS 2 500-800KEDATANGANSEHARIC) KK JENIS 3 300 - 500KEDATANGANSEHARID) KK JENIS 4 < 300KEDATANGANSEHARIE) KK JENIS 4S (SABAH & SARAWAK) 150-300KEDATANGANSEHARIF) KK JENIS 5 (SABAH & SARAWAK) < 150KEDATANGANSEHARIG) KK JENIS 6 (SABAH & SARAWAK) < 50KEDATANGANSEHARI


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KLINIKKESIHATAN JENIS 1

JADUALRUANG

1 RUANGMASUKUTAMA/PENDAFTARAN

1.1 Kaunter Pendaftaran

1.2 Kaunter Pertanyaan

1.3 Kaunter Pembayaran

1.4 Kaunter Triage / Call Centre

1.5 Ruang Menunggu Utama

1.6 Ruang Legar/Pameran

1.7 Ruang Penyusuan / Tukar Lampin

1.8 Ruang Permainan Kanak-kanak (dalam klinik)

1.9 Tandas Awam

1.10 Ruang Troli / Kerusi Roda

1.11 Ruang Menunggu (kenderaan)

2 UNITREKODKESIHATAN

2.1 Ruang menunggu

2.2 Kaunter Penerimaan

2.3 Ruang anggota

2.4 Ruang Rekod

3 UNITKESIHATANKELUARGA

3.1 Ruang Menunggu


3.3 Bilik Pemeriksaan (CE)

3.4 Bilik Rawatan

3.5 Ruang Rawatan Asma

3.6 Bilik Prosedur

3.7 Bilik Persediaan

3.8 Ruang EKG

3.9 Bilik Pemeriksaan Mata

3.10 Bilik Pemeriksaan Pendengaran

3.11 Bilik USG

3.12 Bilik Pendidikan Kesihatan

3.13 Bilik Demonstrasi Memasak

3.14 Setor Peralatan

3.15 Bilik Utiliti Bersih

3.16 Bilik Utiliti Kotor


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3.17 Tandas Awam

3.18 Tandas Anggota

4 UNITKESIHATANPERGIGIAN


4.2 Bilik Pembedahan

4.3 Bilik Tekanan Udara

4.4 Bilik Persediaan/Pensterilan

4.5 Pejabat

4.6 Setor Peralatan

4.7 Makmal Pergigian

4.8 Setor Pergigian

4.9 Utiliti Kotor

5 UNITPEMULIHAN

5.1 Ruang Menunggu


5.3 Ruang Pejabat

5.4 Bilik Penilaian

5.5 Bilik Terapi Pediatrik

5.6 Bilik Terapi Psikiatri

5.7 Bilik Terapi ADL

5.8 Bilik Hidroterapi

5.9 Gimnasium

5.10 Ruang rawatan (wax dan inframerah)

5.11 Makmal kemahiran (skill lab)

5.12 Pantri

5.13 Setor

5.14 Tandas

6 UNITPATOLOGI

6.1 RuangMenunggu6.2 Kaunter Penerimaan

6.3 Ruang Mengambil Spesimen

6.4 Tandas spesimen

6.5 Makmal

6.6 Ruang Anggota

6.7 Setor makmal

6.8 Utiliti bersih

6.9 Utiliti kotor


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7 UNITFARMASI

7.1 Ruang Menunggu

7.2 Dispensari dan kaunter

7.3 Bilik Kaunseling

7.4 Ruang pembungkusan kering

7.5 Ruang pembungkusan basah (internal)

7.6 Ruang pembungkusan basah (racun)

7.7 Bilik Pegawai

7.8 Ruang anggota

7.9 Setor Ubat (Ruang Ubat Makan dan Racun)

8 UNITPENGIMEJANDIAGNOSTIK

8.1 Ruang Menunggu


8.3 Bilik X-ray (termasuk unit x-ray pergigian)

8.4 Ruang Persalinan

8.5 Ruang Kawalan

8.6 Bilik Gelap

8.7 Ruang Penelitian

8.8 Bilik Pegawai

8.9 Setor Filem

8.10 Setor Kimia

8.11 Tandas

9 UNITSURVEILANSKESIHATAN

9.1 Bilik Surveilans Kesihatan

9.2 Bilik Sokongan Teknikal

10 UNITKESIHATANSEKOLAH

10.1 Bilik Kesihatan Sekolah

11 UNITPERAWATANDIRUMAH

11.1 Bilik Perawatan Di Rumah

12 UNITKEBAJIKANPERUBATAN

12.1 Ruang Menunggu


12.3 Bilik Kebajikan Perubatan

12.4 Bilik Kaunselor

12.5 Nilik Kaunseling

13 UNITPENTADBIRAN

13.1 Ruang Menunggu


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13.2 Bilik Pegawai y/m

13.3 Pejabat Am

13.4 Bilik Penyelia/Ketua Jururawat

13.5 Bilik Pembantu Perubatan Kanan

13.6 Bilik Fail

13.7 Bilik Mesyuarat

13.8 Bilik Seminar

13.9 Bilik Server

13.10 Setor APD

13.11 Setor peralatan

13.12 Tandas Anggota

14 KEMUDAHANANGGOTA

14.1 Bilik Persalinan dan tandas

14.2 Bilik Solat

14.3 Bilik Rehat

14.4 Perpusatkaan

14.5 Bilik Pemandu

14.6 Ruang letak kereta

15 KEMUDAHANAWAM

15.1 Taman Terapeutik

15.2 Telefon awam

15.3 Pondok menunggu kenderaan awam


15.5 Kafeteria

15.6 Mesin minuman

15.7 Lif

16 SETORDANLAIN-LAIN

16.1 Ruang letak ambulans

16.2 Ruang letak kenderaan

16.3 Bilik Pencuci

16.4 Ruang membasuh pakaian/linen

16.5 Bilik Pengumpulan Sisa Klinikal

16.6 Setor Bekalan Am

16.7 Setor Bekalan Bersih

16.8 Setor Pukal

16.9 Setor Pelupusan


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16.10 Setor Bahan Mudah Terbakar

16.11 Setor Pasukan Pergigian Bergerak

16.12 Kawasan Pengumpulan Sisa Domestik


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1. INTRODUCTION(To be elaborated by each Project)- Background about the project- Situational Analysis- Projected Workload- NOTE : Further customisation of space if necessary must be elaborated

2. MASTERPLAN(To be elaborated by each project)- Zoning- Land Utilisation- Scope of Services- present and future expansion- Access, Traffic Flow- Transportation- Environmental impact

3. THETYPE1HEALTHCLINIC

3.1. Role Statement

The Health Clinic will provide promotive, preventive, curative and rehabilitative services for 500-800-attendance per-day. Apart from the general out-patient services, the clinic will focus it�s services forthe special target groups i.e. mothers, hildren (0 - 12 years old), adolescence, elderly, well adults,productive women, family and workers. There will be provision for treatment and resuscitation in theclinic facility.

The health clinic will have the following:

3.1.1 Promotive, Preventive, Curative and Rehabilitative services through Family HealthProgramme which covers Maternal and Child Health, Adolescent Health, Family Planning,Geriatric Health, Mental Health, Care for the Children With Special Need, Outpatientservice, Workers� Health and Well Adult clinic.

3.1.2 Dental Health Services will be provided as outpatient services. For serious cases they willbe referred to specialist either at the clinic or the nearest hospital.

3.1.3 Clinical support services include Pharmacy, Laboratory (Level I upgraded), DiagnosticImaging (including ultrasound and x-ray), Rehabilitation and Medical Social service.

3.1.4 Non-medical support services including ambulance, engineering, linen, waste holding,cleaning and security services will be provided.

3.1.5 Staff and client support services such as prayer room, staff change and rest room will alsobe provided.

3.1.6 Training facilities will be provided in the form of conference/seminar rooms, a work stationroom to cater for both undergraduate & postgraduate training, paramedic and medicalpersonnel with teleconferencing equipment wherever necessary.

3.1.7 Computerised system for clinical and non-clinical support services for all or selectedwork-stations.

BRIEF OF REQUIREMENTSHEALTH CLINIC TYPE 1


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3.1.8 Administrative services include registration of client, revenue collection, record andinformation system and administrative services for the overall management of the clinic.

3.1.9 Public amenities such as cafeteria, car parks, playground and water closets will beprovided.

3.1.10 Adequate stores will be made available.

3.2. Services provided in detail

The Health Clinic focuses on preventive and curative services. These services will be delivered byall providers and not confined to any special sessions of the week but will be available everyday.Special sessions are only on appointment basis.

3.2.1 Maternal and Child Healtha) Maternal health which include antenatal and postnatal care, health education to

mothers, support for breast feeding and lactation management.

b) Infant and Child HealthTarget groups are babies (0 to 1 years), toddlers (1 to 4 years) and pre-schoolers (5-6 years). These functions will include development assessment, immunisation,growth monitoring etc. and specific activities for children with special needs such asdisabled children and children of poor families.

3.2.2 Outpatients ServiceThis service includes walk-in and follow-up general and special (chronic disease)outpatient care and emergency care.

3.2.3 Oral HealthThis service will include promotive, preventive and curative activities for the pre-schoolers,school children and adult.

3.2.4 School HealthThe school health team from this clinic will visit school and performs health appraisal toschoolchildren as part of the school health service function. Where necessary, follow-upsof school children will be made in the clinic.

3.2.5 Family PlanningThis service includes counselling, examination and supply of pills, condoms, injectablese.g Devopovera etc., minor procedures eg. IUCD, Norplant insertion and urine pregnancytest.

3.2.6 Well Adult (Well Men and Well Women health appraisal)Well Adult service will provide risk assessment, early detection and health educationactivities such as detection of breast and cervical cancer, quit-smoking counselling andmenopause counselling. Risk assessment activities will include cardiovascularassessment, examination of blood pressure and BMI, laboratory investigation for blood(FBS,LFT,RFT) and urine, ECG andx-ray (CXR).

3.2.7 Adolescence HealthThis service will be provided to school children and other adolescent (7 to 18 years) forcounselling, general physical examination as well as management of disease condition.

3.2.8 Geriatric HealthCare of the elderly includes day care nursing, vocational activities, nutritional assessment,


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rehabilitative activities, counselling, physical examination, regular health screening(similar to health screening in well adult clinic) and accident preventive care.

3.2.9 CommunityMental HealthMental health activities will look into promotion and prevention aspect and riskassessment apart from curative care. Community rehabilitation for the mentally ill will alsobe provided.

3.2.10 HomeCare NursingThis function is to provide nursing care at home to facilitate healing and coping withrecuperation. Services will also be provided to post-hospitalise cases, chronically andterminally ill persons.

3.2.11 Nutrition andDieteticThe nutrition clinic provides advice and counselling to the pregnant and lactating mothers,mother�s/parent�s of infants, toddlers, pre-schoolers and malnourished children. Thedietetic clinic area is for giving advice and counselling of client with clinical conditions suchas diabetes, hypertension, heart disease and renal disease.

3.2.12 Occupational HealthThe service will include promotion, prevention, curative and rehabilitation for the workingpopulation who suffers from work-related illness, including injuries through an integratedcare approach. Main activities will be risk assessment, investigation, specific treatmentand health education, and disease prevention and surveillance related to occupation.

3.2.13 Rehabilitation �Occupational and PhysiotherapyThis service include both physiotherapy and occupational therapy for children with specialneeds (for child and parents), elderly, mentally ill patients, pregnant mothers, post-traumapatients and clients with chronic conditions such as asthma and chronic obstructiveairway diseases.

3.2.14 Health Surveillance (Selected communicable and non-communicable diseases) Serviceprovided will include defaulter tracing, active and passive case detection, contact tracing,notification and investigation of notifiable diseases.

3.2.15 Health PromotionIt is an integral component of the various services in the health clinic and will be providedby all health personnel.

3.2.16 Clinical Support ServicesDiagnostic Imaging, Laboratory, Pharmacy, Medical Social service and Counselling.

3.2.17 Non-clinical Support ServicesInformation technology, ambulance, transport, biomedical and facility engineering, linen,waste holding, cleaning and security service.

3.2.18 OthersStaff and public amenities.

3.3. Operation and Management

The Health Clinic will operate from Monday to Friday (Saturday to Thursday) between 8.00 am -4.30 pm and on Saturday/ Thursday from 8.00 am - 12.30 pm.

Overall management will be by a Family Medicine Specialist or the most senior medical officer in theunit. This officer will report to the local Medical Officer of Health. Nursing care services will be theresponsibility of the sister-in-charge. She will also handle all nursing staff and female


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health attendants.

For the management of client, the Family Medicine Specialist will be supported by Medical officers,Dental Officers, Medical Assistants, Nurses, Dental Nurses, Community Nurses and other supportstaff.

Computerisation will aid appointment system. Clients will be persuaded to follow appointments toensure satisfactory waiting time.

�Call center� will be established to entertain consultation by phone. Trained allied health personnelwill man this �center�.

4. GENERALHEALTHCLINICPOLICIES

4.1. Clinical Services

4.1.1. Family Health Services

a) Services stated in paragraph 3.2.1 to 3.2.15 will be provided through an integratedclinic system or open system. They do not function as isolated clinics or sessionexcept occasionally when there is pre-selected group to be serviced.

b) Services will be provided to walk-in clients. Phone-in will be entertained through call-center by the triaging staff.

c) Multifunctional medical personnel shall carry out these services.d) Family Medicine Specialist role is to manage referred cases from the medical officers

at the clinic and from ancillary clinics.

4.1.2. Oral Health Services

The scope of service includes promotive, preventive and curative and rehabilitative, whichwill be targeted to specific groups i.e.:- Pre-school children- Primary school children- Secondary school children- Pregnant mothers- Children with special need- Adult- Elderly

The activities will be- School dental service- Basic dental care- Dental health promotion

4.1.3. Nutrition and Dietetics

These activities will be provided to mothers, children and client with special nutritionalneeds, e.g. diabetic and hypertensive client, obesity, etc. It includes diet counselling,health education and cooking demonstration.

4.1.4 HomeCare Nursing

The scope is to provide nursing care at home to facilitate healing and coping withrecuperation. The target groups are:- The elderly who needs nursing and other care


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- The disabled- Post-trauma patient- Post-surgery patient- Post-natal cases- Terminal cases requiring palliative care

4.1.5 Rehabilitation

This program will cater for pregnant and post-delivery mothers, disabled and handicappedchildren, injured patients on recovery and client with disease related disabilities. Servicesprovided are physiotherapy and occupational therapy.

4.1.6 Occupational Health

This service will be carried out in CE room and shall cater for work related illnesses/diseases and risk assessment of the working population where full documentation andinvestigations can be done. Visit to the workplace and environmental studies will be done ifnecessary. Necessary procedures will be done in respective room e.g vision tests, fitness testand laboratory tests.

4.1.7 Health Surveillance

Services provided would include defaulter tracing, active and passive case detection,contacttracing, notification and investigation of notifiable diseases (communicable and non-communicable diseases). Investigation of cases, suspects, contacts and suspected source ofinfection will also be done.

4.1.8 Medical Social Service

This service will provide support for clients with specific social-related problems in this area. Itwill be provided through tele-counselling or visiting counsellor and medical social worker

a) Social support - Individual and group counselling and consultation serviceb) Practical support - financial aids, social and welfare institution (for disabled,

old folks home and shelter) and medical and mobility equipment.c) Networking - liaison within and with other agencies (government and non-governmental organisations).d) Case Focus - domestic violent (child, elderly and women), physically and mentallydisabled, single parent, poverty cases e.g. malnutrition and worm infestation andproblems in payment.

4.2. Workflow

4.2.1. Client andRecord Flow

Clients will enter the department via the main entrance of the clinic. Adequate signs anddirection will be made available. All clients will be met at the registration/collection counterbefore proceeding to the respective rooms or units.

4.2.1.1 Client

Client will take a queue-number using their smart-card or identity card. They will wait in theWaiting Area for registration by a Registration/Collection Counter. Client will be identified by theRegistration/Collection counter as new or follow-up case. Retrieval of client�s record will bemade through the Record Office. This process will be computerised. The next destinationfor the client will be determined by the Registration/Collection counter either to the screeningcounter or the consultation room or other rooms/units.

For new walk-in cases, they will be screened at the Triage Counter by trained paramedics todetermine the appropriate provider in the clinic e.g. doctor, paramedic, laboratory or other


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rooms/units by putting a sticker and queue-number on their record. Certain parameters e.g.weight, height and blood pressure may be taken at this counter.

Clients will then wait in the sub-waiting area in front of the respective rooms or units until theyare called for consultation or other purposes.

All client will be called for consultation or other services by using digital call system.

Following examination and consultation by medical officers/paramedical staff, client mayundergo treatment in the Procedure or Treatment Room. They may be further referred forexamination, investigation or other treatment e.g. Diagnostic Imaging unit, laboratory andRehabilitation Unit. Clients who need further management will be referred to Family MedicineSpecialist or Visiting Specialist in the clinic by paramedics. Client may also be referred to otherclinics or admitted to the nearest hospital.

After completion of examination, investigation, consultation and treatment, client will be sent tothe pharmacy for the collection of drugs.

Fees and appointment for the next visit (if applicable) will be collected at the Registration/Collection counter before they leave the clinic. Appointments can also be made by the eachprovider (if fully computerised).

For specific cases, client will be referred to the Medical Social unit once problems of paymentarises.

For the disabled and handicapped, they will wait with accompanying relatives at the commonwaiting area while the collection of drugs and payment is done by their relatives.

4.2.1.2 Dental Clinic

All clients will register at the (common) Registration/ Collection counter before proceeding tothe sub-wait of the Dental Clinic. Upon calling they will enter the Dental Operating room forconsultation and examination.

Client will be referred to the (common) Pharmacy for medication. Payment for the treatment willbe paid at the Registration/Collection counter before leaving.

4.2.1.3 Rehabilitation

Upon arrival, client will go directly to theRegistration/ Collection counter for registration. Clientwill be directed to either occupational therapy or physiotherapy unit as referred bydoctor. Clientwill wait at the sub-wait prior to being assessed. Before returning home, client will be givenappointment date at the Registration/Collection counter.

4.2.1.4 Nutrition and Dietetic, Laboratory, Diagnostic Imaging, Pharmacy,Workers� Health, MedicalSocial services

Client will be directed by Registration/Collection counter, screening counter or consultationrooms to the laboratory, diagnostic imaging unit (ultrasound) etc. The clients will beinformed bythe registration/screening counter the designated room for examination. They will wait at therespective sub-wait prior being called in for attention.

4.2.2. Staff Flow

4.2.2.1 Staff will register either electronically of manually before given access to the clinic.

4.2.2.2 Uniformed staff will change into their uniform in the clinic�s Staff Changing rooms (male


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female staff). They will proceed to their place of work at their rooms/units).

4.2.2.3 Before returning, uniformed staff will change back into their own clothes at the Staff Changingrooms.

4.2.2.4 All staff shall register before leaving the clinic.

4.2.3 Material Flow

4.2.3.1 Sterile items: Bulk sterile items will be collected from the CSSD of the hospital and be broughtand stored at the Sterile Holding Store. Distribution to the rooms/units be made on request.

4.2.3.2 Sterilised items: Sterilised items will be bought and kept in the dedicated cupboard in theSterile Holding Store.

4.2.3.3 Non-Medical Item: Domestic, general and stationary goods will be brought from theIntegrated Store of the hospital or direct purchase from the vendor to the General Store ofthe clinic. Linen will be drawn from the off site laundry and stored in linen cupboards of theGeneral Store prior to distribution.

4.2.3.4 Pharmaceuticals: Pharmaceutical items will also be brought to the Drug Store underthe Pharmacist supervision. Drugs that require pre-packing or preparation will bemade and stored in the Drug Store. Pharmacist/ Assistant Pharmacist will bringappropriate units/package into the pharmacy for replenishment. Poison drugs willbe kept in poison cabinets.

4.2.3.5 Soiled linen will be kept in the Dirty Utility Room awaiting transport to the Laundry or CSSD offsite.

4.2.3.6 Waste will be kept in the sorted bags according to the type of waste by the clinical staff. Thesebags will be collected at the Dirty Utility Room and sent to the Waste Holding Area accordingto types of bags. These wastes will then be collected company contracted to dispose them.

4.3 Supplies

4.3.1 Medical and Non-medical (contracted-out)

2 weeks supply of pharmaceutical products will be delivered from Integrated Store of thedesignated hospital or direct from supplier to the clinic�s Drug Store before sending to thepharmacy.

Other supplies such as stationary will be delivered from the Integrated Store or supplier on arequisition basis to the General Store.

4.3.2 Sterile Items (contracted-out)

Sterile packs will be taken from the Sterile Holding Store to the rooms/units on �top-up� basisand on request. Regular supply of sterilised items to the clinic will be from the c o n t r a c t e dcompany.

4.4. Other Services

4.4.1 Linen Services (contracted-out)

Linen will be supplied from the laundry off site/privatised on a �top-up� and �request� basis to theGeneral Store.

4.4.2 Pottering and Transport Services


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Pottering and Transport Services will be privatised.

4.4.3 Cleaning and Housekeeping (contracted-out)

General cleaning services of the clinic will be privatised. The cleaning services will include allthe various cleaning methods for the rooms/units, corridors, toilets, public areas, landscape,office , training rooms etc.

The scheduled items and chemical/reagents used for the cleaning purposes will be managedaccording to the cleaning requirements and standards.

Cleaner�s room will be provided with equipment, detergents, etc.

4.4.4 Disposal and Waste Services (contracted-out)

Dirty Utility Room for waste holding will be provided before sending waste to the Waste HoldingArea for collection by the company contracted for the waste disposal.

4.4.5 Food&Catering

Staff will have beverage in the staff rest room during breaks. Vending machine will be providedin the main entrance of the clinic for the use of all sections. A canteen might be provided andcontracted out (optional).

4.4.6 Engineering Services

The engineering services will be contracted-out. The Concession Company will beresponsible for the surveillance, maintenance and repair of the buildings� engineering system,plants and medical department, maintenance of inventories and records on equipment,buildings as well as plan and service manuals of engineering maintenance.

This unit will also be responsible for the planned maintenance program for buildings,engineering services, plant and equipment.

4.4.7 Security Services

The whole security services will be contracted-out including security of client, staff and clinic asa whole.

4.4.8 Information Technology (I.T.)

IT concept that is being proposed for Health Clinic is part of a network infrastructure thatconnects Health Offices and Health Clinics as well as Community Clinics.

The administrative Health Office will be the base or hub which will provide IT service to healthclinics that are connected to it. These clinics will be connected with leased lines to the healthoffice. The use of �web-base� system is also being explored, to look for the most cost-effectivenetwork. Users of the workstations will be connected to the database at the �hub�.

Health offices or hubs from the same state will also be connected to each other to the main hubat the State Health Office to form a wide area network.

Each health clinic will be provided with adequate space for servers and telecommunication andtelemedicine facilities according to level of care. Each work station within the health clinic willbe connected to each other through a local area network.


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4.4.8.1. IT System

The IT System will emphasise on clinical management, health information and health systemmanagement. The electronic medical record for each client will be developed and captured inthe database.

Supporting financial, human resource, pharmaceutical, lab, radiological system will bedeveloped to facilitate integrated information utilisation for clinical decision making as well asin health system management.

4.4.8.2. IT System � coverageThe system will have the following functional coverage :a) Registrationb) Appointmentc) Triagingd) Queuinge) Micro cost accountingf) Clinical information systemg) Human resource management systemh) Financial management systemi) Pharmaceutical information systemj) Lab information systemk) Radiological information systeml) School health servicem) Office automationn) Health Education and Informationo) Health Statistics and general informationp) Health Inspectorate and disease surveillance

4.4.8.3 IT System - technologyIt will be an open system with the following characteristics:a) Consistent �Look and feel� facilityb) Graphical User Interfacec) Multimediad) Graphics applications and interfacese) Security in builtf) Window baseg) Windows NT processorsh) SQL Databasei) Switched networkj) Ethernet protocolk) Local area networkl) ISDN lines or Frame Relay.

5. REGISTRATION/COLLECTIONCOUNTER,SCREENINGCOUNTERANDMAINWAITINGAREA

5.1. ROLE/FUNCTION

5.1.1. Reception of inquiry5.1.2. Registration of clients.5.1.3. Tracing of records (Linkage to record office)5.1.4. Screening of walk-in client5.1.5. Collection of fees5.1.6. Attending telephone calls5.1.7. Waiting space for clients


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5.2. LOCATION

The reception/registration/collection/screening area will be accessible through the main entrance. Thecounter should be designed and located so that the staff can easily oversee client entering the clinic andoversee the main waiting area.

5.3. ORGANISATION

5.3.1. Registration will be conducted by the receptionist.5.3.2. Screening will be conducted by paramedics.

5.4. OPERATIONALPOLICIES

5.4.1. Client Circulation

Client will enter the department via the main entrance of the clinic. Client will take a queue-number using their smart-card or identity card. They will wait in the Waiting Area for registrationby a Registration/Collection Counter. Client will be identified by the Registration/Collection counter as new or follow-up case. Retrieval of client�s record will be made throughthe Record Office. This process will be computerised. Destination of the record will bedetermined by the Registration/ Collection counter i.e. screening counter, consultation room orother rooms/units based on appointments given.

For walk-in cases, without appointment, they will be screened at Screening Counter (besidesregistration/collection counter) by a registration personnel to determine where the client issupposed to go, e.g. doctor, paramedic, laboratory or other rooms/units by putting a sticker andqueue- number on their record. Certain parameters e.g. weight, height and blood pressuremay be taken at this counter.

Clients will then wait in the sub-waiting area in-front of the respective rooms or units until theyare called for consultation or other purposes.

5.4.2. Clients Record

a) Clients are registered at the reception/collection counter. The whole process ofregistration will be computerised.

b) For the clients who have an appointment, medical records will be retrieved electronically.Some �hard-copy� record e.g. x-ray film, old medical record, will be retrieved manually from therecord office.

c) Once clinic session ends, the �hard-copy� records will be sent back to the record officewhile electronic record will be stored in the computer.

5.5. COMPONENTS OF REGISTRATION/COLLECTION COUNTER, MAIN WAITING AREA AND SPACEREQUIREMENTS

5.5.1. Entrance

The main entrance shall be easily accessible to client and staff. It should be comfortable toallow 10 clients in and out at any one time.

5.5.2. Registration counter

Clients will be registered here. It should accommodate at least 8 clients at any one time. Itshould be built as 4 sitting and 4 standing counters.


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5.5.3 Information counter

Clients� queries and calls (telephone) will be attended at the information counter. The clericalpersonnel will attend to all queries.

5.5.4 Screening (Triaging) counter and �call-centre�

New cases without appointment will be attended here after registration to identify theirproblems or purpose of visit and which room/unit to go to. Main activities conducted here arehistory taking (main complaints only), and weight, height and blood pressuremeasurement. Manned by paramedics, it should be built for 4 clients at one time.

5.5.5 Medical Record room

Medical Record room will be adjacent to the Registration Area allowing easy communicationbetween these two rooms.

5.5.6 Waiting Area

Client and accompanying relatives will wait before and after registration/ screening beforedirected to consultation rooms, lab or other attending rooms. It should accommodate at least300 clients (including accompanying person), at any point of time. The clients includeoutpatients and preventive care.

5.5.7 Lobby/ExhibitionArea

This is an area where health exhibition materials will be displayed. Electronic informationkiosk will also be placed here.

5.5.8 Public Toilets

Adequate Male and Female client�s toilets will be accessible from the waiting area. 2 toilets forthe disabled will alsobe provided (1 for adult and the other one for child).

5.5.9 Breast Feeding andNappy Changing Area

A room will be provided for mothers to breast-feed their babies. A worktop with washingfacilities is required for nappy changing. This facility should be accessible from the waitingareas and near to public toilets.

5.5.10 Trolleys and Wheel Chairs Parking Area

It will be located near the main entrance and rehabilitation centre for patients� use. It will be ableto accommodate 4 trolleys and 5 wheel chairs.

5.5.11 Shuttle Services Waiting Area

A waiting area near the Main Entrance will be provided for clients waiting to be transported to thehospital/other identified facilities.

5.5.12 Play area

Designed for children recreation while waiting for their examination and consultation. Must benearby and seendirectly from the main waiting area.

5.5.13 Collection counter

It is located besides the registration counter. After collecting medication, client will pay the fees


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and collect education materials, appointment, referral letters etc here. It should accommodateat least 6 clients, at any point of time.

6. HEALTHRECORDUNIT (Size and space depends on level of computerisation)

6.1 ROLE/FUNCTION

6.1.1. To collect, store and retrieve clients� records.6.1.2. To enter diagnosis (ICD) made by doctors.6.1.3. To analyse statistics and present them to the management for decision making and planning.6.1.4. To co-ordinate the preparation of medical reports, quality assurance reports and issuing

returns to District Health Office.

6.2 LOCATION

It will be located near the main registration area.

6.3 ORGANISATION

The medical record unit will be headed by a record officer with the help of other medical record staffsincluding clerks and health attendants.

6.4 OPERATIONALPOLICIES

a) It is a centralised medical record system. All clients records will be kept in this office.

b) At the end of clinic sessions, client�s records will be despatched to the record office within 24 hours.

c) If not fully computerised, record staff will do the ICD coding and indexing.

d) Statistics is generated automatically from the computer system. The record office has to submit theweekly and monthly statistics to the District Health Office. Quality Assurance data report will beprepared six-monthly or annually.

e) Records may be referred and issued to the doctors/clinic. The record office will keep tract ofthe records through the computer system.

f) Records will not be issued to any unauthorised person or outsiders. For accountability, staff hasto sign to prove that he/she is receiving/ handing the records.

g) The distribution of Medical Reports, Quality Assurance report and other official report will beco-ordinated by this office.

6.5 SPACEREQUIREMENT

6.5.1. Waiting areaFor issuing medical records for 8 visitors at any one time.

6.5.2. Reception Counter (open concept)For medical record assistants (clerk) to carry out indexing of client records.

6.5.3. Record Officer AreaOpen Concept Office for administration work.

6.5.4. Record room with record compacts for storage of medical records and x-ray films. Exhaust fanis necessary for the file room.


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7. CONSULTATIONANDEXAMINATION(CE)ROOMS(FAMILYHEALTHUNIT)

7.1 ROLE/FUNCTION

7.1.1 Promotive, Preventive, Curative and Rehabilitative health services to all age group. CE roomswill be manned by either doctors, nurses or medical assistants.

7.1.2 Each CE rooms will cater all type of clients, six days a week.

7.1.3 The services include out-patient curative care, maternal and child health care, well adult clinic,geriatric care, family planning, adolescent health, community mental health and occupationalhealth clinic.

7.1.4 All clients will be seen and managed by the appropriate trained health staff.

7.1.5 Clients who need further treatment will be referred to Family Medicine Specialist or otherspecialists at the hospital or admitted to the ward.

7.1.6 Follow-up appointment will be given to client.

7.1.7 Health Education for all client and accompanying persons.

7.1.8 All CE rooms will be adequately equipped.

7.2 LOCATION

It shall be located at the same floor of the main entrance/lobby, easily accessible from theregistration/collection area. Interconnecting doors or staff corridor must connect these CE rooms.

7.3 ORGANISATION

7.3.1 The CE rooms staff shall be headed by the family medicine specialist

7.3.2 Other staff include medical officers, medical assistants, nurses, community nurses and healthattendants.


7.4.1 Provide promotive, preventive, curative and rehabilitative healthcare to all clients. Examination,education and counselling will be done here.

7.4.2 Follow-up cases referred from the hospital or other clinic will be seen in CE rooms.

7.4.3 Clients who need specialist services will be referred to Family Medicine Specialist,Occupational Health specialist or other specialists at nearest hospital.

7.4.4 Clients who need admission will be referred to the nearest hospital.

7.4.5 Physiotherapy services will be provided by visiting physiotherapist and occupational therapist ifstationed officers are not available.

7.5 SPACEREQUIREMENT INCONSULTATIONANDEXAMINATIONROOMS

7.5.1 EntranceSeparate entrance for staff and clients.


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7.5.2 Waiting area

After registration and screening, clients will wait at the Main Waiting area as mentioned in 5.5.6,before being called for consultation.

7.5.3 Consultation & Examination Rooms

Adequate number of rooms shall be provided depending on workload. Doctors andparamedics shall see patients. A digital call system shall be used to call patients. Eachconsultation room shall be able to accommodate 4 persons and basic equipment e.g.Examination couch with drawing screens, doctors� tables and chairs, x-ray illuminator a n dtrolley.

It must be adequately sound proof.

Number of rooms needed is based on the norms of 50 clients/room/day. On an average theType 2 should have at least 18 rooms.

7.5.4 Treatment Room

This room has several couches with drawing screens. Each area (cubicle can accommodateat least 4 person at any one time). This room can be directly accessible to the public, eitherthrough the main or alternative entrance. This room is for injections, dressing, treatment forasthmatic patient, rehydration and resuscitation. Adequate and lasting worktops and built-incabinets should be installed. This room should accommodate 3 clients at any one time.

7.5.5 Procedure RoomThis room have several couches with drawing screens for performing minor surgicalprocedures such as circumcision, incision and drainage, removal of lumps, fine needle biopsy,pap smear, IUCD and Norplant insertion, CTG examination etc. It shall have a hand-washingfacility and interconnecting doors with other CE rooms.

7.5.6 Preparation and Sterilisation Area

Clean trays and equipment will be prepared here. A sink for washing and cleaning-up and anautoclave area for sterilising equipment will be provided.

7.5.7 Specimens Taking Area

For taking specimens for lab investigation e.g. blood and sputum. Toilets for urine and stoolspecimen are to be provided nearby. This room should be able to accommodate 8 people.

7.5.5 UltrasoundRoom

To place ultrasonagraphy machine for obstetrics and gynaecological and general examination.Preferably nearby the Diagnostic Imaging Unit.

7.5.8 ECGArea

For ECG examination. It shall be able to accommodate at least 4 clients at any one time.Couches and ECG machines will be provided. This facility can be accommodated with eyeexamination area (6.5.8) in one room.

7.5.9 Eye Examination Area

For visual acuity test using Snellens chart and colour blindness test for general medical check-up. Slit lamps may be installed here (optional).


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7.5.10 Hearing Examination Room

For audiometric test for the baby, children and adult. Observation space with glass separator isneeded. The room shall be partially sound-proof and have sound-proof box.

7.5.11 Staff CorridorStaff corridor shall run behind all the rooms.

7.5.12 School Health Room

An office-cum-clinic area for the staff running the School Health Service and school childrenexamination will be provided. It can be located near the office area.

This area will accommodate 5 staff with office furniture and one examination space equippedwith examination couch and trolley.

7.5.13 HomeCare Nursing Room

The room is an office and preparation room for home care nursing that accommodate facilitiesfor washing, storage and preparation of trays and dressing sets on returning to the office.Tabletop sterilising facilities will be provided.

This room shall accommodate at least 6 staff with office tables and working area.

It can also be located near the office area.

8. HEALTHEDUCATIONUNIT

8.1 ROLE/FUNCTION

To provide health education in the form of individual/group teaching, counselling and demonstration.

8.2 LOCATION

Two rooms shall be located near the CE rooms for group counselling, one with facilities for cookingdemonstration.

8.3 ORGANISATION

Booking of the room will be done centrally at the administration office.


8.4.1 The health education room can be used on regular basis e.g. cooking demonstration forexpectantmothers.

8.4.2 Health Education activities can also be arranged by central booking.

8.4.3 It can also be used for teaching purposes for the staff.

8.5 SPACEREQUIREMENTFORHEALTHEDUCATIONAREA

8.5.1 Health EducationRoom

Health education and counselling will be given by health personnel in this room. Models, flipcharts and other audio- visual aids will be used for this purpose. This room will have space fora maximum of 20 people.


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8.5.2 Cooking Demonstration Area

Nutrition education and counselling for mothers and parents, and clients with special needs(e.g. diabetic, hypertensives and obese). It will require:- Healthy kitchen- Actual cooking tools and utensils such kitchen, sink, fridge, kitchen cabinet etc- Audio-visual aids- Sitting facilities (theatre style) which can accommodate 15-20 people at one time.- Show case for food model display.These facilities can be equipped as a portable kitchenette.

9. ORALHEALTHUNIT

9.1 ROLE/FUNCTION

The Dental unit will provide basic dental health services for outpatient.

9.2 LOCATION

It can be located away from the CE rooms but easily accessible to public. If located upstairs it should beaccessible by lifts and stairs located near the lifts.

9.3 ORGANISATION

A senior dental officer will head the unit, which comprised of several nurses, dental technicians etc.


It will operate during office hours and provide basic dental services. Client who need further treatmentwill be send to the local hospital dental specialist clinic.

9.5 SPACEREQUIREMENTFORDENTALUNIT

9.5.1 Reception and Sub-wait

The Dental Clinic will have its own reception and a sub-waiting area. Payment is made at thecommon Collection Counter. A small Exhibit Area will also be at this area for dental healtheducation. It should accommodate 30 persons at any one time.

9.5.2 Dental Operatories (Dental Surgery)

There will be adequate number of dental chairs (6) in a large room with partitions for eachoperatory for privacy and workspace. Each room should be made sound proof. Each room isaccessible to staff through interconnectingdoors.

9.5.3 Air Compressor Room

To house the dental compressor.

9.5.4 Preparation/Sterilisation Area

Clean trays will be prepared here. A sink with a plaster tap for washing/cleaning up and anautoclave for the sterilisation of dental instruments will be provided. Clean supplies can be kepthere.

9.5.5 Staff Office

An office for Dental Officer in-charge to fit in at least 3 person at any one time to be provided. Staffoffice for 4 personnel with furniture will also be provided.


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9.5.6 Equipment Store

For the storage of dental equipment and other items will be provided. Store for the DentalMobile squad will be provided here.

9.5.7 Dental Laboratory

The dental laboratory work will be carried out in this room. It will be equipped with workbenches and cabinets for Dental Technicians.

9.5.8 Dental Store Room

Dental materials are stored here eg. dental impression material, etc. Built-in cupboards aresuitable. It will be annexed to the Dental laboratory.

9.5.9 DirtyUtility

A dirty utility room will be made available near the dental operatories.

10. REHABILITATIONUNIT

10.1 ROLE/FUNCTION

To provide rehabilitative services for all patients requiring rehabilitation under the Health Clinicsoperational area.

10.2 LOCATION

It can be located away from CE room but must be barrier free, preferably have a separate entrancefor easy access by patients and be disabled friendly. Doors and corridors should accommodate forwheelchairs and stretchers.

It should be located on the ground floor and preferably have access to play ground (barrier free andincorporate therapy items e.g. footpath with handrails, wheel- through handbars 4feet x 3 feet x 1feet, wheelchair swings12 feet x 12 feet, special swing seats 12 x 12 feet).

10.3 ORGANISATION

Senior physiotherapist/occupational therapist will head the unit and be under the responsibility ofthe Officer in Charge of the Health Clinic. Unit will be manned by physiotherapist, occupationaltherapist, speech and language therapist, and/or nurses and assisted by health attendants.


10.4.1 Services provided will include physiotherapy, occupational therapy and speech andlanguage therapy. Basic ototic services will be provided when required.

10.4.2 Services provided will cater for;- persons with disabilities (children and adult)- mentally ill patients- elderly- post trauma- short term follow up cases e.g. pregnant mothers, acute respiratory diseases,

orthopedic problems and others- persons with chronic conditions such as chronic obstructive airway disease, chronicbackache, patients with stroke and others


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10.4.3 The unit will operate during office hours and cases that require further treatment will bereferred to hospital. Rehab services in the home will be provided by the therapist asrequired.

10.4.4 Staff of rehab unit will also function as a team with other staff in the Health Clinic i.e. MedicalSocial Worker, Counsellor, Public Health Nurses and Medical Assistants.


10.5.1 Reception andWaiting Area

Waiting area should be large enough for 30 persons (includes patient and care givers) atany one time and accommodate wheel-chairs.

10.5.2 Assessment and Treatment Room

Large room to include;� Area for assessment that should accommodate 6 persons at one time. It will be

equipped with basic facilities for cognitive and physical assessment, couch, table andchairs.

� Area for treatment with 3 cubicles i.e. one for high frequency machine, one for mediumand low frequencymachine and one for pulmonary rehab. Treatment here will includevarious heat therapy, light therapy, traction and electrical stimulation.

� Area for splitting purposes (needs large sink) that will need to be wheelchair andstretcher assessable

10.5.3 Pediatric Therapy Room

For therapy in children with special needs, a separate area is required to reducedistraction. Two connecting rooms with glass panes (one way view glass panes toobserve behavioural responses) for assessment and observation by the therapist as wellas to carry out therapy. Larger room to accommodate for assessment equipment and 3person at any point of time.

10.5.4 Psychiatric Therapy Room

This is for group therapy of psychiatry cases. It will be equipped with a large table andchairs. It will accommodate about 10 persons at one time.

10.5.5 Activities of Daily Living (ADL) Room

This room will be equipped with cooking facilities, toilet and others for training of daily livingactivities. This room will also be used for the psychiatric cases.

10.5.6 Skill Laboratory

This is a therapy room with equipment such as through and other hand fraction equipment.It will accommodate 10 persons at one time.

10.5.7 Gymnasium

Gymnasium should be large enough to accommodate:� 20 persons (including carers) at any one time;� rehabilitation equipment such as :

shoulder wheel, 259x88mm (against the wall)multi exerciser 290x1070x20 mmphysio/therapy balls 450- 1200mm diameter (average of 4 balls per clinic)parallel walking bars 2300mm x 660mm x700 mm


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adjustable rehabilitation corner steps 200 x 150 x960 mmstanding frame 1900 x 660 mmwalker adult and child (2 sizes) � 570 x370 x620 mmwedges ( multiple sizes- 4) 305x914 mm � 1422 x508 mmcorner seat support chairs 2 feet x 3 feetmobile posture mirror � 360 x1200 mmCreepster crawler 2 feet x 2 feetBubble ball bath/multisensori ball pit � 7 feet diameter

10.5.8 Hydrotherapy

10.5.9 Rehab Store

For storage of equipment and disposable items.

10.5.10 Pantry

Pantry for training on activities of daily living and domestic skills for psychosocial rehab ofmentally ill, elderly and disabled. Requires work areas that can fit wheelchairs, large table andspace to accommodate fridge, stove and kitchen utensils.

10.5.11 Toilet

A staff toilet will be provided. Toilet for rehabilitation training for the disabled on self care. Shouldbe large � standard toilet for disabled that includes both toilet and bathroom.

10.5.12 Office for staff

One office for the officer in charge to be able to fit 3 persons at any one time. A common roomas staff office for 2 other personnel.

11. PATHOLOGYUNIT

11.1 ROLE/FUNCTION

To provide diagnostic laboratory support services (level I upgraded) to patient.

11.2 LOCATION

It shall be located near the CE rooms; in a manner that subwait can be shared with other clinics.

11.3 ORGANISATION

11.3.1 The lab will be headed by a senior medical laboratory technologist.11.3.2 He/she will be assisted by medical laboratory technologist and health attendant.


11.4.1 Request For Test

11.4.1.1 The lab will receive requests for lab test from all CE rooms.

11.4.1.2 Request will be made by doctors, nurses or medical assistants using therequest form.

11.4.1.3 Client will bring the request form to the lab where it will be registered.

11.4.1.4 Specimens will be taken in the clinic specimen taking area.


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11.4.2 Receiving Specimens

Specimens will be received registered and sorted out at the reception before the test isdone.

11.4.3 Reporting

11.4.3.1 Result of the investigations will be captured automatically in the computersystem. The staff may key in some information and to endorse the validity ofthe result.

11.4.3.2 End users will be able to retrieve the result from their workstation.

11.5 SPACEREQUIREMENTINLABORATORY

11.5.1 Reception Area

Request forms and specimens will be received here. Specimen will be sorted out here.

Sitting and stand-up work is required. There must be adequate space for movement ofspecimen trolleys.

11.5.2 Waiting Area

Client to wait at the main waiting area before specimen are taken. They will be called intospecimen collection area for specimen collection. It could accommodate 30 clients at anytime.

11.5.3 Specimen collection area

Specimen collection toilets and vene-puncture area are to be provided. It shouldaccommodate at least 5 persons at any one time.

11.5.4 Laboratory Area

A laboratory will provide for test which can be carried out as out-patient. It will be able toaccommodate about 6 staff.

Specimens will be received here and examined immediately. Urine, stool, sputum andsimple blood tests will be carried out. Examinations of specimen will be conducted onheavy duty worktops. Results will be conveyed via electronic device on request or/and willbe put into pigeon holes at the reception counter to be collected by the respective clinics atregular intervals.

11.5.5 Lab Store

For storage of equipment, chemicals and reagents.

11.5.6 DirtyUtility/Disposal Room

For washing test tubes and bottles.

11.5.7 Staff Area

An area for staff to sit and perform paper work away from the lab benches.


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12. PHARMACYUNIT

12.1 ROLE/FUNCTION

12.1.1 Dispensing all pharmaceutical products to all clients.12.1.2 Client counselling in the use of drugs and dissemination of drug information.12.1.3 Monitoring of drug utilisation.

12.2 LOCATION

It shall be located at the end of patient�s flow after which client will go home.

12.3 ORGANIZATION

The unit will be headed . a pharmacist or senior pharmacy assistant. He/she will be assisted bypharmacy assistants and general workers.


12.4.1 It will serve client seen in all the CE room and oral health unit.

12.4.2 Pre-packing of some drugs will be done here.

12.4.3 Out-patient counselling will be done in this unit.

12.5 SPACEREQUIREMENTFORDISPENSARY/PHARMACYUNIT

12.5.1 Sub-wait Area

There will be separate waiting area for clients to wait during the preparation of theirprescription. Space required for 60 people at any one time.

12.5.2 Dispensary Area

a) It is an open concept system for dispensing counters. Adequate working spaceat each counter will be provided for dispensing and computer workstation.

b) Clients will be asked to go to the dispensing counter where they will each be given anumber. They will be called to receive their medicine by digital call when ready.

c) Dispenser working behind the first or screening counter will receive prescriptionand check treatment prescr ibed. Any doubt wi l l be clar i f ied wi th thepharmacist who in turn may check with the medical officer who issue theprescription. Dispensers working behind the other counters will dispensemedic ine wi th inst ruct ion to pat ient . An area wi l l be prov ided for thedispensers to prepare the prescription.

d) There should be at least 6 counters.

12.5.3 Drug Store

2 months stocks of pharmaceutical item will be held here. Supplies will be bought inby the concession company on regular basis and upon request. Certain drugs will bekeptin the refrigerator. Suggested store size is at least 500 sq ft.


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b) Bulk Store

For stocking bulky packaging materials (dispensing containers - mixtures, lotions,oitments and creams), labelling lables and stationaries. Suggested store size is 200sq feet.

c) Inflammable Store

The store must be located away from the main building, for storing several monthsstock of inflammable materials e.g. spirit, liquid paraffin. Suggested size is 120 sq ft.

12.5.4 Dry and Wet Pre-packing Areas

Pre-packing of drugs will be done here. Separate rooms will be provided for dry drugs,internal (wet) preparations and external (wet) preparations. High tap, deep aluminiumbasin and 3 ft skirting tiles are needed.

a) Dry (Tablet/Capsule) Pre-packing areaFor pre-packing of tablet and capsules. Equipped with suction hood for each machineto suck dust.

b) Extemporaneous and internal Pre-packing areaFor reconstitutions of ready to dispense suspensions (antibiotics) and prepacking ofmixtures. Certain drug will de kept in the refrigerator.

c) Extemporaneous and external Pre-packing areaPrepacking of lotions, ointments and creams will be done here.

12.5.5 Pharmacist or officer in-charge Office

An office will be provided for the pharmacist or officer in-charge of the pharmacy to carry outon sultation services and drug information as well as administrative work.

12.5.6 DrugCounsellingRoom

Individual outpatient counselling will be done in this unit. Can accommodate 3 people atany time. Group counselling on drug usage will be carried out in the health educationroom.

12.5.7 Staff Area

An area for staff to perform paper work will be provided away from dispensing benches.

12.5.8 Staff toilet

Staff toilet for male and female staff will be located inside the dispensary. Water hose to befixed in each cabinet

13. DIAGNOSTICIMAGINGUNIT

13.1 ROLE/FUNCTION

13.1.1 Performing x-ray examination i.e. plain radiograph of the chest, abdomen, KUB, skull andextremities.

13.1.2 Performing ultrasound examination, especially for obstetrics purposes.13.1.3 Ensuring radiation safety to the staff and client as well as the public.


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13.2 LOCATION

It shall be located near the CE Rooms; in a manner that sub-wait can be shared with other clinics.

13.3 ORGANIZATION

The unit will be headed by a senior radiographer (diagnostic). He/ she will be assisted by aradiographer (diagnostic) and health attendant.


13.4.1 It will serve client seen in the CE room as ordered by the doctor.

13.4.2 Operation during office hour only.

13.4.3 X-ray examination done by the radiographer (diagnostic).

13.4.4 Ultrasound examination mainly done by the doctor and the specially trained radiographer.

13.4.5 X-ray film will be processed immediately and reported by the ordering doctor.

13.4.6 The radiographer will also monitor and maintain the machine and the store.

13.5 SPACEREQUIREMENTINDIAGNOSTIC IMAGINGUNIT

13.5.1 Reception / Registration

Clients will be registered at this counter.

13.5.2 Subwaiting Area

There will be a waiting area to cater for 20 to 30 patients with spaces to accommodatepatients coming on wheelchairs and trolleys.

13.5.3 ChangingRoom

The unit will provide 2 changing cubicles for the clients.

13.5.4 X-ray Room

A standard size room is provided for general radiography and dental radiographymachine.

13.5.5 Special examination Radiography

An attached toilet will also be provided in this room.

13.5.6 Dark Room

Dark room will be provided with loading and unloading of film facilities, an automaticprocessor and a built-in work bench with Film Hopper. It should also provide an area forpreparing and mixing processing chemicals.

13.5.7 Control Room

A comfortable control working area for Radiographer.


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13.5.8 Chemical Store

For storing of processing chemicals .

13.5.10 Film Store

For storage of unexposed films.

13.5.11 Sorting and Viewing Area

A combined sorting and viewing area will be provided for viewing of x-ray radiographs.

13.5.12 Office space

It will be used for report writing and other office works. The office shall be able toaccommodate 6 staff. It can be combined with the control room.

14. HEALTHSURVEILLANCEUNIT

14.1 ROLE/FUNCTION

To provide health surveillance function for the health clinic�s operational area.

14.2 LOCATION

One room shall be located near the main office and can be away from the CE rooms.

14.3 ORGANISATION

The health inspector performing the function may or may not be under the responsibility of theofficer-in-charge of the Health Clinic. If not, he may be responsible directly to the Medical Officer ofHealth of the District.


14.4.1. The health surveillance unit is required to monitor the various disease pattern captured orreported in the database of the Health Clinic.

14.4.2. The scope of this function is Disease Control for Communicable and Non-CommunicableDiseases, Vector and Rodents, Occupational Health, Environmental Health and Wasteand Sanitation.

14.4.3. Function includes defaulter tracing (for chronic infectious diseases), ensure notification ofall notifiable diseases, analysis of disease database, initiating investigation, institutinginterventionand report writing.

14.5 SPACEREQUIREMENTFORHEALTHSURVEILLANCEAREA

14.5.1 Health Surveillance Room

Meeting room for 10-15 members, for briefing and discussion regarding diseasesurveillance and act as an operation room during outbreaks.

14.5.2 Technical Support Room

An office shall be made available for a health inspector and space for two support staff.Report and charting on disease surveillance, prevention and control will be done here.


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15. INFORMATIONTECHNOLOGY

15.1 ROLE/FUNCTION

15.1.1 To connect each work station within the clinic to the main database15.1.2 To facilitate data collection, data mining and information generation through an integrated

health information system.15.1.3 To facilitate clinical decision making as well as support health management system.15.1.4 To provide realtime data on performance both on workload and on efficient use of

resources.15.1.5 To facilitate telecommunications and telemedicine of health providers.

15.2 LOCATIONOF ITROOM

15.2.1 A small room will be provided to locate servers and telecommunication facilities. It will beair-conditioned or placed in cool area, preferable low-dust area.

15.3 ORGANISATION

15.3.1 The IT services will be under the responsibility of the Family Medicine Specialist who willdelegate it to the most appropriate trained officers in IT management and maintenance.

15.3.2 The Record Office will be made responsible for maintenance and utilisation of data andrecords.


15.3.3 It is a centralised system that collects all electronic medical records on realtime. All clientsEMR will be kept in the database.

15.3.4 Policy on access to individual client�s data will be adopted from the new �National TelehalthPolicy� that will be developed soon.

15.3.5 Statistic for HMIS or QA is generated automatically from the computer system. Aggregatedrecords are accessible to the district health office and state health office.

15.3.6 All providers will be authorised to given level of access to �identified� groups of data and notall data and information. FMS will be responsible to ensure security of data and access.

15.3.7 Data and information will not be issued to any unauthorised person or outsiders. Nocommercialisation f data is allowed.

15.3.8 Only qualified health professional can undertake and deliver telemedicine assistedhealthcare.

15.3.9 Clients will be made accessible to health information and education. A person will bemade in charge to answer any queries if any by clients. The state or district health officemust approve the contents before putting on the web page.

15.3.10 Practice guidelines or management protocols will be constructed into the system.

15.3.11 Data and information may be used to facilitate research by authorised personnel.

15.5 SPACEREQUIREMENTFORINFORMATIONTECHNOLOGYROOM

A room to fit in servers, telecommunications facilities and a table top for working area for 4 personsat any one time.


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16. ADMINISTRATIONOFFICE

16.1 ROLE/FUNCTION

16.1.1 Overall management of the clinics.16.1.2 Human resource management.16.1.3 Management of finance including revenue collection.16.1.4 Co-ordinate the training programme for the staff.16.1.5 Co-ordinate the use of health education room.

16.2 LOCATION

The administration office may be located away from the main clinic areas but easily accessible eg.walking distance, via elevator etc.

16.3 ORGANISATION

16.3.1 The officers-in-charge (Medical Officer of Health, Family Medicine Specialist or Medical Officerin-Charge) will be the overall manager of the clinic.

16.3.2 For day to day operation, he/she will be assisted by senior clerks, clerks and sister-in-charge.

16.4 SPACEREQUIREMENTFORADMINISTRATIVEOFFICE

16.4.1 Officer-In-ChargeOffice

An office for officer-in-change of the health clinic will be provided in this area.

16.4.2 General Office Area

Common office will be provided for the administrative staffs with an open office concept. It willprovide office space for 3 administrative staff. A pantry will be provided in adjacent to thegeneral office.

16.4.3 Seminar Room

A seminar room will be provided to accommodate a minimum of 50 people. Used for in-service and community training.

16.4.4 MeetingRoom

A meeting room will be provided to accommodate a minimum of 30 people.

16.4.5 Visitors Area

A visitors area for 4 persons should be made available in the office.

17.STORES

17.1 GENERALANDSTERILEHOLDINGSTORE

For storage of equipment, domestic goods and stationary as well as linen for the whole Health Clinic.A Sterile Holding area can be partitioned in the same store. Appropriate compartments to be madeavailable in the store.


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17.2 DRUGSTORE (see also 12.5.3)

A drug store will be made available near the dispensaries. There should be adequate shlves forstorage of drugs.

17.3 BULKSTORE

To store bulky material such as medicine bottles and labels and display boards. Minimum suggestedsize is 160 sq ft.

17.4 CONDEMNED MATERIALSSTORE

To store materials and equipment before being condemned.

17.5 INFLAMMABLESTORE

The store must be located away from the main building, for storing several months stock of inflammablematerials e.g. spirit, liquid paraffin. Suggested size is 120 sq ft

17.6 DENTALMOBILEUNITSTORE

To store Dental Mobile Team equipment such as mobile dental chair and surgical equipment.

17.7 HEALTHEDUCATIONSTORE

To store audio-visual aids, display boards and printed materials.

17.8 CLEANERSROOMS

This room will provide sufficient space for the storage of cleaning materials and equipment. It will beplaced at strategic location eg. each level of the multi-storey building

17.9 CLEANUTILITYROOMS

This room will provide sufficient space for the storage of clean/sterilised linen and disposables. It willbe placed at strategic location eg. each level of the multi-storey building.

17.10 DIRTYUTILITYROOMS

This room will provide sufficient space for the collection of dirty linen and equipment and clinical wastebefore being washed, sterilised or disposed. It will be placed at strategic location eg. each level of themulti-storey building

17.11 WASHINGAREA

Room for washing soiled linen. Can be part of dirty utility room.

17.11 CLINICALWASTEHOLDINGROOM

Area for holding of clinical waste before being disposed. Will be manned by concession company.

17.12 WASTEHOLDINGAREA

Areas for holding of domestic waste will be provided and this will be manned by the concessioncompany.


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19. PUBLICAMENITIES

19.1 VENDINGMACHINES

Vending machines will be provided at all strategic locations.

19.2 PLAYGROUND/PLAYAREA

A fenced play area shall be located just outside the clinic waiting areas. An entrance will provided fromthe waiting area to the playground. Playground shall be located just outside the Occupational TherapyUnit (Rehabilitation) for easy access of paediatric cases.

19.3 PARKINGSPACES

Sufficient public parking spaces will be provided in the basement area with elevators for handicappeddrivers.

18. COMMONSTAFFFACILITIES

18.1 STAFFCHANGEROOM

Male and female staff changing rooms will be provided to cater the whole health clinic staff. It shouldhave lockers for the staff to keep their personal items.

18.2 STAFFTOILETS

Staff toilets for male and female staff will be located at strategic places i.e. one at each level. Waterhoses to be fixed in each cabinet.

18.3 SOLATROOM

Prayer rooms will be provided centrally for male and female staffs and client of the health clinic. Eachroom shall accommodate 20 staff/client. Wuduk room will be provided for each prayer room. It shouldbe located near the staff toilet.

18.4 LIBRARY

Staff library room of medical and nursing books, journals, newsletter, reports etc.

18.5 STAFFREST

A common staff rest area at strategic area i.e. one at each level. Storage space as lockers for staffbelongings be attached. It should accommodate 10 staff at any one time.

18.6 COMPUTERWORKSTATIONAREA

Each working stationed staff will be provided with computer workstation. Computers should be locatedthat will allow good interactions between staff and clients.

18.7 STAFFPARKINGAREAS

For clinic staffs to park their vehicles. It shall accommodate 30 staff.

18.8 AMBULANCE/CLINICVEHICLEPARKING

Covered parking spaces will be provided for the clinic ambulance. Space for 5 other clinic vehicles willbe provided.


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19.4 ELEVATORS

Wide elevators which can accommodate stretchers will be provided for patients and staffs.

19.5 FOODANDCATERING

Depending on volume of client, a space for cafeteria may be provided.

19.6 THERAPEUTICGARDEN

Suitable gardens and landscape for the young, old and mentally ill clients.

20. PLANNINGCONCEPT

20.1 In all clinics, the availability of services could be on flexible basis, to be in-step with need, populationgrowth etc.

20.2 Urgent and acute cases will be referred to the Accident and Emergency Department of the localhospital.

20.3 The design of this clinic could therefore be on a �modular concept� (e.g. nucleus concept).

20.4 Land space being of premium in major focus, the facility should have the flexibility to be multi-storeed.Lifts should be provided if they are multi-storeyed.

20.5 Several services will be contracted-out e.g. laundry, cleaning, security, waste disposal and engineeringservices.

20.6 A security station will be provided for 24 hours security.

20.7 The layout of the clinic should ensure an efficient workflow and flexibility for future growth and function.

20.8 The registration area will be easily visible and accessible from the entrance. Accessibility to waitingareas too should be easy. Receptionists shall be able to see waiting clients and should have maximumview of the entrance to consultation/examination rooms. Waiting areas of the individual consultation/examination rooms will be easily accessible for the patients.

20.9 Public toilets will be close to the waiting area. There will be provision for a toilet f

20.10 Central Medical Records room will be adjacent to the Reception/Registration Area allowing easycommunication between these two rooms.

20.11 The basic concept of the Health Clinic design is the provision of standard Consultation/ExaminationRooms. The layout of these rooms will ensure maximum privacy, especially when door is opened aswell as interconnecting passage for staff use.

20.12 The Treatment and Procedure rooms shall be best positioned between the Clean and Dirty UtilityRooms with free access for staff. This measure will also to ensure a clear flow of clean and soileditems.

20.13 The Health Education facilities can be located away from the main Consultation/Examination Area asit is a shared facility for the use of the clinic.

20.11 The components of the Laboratory will be grouped together and should have its own waiting area.

20.12 The Rehabilitation (Occupational therapy & Physiotherapy) will have its own waiting area.


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20.16 The Dental Clinic Area as well as Rehabilitation Area will be separated from the CE rooms with itsregular flow of patients. The individual Reception Counter should face the Waiting Area and thereceptionist should be able to see all incoming and outgoing patients.

20.17 Outdoor Play Area will be accessible for all children accompanying clients and rehabilitative clients.

20.18 Visitors, staff, supply/disposal entrance and exit shall be able to be controlled.

20.19 Security to the centre will be devised to enable staff to work after normal office hours and clinics to beopened to public for Health Promotion activities after working hours.

20.20 Materials and Supplies flow will not interfere with the patients flow. It should have separate entranceto the various units.

20.21 The design will take into consideration future expansion and increase in scope of services.

20.13 TheWaiting Area of the Pharmacy will be clearly segregated from the Main Waiting Area and waitingarea of the CE rooms.

20.14 Within the clinic, natural light is desirable in waiting, working and staff rest areas. To achieve adequateprivacy for staff, the Staff Rest Rooms will be sited away from the patient and waiting areas.

20.15 Rehabilitative Unit (Occupational Therapy & Physiotherapy) will be located close to an entrance foreasy access of handicapped and disabled patients with wheelchairs and also for family to unloadpatient from their vehicle.


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APPENDIX I

(NOTE FROMPLANNING ANDDEVELOPMENT DIVISION)

FORMATINPREPARINGFORMEDICALBRIEFOFREQUIREMENTS

INTRODUCTION

� ROLESTATEMENT� SITUATIONALANALYSIS

� GEOGRAPHICAL� POPULATION� WORKLOAD

DEPARTMENTALBRIEF

� FUNCTIONAL DESCRIPTION� OPERATIONAL POLICIES� WORKLOAD� PLANNING CONCEPT

� WORKFLOW� FUNCTION OF SPACE� MANPOWERANDSTAFFING

� APPLICATIONOF THEWHOLE FACILITY OPERATIONAL POLICIES� SPACE REQUIREMENTS AND LISTS OF ROOMS


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KEPERLUAN PERUBATAN




April 2001


54

NOTA:JENIS-JENISKLINIKKESIHATAN(KK)

A) KK JENIS 1 > 800KEDATANGANSEHARI

B) KKJENIS2 500-800KEDATANGANSEHARI

C) KK JENIS 3 300 - 500 KEDATANGANSEHARI

D) KK JENIS 4 < 300KEDATANGANSEHARI

E) KK JENIS 4S (SABAH&SARAWAK) 150-300KEDATANGANSEHARI

F) KK JENIS 5 (SABAH&SARAWAK) 150KEDATANGANSEHARI

G) KK JENIS 6 (SABAH&SARAWAK) < 50KEDATANGANSEHARI


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1 RUANGMASUKUTAMA/PENDAFTARAN1.1 Kaunter Pendaftaran1.2 Kaunter Pertanyaan1.3 Kaunter Pembayaran1.4 Kaunter Triage / Call Centre1.5 Ruang Menunggu Utama1.6 Ruang Legar/Pameran1.7 Ruang Penyusuan / Tukar Lampin1.8 Ruang Permainan Kanak-kanak (dalam klinik)1.9 Tandas Awam1.10 Ruang Troli / Kerusi Roda1.11 Ruang Menunggu (kenderaan)2 UNITREKODKESIHATAN2.1 Ruang menunggu2.2 Kaunter Penerimaan2.3 Ruang anggota2.4 Ruang Rekod3 UNITKESIHATANKELUARGA3.1 Ruang Menunggu3.2 Kaunter Penerimaan3.3 Bilik Pemeriksaan (CE)3.4 Bilik Rawatan3.5 Ruang Rawatan Asma3.6 Bilik Prosedur3.7 Bilik Persediaan3.8 Ruang EKG3.9 Bilik Pemeriksaan Mata3.10 Bilik Pemeriksaan Pendengaran3.11 Bilik USG3.12 Bilik Pendidikan Kesihatan3.13 Bilik Demonstrasi Memasak3.14 Setor Peralatan3.15 Bilik Utiliti Bersih3.16 Bilik Utiliti Kotor3.17 Tandas Awam3.18 Tandas Anggota4 UNITKESIHATANPERGIGIAN4.1 Kaunter Penerimaan4.2 Bilik Pembedahan


JADUALRUANG

4.3 Bilik Tekanan Udara


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4.4 Bilik Persediaan/Pensterilan4.5 Pejabat4.6 Setor Peralatan4.7 Makmal Pergigian4.8 Setor Pergigian4.9 Utiliti Kotor5 UNITPEMULIHAN5.1 Ruang Menunggu5.2 Kaunter Penerimaan5.3 Ruang Pejabat5.4 Bilik Penilaian5.5 Bilik Terapi Pediatrik5.6 Bilik Terapi Psikiatri5.7 Bilik Terapi ADL5.8 Bilik Hidroterapi5.9 Gimnasium5.10 Ruang rawatan (wax dan inframerah)5.11 Makmal kemahiran (skill lab)5.12 Pantri5.13 Setor5.14 Tandas6 UNITPATOLOGI6.1 Ruang Menunggu6.2 Kaunter Penerimaan6.3 Ruang Mengambil Spesimen6.4 Tandas spesimen6.5 Makmal6.6 Ruang Anggota6.7 Setor makmal6.8 Utiliti bersih6.9 Utiliti kotor

7 UNITFARMASI7.1 Ruang Menunggu7.2 Dispensari dan kaunter7.3 Bilik Kaunseling7.4 Ruang pembungkusan kering7.5 Ruang pembungkusan basah (internal)7.6 Ruang pembungkusan basah (racun)7.7 Bilik Pegawai7.8 Ruang anggota7.9 Setor Ubat (Ruang Ubat Makan dan Racun)8 UNITPENGIMEJANDIAGNOSTIK8.1 Ruang Menunggu


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8.2 Kaunter Penerimaan8.3 Bilik X-ray (termasuk unit x-ray pergigian)8.4 Ruang Persalinan8.5 Ruang Kawalan8.6 Bilik Gelap8.7 Ruang Penelitian8.8 Bilik Pegawai8.9 Setor Filem8.10 Setor Kimia8.11 Tandas9 UNITSURVEILANSKESIHATAN9.1 Bilik Surveilans Kesihatan9.2 Bilik Sokongan Teknikal10 UNITKESIHATANSEKOLAH10.1 Bilik Kesihatan Sekolah11 UNITPERAWATANDIRUMAH11.1 Bilik Perawatan Di Rumah12 UNITKEBAJIKANPERUBATAN12.1 Ruang Menunggu12.2 Kaunter Penerimaan12.3 Bilik Kebajikan Perubatan12.4 Bilik Kaunselor12.5 Nilik Kaunseling13 UNITPENTADBIRAN13.1 Ruang Menunggu13.2 Kaunter Penerimaan13.2 Bilik Pegawai y/m13.3 Pejabat Am13.4 Bilik Penyelia/Ketua Jururawat13.5 Bilik Pembantu Perubatan Kanan13.6 Bilik Fail13.7 Bilik Mesyuarat13.8 Bilik Seminar13.9 Bilik Server13.10 Setor APD13.11 Setor peralatan13.12 Tandas Anggota14 KEMUDAHANANGGOTA14.1 Bilik Persalinan dan tandas14.2 Bilik Solat14.3 Bilik Rehat14.4 Perpusatkaan14.5 Bilik Pemandu


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14.6 Ruang letak kereta15 KEMUDAHANAWAM15.1 Taman Terapeutik15.2 Telefon awam15.3 Pondok menunggu kenderaan awam15.4 Ruang letak kereta15.5 Kafeteria15.6 Mesin minuman15.7 Lif

16 SETORDANLAIN-LAIN

16.1 Ruang letak ambulans


16.3 Bilik Pencuci





16.8 Setor Pukal






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2. MASTERPLAN(To be elaborated by each project)- Zoning- Land Utilisation- Scope of Services

- present and future expansion- Access, Traffic Flow- Transportation- Environmental impact


3.1. Role Statement

TheHealthClinicwill provide promotive, preventive, curative and rehabilitative services for 500-800attendanceper-day. Apart from the general out-patient services, the clinic will focus it�s services for the special targetgroups i.e. mothers, children (0 - 12 years old), adolescence, elderly, well adults, productive women, familyand workers. There will be provision for treatment and resuscitation in the clinic facility.


3.1.1 Promotive, Preventive, Curative and Rehabilitative services through Family Health Programmewhich covers Maternal and Child Health, Adolescent Health, Family Planning, Geriatric Health,Mental Health, Care for the Children With Special Need, Outpatient service, Workers� Health andWell Adult clinic.

3.1.2 Dental Health Services will be provided as outpatient services. For serious cases they will bereferred to specialist either at the clinic or the nearest hospital.

3.1.3 Clinical support services include Pharmacy, Laboratory (Level I upgraded), Diagnostic Imaging(including ultrasound and x-ray), Rehabilitation and Medical Social service.

3.1.4 Non-medical support services including ambulance, engineering, linen, waste holding, cleaningand security services will be provided.

3.1.5 Staff and client support services such as prayer room, staff change and rest room will also beprovided.

3.1.6 Training facilities will be provided in the form of conference/seminar rooms, a work station roomto cater for both undergraduate & postgraduate training, paramedic and medical personnel withteleconferencing equipment wherever necessary.

3.1.7 Computerised system for clinical and non-clinical support services for all or selected work-stations.

MEDICAL BRIEF OF REQUIREMENTSKLINIK KESIHATAN JENIS 2


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The Health Clinic focuses on preventive and curative services. These services will be delivered by allproviders and not confined to any special sessions of the week but will be available everyday. Specialsessions are only on appointment basis.

3.2.1 Maternal andChildHealth

a) Maternal health which include antenatal and postnatal care, health education to mothers,support for breast feeding and lactation management.

b) Infant and Child HelathTarget groups are babies ( 0 to 1 years), toddlers (1 to 4 years) and pre-schools (5 to 6years). These function will include development assessment, immunisation, growthmonitoring atc. and specific activities for children with special needs such as disabledchildren and children of poor families.

3.2.2 Outpatients ServiceThis service includes walk-in and follow-up general and special (chronic disease) outpatient careand emergency care.

3.2.3 Oral HealthThis service will include promotive, preventive and curative activities for the pre-schoolers, schoolchildren and adult.

3.2.4 SchoolHealthThe school health team from this clinic will visit school and performs health appraisal toschoolchildren as part of the school health service function. Where necessary, follow-ups ofschool children will be made in the clinic.

3.2.5 FamilyPlanningThis service includes counselling, examination and supply of pills, condoms, injectables e.gDevopovera etc., minor procedures eg. IUCD, Norplant insertion and urine pregnancy test.

3.2.6 Well Adult (Well Men andWell Women health appraisal)Well Adult service will provide risk assessment, early detection and health education activitiessuch as detection of breast and cervical cancer, quit-smoking counselling and menopausecounselling. Risk assessment activities will include cardiovascular assessment, examination ofblood pressure and BMI, laboratory investigation for blood (FBS,LFT,RFT) and urine, ECG and x-ray (CXR).

3.2.7 AdolescenceHealthThis service will be provided to school children and other adolescent (7 to 18 years) for counselling,general physical examination as well as management of disease condition.

3.2.8 Geriatric HealthCare of the elderly includes day care nursing, vocational activities, nutritional assessment,rehabilitative activities, counselling, physical examination, regular health screening (similar tohealth screening in well adult clinic) and accident preventive care.

3.2.9 CommunityMental HealthMental health activities will look into promotion and prevention aspect and risk assessment apartfrom curative care. Community rehabilitation for the mentally ill will also be provided.

3.2.10 HomeCare NursingThis function is to provide nursing care at home to facilitate healing and coping with recuperation.Services will also be provided to post-hospitalise cases, chronically and terminally ill persons.


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3.2.11 Nutrition andDieteticThe nutrition clinic provides advice and counselling to the pregnant and lactating mothers, mother�s/parent�s of infants, toddlers, pre-schoolers and malnourished children. The dietetic clinic area isfor giving advice and counselling of client with clinical conditions such as diabetes, hypertension,heart disease and renal disease.

3.2.12 Occupational HealthThe service will include promotion, prevention, curative and rehabilitation for the working populationwho suffers from work-related illness, including injuries through an integrated care approach.

Main activities will be risk assessment, investigation, specific treatment and health education,and disease prevention and surveillance related to occupation.

3.2.13 Rehabilitation �Occupational andPhysiotherapyThis service include both physiotherapy and occupational therapy for children with special needs(for child and parents), elderly, mentally ill patients, pregnant mothers, post-trauma patients andclients with chronic conditions such as asthma and chronic obstructive airway diseases.

3.2.14 Health Surveillance (Selected communicable and non-communicable diseases)Service provided will include defaulter tracing, active and passive case detection, contact tracing,notification and investigation of notifiable diseases

3.2.15 Health PromotionIt is an integral component of the various services in the health clinic and will be provided by allhealth personnel.

3.2.16 Clinical Support ServicesDiagnostic Imaging, Laboratory, Pharmacy, Medical Social service and Counselling.

3.2.17 Non-clinical Support ServicesInformation technology, ambulance, transport, biomedical and facility engineering, linen, wasteholding, cleaning and security service.


3.3. Operation andManagement

The Health Clinic will operate from Monday to Friday (Saturday to Thursday) between 8.00 am - 4.30pm and on Saturday/Thursday from 8.00 am - 12.30 pm.

Overall management will be by a Family Medicine Specialist or the most senior medical officer in theunit. This officer will report to the local Medical Officer of Health. Nursing care services will be theresponsibility of the sister-in-charge. She will also handle all nursing staff and female health attendants.

For the management of client, the Family Medicine Specialist will be supported by Medical officers,Dental Officers, Medical Assistants, Nurses, Dental Nurses, Community Nurses and other supportstaff.

Computerisation will aid appointment system. Clients will be persuaded to follow appointments toensure satisfactory waiting time.

�Call center� will be established to entertain consultation by phone. Trained allied health personnel willman this �center


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4.1.1. FamilyHealth Services

a) Services stated in paragraph 3.2.1 to 3.2.15 will be provided through an integrated clinicsystem or open system. They do not function as isolated clinics or session exceptoccasionally when there is pre-selected group to be serviced.

b) Services will be provided to walk-in clients. Phone-in will be entertained through call-center bythe triaging staff.

c) Multifunctional medical personnel shall carry out these services.

d) Family Medicine Specialist role is to manage referred cases from the medical officers atthe clinic and from ancillary clinics.


The scope of service includes promotive, preventive and curative and rehabilitative, which will betargeted to specific groups i.e.:- Pre-school children- Primary school children- Secondary school children- Pregnant mothers- Children with special need- Adult- Elderly


4.1.3. Nutrition andDietetics

These activities will be provided to mothers, children and client with special nutritional needs, e.g.diabetic and hypertensive client, obesity, etc. It includes diet counselling, health education andcooking demonstration.


The scope is to provide nursing care in the home to facilitate healing and coping with recuperation.The target groups are:- The elderly who needs nursing and other care- The disabled- Post-trauma patient- Post-surgery patient- Post-natal cases


This program will cater for pregnant and post-delivery mothers, disabled and handicapped children,injured patients on recovery and client with disease related disabilities. Services provided arephysiotherapy and occupational therapy.


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This service will be carried out in CE room and shall cater for work related illnesses/diseases andrisk assessment of the working population where full documentation and investigations can bedone. Visit to the workplace and environmental studies will be done if necessary. Necessaryprocedures will be done in respective room e.g vision tests, fitness test and laboratory tests.

4.1.7 HealthSurveillance

Services provided would include defaulter tracing, active and passive case detection, contacttracing, notification and investigation of notifiable diseases (communicable and non-communicablediseases). Investigation of cases, suspects, contacts and suspected source of infection will alsobe done.


This service will provide support for clients with specific social-related problems in this area. It willbe provided through tele-counselling or visiting counsellor and medical social workera) Social support - Individual and group counselling and consultation serviceb) Practical support - financial aids, social and welfare institution (for disabled , old folks

home and shelter) and medical and mobility equipment.c) Networking - liaison within and with other agencies (government and non-governmental

organisations).d) Case Focus - domestic violent (child, elderly andwomen), physically andmentally disabled,

single parent, poverty cases e.g. malnutrition and worm infestation and problems inpayment.

4.2. Workflow

4.2.1. Client andRecordFlow

Clients will enter the department via the main entrance of the clinic. Adequate signs and directionwill be made available. All clients will be met at the registration/collection counter beforeproceeding to the respective rooms or units.

4.2.1.1 Client

Client will take a queue-number using their smart-card or identity card. They will wait inthe Waiting Area for registration by a Registration/Collection Counter. Client will beidentified by the Registration/Collection counter as new or follow-up case. Retrieval ofclient�s record will be made through the Record Office. This process will becomputerised. The next destination for the client will be determined by the Registration/Collection counter either to the screening counter or the consultation room or otherrooms/units.

Fornewwalk-in cases, theywill be screened at theScreening (Triaging)Counter (besidesthe registration/collection counter) by a trained paramedic to determine the appropriateprovider in the clinic e.g. doctor, paramedic, laboratory or other rooms/units by putting asticker and queue-number on their record. Certain parameters e.g. weight, height andblood pressure may be taken at this counter.

Clients will then wait in the sub-waiting area in front of the respective rooms or units untilthey are called for consultation or other purposes.



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Following examination and consultation by medical officers/paramedical staff, clientmay undergo treatment in the Procedure or Treatment Room. Theymay be further referredfor examination, investigation or other treatment e.g. Diagnostic Imaging unit, laboratoryand Rehabilitation Unit. Clients who need further management will be referred to FamilyMedicine Specialist or Visiting Specialist in the clinic by paramedics. Client may also bereferred to other clinics or admitted to the nearest hospital.

After completion of examination, investigation, consultation and treatment, client will besent to the pharmacy for the collection of drugs.

Fees and appointment for the next visit (if applicable) will be collected at theRegistration/Collection counter before they leave the clinic. Appointmentscan also be made by the each provider (if fully computerised).

For specific cases, client will be referred to the Medical Social unit once problems ofpayment arises.

For the disabled and handicapped, they will wait with accompanying relatives at thecommon waiting area while the collection of drugs and payment is done by their relatives.

4.2.1.2 DentalClinic

All clientswill register at the (common)Registration/Collection counterbefore proceedingto the sub-wait of the Dental Clinic. Upon calling they will enter the Dental Operatingroom for consultation and examination.

Client will be referred to the (common)Pharmacy formedication. Payment for the treatmentwill be paid at the Registration/Collection counter before leaving.


Upon arrival, client will go directly to theRegistration/ Collection counter for registration.Client will be directed to either occupational therapy or physiotherapy unit as referred bydoctor. Client will wait at the sub-wait prior to being assessed. Before returning home,client will be given appointment date at the Registration/Collection counter.

4.2.1.4 Nutrition and Dietetic, Laboratory, Diagnostic Imaging, Pharmacy, Workers� Health,Medical Social services

Client will be directed by Registration/Collection counter, screening counter or consultationrooms to the laboratory, diagnostic imaging unit (ultrasound) etc. The clients will beinformed by the registration/screening counter the designated room for examination.They will wait at the respective sub-wait prior being called in for attention.

4.2.2. Staff Flow


4.2.2.2 Uniformed staff will change into their uniform in the clinic�s Staff Changing rooms (maleand female staff). They will proceed to their place of work at their rooms/units).

4.2.2.3 Before returning, uniformed staff will change back into their own clothes at the StaffChanging rooms.



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4.2.3 Material Flow

4.2.3.1 Sterile items: Bulk sterile items will be collected from the CSSD of the hospital and bebrought and stored at the Sterile Holding Store. Distribution to the rooms/units be madeon request.

4.2.3.2 Sterilised items: Sterilised items will be bought and kept in the dedicated cupboard in theSterileHoldingStore.

4.2.3.3 Non-Medical Item: Domestic, general and stationary goods will be brought from theIntegrated Store of the hospital or direct purchase from the vendor to theGeneral Store ofthe clinic. Linen will be drawn from the off site laundry and stored in linen cupboards ofthe General Store prior to distribution.

4.2.3.4 Pharmaceuticals: Pharmaceutical items will also be brought to the Drug Store underthe Pharmacist supervision. Drugs that require pre-packing or preparation will bemade and stored in the Drug Store. Pharmacist/Assistant Pharmacist will bringappropriate units/package into the pharmacy for replenishment. Poison drugs willbe kept in poison cabinets.

4.2.3.5 Soiled linen will be kept in the Dirty Utility Room awaiting transport to the Laundry orCSSD off site.

4.2.3.6 Waste will be kept in the sorted bags according to the type of waste by the clinical staff.These bagswill be collected at theDirtyUtility Roomand sent to theWasteHoldingAreaaccording to types of bags. These wastes will then be collected company contracted todispose them.

4.3 Supplies

4.3.1 Medical andNon-medical (contracted-out)

2 weeks supply of pharmaceutical products will be delivered from Integrated Store of the designatedhospital or direct from supplier to the clinic�s Drug Store before sending to the pharmacy.



Sterile packs will be taken from the Sterile Holding Store to the rooms/units on �top-up� basis andon request. Regular supply of sterilised items to the clinic will be from the contracted company.

4.4. Other Services





4.4.3 Cleaning andHousekeeping (contracted-out)

General cleaning services of the clinic will be privatised. The cleaning services will include all thevarious cleaning methods for the rooms/units, corridors, toilets, public areas, landscape, office ,training rooms etc.


.Cleaner�s room will be provided with equipment, detergents, etc.


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4.4.5 Food&Catering

Staff will have beverage in the staff rest room during breaks. Vending machine will be provided inthe main entrance of the clinic for the use of all sections. A canteen might be provided andcontracted out (optional).

4.4.6 EngineeringServices

The engineering services will be contracted-out. The Concession Company will be responsiblefor the surveillance, maintenance and repair of the buildings� engineering system, plants andmedical department, maintenance of inventories and records on equipment, buildings as well asplan and service manuals of engineering maintenance.

This unit will also be responsible for the planned maintenance program for buildings, engineeringservices, plant and equipment.


The whole security services will be contracted-out including security of client, staff and clinic as awhole.

4.4.8 InformationTechnology (I.T.)

IT concept that is being proposed for Health Clinic is part of a network infrastructure that connectsHealth Offices and Health Clinics as well as Community Clinics.

The administrative Health Office will be the base or hub which will provide IT service to healthclinics that are connected to it. These clinics will be connected with leased lines to the healthoffice. SCREENINGCOUNTERANDMAINWAITINGAREA

Health offices or hubs from the same state will also be connected to each other to the main hub atthe State Health Office to form a wide area network.

Each health clinic will be provided with adequate space for servers and telecommunication andtelemedicine facilities according to level of care. Each work station within the health clinic will beconnected to each other through a local area network.

4.4.8.1. IT System

The IT System will emphasise on clinical management, health information and healthsystem management. The electronic medical record for each client will be developedand captured in the database.

Supporting financial, human resource, pharmaceutical, lab, radiological system will bedeveloped to facilitate integrated information utilisation for clinical decision making aswell as in health system management.

4.4.8.2. IT System � coverage

The system will have the following functional coverage :a) Registrationb) Appointmentc) Triagingd) Queuinge) Micro cost accountingf) Clinical information systemg) Human resource management system


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h) Financial management systemi) Pharmaceutical information systemj) Lab information systemk) Radiological information systeml) School health servicem) Office automationn) Health Education and Informationo) Health Statistics and general informationp) Health Inspectorate and disease surveillance

4.4.8.3. IT System� technology

It will be an open systemwith the following characteristics:a) Consistent �Look and feel� facilityb) Graphical User Interfacec) Multimediad) Graphics applications and interfacese) Security in builtf) Window baseg) Windows NT processorsh) SQL Databasei) Switched networkj) Ethernet protocolk) Local area networkl) ISDN lines or Frame Relay.Clients� queries and calls (telephone) will be attended

at the information counter. The clerical personnel will attend to all queries.

5. REGISTRATION/COLLECTIONCUONTER,SCREENINGCUONTERANDMAINWAITINGAREA

5.1. ROLE/FUNCTION


5.2. LOCATION


5.3. ORGANISATION



5.4.1. ClientCirculation

Client will enter the department via the main entrance of the clinic. Client will take a queue-numberusing their smart-card or identity card. They will wait in the Waiting Area for registration by aRegistration/Collection Counter. Client will be identified by the Registration/Collection counter as


68

new or follow-up case. Retrieval of client�s record will be made through the Record Office. Thisprocess will be computerised. Destination of the record will be determined by the Registration/Collection counter i.e. screening counter, consultation room or other rooms/units based onappointments given.

For walk-in cases, without appointment, they will be screened at Screening Counter (besidesregistration/collection counter) by a registration personnel to determine where the client is supposedto go, e.g. doctor, paramedic, laboratory or other rooms/units by putting a sticker and queue-number on their record. Certain parameters e.g. weight, height and blood pressure may be takenat this counter.

Clients will then wait in the sub-waiting area in-front of the respective rooms or units until they arecalled for consultation or other purposes.


a) Clients are registered at the reception/collection counter. The whole process of registrationill be computerised.

b) For the clients who have an appointment, medical records will be retrieved electronically.Some �hard-copy� record e.g. x-ray film, old medical record, will be retrieved manuallyfrom the record office.

c ) Once clinic session ends, the �hard-copy� records will be sent back to the record office whileelectronic record will be stored in the computer.

5.5. COMPONENTS OF REGISTRATION/COLLECTION COUNTER, MAIN WAITING AREA AND SPACEREQUIREMENTS

5.5.1. Entrance

The main entrance shall be easily accessible to client and staff. It should be comfortable to allow10 clients in and out at any one time.


Clients will be registered here. It should accommodate at least 8 clients at any one time. It shouldbe built as 4 sitting and 4 standing counters.


Clients� queries and calls (telephone) will be attended at the information counter. The clericalpersonal will attend to all queries.

5.5.4 Triage counter and �call-centre�

New cases without appointment will be attended here after registration to identify their problemsor purpose of visit and which room/unit to go to. Main activities conducted here are history taking(main complaints only), and weight, height and blood pressure measurement. Manned byparamedics, it should be built for 4 clients at one time.

5.5.5 Waiting Area

Client and accompanying relatives will wait before and after registration/ screening before directedto consultation rooms, lab or other attending rooms. It should accommodate at least 200 clients(including accompanying person), at any point of time. The clients include outpatients and preventivecare.


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This is an area where health exhibition materials will be displayed. Electronic information kioskwill also be placed here.


Adequate Male and Female client�s toilets will be accessible from the waiting area. 2 toilets for thedisabled will also be provided (1 for adult and the other one for child).

5.5.8 Breast Feeding andNappyChangingArea

A room will be provided for mothers to breast-feed their babies. A worktop with washing facilitiesis required for nappy changing. This facility should be accessible from the waiting areas and nearto public toilets.

5.5.9 Trolleys andWheel Chairs Parking Area




5.5.11 Play area

Designed fof children recreation while waiting for thei examination and consultation. Must benearby and seen directly from the main waiting area.

5.5.12 Collection counterIt is located besides the registration counter. After collecting medication, client will pay the feesand collect education materials, appointment, referral letters etc here. It should accommodate atleast 6 clients, at any point of time.


6.1 ROLE/FUNCTION

6.1.1. To collect, store and retrieve clients� records.6.1.2. To enter diagnosis (ICD) made by doctors.6.1.3. To analyse statistics and present them to the management for decision making and planning.6.1.4. To co-ordinate the preparation of medical reports, quality assurance reports and issuing returns

to District Health Office.

6.2 LOCATION


6.3 ORGANISATION





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6.5.1. Waiting area

For issuing medical records for 8 visitors at any one time.

6.5.2. ReceptionCounter (open concept)

For medical record assistants (clerk) to carry out indexing of client records.

6.5.3. Record Officer AreaOpen Concept Office for administration work.

6.5.4. Record roomwith record compacts for storage of medical records and x-ray films. Exhaust fanis necessary for the file room.

b) At the end of clinic sessions, client�s records will be despatched to the record office within 24hours.


d) Statistics is generated automatically from the computer system. The record office has to submitthe weekly and monthly statistics to the District Health Office. Quality Assurance data report will beprepared six-monthly or annually.

e) Records may be referred and issued to the doctors/clinic. The record office will keep tract of therecords through the computer system.


g) The distribution of Medical Reports, Quality Assurance report and other official report will be co-ordinated by this office.

7. CONSULTATIONANDEXAMINATION (CE)ROOMS(FAMILYHEALTHUNIT)

7.1. ROLE/FUNCTION

7.1.1 Promotive, Preventive, Curative and Rehabilitative health services to all age group. CE rooms willbe manned by either doctors, nurses or medical assistants.




7.1.5 Clients who need further treatment will be referred to Family Medicine Specialist or other specialistsat the hospital or admitted to the ward.




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7.2. LOCATION

It shall be located at the same floor of the main entrance/lobby, easily accessible from the registration/collection area. Interconnecting doors or staff corridor must connect these CE rooms.

7.3. ORGANISATION

7.3.1 The CE rooms staff shall be headed by the family medicine specialist

7.3.2 Other staff include medical officers, medical assistants, nurses, community nurses and healthattendants.




7.4.3 Clients who need specialist services will be referred to Family Medicine Specialist, OccupationalHealth specialist or other specialists at nearest hospital.




7.5. SPACEREQUIREMENTINCONSULTATIONANDEXAMINATIONROOMS

7.5.1 Entrance

Separate entrance for staff and clients.

7.5.3 Consultation&ExaminationRooms

Adequate number of rooms shall be provided depending on workload. Doctors and paramedicsshall see patients. A digital call system shall be used to call patients. Each consultation roomIt must be adequately sound proof.

7.5.2 Waiting area Number of rooms needed is based on the norms of 50 clients/room/day. On anaverage the Type 2 should have at least 16 rooms.


This room has several couches with drawing screens. Each area (cubicle can accommodate atleast 4 person at any one time). This room can be directly accessible to the public, either throughthe main or alternative entrance. This room is for injections, dressing, treatment for asthmaticpatient, rehydration and resuscitation. Adequate and lasting worktops and built-in cabinets shouldbe installed. This room should accommodate 3 clients at any one time.


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7.5.5 Procedure Room

This room have operation table for performing minor surgical procedures such as circumcision,incision and drainage, removal of lumps, fine needle biopsy, pap smear, IUCD and Norplantinsertion, CTG examination etc. It shall have a hand-washing facility and interconnecting doorswith other CE rooms. The room can accommodate 1 clients at any one time.




For taking specimens for lab investigation e.g. blood and sputum. Toilets for urine and stoolspecimen are to be provided nearby. This room should be able to accommodate 8 people.


To place ultrasonagraphy machine for obstetrics and gynaecological and general examination.Preferably nearby the Diagnostic Imaging Unit.

7.5.9 ECGArea

For ECG examination. It shall be able to accommodate at least 4 clients at any one time. Couchesand ECG machines will be provided. This facility can be accommodated with eye examinationarea (6.5.8) in one room.

7.5.9 EyeExaminationArea

For visual acuity test using Snellens chart and colour blindness test for general medical check-up.Slit lamps may be installed here (optional).

7.5.10 HearingExaminationRoom

For audiometric test for the baby, children and adult. Observation space with glass separator isneeded. The room shall be partially sound-proof and have sound-proof box.

7.5.11 Staff Corridor

Staff corridor shall run behind all the rooms.

7.5.12 SchoolHealthRoom


This area will accommodate 5 staff with office furniture and one examination space equipped withexamination couch and trolley.

7.5.13 HomeCareNursingRoom

The room is an office and preparation room for home care nursing that accommodate facilities forwashing, storage and preparation of trays and dressing sets on returning to the office. Tabletopsterilising facilities will be provided.

This room shall accommodate at least 6 staff with office tables and working area. It can also belocated near the office area


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8.1 ROLE/FUNCTION


8.2 LOCATION


8.3 ORGANISATION



8.4.1 The health education room can be used on regular basis e.g. cooking demonstration for expectantmothers.

8.4.2 Health Education activities can also be arranged by central booking.

8.4.3 It can also be used for teaching purposes for the staff.

8.5 SPACEREQUIREMENTFORHEALTHEDUCATIONAREA

8.5.1 HealthEducationRoom

Health education and counselling will be given by health personnel in this room. Models, flipcharts and other audio-visual aids will be used for this purpose. This room will have space for amaximum of 20 people.

8.5.2 CookingDemonstrationArea

Nutrition education and counselling for mothers and parents, and clients with special needs(e.g. diabetic, hypertensives and obese). It will require:

- Healthy kitchen- Actual cooking tools and utensils such kitchen, sink, fridge, kitchen cabinet etc- Audio-visual aids- Sitting facilities (theatre style) which can accommodate 15-20 people at one

time.- Show case for food model display.

These facilities can be equipped as a portable kitchenette.

9. ORALHEALTHUNIT

9.1 ROLE/FUNCTION

The Oral Health unit will provide basic dental health services for outpatient.

9.2 LOCATION



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9.3 ORGANISATION



It will operate during office hours and provide basic dental services. Client who need further treatment willbe send to the local hospital dental specialist clinic.

9.5 SPACEREQUIREMENTFORDENTALUNIT

9.5.1 Reception andSub-wait

The Dental Clinic will have its own reception and a sub-waiting area. Payment is made at thecommonCollection Counter. A small Exhibit Areawill also be at this area for dental health education.It should accommodate 30 persons at any one time.

9.5.2 Dental Operatories (Dental Surgery)

There will be adequate number of dental chairs (4) in a large room with partitions for eachoperatory for privacy and workspace. Each room should be made sound proof. Each room isaccessible to staff through interconnecting doors.

9.5.3 Air CompressorRoom


9.5.4 Preparation/SterilisationArea


9.5.5 Staff Office



For the storage of dental equipment and other items will be provided. Store for the Dental Mobilesquad will be provided here.

9.5.7 Dental Laboratory

The dental laboratory work will be carried out in this room. It will be equipped with work benchesand cabinets for Dental Technicians.

9.5.8 Dental Store Room


9.5.9 DirtyUtilityA dirty utility room will be made available near the dental operatories.


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10.1 ROLE/FUNCTION


10.2 LOCATION

It can be located away from CE room but must be barrier free, preferably have a separate entrancefor easy access by patients and be disabled friendly. Doors and corridors should accommodatefor wheelchairs and stretchers.

It should be located on the ground floor and preferably have access to play ground (barrier freeand incorporate therapy items e.g. footpath with handrails, wheel- through handbars 4feet x 3 feetx 1 feet, wheelchair swings12 feet x 12 feet, special swing seats 12 x 12 feet).

10.3 ORGANISATION




10.4.2 Services provided will cater for;- persons with disabilities (children and adult- mentally ill patients- elderly- post trauma - short term follow up cases e.g. pregnant mothers, acute respiratory

diseases, orthopedic problems and others- persons with chronic conditions such as chronic obstructive airway disease, chronic

backache, patients with stroke and others


10.4.4 Staff of rehab unit will also function as a team with other staff in the Health Clinic i.e.Medical Social Worker, Counsellor, Public Health Nurses and Medical Assistants.


10.5.1 Reception andWaitingArea

Waiting area should be large enough for 30 persons (includes patient and care givers) atany one time and accommodate wheel-chairs.




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equipped with basic facilities for cognitive and physical assessment, couch, table anchairs.

� Area for treatment with 3 cubicles i.e. one for high frequency machine, one for mediumand low frequency machine and one for pulmonary rehab. Treatment here will includevarious heat therapy, light therapy, traction and electrical stimulation.



For therapy in children with special needs, a separate area is required to reducedistraction. Two connecting rooms with glass panes (one way view glass panes toobserve behavioural responses) for assessment and observation by the therapistas well as to carry out therapy. Larger room to accommodate for assessmentequipment and 3 person at any point of time.

10.5.4 Psychiatric TherapyRoom

This is for group therapy of psychiatry cases. It will be equipped with a large table andchairs. It will accommodate about 10 persons at one time.

10.5.5 ActivitiesofDailyLiving (ADL)Room

This room will be equipped with cooking facilities, toilet and others for training of dailyliving activities. This room will also be used for the psychiatric cases.

10.5.6 Skill Laboratory

This is a therapy roomwith equipment such as through and other hand fraction equipment.It will accommodate 10 persons at one time.

10.5.7 Gymnasium


shoulder wheel, 259x88mm (against the wall)multi exerciser 290x1070x20 mmphysio/therapy balls 450- 1200mm diameter (average of 4 balls per clinic)parallel walking bars 2300mm x 660mm x700 mmadjustable rehabilitation corner steps 200 x 150 x960 mmstanding frame 1900 x 660 mmwalker adult and child (2 sizes) � 570 x370 x620 mmwedges ( multiple sizes- 4) 305x914 mm � 1422 x508 mmcorner seat support chairs 2 feet x 3 feetmobile posture mirror � 360 x1200 mmCreepster crawler 2 feet x 2 feetBubble ball bath/multisensori ball pit � 7 feet diameter

10.5.8 Hydrotherapy

10.5.9 Rehab Store



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11. PATHOLOGYUNIT

11.1. ROLE/FUNCTION

To provide diagnostic laboratory support services (level I upgraded) to patient.

11.2. LOCATION


11.3. ORGANISATION

10.3.1 The lab will be headed by a senior medical laboratory technologist.10.3.2 He/she will be assisted by medical laboratory technologist and health attendant.


11..41 Request For Test

10.4.1.1. The lab will receive requests for lab test from all CE rooms.10.4.1.2. Request will be made by doctors, nurses or medical assistants using the

request form.10.4.1.3. Client will bring the request form to the lab where it will be registered.10.4.1.4. Specimens will be taken in the clinic specimen taking area.

11.4.2 ReceivingSpecimensSpecimens will be received registered and sorted out at the reception before the test is done.

11.4.3 Reporting

10.4.3.1. Result of the investigations will be captured automatically in the computersystem. The staff may key in some information and to endorse the validity ofthe result.

10.4.3.2. End users will be able to retrieve the result from their workstation.

10.5.10 Pantry

Pantry for training on activities of daily living and domestic skills for psychosocialrehab of mentally ill, elderly and disabled. Requires work areas that can fit wheelchairs,large table and space to accommodate fridge, stove and kitchen utensils.

10.5.11 Toilet

A staff toilet will be provided. Toilet for rehabilitation training for the disabled on selfcare. Should be large � standard toilet for disabled that includes both toilet andbathroom.


One office for the officer in charge to be able to fit 3 persons at any one time. A commonroom as staff office for 2 other personnel.


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11.5. SPACEREQUIREMENTINLABORATORY

11.5.1 Reception Area



11.5.2 Waiting Area



Specimen collection toilets and vene-puncture area are to be provided. It should accommodateat least 5 persons at any one time.



Specimens will be received here and examined immediately. Urine, stool, sputum and simpleblood tests will be carried out. Examinations of specimen will be conducted on heavy dutyworktops. Results will be conveyed via electronic device on request or/and will be put intopigeon holes at the reception counter to be collected by the respective clinics at regularintervals.

11.5.5 Lab Store


11.5.6 DirtyUtility/DisposalRoom


11.5.7 Staff Area



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12. PHARMACYUNIT

12.1 ROLE/FUNCTION

11.1.1 Dispensing all pharmaceutical products to all clients.11.1.2. Client counselling in the use of drugs and dissemination of drug information.11.1.3. Monitoring of drug utilisation.

12.2 LOCATION


12.3 ORGANIZATION

The unit will be headed by a pharmacist or senior pharmacy assistant. He/she will be assisted bypharmacy assistants and general workers.


12.4.1. It will serve client seen in all the CE room and oral health unit.12.4.2. Pre-packing of some drugs will be done here.12.4.3. Out-patient counselling will be done in this unit.

12.5 SPACEREQUIREMENTFORPHARMACYUNIT


There will be separate waiting area for clients to wait during the preparation of their prescription.Space required for 60 people at any one time.


a) It is an open concept system for dispensing counters. Adequate working space at eachcounter will be provided for dispensing and computer workstation.


c) Dispenser working behind the first or screening counter will receive prescription andcheck treatment prescribed. Any doubt will be clarified with the pharmacist who inturn may check with the medical officer who issue the prescription. Dispensersworking behind the other counters will dispense medicine with instruction to patient.An area will be provided for the dispensers to prepare the prescription.


12.5.3 Drug Store

2 months stocks of pharmaceutical item will be held here. Supplies will be bought in by theconcession company on regular basis and upon request. Certain drugs will be kept in therefrigerator. Suggested store size is at least 400 sq ft.

a) Bulk Store

For stocking bulky packaging materials (dispensing containers - mixtures, lotions,oitments and creams), labelling lables and stationaries. Suggested store size is 200 sqfeet.


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b) Inflammable Store

The store must be located away from the main building, for storing several months stockof inflammable materials e.g. spirit, liquid paraffin. Suggested size is 120 sq ft.

12.5.4 Dry and Wet Pre-packing Areas

Pre-packing of drugs will be done here. Separate rooms will be provided for dry drugs,internal (wet) preparations and external (wet) preparations. High tap, deep aluminium basinand 3 ft skirting tiles are needed.

a) Dry (Tablet/Capsule) Pre-packing area

For pre-packing of tablet and capsules. Equipped with suction hood for each machine tosuck dust.

b) Extemporaneous and Internal Pre-packing area

For reconstitutions of ready to dispense suspensions (antibiotics) and prepacking ofmixtures. Certain drug will de kept in the refrigerator.

c) Extemporaneous and external Pre-packing area

Prepacking of lotions, ointments and creams will be done here.


An office will be provided for the pharmacist or officer in-charge of the pharmacy to carry outconsultation services and drug information as well as administrative work.

12.5.6 DrugCounsellingRoom(optional)

Individual outpatient counselling will be done in this unit. Can accommodate 3 people at anytime. Group counselling on drug usage will be carried out in the health education room.

12.5.7 Staff Area


12.5.8 Staff toilet

Staff toilet for male and female staff will be located inside the dispensary. Water hose to befixed in each cabinet.

13. DIAGNOSTIC IMAGINGUNIT

13.1 ROLE/FUNCTION



13.2 LOCATION



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13.3 ORGANIZATION

The unit will be headed by a senior radiographer (diagnostic). He/ she will be assisted by a radiographer(diagnostic) and health attendant.





13.4.4 Ultrasound examination mainly done by the doctor and the specially trained radiographer.



13.5 SPACEREQUIREMENT INDIAGNOSTIC IMAGINGUNIT

13.5.1 Reception / Registration



There will be a waiting area to cater for 20 to 30 patients with spaces to accommodatepatients coming on wheelchairs and trolleys.

13.5.3 ChangingRoom

The unit will provide 2 changing cubicles for the clients.

13.5.4 X-Rray Room

A standard size room is provided for general radiography and dental radiographymachine.

13.5.5 Special examination Radiography

An attached toilet will also be provided in this room.

13.5.6 Dark Room


13.5.7 Control Room





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13.5.10 Film Store

For storage of unexposed films.


A combined sorting and viewing area will be provided for viewing of x-ray radiographs.

13.5.12 Office space

It will be used for report writing and other office works. The office shall be able toaccommodate 6 staff. It can be combined with the control room.


14.1 ROLE/FUNCTIONTo provide health surveillance function for the health clinic�s operational area.

14.2 LOCATION


14.3 ORGANISATION

The health inspector performing the function may or may not be under the responsibility of the officer-in-charge of the Health Clinic. If not, he may be responsible directly to the Medical Officer of Health of theDistrict.



14.4.2. The scope of this function is Disease Control for Communicable and Non-CommunicableDiseases, Vector and Rodents, Occupational Health, Environmental Health and Waste andSanitation.

14.4.3. Function includes defaulter tracing (for chronic infectious diseases), ensure notification of allnotifiable diseases, analysis of disease database, initiating investigation, institutingintervention and report writing.

14.5 SPACEREQUIREMENTFORHEALTHSURVEILLANCEAREA

14.5.1 HealthSurveillanceRoom

Meeting room for 10-15 members, for briefing and discussion regarding disease surveillanceand act as an operation room during outbreaks.

14.5.2 Technical Support Room

An office shall be made available for a health inspector and space for two support staff.Report and charting on disease surveillance, prevention and control will be done here.


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15.1 ROLE/FUNCTION


health information system.15.1.3 To facilitate clinical decision making as well as support health management system.15.1.4 To provide realtime data on performance both on workload and on efficient use of resources.15.1.5 To facilitate telecommunications and telemedicine of health providers.

15.2 LOCATIONOFITROOM

15.2.1 A small room will be provided to locate servers and telecommunication facilities. It will be air-conditioned or placed in cool area, preferable low-dust area.

15.3 ORGANISATION

15.3.1 The IT services will be under the responsibility of the Family Medicine Specialist who willdelegate it to the most appropriate trained officers in IT management and maintenance






15.4.4 All providers will be authorised to given level of access to �identified� groups of data and not alldata and information. FMS will be responsible to ensure security of data and access.


15.4.6 Only qualified health professional can undertake and deliver telehealth assisted healthcare.

15.4.7 Clients will be made accessible to health information and education. A person will be madein charge to answer any queries if any by clients. The state or district health office shallapprove the contents before putting on the web page.






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16.1 ROLE/FUNCTION


16.2 LOCATION


16.3 ORGANISATION


16.3.2 For day to day operation, he/she will be assisted by senior clerks, clerks and sister-in-charge.






16.4.3 Seminar Room

A seminar room will be provided to accommodate a minimum of 50 people. Used for in-service and community training.

16.4.4 MeetingRoom




17. STORES




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17.3 BULKSTORE


17.4 CONDEMNEDSTORE



The store must be located away from the main building, for storing several months stock of inflammablematerials e.g. spirit, liquid paraffin. Suggested size is 120 sq ft.



17.7 HEALTHEDUCATIONSTORE

To store audio-visual aids, display boards and printed materials.

17.8 CLEANERSROOMS

This room will provide sufficient space for the storage of cleaning materials and equipment. It will beplaced at strategic location eg. each level of the multi-storey building.




This room will provide sufficient space for the collection of dirty linen and equipment and clinical wastebefore being washed, sterilised or disposed. It will be placed at strategic location eg. each level of themulti-storey building.

17.11 WASHINGAREA







86



Male and female staff changing rooms will be provided to cater the whole health clinic staff. It shouldhave lockers for the staff to keep their personal items.

18.2 STAFFTOILETS


18.3 PRAYERROOM


18.4 LIBRARY


18.5 STAFFRESTA common staff rest area at strategic area i.e. one at each level. Storage space as lockers for staffbelongings be attached. It should accommodate 10 staff at any one time.







19. PUBLICAMENITIES





19.3 PARKINGSPACES



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19.4 ELEVATORS

Wide elevators which can accommodate stretchers will be provided for patients and staffs.

19.5 FOODANDCATERING

Depending on volume of client, a space for cafeteria may be provided.



20. PLANNINGCONCEPT


20.2 Urgent and acute cases will be referred to the Accident and Emergency Department of the nearesthospital.

20.3 The design of this clinic could therefore be on a �modular concept�.

20.4 Land space being of premium in major focus, the facility should have the flexibility to be multi-storeyed. Lifts should be provided if they are multi-storeyed.




20.7.1 The registration area will be easily visible and accessible from the entrance. Accessibility to waitingareas too should be easy. Receptionists shall be able to see waiting clients and should have maximumview of the entrance to consultation/examination rooms. Waiting areas of the individual consultation/examination rooms will be easily accessible for the patients.

20.7.2 Public toilets will be close to the waiting area. There will be provision for a toilet for the handicapped.

20.7.3 Central Medical Records room will be adjacent to the Reception/Registration Area allowing easycommunication between these two rooms.

20.7.4 The basic concept of the Health Clinic design is the provision of standard Consultation/ExaminationRooms. The layout of these rooms will ensure maximum privacy, especially when door is opened aswell as interconnecting passage for staff use.

20.7.5 The Treatment and Procedure rooms shall be best positioned between the Clean and Dirty UtilityRooms with free access for staff. This measure will also to ensure a clear flow of clean and soileditems.

20.7.6 The Health Education facilities can be located away from the main Consultation/Examination Area asit is a shared facility for the use of the clinic.

20.7.7 The components of the Laboratory will be grouped together and should have its own waiting area.

20.7.8 The Rehabilitation (Occupational therapy & Physiotherapy) will have its own waiting area.


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20.7.9 TheWaiting Area of the Pharmacy will be clearly segregated from the Main Waiting Area and waitingarea of the CE rooms.

20.7.10 Within the clinic, natural light is desirable in waiting, working and staff rest areas. To achieve adequateprivacy for staff, the Staff Rest Rooms will be sited away from the patient and waiting areas.

20.7.11 Rehabilitative Unit (Occupational Therapy & Physiotherapy) will be located close to an entrance foreasy access of handicapped and disabled patients with wheelchairs and also for family to unloadpatient from their vehicle.

20.7.12 The Dental Clinic Area as well as Rehabilitation Area will be separated from the CE rooms with itsregular flow of patients. The individual Reception Counter should face the Waiting Area and thereceptionist should be able to see all incoming and outgoing patients.

20.7.13 Outdoor Play Area will be accessible for all children accompanying clients and rehabilitative clients.

20.7.14 Visitors, staff, supply/disposal entrance and exit shall be able to be controlled.

20.7.15 Security to the centre will be devised to enable staff to work after normal office hours and clinics to beopened to public for Health Promotion activities after working hours.

20.7.16 Materials and Supplies flow will not interfere with the patients flow. It should have separate entranceto the various units.

20.7.17 The design will take into consideration future expansion and increase in scope of services.


89

LAMPIRAN I



INTRODUCTION



DEPARTMENTALBRIEF


� WORFLOW� FUNCTION OF SPACE� MANPOWERANDSTAFFING



90


91

KEPERLUAN PERUBATAN




April 2001


92

NOTA:JENIS-JENISKLINIKIKESIHATAN(KK)


B) KK JENIS 2 500-800KEDATANGANSEHARI

C) KKJENIS3 300 -500KEDATANGANSEHARI


E) KK JENIS 4S (SABAH & SARAWAK) 150-300KEDATANGANSEHARI

F) KK JENIS 5 (SABAH & SARAWAK) < 150KEDATANGANSEHARI

G) KK JENIS 6 (SABAH & SARAWAK) < 50KEDATANGANSEHARI


93

JADUALRUANG

1 RUANGMASUKUTAMA/PENDAFTARAN1.1 Kaunter Pendaftaran1.2 Kaunter Pertanyaan1.3 Kaunter Pembayaran-1.4 Kaunter Triage / Call Centre1.5 Ruang Menunggu Utama1.6 Ruang Legar/Pameran1.7 Ruang Penyusuan / Tukar Lampin1.8 Ruang Permainan Kanak-kanak (dalam klinik)1.9 Tandas Awam1.10 Ruang Troli / Kerusi Roda1.11 Ruang Menunggu (kenderaan)2 UNITREKODKESIHATAN2.1 Ruang menunggu2.2 Kaunter Penerimaan2.3 Ruang anggota2.4 Ruang Rekod3 UNITKESIHATANKELUARGA3.1 Ruang Menunggu3.2 Kaunter Penerimaan3.3 Bilik Pemeriksaan (CE)3.4 Bilik Rawatan3.5 Ruang Rawatan Asma3.6 Bilik Prosedur3.7 Bilik Persediaan3.8 Ruang EKG3.9 Bilik Pemeriksaan Mata3.10 Bilik Pemeriksaan Pendengaran3.11 Bilik USG3.12 Bilik Pendidikan Kesihatan3.13 Bilik Demonstrasi Memasak3.14 Setor Peralatan3.15 Bilik Utiliti Bersih3.16 Bilik Utiliti Kotor3.17 Tandas Awam3.18 Tandas Anggota4 UNITKESIHATANPERGIGIAN4.1 Kaunter Penerimaan4.2 Bilik Pembedahan4.3 Bilik Tekanan Udara



94

4.4 Bilik Persediaan/Pensterilan4.5 Pejabat4.6 Unit X-ray Pergigian (jika Unit Pengimejan Diagnostik tiada)4.7 Setor Peralatan4.8 Makmal Pergigian4.9 Setor Pergigian4.10 Utiliti Kotor5 UNITPEMULIHAN5.1 Ruang Menunggu5.2 Kaunter Penerimaan5.3 Bilik Penilaian dan Rawatan5.4 Bilik Terapi Pediatrik5.5 Gimnasium5.6 Pantri5.7 Setor5.8 Tandas5.9 Ruang Anggota6 UNITPATOLOGI6.1 Ruang Menunggu6.2 Kaunter Penerimaan6.3 Ruang Mengambil Spesimen6.4 Tandas spesimen6.5 Makmal6.6 Ruang Anggota6.7 Setor makmal6.8 Utiliti bersih6.9 Utiliti kotor7 UNITFARMASI7.1 Ruang Menunggu7.2 Dispensari dan kaunter7.3 Bilik Kaunseling7.4 Ruang pembungkusan kering7.5 Ruang pembungkusan basah (internal)7.6 Ruang pembungkusan basah (racun)7.7 Bilik Pegawai7.8 Ruang anggota7.9 Setor Ubat (Ruang Ubat Makan dan Racun)8 UNITPENGIMEJANDIAGNOSTIK (hanya untukKlinik Kesihatan

yang menggantikan Jabatan/Unit Pesakit Luar hospital ataumempunyai justifikasi tertentu yang lain)

8.1 Ruang Menunggu8.2 Kaunter Penerimaan8.3 Bilik X-ray (termasuk unit x-ray pergigian)8.4 Ruang Persalinan


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8.5 Ruang Kawalan8.6 Bilik Gelap8.7 Ruang Penelitian8.8 Bilik Pegawai8.9 Setor Filem8.10 Setor Kimia8.11 Tandas9 UNITSURVEILANSKESIHATAN9.1 Bilik Surveilans Kesihatan9.2 Bilik Sokongan Teknikal10 UNITKESIHATANALAMSEKITAR10.1 Bilik Kesihatan Alam Sekitar10.2 Ruang Rekod11 UNITKESIHATANSEKOLAH11.1 Bilik Kesihatan Sekolah12 UNITPERAWATANDIRUMAH12.1 Bilik Perawatan Di Rumah13 UNITKEBAJIKANPERUBATAN13.1 Ruang Menunggu13.2 Kaunter Penerimaan13.3 Bilik Kebajikan Perubatan13.4 Bilik Kaunselor13.5 Nilik Kaunseling14 UNITPENTADBIRAN14.1 Ruang Menunggu14.2 Kaunter Penerimaan14.2 Bilik Pegawai y/m14.3 Pejabat Am14.4 Bilik Penyelia/Ketua Jururawat14.5 Bilik Pembantu Perubatan Kanan14.6 Bilik Fail14.7 Bilik Mesyuarat14.8 Bilik Seminar14.9 Bilik Server14.10 Setor APD14.11 Setor peralatan14.12 Tandas Anggota15 KEMUDAHANANGGOTA15.1 Bilik Persalinan dan tandas15.2 Bilik Solat15.3 Bilik Rehat15.4 Perpusatkaan15.5 Bilik Pemandu


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15.6 Ruang letak kereta16 KEMUDAHANAWAM16.1 Taman Terapeutik16.2 Telefon awam16.3 Pondok menunggu kenderaan awam16.4 Ruang letak kereta

16.5 Kafeteria

16.6 Mesin minuman

16.7 Lif

17 SETORDANLAIN-LAIN17.1 Ruang letak ambulans


17.3 Bilik Pencuci





17.8 Setor Pukal



17.11 SetorBAKAS




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1. INTRODUCTION(To be elaborated by each Project)- Background about the project- Situational Analys- Projected Workloa- NOTE : Further customisation of space if necessary must be elaborated



3.1. Role Statement

TheHealthClinicwill provide promotive, preventive, curative and rehabilitative services for 300-500attendanceper-day. Apart from the general out-patient services, the clinic will focus it�s services for the special targetgroups i.e. mothers, children (0 - 12 years old), adolescence, elderly, well adults, productive women, familyand workers. There will be provision for treatment and resuscitation in the clinic facility.











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3.1.8 Administrative services include registration of client, revenue collection, record and informationsystem and administrative services for the overall management of the clinic.

3.1.9 Public amenities such as cafeteria, car parks, playground and water closets will be provided.




3.2.1 Maternal andChildHealtha) Maternal health which include antenatal and postnatal care, health education to mothers,

support for breast feeding and lactation management.b) Infant and Child Health

Target groups are babies (0 to 1 years), toddlers (1 to 4 years) and pre-schoolers (5-6years). These functions will include development assessment, immunisation, growthmonitoring etc. and specific activities for children with special needs such as disabledchildren and children of poor families.










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3.2.11 Occupational HealthThe service will include promotion, prevention, curative and rehabilitation for the working populationwho suffers from work-related illness, including injuries through an integrated care approach.Main activities will be risk assessment, investigation, specific treatment and health education,and disease prevention and surveillance related to occupation.


3.2.13 HealthSurveillanceService provided will include defaulter tracing, active and passive case detection, contact tracing,notification and investigation of notifiable diseases.

3.2.14 EnvironmentalHealthService provided will include environmental sanitation, safe water supply, drinking water monitoringand sampling, food premise inspection, food sampling, workplace inspection and health promotionand education.


3.2.16 Clinical Support ServicesDiagnostic Imaging (selected clinic only), Pathology (laboratory), Pharmacy, Rehabilitation, MedicalSocial service and Counselling.




The Health Clinic will operate from Monday to Friday (or Saturday to Thursday) between 8.00 am - 4.30 pmand on Saturday/Thursday from 8.00 am - 12.30 pm.

Where services after office hours* is required (in rural area), on call services shall be provided as deemrequired by the state/district.

Overall management will be by a Family Medicine Specialist or the most senior medical officer in the unit.This officer will report to the local Medical Officer of Health. Nursing care services will be the responsibilityof the sister-in-charge. She will also handle all nursing staff and female health attendants.


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For the management of client, the Family Medicine Specialist will be supported by Medical officers, DentalOfficers, Medical Assistants, Nurses, Dental Nurses, Community Nurses and other support staff.

Computerisation will aid appointment system. Clients will be persuaded to follow appointments to ensuresatisfactory waiting time.

�Call centre� will be established to entertain consultation by phone. Trained allied health personnel will manthis �centre�.




a) Services stated in paragraph 3.2.1 to 3.2.15 will be provided through an integrated clinicsystem or open system. They do not function as isolated clinics or session except occasionallywhen there is pre-selected group to be serviced.

b) Services will be provided to walk-in clients. Phone-in will be entertained through call-centre bythe triaging staff.

c) Multifunctional medical personnel shall carry out these services.d) Family Medicine Specialist role is to manage referred cases from the medical officers at the

clinic and from ancillary clinics.


The scope of service includes promotive, preventive and curative and rehabilitative, which will betargeted to specific groups i.e.:- Pre-school children- Primary school children- Secondary school children- Pregnant mothers- Children with special need- Adult- Elderly





The scope is to provide nursing care in the home to facilitate healing and coping with recuperation.The target groups are:- The elderly who needs nursing and other care- The disabled- Post-trauma patient- Post-surgery patient- Post-natal cases- Terminal cases requiring palliation


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Services provided would include defaulter tracing, active and passive case detection, contacttracing, notification and investigation of notifiable diseases (communicable and non-communicablediseases). Investigation of cases, suspects, contacts and suspected source

4.1.6 EnvironmentalHealth

Service provided will include environmental sanitation, safe water supply, drinking water monitoringand sampling, food premise inspection, food sampling, workplace inspection and health promotionand education.


This service will provide support for clients with specific social-related problems in this area. It willbe provided through tele-counselling or visiting counsellor and medical social workera) Social support - Individual and group counselling and consultation serviceb) Practical support - financial aids, social and welfare institution (for disabled , old folks

home and shelter) and medical and mobility equipment.c) Networking - liaison within and with other agencies (government and non-

governmental organisations).d) Case Focus - domestic violent (child, elderly and women), physically and mentally

disabled, single parent, poverty cases e.g. malnutrition and worm infestation andproblems in payment.

4.2. Workflow



4.2.1.1 Client


For new walk-in cases, they will be screened at the Triage Counter (besides theregistration/collection counter) by a trained paramedic to determine the appropriateprovider in the clinic e.g. doctor, paramedic, laboratory or other rooms/units by putting a


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sticker and queue-number on their record. Certain parameters e.g. weight, height andblood pressure may be taken at this counter.





Fees and appointment for the next visit (if applicable) will be collected at theRegistration/Collection counter before they leave the clinic. Appointments can also be made by theeach provider (if fully computerised).








4.2.1.4 Nutrition andDietetic, Laboratory, Diagnostic Imaging, Pharmacy,Workers� Health,Medical Social servicesClient will be directed by Registration/Collection counter, screening counter or consultationrooms to the laboratory, diagnostic imaging unit (ultrasound) etc. The clients will beinformed by the registration/screening counter the designated room for examination.They will wait at the respective sub-wait prior being called in for attention.

4.2.2. Staff Flow


4.2.2.2 Uniformed staff will change into their uniform in the clinic�s Staff Changing rooms(male and female staff). They will proceed to their place of work at their rooms units).


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4.2.3 Material Flow







4.3 Supplies






4.4 Other Services






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The IT System will emphasise on clinical management, health information and health systemmanagement. The electronic medical record for each client will be developed and captured in thedatabase.







4.4.5 Food&Catering

Staff will have beverage in the staff rest room during breaks. Vending machine will be provided inthe main entrance of the clinic for the use of all sections.












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4.4.8.1. IT System


4.4.8.1. IT System � coverageThe system will have the following functional coverage :a) Registrationb) Appointmentc) Triagingd) Queuinge) Micro cost accountingf) Clinical information systemg) Human resource management systemh) Financial management systemi) Pharmaceutical information systemj) Lab information systemk) Radiological information systeml) School health servicem) Office automationn) Health Education and Informationo) Health Statistics and general informationp) Health Inspectorate and disease surveillance

4.4.8.2. IT System� technologyIt will be an open system with the following characteristics:a) Consistent �Look and feel� facilityb) Graphical User Interfacec) Multimediad) Graphics applications and interfacese) Security in builtf) Window baseg) Windows NT processorsh) SQL Databasei) Switched networkj) Ethernet protocolk) Local area networkl) ISDN lines or Frame Relay.

5. REGISTRATION/COLLECTIONCOUNTER,TRIAGECOUNTERANDMAINWAITINGAREA

5.1. ROLE/FUNCTION


5.2. LOCATION



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5.3. ORGANISATION




Client will enter the department via the main entrance of the clinic. Client will take a queue-numberusing their smart-card or identity card. They will wait in the Waiting Area for registration by aRegistration/Collection Counter. Client will be identified by the Registration/Collection counter asnew or follow-up case. Retrieval of client�s record will be made through the Record Office. Thisprocess will be computerised. Destination of the record will be determined by the Registration/Collection counter i.e. screening counter, consultation room or other rooms/units based onappointments given.

For walk-in cases, without appointment, they will be screened at Triage Counter (besidesregistration/collection counter) by a registration personnel to determine where the client is supposedto go, e.g. doctor, paramedic, laboratory or other rooms/units by putting a sticker and queue-number on their record. Certain parameters e.g. weight, height and blood pressure may be takenat this counter.


5.4.2. ClientsRecord

a) Clients are registered at the reception/collection counter. Thewhole process of registrationwill be computerised.


b) Once clinic session ends, the �hard-copy� records will be sent back to the record officewhile electronic record will be stored in the computer.

5.5. COMPONENTSOFREGISTRATION/COLLECTIONCOUNTER,MAINWAITINGAREAANDSPACEREQUIREMENTS

5.5.1. Entrance







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It is located besides the registration counter. After collecting medication, client will pay the feesand collect education materials, appointment, referral letters etc here. It should accommodate atleast 4 clients, at any point of time.



5.5.6 Main Waiting Area






5.5.9 Play area

Designed for children recreation while waiting for their examination and consultation. Must benearby and seen directly from the main waiting area.








6.1 ROLE/FUNCTION

6.1.1. To collect, store and retrieve clients� records.6.1.2. To enter diagnosis (ICD) made by doctors.6.1.3. To analyse statistics and present them to the management for decision making and planning.


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6.1.4. To co-ordinate the preparation of medical reports, quality assurance reports and issuing returnsto District Health Office.

6.2 LOCATION


6.3 ORGANISATION











6.5.1. Waiting area


6.5.2. Reception Counter (open concept)


6.5.3. Record Officer Area

Open Concept Office for administration work.

6.5.4. Record room with record compacts for storage of medical records and x-ray films. Exhaust fan isnecessary for the file room.


7.1. ROLE/FUNCTION

7.1.1 Promotive, Preventive, Curative and Rehabilitative health services to all age group. CE rooms willbe manned by either doctors, nurses or medical assistants.


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7.1.5 Clients who need further treatment will be referred to Family Medicine Specialist or other specialistsat the hospital or admitted to the ward.




7.2. LOCATION


7.3. ORGANISATION

7.3.1. The CE rooms staff shall be headed by the family medicine specialist or the senior most medicalofficer.

7.3.2. Other staff include medical officers, medical assistants, nurses, community nurses and healthattendants.




7.4.3 Clients who need specialist services will be referred to Family Medicine Specialist, OccupationalHealth specialist or other specialists at nearest hospital.



7.4.6 Medical Social Services will be provided by medical social officert if stationed officer is not available.

7.5. SPACEREQUIREMENT

7.5.1 Entrance


7.5.2 Waiting area and Reception Counter

After registration and screening, clients will wait at the Main Waiting, before being called forconsultation. Their presence will be addressed at the reception counter.


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Adequate number of rooms shall be provided depending on workload. Doctors and paramedicsshall see patients. A digital call system shall be used to call patients. Each consultation roomshall be able to accommodate 4 persons and basic equipment e.g. Examination couch withdrawing screens, doctors� tables and chairs, x-ray illuminator and trolley.


Number of rooms needed is based on the norms of 50 clients/room/day. On an average the Type3 should have at least 12 rooms.


This room has couches with drawing screens. Each area (cubicle) can accommodate at least 4person at any one time. This room can be directly accessible to the public, either through themain or alternative entrance. This room is for injections, dressing, rehydration and resuscitation.Adequate and lasting worktops and built-in cabinets should be installed. This room shouldaccommodate 4 clients at any one time.

7.5.5 Asthma bay

This area has appropriate chairs with drawing screens. Each area (cubicle) can accommodate atleast 4 person at any one time. This area can be directly accessible to the public, either throughthe main or alternative entrance. This area is for asthma treatment and observation. Adequate andlasting worktops and built-in cabinets should be installed. This room should accommodate 2clients at any one time.



7.5.7 Preparation Area


7.5.8 ECGArea


7.5.9 EyeExaminationRoom

For visual acuity test using Snellens chart and colour blindness test for general medical check-up.Slit lamps may be installed here (optional).

7.5.10 HearingExaminationRoom

For hearing test for adult and babies, using audiometers and infantometer. Sound-proofaudiometric box may be installed here (optional).


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Located nearby the Diagnostic Imaging Unit.




For storage of medical equipment which will be shared by CE rooms.

7.5.14 CleanUtilityRoom

To keep linen and disposables before distribution to CE rooms. Appropriately near to thePreparation Area.

7.5.15 DirtyUtilityRoom

Should be near the Treatment and Procedure rooms.


8.1 FUNCTION


8.2 LOCATION


8.3. ORGANISATION



8.4.1. The health education room can be used on regular basis e.g. cooking demonstration for expectantmothers.

8.4.2. Health Education activities can also be arranged by central booking.

8.4.3. It can also be used for teaching purposes for the staff.


8.5.1 HealthEducationRoom

Health education and counselling will be given by health personnel in this room. Models, flipcharts and other audio-visual aids will be used for this purpose. This room will have space for amaximum of 20 people.

8.5.2 CookingDemonstrationArea



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- Healthy kitchen- Actual cooking tools and utensils such kitchen, sink, fridge, kitchen cabinet etc- Audio-visual aids- Sitting facilities (theatre style) which can accommodate 15-20 people at one



9. ORALHEALTHUNIT

9.1. ROLE/FUNCTION


9.2. LOCATION


9.3. ORGANISATION





9.5.1. Reception andSub-wait


9.5.2. Dental Operatories (Dental Surgery)


9.5.3. Air CompressorRoom


9.5.4. Preparation/SterilisationArea


9.5.5. Staff Office



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9.5.6. Dental X-ray room

Situated near the operatories, in theDiagnostic ImagingUnit,or special unit if diagnostic ImagingUnit is not available.

Walls are leaded in line with the requirements of X-rays department. X-rays will be taken bydental operators.

9.5.7. Equipment Store


9.5.8. Dental Laboratory

The dental laboratory work will be carried out in this room. It will be equipped with work benches

9.5.9. Dental Store Room


9.5.10 DirtyUtility



10.1 ROLE/FUNCTION


10.2 LOCATION

It can be located away from CE room but must be barrier free, preferably have a separate entrancefor easy access by patients and be disabled friendly. Doors and corridors should accommodatefor wheelchairs and stretchers.

It should be located on the ground floor and preferably have access to play ground (barrier freeand incorporate therapy items e.g. footpath with handrails, wheel- through handbars 4feet x 3 feetx 1 feet, wheelchair swings12 feet x 12 feet, special swing seats 12 x 12 feet).

10.3 ORGANISATION





orthopedic problems and others


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- persons with chronic conditions such as chronic obstructive airway disease, chronicbackache, patients with stroke and others


10.4.4 Staff of rehab unit will also function as a team with other staff in the Health Clinic i.e.Medical Social Worker, Counsellor, Public Health Nurses and Medical Assistants.


10.5.1 Reception andWaitingArea

Waiting area should be large enough for 20 persons (includes patient and carers) at anyone time and accommodate wheel chair users wheelchairs.



equipped with basic facilities for cognitive and physical assessment, couch, tableand chairs.


� Area for splitting purposes ( needs large sink) that will need to be wheelchair andstretcher assessable


For therapy in children with special needs, a separate area is required to reducedistraction. Two connecting rooms with glass panes (one way view glass panes toobserve behavioural responses) for assessment and observation by the therapist / rehabteam as well as to carry out therapy. Larger room to accommodate for assessmentequipment and 3 person at any point of time.

10.5.4 Gymnasium



10.5.6 Rehab Store



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10.5.7 Pantry

Pantry for training on activities of daily living and domestic skills for psychosocial rehab ofmentally ill, elderly and disabled. Requires work areas that can fit wheelchairs, largetable and space to accommodate fridge, stove and kitchen utensils.

10.5.8 Toilet

A staff toilet will be provided. Toilet for rehabilitation training for the disabled on self care.Should be large � standard toilet for disabled that includes both toilet and bathroom.


One office for the officer in charge to be able to fit 3 persons at any one time. A common roomas staff office for 2 other personnel.

10.5.10 Expansion (future)

Space for hydrotherapy should be made available

11. PATHOLOGYUNIT

11.1. ROLE/FUNCTION

To provide diagnostic laboratory support services (level I upgraded) to client.

11.2. LOCATION


11.3. ORGANISATION

10.3.1 The lab will be headed by a senior medical laboratory technologist.

10.3.2 He/she will be assisted by medical laboratory technologist and health attendant.


11.4.1. Request For Test

11.4.1.1. The lab will receive requests for lab test from all CE rooms.

11.4.1.2. Request will be made by doctors, nurses or medical assistants using the requestform.

11.4.1.3. Client will bring the request form to the lab where it will be registered.

11.4.1.4. Specimens will be taken in the clinic specimen taking area.

11.4.2. Receiving Specimens

Specimens will be received registered and sorted out at the reception before the test is done.

11.4.3. Reporting

11.4.3.1. Result of the investigations will be captured automatically in the computer system.The staff may key in some information and to endorse the validity of the result.


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11.5.1 ReceptionArea

Request forms and specimens will be received here. Specimen will be sorted outhere.

Sitting and stand-up work is required. There must be adequate space for movementof specimen trolleys.

11.5.2 Waiting Area

Client to wait at the main waiting area before specimen are taken. They will be calledinto specimen collection area for specimen collection. It could accommodate 30clients at any time.



11.5.4 Laboratory

A laboratory will provide for test which can be carried out as out-patient. It will beable to accommodate about 6 staff.

Specimens will be received here and examined immediately. Urine, stool, sputumand simple blood tests will be carried out. Examinations of specimen will beconducted on heavy duty worktops. Results will be conveyed via electronic device onrequest or/and will be put into pigeon holes at the reception counter to be collectedby the respective clinics at regular intervals.

11.5.5 Lab Store





To keep clean disposables, test tubes and bottles.

11.5.8 Staff Area


12. PHARMACYUNIT

12.1 ROLE/FUNCTION

12.1.1. Dispensing all pharmaceutical products to all clients.12.1.2. Client counselling in the use of drugs and dissemination of drug information.12.1.3. Monitoring of drug utilisation.


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12.2 LOCATION


12.3 ORGANIZATION



12.4.1. It will serve client seen in all the CE room and oral health unit.

12.4.2. Pre-packing of some drugs will be done here.

12.4.3. Out-patient counselling will be done in this unit.







c) Dispenser working behind the first or screening counter will receive prescription andcheck treatment prescribed. Any doubt will be clarified with the pharmacist who inturn may check with the medical officer who issue the prescription. Dispensersworking behind the other counters will dispense medicine with instruction to patient.An area will be provided for the dispensers to prepare the prescription.


12.5.3 Drug Store

2 months stocks of pharmaceutical item will be held here. Supplies will be bought in by theconcession company on regular basis and upon request. Certain drugs will be kept in therefrigerator. Suggested store size is at least 300 sq ft. To be 24-hourly air-conditioned

12.5.4 Pre-packing Areas


a) Dry (Tablet/Capsule) Pre-packing areaFor pre-packing of tablet and capsules. Equipped with suction hood for each machine tosuck dust.

b) Extemporaneous and internal Pre-packing areaFor reconstitutions of ready to dispense suspensions (antibiotics) and prepacking ofmixtures. Certain drug will de kept in the refrigerator.


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An office will be provided for the pharmacist or officer in-charge of the pharmacy to carry outconsultation services and drug information as well as administrative work.

12.5.6 DrugCounsellingRoom

Individual outpatient counselling will be done in this unit. Can accommodate 3 people at anytime. Group counselling on drug usage will be carried out in the health education room.

12.5.7 Staff Area


13. DIAGNOSTIC IMAGINGUNIT (OPTIONAL)

13.1 ROLE/FUNCTION



13.2 LOCATION


13.3 ORGANIZATION

The unit will be headed by a senior radiographer (diagnostic). He/ she will be assisted by a radiographer(diagnostic) and health attendant.








13.5.1 Reception



There will be a waiting area to cater for 20 clients with spaces to accommodate patientscoming on wheelchairs and trolleys.


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13.5.3 X-ray Room

A standard size room is provided for general and dental radiography machine.

13.5.4 ChangingRoom

The unit will provide 1 changing cubicle for the clients, accessible from the generalradiography room.

13.5.5 Dark Room


13.5.6 Control Area



For storage of unexposed films. To be air-conditioned for 24-hours.

13.5.8 Film Store



A combined sorting and viewing area will be provided for viewing of x-ray radiographs.Recording and report writing will be done here. Can accommodate at least 3 staff.

13.5.10 Officer in-charge Room

Office of the senior radiographer


14.1 ROLE/FUNCTION


14.2 LOCATION


14.3 ORGANISATION

The health inspector performing the function may or may not be under the responsibility of the officer-in-charge of the Health Clinic. If not, he may be responsible directly to the Medical Officer of Health of theDistrict. Supporting staff are 3 PKA�s and 3 PRA�s.




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14.4.2. The scope of this function is Disease Control for Communicable and Non-CommunicableDiseases, Vector and Rodents Control and Occupational Health.

14.4.3. Function includes defaulter tracing (for chronic infectious diseases), ensure notification of allnotifiable diseases, analysis of disease database, initiating investigation, institutingintervention and control measures, health promotion in the community and report writing.


14.5.1 Health Surveillance Room

An office shall be made available for a health inspective and supportive staff. It is used foroffice work, discussion/meeting with clients/staff and preparation of education material.

15. ENVIRONMENTALHEALTHUNIT

15.1 ROLE/FUNCTION

To provide environmental health surveillance function for the health clinic�s operational area.

15.2 LOCATION


15.3 ORGANISATION



15.4.1. The Environmental Health unit is required to monitor the environmental health status of thecommunity.

15.4.2. The scope of this function are Environmental Sanitation and Pollution Control, CommunityWater Supply, Drinking Water Quality Control and Food Quality Control.

15.4.3. Function includes premise inspection, food and water sampling, plan, built and monitor safecommunity water supply and hygienic waste disposal, update and analysis of communityand environment database, health promotion in the community and report writing.


15.5.1 EnvironmentalHealthRoom

An office shall be made available for a health inspective and supportive staff. It is used foroffice work and preparation of education material.

15.5.2 Record space

Space for keeping and displaying of environmental and population health charts and records.Can also be used for meeting with clients.


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16.1 ROLE/FUNCTION



16.2 LOCATIONOF ITROOM


16.3 ORGANISATION









16.4.6 Only qualified health professional can undertake and deliver telemedicine assisted healthcare.

16.4.7 Clients will be made accessible to health information and education. A person will be madeincharge to answer any queries if any by clients. The state or district health office mustpreapprove the contents before putting on the web page.






17.1 ROLE/FUNCTION

17.1.1 Overall management of the clinics.17.1.2 Human resource management.17.1.3 Management of finance including revenue collection.17.1.4 Management and control of stocks.


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17.1.5 Co-ordinate the training programme for the staff.17.1.6 Co-ordinate the use of health education room.

17.2 LOCATION

The administration office may be located away from the CE areas but easily accessible eg. walkingdistance, via elevator etc.

17.3 ORGANISATION

17.3.1 The officers-in-charge (Medical Officer in-Charge or Family Medicine Specialist) will be theoverall manager of the clinic.

17.3.2 For day to day operation, he/she will be assisted by senior clerks, clerks, sister/matron-in-charge and medical assistant-in-charge.





Common office will be provided for the administrative staffs with an open office concept. It willprovide office space for 3 administrative staff and for printing works. A pantry will be providedin adjacent to the general office.

17.4.3 Matron/Sister�s Room

Office for the matron/sister-in/charge.

17.4.4 SeniorMedical Assistant�s Room

Office for medical assistant-in-charge.

17.4.5 FileRoom

To keep administrative files. Exhaust fan is required.

17.4.6 AVAStore

To keep AVA equipment e.g. overhead projector, LCD projector, slide projector/maker andaudio-video sets.

17.4.7 Stationary Store

To keep statioinary stock.



17.4.9 MeetingRoom



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17.4.10 Seminar Room

A theatre-style room to accommodate a minimum of 40 people.







17.4.13 Medical Social Unit

17.4.13.1 Sub-wait AreaA sub-wait area will be providede for clients before attended by MedicalSocialOfficer and/or Counsellor. It should accommodate minimum of 8 clientsat any time.

17.4.13.2 Reception counterThe presence of clients will be addressed here.

17.4.13.3 Medical Social RoomOffice-cum-clinic for Medical Social Officer. Advice and counselling may beconducted here.

17.4.13.4 Counsellor�sRoomOffice-cum-clinic for the counsellor. Individual counselling will be conductedhere.

17.4.13.5 CounsellingRoomCounselling room for scheduled individual counselling conducted either by thedoctors, nurses, medical assistants, health inspectors, counsellor etc.



Male and female staff changing rooms will be provided to cater the whole health clinic staff. It shouldhave lockers for the staff to keep their personal items. Toilets attached.

18.2 STAFFTOILETS

Staff toilets for male and female staff will be located at strategic places e.g. one at each level. Waterhoses to be fixed in each cabinet.

18.3 SOLATROOM

Prayer rooms will be provided centrally for male and female staffs and client of the health clinic. Eachroom shall accommodate 10 people. Ablution room will be provided for each prayer room. It should belocated near the staff toilet.


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18.4 LIBRARY


18.5 STAFFREST

A common male and female staff rest area at strategic area i.e. one at each level. Storage space aslockers for staff belongings be attached. It should accommodate 10 staff at any one time.



18.7 DRIVERSWAITINGROOM

A common room for drivers while waiting for call.



18.9 AMBULANCE /CLINICVEHICLEPARKING


19. PUBLICAMENITIES





19.3 PARKINGSPACES


19.4 ELEVATORS

Wide elevators which can accommodate stretchers will be provided for patients and staffs if more thana storey.

19.5 CANTEEN

Pre-packed food and beverages may be served in the canteen for the public.




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19.7 BUSSTOP

Covered bus stop for the public may be placed outside the clinic compound.

19.8 PUBLICPHONESTATION

Station for public phone should be located in strategic area for public use.

20. STORES



20.2 DRUG STORE (see also 12.5.3)A drug store will be made available near the dispensaries. There should be adequate shlves forstorage of drugs.

20.3 BULKSTORE


20.4 CONDEMNED MATERIALSTORE




20.6 BAKASSTORE

To store material for BAKAS activities, such as



20.8 CLEANERSROOMS







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20.11 WASHINGAREA






21. PLANNINGCONCEPT




21.4 Land space being of premium in major focus, the facility should have the flexibility to be multi-storeyed.Lifts should be provided if they are multi-storeyed.





21.8.1 Public toilets will be close to the waiting area. There will be provision for a toilet for thehandicapped.

21.8.2 Central Medical Records room will be adjacent to the Reception/Registration Areaallowing easy communication between these two rooms.

21.8.3 The basic concept of the Health Clinic design is the provision of standard Consultation/Examination Rooms. The layout of these rooms will ensure maximum privacy, especiallywhen door is opened as well as interconnecting passage for staff use.

21.8.4 The Treatment and Procedure rooms shall be easily accessible to the public (via mainor special entry) and best positioned between the Clean and Dirty Utility Rooms with freeaccess for staff. This measure will also to ensure a clear flow of clean and soiled items.

21.8.5 The Health Education facilities can be located away from the main Consultation/Examination Area as it is a shared facility for the use of the clinic.


127

21.8.6 The components of the Laboratory will be grouped together and should have itsown waiting area.

21.8.7 The Rehabilitation (Occupational therapy & Physiotherapy) will have its own waitingarea.

21.8.8 TheWaiting Area of the Pharmacywill be clearly segregated from theMainWaiting Areaand waiting area of the CE rooms.

21.8.9 Within the clinic, natural light is desirable in waiting, working and staff rest areas. Toachieve adequate privacy for staff, the Staff Rest Rooms will be sited away from thepatient and waiting areas.

21.8.10 Rehabilitative Unit (Occupational Therapy & Physiotherapy) will be located close toan entrance for easy access of handicapped and disabled patients with wheelchairsand also for family to unload patient from their vehicle.

21.8.11 The Dental Clinic Area as well as Rehabilitation Area will be separated from the CErooms with its regular flow of patients. The individual Reception Counter shouldface the Waiting Area and the receptionist should be able to see all incoming andoutgoing patients.

21.8.12 Outdoor Play Area will be accessible for all children accompanying clients andrehabilitative clients.


21.8.14 Security to the centre will be devised to enable staff to work after normal office hours andclinics to be opened to public for Health Promotion activities after working hours.

21.8.15 Materials and Supplies flow will not interfere with the patients flow. It shouldhave separate entrance to the various units.



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INTRODUCTION

� ROLESTATEMENT� � � SITUATIONALANALYSIS


DEPARTMENTALBRIEF





129

KEPERLUAN PERUBATAN




April 2001


130





D) KKJENIS4 <300KEDATANGANSEHARI


F) KK JENIS 5 (SABAH&SARAWAK) < 150KEDATANGANSEHARI



131

KLINIKKESIHATAN JENIS 4JADUALRUANG

1 RUANGMASUKUTAMA/PENDAFTARAN1.1 Kaunter Pendaftaran1.2 Kaunter Pertanyaan1.3 Kaunter Pembayaran1.4 Kaunter Triage / Call Centre1.5 Ruang Menunggu Utama1.6 Ruang Legar/Pameran1.7 Ruang Penyusuan / Tukar Lampin1.8 Ruang Permainan Kanak-kanak (dalam klinik)1.9 Tandas Awam1.10 Ruang Troli / Kerusi Roda1.11 Ruang Menunggu (kenderaan)

2 UNITREKODKESIHATAN2.1 Ruang menunggu2.2 Kaunter Penerimaan2.3 Ruang anggota2.4 Ruang Rekod

3 UNITKESIHATANKELUARGA3.1 Ruang Menunggu3.2 Kaunter Penerimaan3.3 Bilik Pemeriksaan (CE)3.4 Bilik Rawatan3.5 Ruang Rawatan Asma

3.7 Bilik Persediaan3.8 Ruang EKG3.9 Bilik Pemeriksaan Mata3.10 Bilik Pemeriksaan Pendengaran

3.11 Bilik USG

3.12 Bilik Pendidikan Kesihatan3.13 Bilik Demonstrasi Memasak3.14 Setor Peralatan3.15 Bilik Utiliti Bersih3.16 Bilik Utiliti Kotor3.17 Tandas Awam3.18 Tandas Anggota4 UNITKESIHATANPERGIGIAN4.1 Kaunter Penerimaan

4.2 Bilik Pembedahan

Bilik Prosedur3.6


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4.3 Bilik Tekanan Udara4.4 Bilik Persediaan/Pensterilan4.5 Pejabat4.6 Unit X-ray Pergigian (jika Unit Pengimejan Diagnostik tiada)4.7 Setor Peralatan4.8 Makmal Pergigian4.9 Setor Pergigian4.10 Utiliti Kotor5 UNITPEMULIHAN5.1 Ruang Menunggu5.2 Kaunter Penerimaan5.3 Bilik Penilaian dan Rawatan5.4 Gimnasium5.5 Pantri5.6 Setor5.7 Tandas6 UNITPATOLOGI6.1 Ruang Menunggu6.2 Kaunter Penerimaan6.3 Ruang Mengambil Spesimen6.4 Tandas spesimen6.5 Makmal6.6 Ruang Anggota6.7 Setor makmal6.8 Utiliti bersih6.9 Utiliti kotor7 UNITFARMASI7.1 Ruang Menunggu7.2 Dispensari dan kaunter7.3 Bilik Kaunseling7.4 Ruang pembungkusan kering7.5 Ruang pembungkusan basah (internal)7.6 Ruang pembungkusan basah (racun)7.7 Bilik Pegawai7.8 Ruang anggota7.9 Setor Ubat (Ruang Ubat Makan dan Racun)8 UNITPENGIMEJANDIAGNOSTIK (hanyauntukKlinik

Kesihatan yang menggantikan Jabatan/Unit Pesakit Luarhospital atau mempunyai justifikasi tertentu yang lain)

8.1 Ruang Menunggu8.2 Kaunter Penerimaan8.3 Bilik X-ray (termasuk unit x-ray pergigian)8.4 Ruang Persalinan8.5 Ruang Kawalan


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8.6 Bilik Gelap8.7 Ruang Penelitian8.8 Bilik Pegawai8.9 Setor Filem8.10 Setor Kimia8.11 Tandas9 UNITSURVEILANSKESIHATAN9.1 Bilik Surveilans Kesihatan9.2 Bilik Sokongan Teknikal10 UNITKESIHATANALAMSEKITAR10.1 Bilik Kesihatan Alam Sekitar10.2 Ruang Rekod11 UNITKESIHATANSEKOLAH11.1 Bilik Kesihatan Sekolah12 UNITPERAWATANDIRUMAH12.1 Bilik Perawatan Di Rumah13 UNITKEBAJIKANPERUBATAN13.1 Ruang Menunggu13.2 Kaunter Penerimaan13.3 Bilik Kebajikan Perubatan13.4 Bilik Kaunselor13.5 Nilik Kaunseling14 UNITPENTADBIRAN14.1 Ruang Menunggu14.2 Kaunter Penerimaan14.2 Bilik Pegawai y/m14.3 Pejabat Am14.4 Bilik Penyelia/Ketua Jururawat14.5 Bilik Pembantu Perubatan Kanan14.6 Bilik Fail14.7 Bilik Mesyuarat14.8 Bilik Seminar14.9 Bilik Server14.10 Setor APD14.11 Setor peralatan14.12 Tandas Anggota15 KEMUDAHANANGGOTA15.1 Bilik Persalinan dan tandas15.2 Bilik Solat15.3 Bilik Rehat15.4 Perpusatkaan15.5 Bilik Pemandu15.6 Ruang letak kereta


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16 KEMUDAHANAWAM16.1 Taman Terapeutik

16.2 Telefon awam



16.5 Kafeteria

16.6 Mesin minuman

16.7 Lif

17 SETORDANLAIN-LAIN17.1 Ruang letak ambulans


17.3 Bilik Pencuci





17.8 Setor Pukal



17.11 SetorBAKAS




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3.1. Role Statement

The Health Clinic will provide promotive, preventive, curative and rehabilitative services for less than300 attendance per-day. Apart from the general out-patient services, the clinic will focus it�s servicesfor thespecial target groups i.e. mothers, children (0 - 12 years old), adolescence, elderly, well adults,productivewomen, family and workers. There will be provision for treatment and resuscitation in theclinic facility.










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3.1.9 Public amenities such as cafeteria, car parks, playground and water closets will be provided.





support for breast feeding and lactation management.

b) Infant and Child HealthTarget groups are babies (0 to 1 years), toddlers (1 to 4 years) and pre-schoolers (5-6years). These functions will include development assessment, immunisation, growthmonitoring etc. and specific activities for children with special needs such as disabledchildren and children of poor families.










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3.2.14 HealthSurveillanceService provided will include defaulter tracing, active and passive case detection, contact tracing,notification and investigation of notifiable diseases.

3.2.1 EnvironmentalHealthService provided will include environmental sanitation, safe water supply, drinking water monitoringand sampling, food premise inspection, food sampling, workplace inspection and health promotionand education.


3.2.3 Clinical Support ServicesPathology (laboratory), Pharmacy, Rehabilitation and Counselling.




The Health Clinic will operate from Monday to Friday (or Saturday to Thursday) between 8.00 am - 4.30 pmand on Saturday/Thursday from 8.00 am - 12.30 pm.

Where services after office hours* is required (in rural area), on call services shall be provided as deemrequired by the state/district.


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�Call centre� will be established to entertain consultation by phone. Trained allied health personnel will manthis �centre�.




a) Services stated in paragraph 3.2.1 to 3.2.15 will be provided through an integrated clinic systemor open system. They do not function as isolated clinics or session except occasionally whenthere is pre-selected group to be serviced.

b) Services will be provided to walk-in clients. Phone-in will be entertained through call-centre by thetriaging staff.

c) Multifunctional medical personnel shall carry out these services.d) Family Medicine Specialist role is to manage referred cases from the medical officers at the clinic

and from ancillary clinics.


The scope of service includes promotive, preventive and curative and rehabilitative, which will betargeted to specific groups i.e.:

- Pre-school children- Primary school children- Secondary school children- Pregnant mothers- Children with special need- Adult- Elderly





The scope is to provide nursing care in the home to facilitate healing and coping with recuperation.The target groups are:

- The elderly who needs nursing and other care- The disabled- Post-trauma patient


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- Post-surgery patient- Post-natal cases- Terminal cases requiring palliation







4.18 EnvironmentalHealth

Service provided will include environmental sanitation, safe water supply, drinking water monitoringand sampling, food premise inspection, food sampling, workplace inspection and health promotionand education.

4.19 Medical Social Service

This service will provide support for clients with specific social-related problems in this area. It willbe provided through tele-counselling or visiting counsellor and medical social worker.a) Social support - Individual and group counselling and consultation serviceb) Practical support - financial aids, social and welfare institution (for disabled , old folks

home and shelter) and medical and mobility equipment.c) Networking - liaison within and with other agencies (government and non-

governmental organisations).d) Case Focus - domestic violent (child, elderly and women), physically and mentally

disabled, single parent, poverty cases e.g. malnutrition and worm infestation andproblems in payment.

4.2. Workflow



4.2.1.1 Client

Client will take a queue-number using their smart-card or identity card. They will wait inthe Waiting Area for registration by a Registration/Collection Counter. Client will beidentified by the Registration/Collection counter as new or follow-up case. Retrieval ofclient�s record will be made through the Record Office. This process will becomputerised. The next destination for the client will be determined by the Registration/


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Collection counter either to the screening counter or the consultation room or otherrooms/units.

For new walk-in cases, they will be screened at the Triage Counter (besides theregistration/collection counter) by a trained paramedic to determine the appropriateprovider in the clinic e.g. doctor, paramedic, laboratory or other rooms/units by putting asticker and queue-number on their record. Certain parameters e.g. weight, height andblood pressure may be taken at this counter.













4.2.1.4 NutritionandDietetic, Laboratory,Pharmacy,Workers�Health,MedicalSocial services

Client will be directed by Registration/Collection counter, screening counter or consultationrooms to the laboratory, diagnostic imaging unit (ultrasound) etc. The clients will beinformed by the registration/screening counter the designated room for examination.They will wait at the respective sub-wait prior being called in for attention.


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4.2.2. Staff Flow


4.2.2.2 Uniformed staff will change into their uniform in the clinic�s Staff Changing rooms(male and female staff). They will proceed to their place of work at their rooms/units).



4.2.3 Material Flow







4.3 Supplies







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4.4. Other Services











4.4.5 Food&Catering











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4.4.8.1. IT System




The system will have the following functional coverage :a) Registrationb) Appointmentc) Triagingd) Queuinge) Micro cost accountingf) Clinical information systemg) Human resource management systemh) Financial management systemi) Pharmaceutical information systemj) Lab information systemk) Radiological information systeml) School health servicem) Office automationn) Health Education and Informationo) Health Statistics and general informationp) Health Inspectorate and disease surveillance

4.4.8.3. IT System� technology

It will be an open systemwith the following characteristics:a) Consistent �Look and feel� facilityb) Graphical User Interfacec) Multimediad) Graphics applications and interfacese) Security in builtf) Window baseg) Windows NT processorsh) SQL Databasei) Switched networkj) Ethernet protocolk) Local area networkl) ISDN lines or Frame Relay.


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5. REGISTRATION/COLLECTIONCOUNTER,TRIAGECOUNTERANDMAINWAITINGAREA

5.1. ROLE/FUNCTION


5.2. LOCATION

The reception/registration/collection/screening area will be accessible through the main entrance.The counter should be designed and located so that the staff can easily oversee client entering theclinic and oversee the main waiting area.

5.3. ORGANISATION




Client will enter the department via the main entrance of the clinic. Client will take a queue-numberusing their smart-card or identity card. They will wait in the Waiting Area for registration by aRegistration/Collection Counter. Client will be identified by the Registration/Collection counter asnew or follow-up case. Retrieval of client�s record will be made through the Record Office. Thisprocess will be computerised. Destination of the record will be determined by the Registration/Collection counter i.e. screening counter, consultation room or other rooms/units based onappointments given.

For walk-in cases, without appointment, they will be screened at Triage Counter (besidesregistration/collection counter) by a registration personnel to determine where the client is supposedto go, e.g. doctor, paramedic, laboratory or other rooms/units by putting a sticker and queue-number on their record. Certain parameters e.g. weight, height and blood pressure may be takenat this counter.





b) Once clinic session ends, the �hard-copy� records will be sent back to the record officewhile electronic record will be stored in the computer.


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5.5. SPACEREQUIREMENTS

5.5.1. Entrance





Clients� queries and calls (telephone) will be attended at the information counter. The clericalpersonnel will attend to all queries. This can be part of the Registration Counter.


It is located besides the registration counter. After collecting medication, client will pay the feesand collect education materials, appointment, referral letters etc here. It should accommodate atleast 2 clients, at any point of time. This can be part of Registration Counter.



5.5.6 Medical RecordRoom

It will be adjacent to the Registration Area allowing easy communication between these tworooms.

5.5.7 Medical Record Staff Area

This is where the record office clerk prepares medical reports.

5.5.8 Main Waiting Area







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5.5.11 Play area









6.1. ROLE/FUNCTION

6.1.1. Promotive, Preventive, Curative and Rehabilitative health services to all age group. CE rooms willbe manned by either doctors, nurses or medical assistants.

6.1.2. Each CE rooms will cater all type of clients, six days a week.

6.1.3. The services include out-patient curative care, maternal and child health care, well adult clinic,geriatric care, family planning, adolescent health, community mental health and occupationalhealth clinic.

6.1.4. All clients will be seen and managed by the appropriate trained health staff.

6.1.5. Clients who need further treatment will be referred to Family Medicine Specialist or other specialistsat the hospital or admitted to the ward.

6.1.6. Follow-up appointment will be given to client.

6.1.7. Health Education for all client and accompanying persons.

6.1.8. All CE rooms will be adequately equipped.

6.2. LOCATION


6.3. ORGANISATION


6.3.2. Other staff include medical officers, medical assistants, nurses, community nurses and healthattendants.


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6.4.1. Provide promotive, preventive, curative and rehabilitative healthcare to all clients. Examination,education and counselling will be done here.

6.4.2. Follow-up cases referred from the hospital or other clinic will be seen in CE rooms.

6.4.3. Clients who need specialist services will be referred to Family Medicine Specialist, OccupationalHealth specialist or other specialists at nearest hospital.

6.4.4. Clients who need admission will be referred to the nearest hospital.

6.4.5. Physiotherapy services will be provided by visiting physiotherapist and occupational therapistif stationed officers are not available.

6.4.6. Medical Social Services will be provided by medical social officert if stationed officer is not available.


6.5.1 Entrance


6.5.2 Waiting area and Reception Counter

After registration and screening, clients will wait at the Main Waiting, before being called forconsultation. Their presence will be addressed at the reception counter.




Number of rooms needed is based on the norms of 50 clients/room/day. On an average the Type4 should have at least 8 rooms.


This room has couches with drawing screens. Each area (cubicle) can accommodate at least 4person at any one time. This room can be directly accessible to the public, either through themain or alternative entrance. This room is for injections, dressing, asthma treatment andobservation, rehydration and resuscitation. Adequate and lasting worktops and built-in cabinetsshould be installed. This room should accommodate 4 clients at any one time.




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6.5.6 Preparation Area


6.5.7 ECGArea


6.5.9 EyeandHearingExaminationRoom

For visual acuity test using Snellens chart and colour blindness test for general medical check-up.For hearing test for adult and babies, using audiometers and infantometer.


Located nearby the Diagnostic Imaging Unit.




For storage of medical equipment which will be shared by CE rooms.


To keep linen and disposables before distribution to CE rooms. Appropriately near to thePreparation Area.


Should be near the Treatment and Procedure rooms.


7.1 FUNCTION


7.2 LOCATION


7.3. ORGANISATION





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7.5.1 HealthEducation (andCookingDemonstration)Room

Health education and counselling will be given by health personnel in this room. Models, flipcharts and other audio-visual aids will be used for this purpose.

Nutrition education and counselling for mothers and parents, and clients with special needs(e.g. diabetic, hypertensives and obese) will also be done here. It will require:

- Healthy kitchen- Actual cooking tools and utensils such kitchen, sink, fridge, kitchen cabinet etc- Show case for food model display.

This room will have space for a maximum of 20 people.

8. ORALHEALTHUNIT

8.1. ROLE/FUNCTION


8.2. LOCATION


8.3. ORGANISATION












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8.5.5. Staff Office



Situated near the operatories, in the Diagnostic Imaging Unit. Walls are leaded in line with therequirements of X-rays department. X-rays will be taken by dental operators.




The dental laboratory work will be carried out in this room. It will be equipped with work benchesand cabinets for Dental Technicians


The Dental unit will provide basic dental health services for outpatient

8.5.10 DirtyUtility

A dirty utility will be available near the dental operatories.


9.1 ROLE/FUNCTION

To provide rehabilitative services for all patients requiring rehabilitation under the Health Clinics operationalarea.

9.2 LOCATION

It preferably located adjacent to CE room and have a separate entrance for easy access by patientsand be disabled friendly. Doors and corridors should accommodate for wheelchairs and stretchers.

It should be located on the ground floor and preferably have access to play ground (barrier free andincorporate therapy items e.g. footpath with handrails, wheel- through handbars 4feet x 3 feet x 1 feet,wheelchair swings 12 feet x 12 feet, special swing seats 12 x 12 feet).

9.3 ORGANISATION

Specially trained nurse will head the unit and be under the responsibility of the Officer in Charge of theHealth Clinic. Unit will be manned by visiting physiotherapist, occupational therapist, speech andlanguage therapist, and nurses, and assisted by health attendant.


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9.4.1 Services provided will include physiotherapy, occupational therapy and speech and languagetherapy. Basic ototic services will be provided when required.


orthopedic problems and others- persons with chronic conditions such as chronic obstructive airway disease, chronic

backache, patients with stroke and others

9.4.3 The unit will operate during office hours and cases that require further treatment will bereferred to hospital. Rehab services in the home will be provided by the therapist as required.

9.4.4 Staff of rehab unit will also function as a team with other staff in the Health Clinic i.e. doctors,Medical Social Worker, Counsellor, Public Health Nurses and Medical Assistants.


9.5.1 Reception andWaiting Area

Waiting area should be large enough for 10 persons (includes patient and carers) at any onetime and accommodate wheel chair users wheelchairs.



equipped with basic facilities for cognitive and physical assessment, couch, tableand chairs.



9.5.3 Gymnasium




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9.5.4 Rehab Store


10. PATHOLOGYUNIT

10.1. ROLE/FUNCTION

To provide diagnostic laboratory support services (level I upgraded) to client.

10.2. LOCATION


10.3. ORGANISATION






10.4.1.2. Request will be made by doctors, nurses or medical assistants using therequest form.



10.4.2. ReceivingSpecimens


10.4.3. Reporting

10.4.3.1. Result of the investigations will be captured automatically in the computersystem. The staff may key in some information and to endorse the validity ofthe result.






10.5.2 Waiting Area



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10.5.4 Laboratory


Specimens will be received here and examined immediately. Urine, stool, sputum and simpleblood tests will be carried out. Examinations of specimen will be conducted on heavy dutyworktops. Results will be conveyed via electronic device on request or/and will be put intopigeon holes at the reception counter to be collected by the respective clinics at regularintervals.

10.5.5 Lab Store





To keep clean disposables, test tubes and bottles.

10.5.8 Staff Area


11. PHARMACYUNIT

11.1 ROLE/FUNCTION


11.2 LOCATION


11.3 ORGANIZATION







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c) Dispenser working behind the first or screening counter will receive prescription andcheck treatment prescribed. Any doubt will be clarified with the pharmacist whointurn may check with the medical officer who issue the prescription. Dispensersworking behind the other counters will dispense medicine with instruction to patient.An area will be provided for the dispensers to prepare the prescription.


11.5.3 Drug Store

2 months stocks of pharmaceutical item will be held here. Supplies will be bought in by theconcession company on regular basis and upon request. Certain drugs will be kept in therefrigerator. Suggested store size is at least 300 sq ft. To be 24-hourly air-conditioned.



a) Dry (Tablet/Capsule) Pre-packing areaFor pre-packing of tablet and capsules. Equipped with suction hood for each machine tosuck dust.

b) Internal Pre-packing areaFor reconstitutions of ready to dispense suspensions (antibiotics) and prepackingof mixtures. Certain drug will de kept in the refrigerator.


11.5.5 Officer-in-charge cumCounselling room

An office will be provided for the officer-in-charge of the pharmacy to carry out consultationservices and drug information as well as administrative work. Individual outpatient counsellingwill be done in this room.

11.5.6 Staff Area



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2.1 ROLE/FUNCTIONTo provide health surveillance function for the health clinic�s operational area.

12.2 LOCATION


12.3 ORGANISATION




12.4.2. The scope of this function is Disease Control for Communicable and Non-CommunicableDiseases, Vector and Rodents Control and Occupational Health.

12.4.3. Function includes defaulter tracing (for chronic infectious diseases), ensure notification of allnotifiable diseases, analysis of disease database, initiating investigation, institutingintervention and control measures, health promotion in the community and report writing.


12.5.1 HealthSurveillanceRoom

An office shall be made available for a health inspective and supportive staff. It is used foroffice work, discussion/meeting with clients/staff and preparation of education material.

13. ENVIRONMENTALHEALTHUNIT

13.1 ROLE/FUNCTION

To provide environmental health surveillance function for the health clinic�s operational area.

13.2 LOCATION


13.3 ORGANISATION



10.4.1. The Environmental Health unit is required to monitor the environmental health status ofthe community.


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10.4.2. The scope of this function are Environmental Sanitation and Pollution Control, CommunityWater Supply, Drinking Water Quality Control and Food Quality Control.

10.4.3. Function includes premise inspection, food and water sampling, plan, built and monitorsafe community water supply and hygienic waste disposal, update and analysisof community and environment database, health promotion in the community and reportwriting.



An office shall be made available for a health inspective and supportive staff. It is used foroffice work and preparation of education material.

13.5.2 Record space

Space for keeping and displaying of environmental and population health charts andrecords. Can also be used for meeting with clients.


14.1 ROLE/FUNCTION





14.3 ORGANISATION









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14.4.7 Clients will be made accessible to health information and education. A person will be madein charge to answer any queries if any by clients. The state or district health office mustpreapprove the contents before putting on the web page.




A room to fit in servers, telecommunications facilities and a table top for working area for 4 persons atany one time.


15.1 ROLE/FUNCTION

15.1.1 Overall management of the clinics.15.1.2 Human resource management.15.1.3 Management of finance including revenue collection.15.1.4 Management and control of stocks.15.1.4 Co-ordinate the training programme for the staff.15.1.5 Co-ordinate the use of health education room.

15.2 LOCATION

The administration office may be located away from the CE areas but easily accessible eg. walkingdistance, via elevator etc.

15.3 ORGANISATION

15.3.1 The officers-in-charge (Medical Officer in-Charge or Family Medicine Specialist) willbe the overall manager of the clinic.

15.3.2 For day to day operation, he/she will be assisted by senior clerks, clerks, sister/matron-incharge and medical assistant-in-charge.





Common office will be provided for the administrative staffs with an open office concept. It willprovide office space for 2 administrative staff and for printing works. A pantry will be providedin adjacent to the general office.

15.4.3 Sister�s Room

Office for the matron/sister-in/charge.


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15.4.4 SeniorMedical Assistant�s Room

Office for medical assistant-in-charge.

15.4.5 FileRoom

To keep administrative files. Exhaust fan is required.

15.4.6 AVAStore

To keep AVA equipment e.g. overhead projector, LCD projector, slide projector/maker andaudio-video sets.

15.4.7 Stationary Store

To keep statioinary stock.



15.4.9 Meeting cumSeminar Room

An expandable meeting room will be provided to accommodate a minimum of 30 people.









Male and female staff changing rooms will be provided to cater the whole health clinic staff. It shouldhave lockers for the staff to keep their personal items. Toilets attached.

16.2 STAFFTOILETS

Staff toilets for male and female staff will be located at strategic places e.g. one at each level. Waterhoses to be fixed in each cabinet.

16.3 SOLATROOM

Prayer rooms will be provided centrally for male and female staffs and client of the health clinic. Eachroom shall accommodate 10 people. Ablution room will be provided for each prayer room. It should belocated near the staff toilet.


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16.4 LIBRARY


16.5 STAFFREST

A common male and female staff rest area at strategic area i.e. one at each level. Storage space aslockers for staff belongings be attached. It should accommodate 10 staff at any one time.



16.7 DRIVERSWAITINGROOM

A common room for drivers while waiting for call.





17. PUBLICAMENITIES





17.3 PARKINGSPACES


17.4 ELEVATORS


17.5 CANTEEN

Pre-packed food and beverages may be served in the canteen for the public.




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17.7 BUSSTOP

Covered bus stop for the public may be placed outside the clinic compound.

17.8 PUBLICPHONESTATION

Station for public phone should be located in strategic area for public use.

18. STORES





18.3 BULKSTORE


18.4 CONDEMNED MATERIALSTORE




18.6 BAKASSTORE

To store material for BAKAS activities, such as



18.8 CLEANERSROOMS


18.9 CLEANUTILITYROOM


18.10 DIRTYUTILITYROOM



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18.11 WASHINGAREA


18.12 CINICALWASTEHOLDINGROOM




19. PLANNINGCONCEPT




19.4 Land space being of premium in major focus, the facility should have the flexibility to be multi-storeyed.Lifts should be provided if they are multi-storeyed.




19.7.1 The registration area will be easily visible and accessible from the entrance. Accessibility towaiting areas too should be easy. Receptionists shall be able to see waiting clients andshould have maximum view of the entrance to consultation/examination rooms. Waitingareas of the individual consultation/ examination rooms will be easily accessible for thepatients.


19.7.3 Central Medical Records room will be adjacent to the Reception/Registration Area allowingeasy communication between these two rooms.


19.7.5 The Treatment and Procedure rooms shall be easily accessible to the public (via main orspecial entry) and best positioned between the Clean and Dirty Utility Rooms with free accessfor staff. This measure will also to ensure a clear flow of clean and soiled items.

19.7.6 TheHealth Education facilities can be located away from themain Consultation/ExaminationArea as it is a shared facility for the use of the clinic.


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19.7.7 The components of the Laboratory will be grouped together and should have its own waitingarea.

19.7.8 The Rehabilitation (Occupational therapy & Physiotherapy) will have its own waiting area.

19.7.9 TheWaiting Area of the Pharmacywill be clearly segregated from theMainWaiting Area andwaiting area of the CE rooms.

19.7.10 Within the clinic, natural light is desirable in waiting, working and staff rest areas. To achieveadequate privacy for staff, the Staff Rest Rooms will be sited away from the patient and waitingareas.

19.7.11 RehabilitativeUnit (Occupational Therapy&Physiotherapy)will be located close to an entrancefor easy access of handicapped and disabled patients with wheelchairs and also for family tounload patient from their vehicle.

19.7.12 The Dental Clinic Area as well as Rehabilitation Area will be separated from the CE roomswith its regular flow of patients. The individual Reception Counter should face the WaitingArea and the receptionist should be able to see all incoming and outgoing patients.

19.7.13 Outdoor Play Area will be accessible for all children accompanying clients and rehabilitativeclients.



19.7.16 Materials and Supplies flow will not interfere with the patients flow. It should have separateentrance to the various units.



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INTRODUCTION



DEPARTMENTALBRIEF





164

KK4SKeperluan Perubatan

165

KEPERLUAN PERUBATAN

KLINIKKESIHATANJENIS4S



April 2001


166






E) KKJENIS4S (SABAH&SARAWAK) 150-300KEDATANGANSEHARI




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KLINIKKESIHATAN JENIS 4JADUALRUANG

1 RUANGMASUKUTAMA/PENDAFTARAN1.1 Kaunter Pertanyaan, Pendaftaran dan Pembayaran1.2 Kaunter Triage / Call Centre1.3 Ruang Menunggu Utama1.4 Ruang Legar/Pameran1.5 Ruang Penyusuan / Tukar Lampin1.6 Ruang Permainan Kanak-kanak (dalam klinik)1.7 Tandas Awam1.8 Ruang Troli / Kerusi Roda2 UNITREKODKESIHATAN2.1 Ruang menunggu2.2 Kaunter Penerimaan2.3 Ruang anggota2.4 Ruang Rekod3 UNITKESIHATANKELUARGA3.1 Ruang Menunggu3.2 Kaunter Penerimaan3.3 Bilik Pemeriksaan (CE)3.4 Bilik Rawatan3.5 Bilik Prosedur3.6 Bilik Persediaan3.7 Ruang EKG3.8 Bilik Pemeriksaan Mata3.9 Bilik USG3.10 Bilik Pendidikan Kesihatan3.11 Bilik Demonstrasi Memasak3.12 Setor Peralatan3.13 Bilik Utiliti Bersih3.14 Bilik Utiliti Kotor3.15 Tandas Awam3.16 Tandas Anggota4 UNITKESIHATANPERGIGIAN*4.1 Kaunter Penerimaan4.2 Bilik Pembedahan4.3 Bilik Tekanan Udara4.4 Bilik Persediaan/Pensterilan


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4.5 Ruang anggota4.6 Unit X-ray Pergigian (jika tiada unit X-ray am)4.7 Setor Peralatan4.8 Makmal Pergigian4.9 Setor Pergigian4.10 Utiliti Kotor5 BILIKPEMERHATIAN(SICKBAY)5.1 Kaunter penerimaan5.2 Wad Lelaki5.3 Wad Perempuan5.4 Wad Postnatal5.5 Ruang Persediaan5.6 Tandas lelaki dan wanita5.7 Tandas anggota5.8 Utiliti Kotor6 PUSATBERSALINALTERNATIF6.1 Kaunter penerimaan6.2 Bilik Bersalin6.3 Bilik Rehat6.4 Ruang persediaan6.5 Utiliti Bersih6.6 Utiliti Kotor6.7 Tandas6.8 Setor7 UNITPEMULIHAN7.1 Ruang Menunggu7.2 Kaunter Penerimaan7.3 Bilik Penilaian dan Rawatan7.4 Gimnasium7.5 Pantri7.6 Setor7.7 Tandas8 UNITPATOLOGI8.1 Ruang Menunggu8.2 Kaunter Penerimaan8.3 Ruang Mengambil Spesimen8.4 Tandas spesimen8.5 Makmal


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8.6 Ruang Anggota8.7 Setor makmal8.8 Utiliti bersih8.9 Utiliti kotor9 UNITFARMASI9.1 Ruang Menunggu9.2 Dispensari dan kaunter9.3 Ruang pembungkusan kering9.4 Ruang pembungkusan basah (internal)9.5 Ruang pembungkusan basah (racun)9.6 Ruang anggota9.7 Setor Ubat (Ruang Ubat Makan dan Racun)10 UNITPENGIMEJANDIAGNOSTIK (hanyauntukKlinik

Kesihatan yang menggantikan Jabatan/Unit Pesakit Luar hospital)10.1 Ruang Menunggu10.2 Kaunter Penerimaan10.3 Bilik X-ray (termasuk unit x-ray pergigian)8.4 Ruang Persalinan8.5 Ruang Kawalan8.6 Bilik Gelap8.7 Ruang Penelitian8.8 Bilik Pegawai8.9 Setor Filem8.10 Setor Kimia8.11 Tandas9 UNITSURVEILANSKESIHATAN9.1 Bilik Surveilans Kesihatan9.2 Bilik Sokongan Teknikal10 UNITKESIHATANALAMSEKITAR10.1 Bilik Kesihatan Alam Sekitar10.2 Ruang Rekod11 UNITKESIHATANSEKOLAH11.1 Bilik Kesihatan Sekolah12 UNITPERAWATANDIRUMAH12.1 Bilik Perawatan Di Rumah13 UNITKEBAJIKANPERUBATAN13.1 Ruang Menunggu13.2 Kaunter Penerimaan13.3 Bilik Kebajikan Perubatan13.4 Bilik Kaunselor


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13.5 Bilik Kaunseling14 UNITPENTADBIRAN14.1 Ruang Menunggu14.2 Kaunter Penerimaan14.2 Bilik Pegawai y/m14.3 Pejabat Am14.4 Bilik Penyelia/Ketua Jururawat14.5 Bilik Pembantu Perubatan Kanan14.6 Bilik Fail14.7 Bilik Mesyuarat14.8 Bilik Seminar14.9 Bilik Server14.10 Setor APD14.11 Setor peralatan14.12 Tandas Anggota15 KEMUDAHANANGGOTA15.1 Bilik Persalinan dan tandas15.2 Bilik Solat15.3 Bilik Rehat15.4 Perpusatkaan15.5 Bilik Pemandu15.6 Ruang letak kereta16 KEMUDAHANAWAM16.1 Taman Terapeutik16.2 Telefon awam16.3 Pondok menunggu kenderaan awam16.4 Ruang letak kereta16.5 Kafeteria16.6 Mesin minuman16.7 Lif17 SETORDANLAIN-LAIN17.1 Ruang letak ambulans17.2 Ruang letak kenderaan17.3 Bilik Pencuci17.4 Ruang membasuh pakaian/linen17.5 Bilik Pengumpulan Sisa Klinikal17.6 Setor Bekalan Am17.7 Setor Bekalan Bersih17.8 Setor Pukal


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17.9 Setor Pelupusan17.10 Setor Bahan Mudah Terbakar17.11 SetorBAKAS17.12 Setor Pasukan Pergigian Bergerak17.13 Kawasan Pengumpulan Sisa Domestik


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BRIEFOFREQUIREMENTSHEALTHCLINICTYPE4SABAH&SARAWAK



3. THETYPE4-SABAH&SARAWAKHEALTHCLINIC

3.1. Role Statement

The Health Clinic will provide promotive, preventive, curative and rehabilitative services for less than 300attendances per-day. Apart from the general out-patient services, the clinic will focus it�s services for thespecial target groups i.e. mothers, children (0 - 12 years old), adolescence, elderly, well adults, productivewomen, family and workers. There will be provision for treatment and resuscitation in the clinic facility.




3.1.3 Clinical support services include Pharmacy, Laboratory (Level I upgraded), Rehabilitation.







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3.1.4 Public amenities such as car parks, playground and toilets will be provided.
















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3.2.10 Home Care NursingThis function is to provide nursing care at home to facilitate healing and coping with recuperation.Services will also be provided to post-hospitalise cases, chronically and terminally ill persons.

3.2.11 Nutrition and DieteticThe nutrition clinic provides advice and counselling to the pregnant and lactating mothers, mother�s/parent�s of infants, toddlers, pre-schoolers and malnourished children. The dietetic clinic area isfor giving advice and counselling of client with clinical conditions such as diabetes, hypertension,heart disease and renal disease.


3.2.13 Rehabilitation �Occupational and PhysiotherapyThis service include both physiotherapy and occupational therapy for children with special needs(for child and parents), elderly, mentally ill patients, pregnant mothers, post-trauma patients andclients with chronic conditions such as asthma and chronic obstructive airway diseases.

3.2.14 Health Surveillance ( Selected communicable and non-com. diseases).Service provided will include defaulter tracing, active and passive case detection, contact tracing,notification and investigation of notifiable diseases


3.2.16 Clinical Support ServicesLaboratory, Pharmacy, Medical Social service and Counselling.




The Health Clinic will operate from Monday to Friday (Saturday to Thursday) between 8.00 am - 4.30 pmand on Saturday/Thursday from 8.00 am - 12.30 pm.

It will also operate after office hours for emergency calls.




�Call center� will be established to entertain consultation by phone. Trained allied health personnel will manthis �center�.


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4 GENERALHEALTHCLINICPOLICIES



a) Services stated in paragraph 3.2.1 to 3.2.15 will be provided through an integrated clinicsystem or open system. They do not function as isolated clinics or session except occasionallywhen there is pre-selected group to be serviced.

b) Services will be provided to walk-in clients. Phone-in will be entertained through call-center bythe triaging staff.

c) Multifunctional medical personnel shall carry out these services.d) Family Medicine Specialist role is to manage referred cases from the medical officers at the

clinic and from ancillary clinics.


The scope of service includes promotive, preventive and curative and rehabilitative, which will betargeted to specific groups i.e.:

- Pre-school children- Primary school children- Secondary school children- Pregnant mothers- Children with special need- Adult- Elderly





The scope is to provide nursing care in the home to facilitate healing and coping with recuperation.The target groups are:

- The elderly who needs nursing and other care- The disabled- Post-trauma patient- Post-surgery patient- Post-natal cases- Terminal cases requiring palliation




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This service will be carried out in CE room and shall cater for work related illnesses/diseases andrisk assessment of the working population where full documentation and investigations can bedone. Visit to the workplace and environmental studies will be done if necessary. Necessaryprocedures will be done in respective room e.g vision tests, fitness test and laboratory tests



4.2. Workflow



4.2.1.1 Client


Fornewwalk-in cases, theywill be screened at theScreening (Triaging)Counter (besidesthe registration/collection counter) by a trained paramedic to determine the appropriateprovider in the clinic e.g. doctor, paramedic, laboratory or other rooms/units by putting asticker and queue-number on their record. Certain parameters e.g. weight, height andblood pressure may be taken at this counter.

Clients will then wait in the sub-waiting area in front of the respective rooms or units untilthey are called for consultation or other purposes. All client will be called for consultationor other services by using digital call system.




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All clientswill register at the (common)Registration/Collection counter before proceedingto the sub-wait of the Dental Clinic. Upon calling they will enter the Dental Operatingroom for consultation and examination.



Upon arrival, client will go directly to theRegistration/ Collection counter for registration.Client will be directed to Main waiting area before directed to the consultation room priorbeing assessed. Before returning home, client will be given appointment date at theRegistration/Collectioncounter.

4.2.1.4 NutritionandDietetic, Laboratory,Pharmacy,Workers�Health,MedicalSocial services

Client will be directed by Registration/Collection counter, screening counter or consultationrooms to the laboratory. The clients will be informed by the registration/screening counterthe designated room for examination. They will wait at the respective sub-wait prior beingcalled in for attention.

4.2.2. Staff Flow

4.2.2.1 Staff will register either electronically of manually before given access to theclinic.

4.2.2.2 Uniformed staff will change into their uniform in the clinic�s Staff Changingrooms (male and female staff). They will proceed to their place of work at theirrooms/units).

4.2.2.3 Before returning, uniformed staff will change back into their own clothes at theStaff Changing rooms.


4.2.3 Material Flow




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4.2.3.6 Waste will be kept in the sorted bags according to the type of waste by the clinical staff.These bagswill be collected at theDirtyUtility Room and sent to theWasteHoldingAreaaccording to types of bags. These wastes will then be collected company contracted todispose them.

4.3 Supplies


2 months supply of pharmaceutical products will be delivered from Integrated Store of thedesignated hospital or direct from supplier to the clinic�sDrugStore before sending to the pharmacy.




4.4 Other Services


Linen will be supplied from the laundry off site/privatised on a �top-up� and �request� basis to theGeneral Store.Where it cannot be contracted, washing and drying area will be provided.








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4.4.5 Food&Catering












4.4.8.1. IT System




The system will have the following functional coverage :a) Registrationb) Appointmentc) Triaging


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d) Queuinge) Micro cost accountingf) Clinical information systemg) Human resource management systemh) Financial management systemi) Pharmaceutical information systemj) Lab information systemk) School health servicel) Office automationm) Health Education and Informationn) Health Statistics and general informationo) Health Inspectorate and disease surveillance

4.4.83 IT System� technology


5. REGISTRATION/COLLECTION/INFORMATION,SCREENINGCOUNTERANDMAINWAITINGAREA

5.1. ROLE/FUNCTION


5.2. LOCATION


5.3. ORGANISATION




Client will enter the department via the main entrance of the clinic. Client will take a queue-numberusing their smart-card or identity card. They will wait in the Waiting Area for registration by a


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Registration/Collection Counter. Client will be identified by the Registration/Collection counter asnew or follow-up case. Retrieval of client�s record will be made through the Record Office. Thisprocess will be computerised. Destination of the record will be determined by the Registration/Collection counter i.e. screening counter, consultation room or other rooms/units based onappointments given.

For walk-in cases, without appointment, they will be screened at Screening Counter (besidesregistration/collection counter) by a registration personnel to determine where the client is supposedto go, e.g. doctor, paramedic, laboratory or other rooms/units by putting a sticker and queue-number on their record. Certain parameters e.g. weight, height and blood pressure may be takenat this counter.





c) Once clinic session ends, the �hard-copy� records will be sent back to the record office whileelectronic record will be stored in the computer.

5.5. COMPONENTSOFREGISTRATION/COLLECTION/INFORMATIONCOUNTER,MAINWAITINGAREAANDSPACEREQUIREMENTS

5.5.1. Entrance






5.5.4 Screening (Triaging) counter and �call-center�

New cases without appointment will be attended here after registration to identify their problemsor purpose of visit and which room/unit to go to. Main activities conducted here are history taking(main complaints only), and weight, height and blood pressure measurement. Manned byparamedics, it should be built to fit for 4 persons at one time (including clients).




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5.5.6 Waiting Area

Client and accompanying relatives will wait before and after registration/ screening before directedto consultation rooms, lab or other attending rooms. It should accommodate at least 70 clients(including accompanying persons), at any point of time. The clients include outpatients andpreventive care.








It will be located near the main entrance and rehabilitation centre for patients� use. It will be ableto accommodate 1 trolley and 2 wheel chairs.

5.5.11 Shuttle/ Pick-upWaiting Area

A waiting area near the Main Entrance will be provided for clients waiting to be transported orpicked-up.

5.5.12 Play area



It is located besides the registration counter. After collecting medication, client will pay the feesand collect education materials, appointment, referral letters etc here. It should accommodate atleast 4 clients, at any point of time.

6. CONSULTATIONANDEXAMINATION(CE)ROOMS

6.1. ROLE/FUNCTION






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6.2. LOCATION


6.3. ORGANISATION


6.3.2. Other staff includes medical officers, medical assistants, nurses, community nurses and healthattendants.




6.4.3. Clients who need specialist services will be referred to Family Medicine Specialist, OccupationalHealth specialist or other specialists at nearest hospital or clinics.

6.4.4 Clients who need admission will be referred to the nearest hospital

6.4.5. Physiotherapy services will be provided by visiting physiotherapist and occupational therapist ifstationed officers are not available.

6.4.6. Medical Social Services will be provided by medical social officer if stationed officer is not available.


6.5.1 Entrance


6.5.2 Waiting area






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Number of rooms needed is based on the norms of 50 clients/room/day. On an average the Type4 -SABAH & SARAWAK should have at least 6 rooms. These rooms are not only for doctors butalso for paramedics who attends to patients.


This room can be directly accessible to the public, either through the main or alternative entrance.This room is for injections, dressing, treatment for asthmatic patient, rehydration and resuscitation.Adequate and lasting worktops and built-in cabinets should be installed.


This room is for performing minor surgical procedures such as circumcision, incision and drainage,removal of lumps, fine needle biopsy, pap smear, IUCD and Norplant insertion, CTG examinationetc. Each cubicle can accommodate at least 4 persons at any one time. It shall have a hand-washing facility and interconnecting doors with other CE rooms.




For taking specimens for lab investigation e.g. blood and sputum. Toilets for urine and stoolspecimen are to be provided nearby. This room should be able to accommodate 4 persons.

6.5.7 ECGArea

For ECG examination. It shall be able to accommodate at least 3 persons at any one time.Couches and ECG machines will be provided. This facility can be accommodated with eyeexamination area (6.5.8) in one room.

6.5.8 EyeExaminationArea

For visual acuity test using Snellens chart and colour blindness test for general medical check-up.



6.5.9. SchoolHealthRoom



6.5.10. HomeCare Nursing Room

The room is an office and preparation room for home care nursing that accommodate facilities forwashing, storage and preparation of trays and dressing sets on returning to the office. Tabletopsterilising facilities will be provided.



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It can also be located near the office area.

6.5.11 RehabilitationRoom -Physiotherapy andOccupational Therapy

6.5.11.1. ToiletA staff toilet will be provided. 2 handicapped toilets (child & adult) will also be provided.

6.5.11.2. Assessment RoomClient referred for Physio will be assessed in this room. It will be equipped withcouch, table and chairs. This room will also be

equipped with basic facilities for cognitive and physical assessment. A table andchairs for client will also be provided. The room can accommodate 6 persons at onetime.

6.5.11.1. GymnasiumTo provide treatment for antenatal and postnatal cases and adult cases with variousneeds. Couches will be provided for treatment. This gym will accommodate varioustreatment equipment.

6.5.11.2. Paediatric Therapy RoomFor the therapy of children with special needs, e.g. cerebral palsy and DownSyndrome. This will be a larger room for assessment and treatment.


7.1. ROLE/FUNCTION


7.2. LOCATION


7.3. ORGANISATION






7.5. SPACEREQUIREMENTFORHEALTHEDUCATIONAREA

7.5.2. HealthEducationRoom

Health education and counselling will be given by health personnel in this room. Models, flipcharts and other audio-visual aids will be used for this purpose. This room will have space for amaximum of 20 persons.


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7.5.3. CookingDemonstrationArea


- Healthy kitchen- Actual cooking tools and utensils such kitchen, sink, fridge, kitchen cabinet etc- Audio-visual aids- Sitting facilities (theatre style) which can accommodate 15-20 persons at one



8. ORALHEALTHUNIT

8.1. ROLE/FUNCTION


8.2. LOCATION


8.3. ORGANISATION




8.5. SPACEREQUIREMENTFORDENTALUNIT










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8.5.5. Staff Office

An office for Dental Officer in-charge to fit in at least 3 persons at any one time to be provided.


Situated near the operatories.Walls are leaded in line with the requirements of X-rays department.X-rays will be taken by dental operators.A sink and a bench are necessary for developing the X-rays.




The dental laboratory work will be carried out in this room. It will be equipped with work benchesand cabinets for Dental Technicians.



8.5.10. DirtyUtility


9. INPATIENT / SICKBAY

9.1. ROLEFUNCTION.

The in-patient area or sick bay will provide as place of rest for patients whore kept underobservation.

9.2. LOCATION

It will be located nearest to the delivery room and easily accessible to general public.

9.3. ORGANISATION

General ward catering for male and female ward. The nurse and medical assistants attend to themanagement of female and male wards respectively.


The sick bay will operate 24 hours. Paramedics on-call will attend to patients on scheduled basis.

9.5. SPACEREQUIREMENTFOR INPATIENT

9.5.1. General ward � one each for male and female.Each ward will have 3 beds with side table and dripstand.

9.5.2. A work area with computer to be made available for staff.

9.5.3. Holding stores, clean and dirty utilities will be shared with that of the consultation rooms.


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9.5.4. Access to the ward.General ward must have 2 access one from outside and another from the main waitingarea.

Toilets are located near these wards.

10. DELIVERYROOM

10.1. ROLE/FUNCTION

The delivery room will be used in conducting all patients in labour

10.2 . LOCATION

The labour room will be located where it is accessible to the public for delivery of low risk casese.g. White tag and green tag.

10.3. ORGANISATION

10.3.1. The cases conducted will be assessed by on cal community nurse andconducted if in labour.

10.3.2. The cases that are beyond the staff scope of activities as yellow tag she will refer toMedical officer.

10.3.3. Cases that cannot be conducted in health clinic will be referred to the nearesthospital.

10.4. SPACEREQUIREMENTFORDELIVERYROOM

10.4.1. Two postnatal bed will be provided

10.4.2. A delivery room with obstetric bed can accommodate 5 staff at any one time

10.4.3. Hanging cupboards are used for storing clean sterile delivery set.

10.4.4. Emergency trolley for resuscitation is required for emergency management ofobstetric and neonatal resuscitation cases.

10.4.5. Space required for storing neonatal resuscitation and warmer

10.4.6. Single bed for patients after delivery. Attached with the room should be a toilet cumbathing area.

10.4.7. Post natal room will have 2 access one to the delivery room and the other to theoutside.


10.4.9. Holding stores, clean and dirty utilities will be shared with that of the consultationrooms.


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11.1 ROLE/FUNCTION


11.2. LOCATION

One room shall be located near the main office and can be away from the CE rooms

1.3. ORGANISATION

The health inspector performing the function may or may not be under the responsibility of the officer-in-charge of the Health Clinic. If not, he may be responsible directly to the Medical Officer of Health of theDistrict.


11.4.1. The health surveillance unit is required to monitor the various disease pattern capturedor reported in the database of the Health Clinic.

11.4.2. The scope of this function is Disease Control for Communicable and Non-CommunicableDiseases, Vector and Rodents, Occupational Health, Environmental Health and Wasteand Sanitation.

11.4.3. Function includes defaulter tracing (for chronic infectious diseases), ensure notificationof all notifiable diseases, analysis of disease database, initiating investigation, institutingintervention and report writing.


HealthSurveillanceRoom

An office shall be made available for a health inspector. It should accommodate 3 persons at any onetime.

12. LABORATORY

12.1. ROLE/FUNCTION

To provide diagnostic laboratory support services (level I upgraded) to patient

12.2. LOCATION


12.3. ORGANISATION




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12.4.1.2. Request will be made by doctors, nurses or medical assistants usingthe request form.



12.4.2. Receiving Specimens


12.4.3 Reporting

12.4.3.1. Result of the investigations will be captured automatically in the computersystem. The staff may key in some information and to endorse the validity of theresult.

12.4.3.2. End users will be able to retrieve the result from their workstation

12.5. SPACEREQUIREMENTINLABORATOR

12.5.1. Reception Area



12.5.2. Waiting Area




12.5.4. Laboratory Area


Specimens will be received here and examined immediately. Urine, stool, sputum andsimple blood tests will be carried out. Examinations of specimen will be conducted onheavy duty worktops. Results will be conveyed via electronic device on request or/andwill be put into pigeon holes at the reception counter to be collected by the respectiveclinics at regular intervals.


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12.5.5. Lab Store


12.5.6. DirtyUtility/DisposalRoom


12.5.7. Staff AreaAn area for staff to sit and perform paper work away from the lab benches.

13. PHARMACYUNIT

13.1. ROLE/FUNCTION


13.2. LOCATION


13.3. ORGANIZATION

The unit will be headed by a senior pharmacy assistant. He/she will be assisted by pharmacyassistants and general workers.





13.5. SPACEREQUIREMENTFORDISPENSARY/PHARMACYUNIT

13.5.1. Sub-wait Area

There will be separate waiting area for clients to wait during the preparation of their prescription. Spacerequired for 15 persons at any one time.

13.5.2. Dispensary Area

a) It is an open concept system for dispensing counters.


c) Dispenser working behind the counter will receive prescription, check treatmentprescribed, prepare prescription and dispense with instruction to patient. Any dobtsor problem will be clarified with the supervising Pharmacist (on-line) who in turn maycheck with the medical officer who issues the prescription.



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13.5.3. Drug Store

2 months stocks of pharmaceutical item will be held here. Supplies will be bought in by theconcession company on regular basis and upon request. Certain drugs will be kept in therefrigerator. Suggested store size is at least 200 sq ft.

a) Bulk Area

For stocking bulky packaging materials (dispensing containers - mixtures, lotions, oitments andcreams), labelling lables and stationaries. Suggested store size is 120 sq feet.

b) Inflammable Store

The store must be located away from the main building, for storing several months stock ofinflammable materials e.g. spirit, liquid paraffin. Suggested size is 100 sq ft.

11.5.4. Dry and Wet Pre-packing Areas

Pre-packing of drugs will be done here. Separate rooms will be provided for dry drugs, internal(wet) preparations and external (wet) preparations. High tap, deep aluminium basin and 3 ftskirting tiles are needed.

a) Dry (Tablet/Capsule) Pre-packing area

For pre-packing of tablet and capsules. Equipped with suction hood for each machine to suckdust.

b) Internal Pre-packing area

For reconstitutions of ready to dispense suspensions (antibiotics) and prepacking of mixtures.Certain drug will de kept in the refrigerator.

c) Extemporaneous and external Pre-packing area

Prepacking of lotions, ointments and creams will be done here.

13.5.5. DrugCounselling

Counselling on drug usage will be carried out in the health education room.


14.1. ROLE/FUNCTION

14.1.1. To connect each work station within the clinic to the main database14.1.2 To facilitate data collection, data mining and information generation through an integrated

health information system.14.1.3. To facilitate clinical decision making as well as support health management system.14.1.4. To provide realtime data on performance both on workload and on efficient use of resources14.1.5. To facilitate telecommunications and telemedicine of health providers

14.2. LOCATIONOFITROOM

14.2.1. A small room will be provided to locate servers and telecommunication facilities. It willbe air-conditioned or placed in cool area, preferable low-dust area.


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14.3. ORGANISATION

14.3.1. The IT services will be under the responsibility of the Family Medicine Specialist whowill delegate it to the most appropriate trained officers in IT managemen maintenance

14.3.2. The Record Office will be made responsible for maintenance and utilisation of data andrecords.

14.4. OPERATIONALPOLICIE

14.4.1. All identified providers an rooms will have access to computers to key data and or attendingto patients

14.4.2. It is a centralised system that collects all electronic medical records on real time. Allclients EMR will be kept in the database.

14.4.3. Policy on access to individual client�s data will be adopted from the new �National TelehalthPolicy� that will be developed soon

14.4.4. Statistic for HMIS or QA is generated automatically from the computer system. Aggregatedrecords are accessible to the district health office and state health office.

14.4.5. All providers will be authorised to given level of access to �identified� groups of data andnot all data and information. FMS will be responsible to ensure security of data andaccess.

14.4.6. Data and information will not be issued to any unauthorised persons or outsiders. Nocommercialisation f data is allowed

14.4.7. Only qualified health professional can undertake and deliver telemedicine assisted healthcare

14.4.8 Clients will be made accessible to health information and education. A persons will be madein charge to answer any queries if any by clients. The state or district health office mustpreapprove the contents before putting on the web page


14.410 Data and information may be used to facilitate research by authorised personnel.



15. MEDICALRECORDUNIT (Size and space depends on level of computeristaion)

15.1 ROLE/FUNCTION

15.1.1. To collect, store and retrieve clients� records.15.1.2. To enter diagnosis (ICD) made by doctors.15.1.3. To analyse statistics and present them to the management for decision making and planning.15.1.4. To co-ordinate the preparation of medical reports, quality assurance reports and issuing

returns to District Health Office.

15.2 LOCATION



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15.3 ORGANISATION








f) Records will not be issued to any unauthorised persons or outsiders. For accountability, staff hasto sign to prove that he/she is receiving/ handing the records.


15.5 SPACEREQUIREMENTFORMEDICALRECORDUNIT

15.5.1 Reception andWaiting area


15.5.2. Counter (open concept)


15.5.3 Record Officer Area

Open Concept Office for administration work

15.5.4. Main file room with record compacts for storage of medical records and x-ray films. Exhaustfan is necessary for the file room.


16.1 ROLE/FUNCTION


16.2 LOCATION



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16.3 ORGANISATION


16.3.2 For day to day operation, he/she will be assisted by senior clerks, clerks and sister-in-charge






16.4.3 Seminar cumMeeting Room

A meeting room will be provided to accommodate a minimum of 30 persons.

16.4.4. Visitors Area


17. STORES



17.2 DRUGSTORE


17.3 CLEANERSROOMS



In view of contracting-out of this service, only a central linen holding area will be provided for the wholehealth clinic, as part or separated from the general store.


Areas for holding of waste will be provided and this will be manned by the concession company.


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Male and female staff changing rooms will be provided to cater the whole health clinic staff. It shouldhave lockers for the staff to keep their personsal items.

18.2 STAFFTOILETS


16.3 SOLATROOM


16.4 LIBRARY


16.5 STAFFREST








19. PUBLICAMENITIES






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19.3 PARKINGSPACES


19.4 ELEVATORS


19.5 FOOD

Vending machines to be provided.



20. PLANNINGCONCEPT

20.1. In all clinics, the availability of services could be on flexible basis, to be in-step with need, populationgrowth etc.



20.4 Land space being of premium in major focus, the facility should have the flexibility to be multi-storeyed.Lifts* should be provided if they are multi-storeyed.








20.8.4 The Treatment and Procedure rooms shall be best positioned between the Clean and DirtyUtility Rooms with free access for staff. This measure will also to ensure a clear flow of cleanand soiled items.


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20.8.7 TheWaiting Area of the Pharmacy will be clearly segregated from the MainWaiting Area andwaiting area of the CE rooms.


20.8.9 Rehabilitative area will be located close to an entrance for easy access of handicapped anddisabled patients with wheelchairs and also for family to unload patient from their vehicle.

20.8.10 The Dental Clinic Area as well as Rehabilitation Area will be separated from the CE roomswith its regular flow of patients. The individual Reception Counter should face the WaitingArea and the receptionist should be able to see all incoming and outgoing patients.







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APPENDIX I



INTRODUCTION



DEPARTMENTALBRIEF





200

KK5Kperluan Perubatan

201

KEPERLUAN PERUBATAN

KLINIKKESIHATANJENIS5

UNTUK

RANCANGANMALAYSIAKE-8


DISEMBER2001


202




C) KK JENIS 3 300 - 500KEDATANGANSEHARI


E) KK JENIS 4S (SABAH & SARAWAK) 150-300KEDATANGANSEHARI

F) KKJENIS5 <150KEDATANGANSEHARI

G) KK JENIS 6 (SABAH & SARAWAK) < 50KEDATANGANSEHARI


203


1.1 Kaunter Pendaftaran/Pertanyaan/Pembayaran


1.3 Ruang Legar/Pameran


1.5 Bilik Rekod Kesihatan

1.6 Ruang permainan kanak-kanak


2.1 Bilik Pemeriksaan (CE) - 4

2.2 Bilik Rawatan dan Prosedur

KLINIKKESIHATAN JENIS 5(UNTUKSARAWAKDANSABAH)

JADUALRUANG


2.4 Ruang EKG dan Pemeriksaan Mata

2.5 Bilik Pendidikan Kesihatan dan Demonstrasi Memasak

2.6 Bilik Pemulihan dan Setor


28 Bilik Utiliti Kotor

2.9 Tandas Awam

3 MAKMALKLINIKAL

3.1 Ruang Menunggu

3.2 Ruang Mengambil Spesimen

3.3 Makmal3.4 Setor makmal

4 MINI-FARMASI

4.1 Ruang Menunggu

4.2 Dispensari dan kaunter

4.3 Ruang pembungkusan

4.4 Ruang anggota

4.5 Setor Ubat

5 UNITBERSALINALTERNATIF

5.1 Bilik Bersalin

5.2 Bilik Postnatal

5.3 Ruang Persediaan/Pensterilan

6 WADPEMERHATIAN

6.1 Wad Pemerhatian Lelaki

6.2 Wad Pemerhatian Perempuan


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7 UNITKESIHATANALAMSEKITAR

7.1 Bilik Kesihatan Alam Sekitar

7.2 Ruang Rekod

8 UNIT KESIHATAN SEKOLAH (pilihan � mengikut keperluan setempat)

8.1 Bilik Kesihatan Sekolah

9 UNITKESIHATANLUARBANDAR/PERAWATANDIRUMAH

9.1 Bilik Kesihatan Luar Bandar dan Perawatan Di Rumah

10 UNITPENTADBIRAN


10.2 Bilik Mesyuarat

10.3 Bilik server

11 KEMUDAHANANGGOTA

11.1 Bilik Persalinan (L/P) dan tandas

11.2 Bilik Pelbagaiguna (Solat dan Meditasi)

11.3 Bilik Rehat

12 KEMUDAHANAWAM12.1 Taman Terapeutik12.2 Pondok menunggu kenderaan awam12.3 Tempat letak kereta12.4 Balai pelawat

13 SETORDANLAIN-LAIN13.1 Ruang letak ambulans13.2 Ruang letak kenderaan dan bot13.3 Bilik Pencuci / Ruang membasuh pakaian/linen13.4 Setor Bekalan Am13.5 Setor Bekalan Bersih


13.7 Unit Generator

13.8 Unit Rawatan Air

14 KOMPLEKSKUARTERS14.1 Kuarters

14.2 Taman Permainan Kanak-kanak14.3 Gelanggang Permainan


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BRIEF OF REQUIREMENTSHEALTH CLINIC TYPE 5 SABAH & SARAWAK



3. THETYPE5HEALTHCLINIC- (SABAH&SARAWAK)

3.1. Role Statement

These clinics were upgraded version of �Klinik Desa� run by one or two Medical Assistants, Staff Nurses,Community Nurses and Health Overseers. It shall now be called Klinik Kesihatan Type 5 -Sabah andSarawak, with information Technology requirements spelt out.

These clinics are generally located away from the town, and some can be assessed through river orlogging road. Traditionally, they provide maternal and child care, out-patient care, low-risk delivery andenvironmental health. Clinical laboratory and mini-pharmacy were also present. They usually haveobservation �ward� with cooking facility for the accompanying family member. Patient may be kept forobservation before being transferred to the nearest hospital or while waiting for �high-tide�. The clinic wasalso being the referral centre for Wakil Kesihatan Kampung / Primary Health Care Volunteers scheme andVillage Health Team activities.

Physically, they are raised-wooden building with a common waiting area, and functional rooms. Theground level may be used for social purpose by the staff and community. There are also adequate quarters,separated from the clinic building. Most of these clinics do not have public water and electricity supply. Theyuse petrol-fuelled machine to generate electricity and get clean water supply from Community WaterScheme provided by the Ministry of Health and the community.

The �upgraded� Health Clinic will provide promotive, preventive, curative and rehabilitative services for lessthan 150 attendances per-day. Apart from the general out-patient services, the clinic will focus it�s servicesfor the special target groups i.e. mothers, children (0 - 12 years old), adolescence, elderly, adults, productivewomen, family and workers. There will be provision for treatment and resuscitation in the clinic facility.


3.1.1 Promotive, Preventive, Curative and Rehabilitative services through Family Health Programmewhich covers Outpatient services, Maternal and Child Health, Family Planning and to some extendAdolescent Health, Geriatric Health, Mental Health, Care for the Children With Special Need,Workers� Health and Well Adult clinic.


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3.1.2 Clinical support services include mini-Pharmacy and Clinical Laboratory.

3.1.3 Non-medical support services including ambulance, transport, engineering, linen, waste holdingand cleaning services will be provided. Adequate safe water and power supply will be ensured.

3.1.4 Staff support services such as prayer/meditation room, staff change and rest room will also beprovided.

3.1.5 Telecommunication facilities will use the best system available.



3.1.8 Public amenities such as Balai Pelawat, playground and toilets will be provided.




3.2.1 Maternal andChildHealtha) Maternal health care which include antenatal, intra-partum and postnatal care, health

education to mothers, support for breast feeding and lactation management.



3.2.3 Village Health ServiceAn outreach service by a team of paramedics at the community centres located more than 10 kmfrom the clinic on monthly basis. They will provide outpatient care, maternal and child health care,nutrition and disease control activities. Preparation for the visits is done in the clinic.

3.2.4 FamilyPlanningThis service includes counselling, examination and supply of contraceptive pills and injectables,condoms and urine pregnancy test.

3.2.5 Well Adult (Well Men andWell Women health appraisal)Well Adult service will provide risk assessment, early detection and health education activitiessuch as detection of breast and cervical cancer, quit-smoking counselling and menopausecounselling. Risk assessment activities will include cardiovascular assessment, examination ofblood pressure and BMI, laboratory investigation for blood and urine as well as ECG*.

3.2.6 AdolescenceHealthThis service will be provided to school children and other adolescent (7 to 18 years) for healtheducation and counselling, general physical examination as well as management of diseaseand health condition.


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3.2.10 NutritionThe nutrition clinic provides advice and counselling to the pregnant and lactating mothers, mother�s/parent�s of infants, toddlers, pre-schoolers and malnourished children.


3.2.1 Clinical Support ServicesClinical laboratory, mini-Pharmacy and Rehabilitation.




The Health Clinic will operate from Monday to Friday between 8.00 am - 4.30 pm and on Saturday from 8.00am - 12.30 pm.


Overall management will be by the Medical Assistant or the most senior nurse in the clinic. This officer willreport to the local Medical Officer of Health.




4.1.1 FamilyHealth Services

a) Services stated in paragraph 3.2.1 to 3.2.15 will be provided through an integrated clinic system.They do not function as isolated clinics or session except occasionally when there is pre-selectedgroup to be serviced.

b) Services will be provided to walk-in clients. Multifunctional medical personnel shall carry out theseservices.

c) Referrals will be made to the nearest clinic with medical officers or hospitals.


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4.1.2 Nutrition

These activities will be provided to mothers, children and client with special nutritional needs, e.g.diabetic and hypertensive client, and obesity. It includes diet counselling, health education andcooking demonstration.

4.1.3 Village Health Team

A team of paramedic based in the clinic provide outreach services in outpatient care, maternal andchild health care, nutrition and disease control activities.


The scope is to provide nursing care in the home to facilitate healing and coping with recuperation.The target groups are:The elderly who needs nursing and other care

- The disabled- Post-natal cases

4.1.4. Delivery andPost-NatalDeliveries will be conducted by community nurse or public health nurse, for cases with low risks.They will be kept in the post-natal ward after delivery and will be discharged once stabilised.

4.1.5. Sick baysSick bays are for patients who require observations. They will be kept for not more than 2 days.

4.2. Workflow



4.2.1.1 Client

Client will take a queue-number using their smart-card or identity card. They will wait inthe Waiting Area for registration by a Registration/Collection Counter. Client will beidentified by the Registration/Collection counter as new or follow-up case. Retrieval ofclient�s record will be made through theRecord Room. This process will be computerisedlater. Fees will be collected here. Client will then be directed to the consultation room orindicated otherwise by referring staff.

Clients will then wait in the Waiting area until they are called for consultation or otherpurposes. All client will be called for consultation or other services by using digital callsystem*.

Following examination and consultation by medical officers/paramedical staff, clientmay undergo treatment in the Procedure or Treatment Room. Theymay be further referredfor examination, investigation or treatment e.g. laboratory and rehabilitation. Client mayalso be referred to other clinics or admitted to the nearest hospital. Appointment andhealth education material will be collected from the consulting doctor/paramedics beforeleaving the room.

After completion of examination, investigation, consultation and treatment, client will besent to the mini-pharmacy for the collection of drugs.

For the disabled, they will wait with accompanying relatives at the common waiting areawhile the collection of drugs by their relatives.


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4.2.2. Staff Flow

4.2.2.1 Staff will register either electronically or manually before given access to the clinic.

4.2.2.2 Uniformed staff will change into their uniform in the clinic�s Staff Changing rooms*(maleand female staff). They will proceed to their place of work at their rooms/units.



4.2.3 Material Flow

4.2.3.1 Sterile items: Bulk sterile items will be collected from the CSSD of the hospital and bebrought and stored at the General Store. Distribution to the rooms/units be made onrequest.

4.2.3.2 Sterilised items: Sterilised items will be bought and kept in the dedicated cupboard in theGeneral Store.





4.3 Supplies

4.3.1 Medical andNon-medical (contracted-out)

2 months supply of pharmaceutical products will be delivered from Integrated Store of thedesignated hospital or direct from supplier to the clinic�sDrugStore before sending to the pharmacy.





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4.4. Other Services


Linen will be supplied from the laundry off site/privatised on a �top-up� and �request� basis to theGeneral Store.Where it cannot be contracted, washing and drying area will be provided.


General cleaning services of the clinic will be privatised. The cleaning services will include all thevarious cleaning methods for the rooms/units, corridors, toilets, public areas, landscape, officeetc.








4.4.7 InformationandCommunicationTechnology (ICT

ICT concept that is being proposed for Health Clinic is part of a network infrastructure that connectsHealth Offices and Health Clinics as well as Community Clinics.

The administrative Health Office will be the base or hub which will provide ICT service to healthclinics that are connected to it. These clinics will be connected with ISDN/leased lines (or anyother appropriate system) to the health office. The use of �web-base� system is also beingexplored, to look for the most cost-effective network. Users of the workstations will be connectedto the database at the �hub�.



4.4.7.1 IT System



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Supporting human resource, pharmaceutical and laboratory will be developed tofacilitate integrated information utilisation for clinical decision making as well as inhealth system management.

4.4.7.2 IT System � coverage

The system will have the following functional coverage :a) Registrationb) Appointmentc) Queuingd) Micro-cost accountinge) Clinical information systemf) Human resource management systemg) Pharmaceuticalh) Laboratoryi) School health servicej) Office automationk) Health Education and Informationl) Health Statisticsm) Disease surveillance and environmental health

5. REGISTRATION/COLLECTION/INFORMATION,SCREENINGCOUNTERANDMAINWAITINGAREA

5.1. ROLE/FUNCTION

5.1.1. Reception of inquiry5.1.2. Registration of clients.5.1.3. Tracing of records (linkage to record room)5.1.4. Screening of walk-in client5.1.5. Collection of fees5.1.6. Attending telephone calls5.1.7. Waiting space for clients

5.2. LOCATION


5.3. ORGANISATION




Client will enter the department via the main entrance of the clinic. Client will take a queue-numberusing their smart-card or identity card. They will wait in the Waiting Area for registration by aRegistration/Collection Counter. Client will be identified by the Registration/Collection counter asnew or follow-up case. Retrieval of client�s record will be made through the Record Room. Thisprocess will be computerised. Destination of the record will be determined by the Registration/


212

Collection counter i.e. screening counter, consultation room or other rooms/units based onappointments given.

For walk-in cases, without appointment, the staff in the information counter will screen to determinewhere the client is supposed to go, e.g. Medical Assistant, Nurse, laboratory or other rooms/unitsby putting a sticker and queue-number on their record. Certain parameters e.g. weight, height andblood pressure may be taken at this counter.




b) For the clients who have an appointment, medical records will be retrieved electronically.Some �hard-copy� record e.g. x-ray film, old medical record, will be retrieved manuallyfrom the record room.

c) Once clinic session ends, the �hard-copy� records will be sent back to the record roomwhileelectronic record will be stored in the computer.

5.5. COMPONENTSOFREGISTRATION/COLLECTION/INFORMATIONCOUNTER,MAINWAITINGAREAANDSPACEREQUIREMENTS

5.5.1. Entrance


5.5.2. Registration counter / Information counter / Collection counter

Clients will be registered here. It should accommodate at least 4 clients at any one time. It shouldbe built as 2 sitting and 2 standing counters. Clients� queries and calls (telephone) will be attendedhere. The clerical personnel will attend to all queries. Collection fees will also be collected here.



5.5.6 Waiting Area

Client and accompanying relatives will wait before and after registration/ screening before directedto consultation rooms, lab or other attending rooms. It should accommodate at least 30 clients(including accompanying persons), at any point of time. The clients include outpatients andpreventive care.






213




It will be located near the main. It will be able to accommodate 1 trolley and 1 wheel chair.

5.5.11 Shuttle/ Pick-upWaiting Area

A waiting area near the Main Entrance will be provided for clients waiting to be transported orpicked-up.

5.5.12 Play area



6.1. ROLE/FUNCTION









6.2. LOCATION


6.3. ORGANISATION

6.3.1. The CE rooms staff shall be headed by the medical assistant or most senior nurse.




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6.4.3. Clients who need specialist services will be referred to Family Medicine Specialist, OccupationalHealth specialist or other specialists at nearest hospital.

6.4.4. Clients who need admission will be referred to the nearest hospital.

6.5.5. SPACEREQUIREMENTINCONSULTATIONANDEXAMINATIONROOMS

6.5.1 Entrance


6.5.2 Waiting area



Adequate number of rooms shall be provided depending on workload. Doctors and paramedicsshall see patients. A digital call system* shall be used to call patients. Each consultation roomshall be able to accommodate 4 persons and basic equipment e.g. Examination couch withdrawing screens, paramedic�s tables and chairs, x-ray illuminator.


Number of rooms needed is based on the norms of 50 clients/room/day. On an average the Type5 -SABAH & SARAWAK should have at least 3 rooms. These rooms are for paramedics whoattends to patients, and for the visiting doctor.


This room can be directly accessible to the public, either through the main or alternative entrance.This room is for injections, dressing, treatment for asthmatic patient, rehydration and resuscitation.Adequate and lasting worktops and built-in cabinets should be installed. It should also cater forperforming minor surgical procedures such as circumcision, incision and drainage, removal oflumps, fine needle biopsy, pap smear, IUCD and Norplant insertion, CTG examination etc* (forvisiting doctor). This room shall accommodate two cubicles, each cubicle can accommodate atleast 4 persons at any one time. It shall have a hand-washing facility and interconnecting doorswith CE rooms.



6.5.6 ECGandEyeExaminationArea

For ECG and eye examination. It shall be able to accommodate at least 2 persons at any one time.Couches, ECG machine and Snellens Chart will be provided.




215

6.5.8 School HealthRoom* (if required)



6.5.9 VillageHealth TeamandHomeCareNursingRoom

The room is an office and preparation room for Village Health Team and home care nursing thataccommodate facilities for washing, storage and preparation of trays and dressing sets on returningto the office. Tabletop sterilising facilities will be provided.

This room shall accommodate at least 6 staff with office tables and working area. It can also belocated near the office area.

7. HEALTHEDUCATION

7.1. ROLE/FUNCTION


7.2. LOCATION

A room shall be located near the CE rooms for group counselling, with facilities for cooking demonstration.

7.3. ORGANISATION







7.5.1 HealthEducation andCookingDemonstrationRoom

Health education and counselling will be given by health personnel in this room. Nutritioneducation and counselling for mothers and parents, and clients with special needs (e.g.diabetic, hypertensives and obese) will also be done here.Healthy kitchenette, show case forfood model display, flip charts and other audio-visual aids will be used for this purpose. This roomwill have space for a maximum of 20 persons.


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8. SICKBAY

8.1. ROLEFUNCTION.


8.2. LOCATION


8.3. ORGANISATION





8.5.1. General ward � one each for male and female. Each ward will have 2 beds with side tableand drip-stand.

8.5.2 Holding stores, clean and dirty utilities will be shared with that of the consultation rooms.

8.5.3. Toilets are located near these wards.

9. ALTERNATIVEBIRTHINGUNIT

9.1. ROLE/FUNCTION

The delivery room will be used in conducting all patients in labour.

9.2. LOCATION

The labour room will be located where it is accessible to the public for delivery of low risk cases i.e.white and green tag.

9.3. ORGANISATION

9.3.1. The cases conducted will be assessed by on-call community nurse and conducted if in labour.

9.3.2. The cases that are beyond the staff scope of activities as yellow tag she will refer to Medicalofficer.

9.3.3. Cases that cannot be conducted in health clinic will be referred to the nearest hospital.




9.4.3. Emergency trolley for resuscitation is required for emergency management of obstetricand neonatal resuscitation cases.


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9.4.5. 2 Single beds for patients after delivery will be made available. Attached with the roomshould be a toilet cum bathing area.



9.4.8. Sterilisation area and wash area should be made available for after delivery wash.

10. CLINICALLABORATORY

10.1. ROLE/FUNCTION

To provide clinical laboratory support to patient care.

10.2. LOCATION

It shall be located near the CE rooms; in a manner that sub-wait can be shared with other function.

10.3. ORGANISATION

The lab services will be performed by a medical laboratory technologist or a medical assistant.


10.4.1 Request For Test

10.4.1.1 The lab will receive requests for lab test from all CE rooms.

10.4.1.2 Request will be made by doctors, nurses or medical assistants using therequest form.

10.4.1.3 Client will bring the request form to the lab where it will be registered.

10.4.2 ReceivingSpecimens

Specimens will be received registered and sorted out at the reception before the test isdone.

10.4.3 Reporting

10.4.3.1 Result of the investigations will be captured automatically in the computer system. Thestaff may key in some information and to endorse the validity of the result or write it in therequest form using the standard reporting format.

10.4.3.2 End users will be able to retrieve the result from their workstation or receive the result slipsend in by the porter/client.

10.5 SPACEREQUIREMENTINLABORATORY





218





Specimens will be received here and examined immediately. Urine, stool, sputum andsimple blood tests will be carried out. Examinations of specimen will be conducted onheavy duty worktops. Results will be conveyed via electronic device on request or/and willbe put into pigeon holes at the reception counter to be collected by the respective clinicsat regular intervals.

10.5.4 Lab Store


11. MINI-PHARMACY

11.1. ROLE/FUNCTION


11.2. LOCATION


11.3. ORGANIZATION

The unit will be headed by a pharmacy assistant.


11.4.1 It will serve client seen in all the CE room.

11.4.2 Pre-packing of some drugs will be done here.

11.4.3 Out-patient counselling will be done in this unit.

11.5. SPACEREQUIREMENTFORMINI-PHARMACY


There will be separate waiting area for clients to wait during the preparation of their prescription. Spacerequired for 15 persons at any one time. This can be shared with the common Main Wait area.


a) It is an open concept system for dispensing counters.

b) Clients will be asked to go to the dispensing counter where they will each be given a number. They will becalled to receive their medicine by digital call when ready.


219

c) Dispenser will receive prescription, check treatment prescribed, prepare prescription and dispensewith instruction to patient. Any doubts or problem will be clarified with the supervising Pharmacist (on-line)who in turn may check with the medical officer who issues the prescription.

d) There should be at least 1 counter.

11.5.3 Drug Store

2 months stocks of pharmaceutical item will be held here. Supplies will be bought in by the concessioncompany on regular basis and upon request. Certain drugs will be kept in the refrigerator. Suggestedstore size is at least 4 X 4 m.


Pre-packing of drugs will be done here. Separate compartment will be provided for dry and wet drugs.High tap, deep aluminium basin and 1 m skirting tiles are needed.

11.5.5 Staff Area

An area for a staff to perform paper work will be provided away from dispensing benches.


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12. ENVIRONMENTALHEALTH

12.1 ROLE/FUNCTION

To provide health surveillance and environmental sanitation function for the health clinic�s operationalarea.

12.2 LOCATION

One room shall be located preferably near the clinical laboratory.

12.3 ORGANISATION

The health inspector may be posted here reported directly to the Medical and Health Officer in-chargeof the Health Clinic or Medical Officer of Health of the District. Supporting staff are 3 PKA�s and 3 PRA�s.


12.4.1. The health surveillance unit is required to monitor the various disease pattern captured orreported in the database of the Health Clinic and/or monitor the sanitation of the community.

12.4.2. The scope of this function are Disease Control for Communicable and Non-CommunicableDiseases, Vector and Rodents Control and Occupational Health and/or EnvironmentalSanitation and Pollution Control and Community Water Supply.

12.4.3. Function includes defaulter tracing (for chronic infectious diseases), ensure notification of allnotifiable diseases, initiating investigation, instituting intervention and control measures,food and water sampling, plan, built and monitor safe community water supply and hygienicwaste disposal, update and analysis of disease database and community and environmentdatabase, health promotion in the community and report writing.

12.4.4. Required laboratory tests, e,g, BFMP, microfilaria and sputum AFB will be done in the ClinicalLab.



An office shall be made available for a health inspector and supportive staff. It is used for officework, keep/displays sanitation and disease surveillance info, discussion/meeting with clients/staff and preparation of education material.

13 INFORMATIONTECHNOLOGY

13.1 ROLE/FUNCTION




13.2.1 A small room will be provided to locate servers and telecommunication facilities. It willbeair conditioned or placed in cool area, preferable low-dust area.


221

13.3 ORGANISATION

13.3.1 The IT services will be under the responsibility of the Medical Officer of Health who willdelegate it to the most appropriate trained officers in IT management and maintenance.



13.4.1 All identified providers an rooms will have access to computers to key data and or attendingto patients.





13.4.6 Data and information will not be issued to any unauthorised persons or outsiders. Nocommercialisation f data is allowed.


Clients will be made accessible to health information and education. A persons will be madein charge to answer any queries if any by clients. The state or district health office mustpreapprove the contents before putting on the web page.




A room to fit in servers, telecommunications facilities and a table top for working area for 2 persons atany one time.

The clinic needs a minimum of two telecommuncation ports.

All clnical and office rooms and space need to be ready with ICT and network infrastructure.


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14. STORES


For storage of equipment, domestic goods and stationary as well as linen for the whole HealthClinic. A Sterile Holding area can be partitioned in the same store. Appropriate compartments to bemade available in the store.

14.2 DRUGSTOREA drug store will be made available near the dispensaries. There should be adequate shlves forstorage of drugs.

14.3 CLEANERSROOMS

This room will provide sufficient space for the storage of cleaning materials and equipment. It willbe placed at strategic location eg. each level of the multi-storey building. A washing machine will belocated here to wash linen and cloths.

A drying area shall be available nearby.


In view of contracting-out of this service, only a central linen holding area will be provided for thewhole health clinic, as part or separated from the general store.



14.6 GENERATORUNIT

A set of generator will be placed here to generate electricity for the use of the clinic and quarters.

14.7 WATERTREATMENTUNIT

A mini-water treatment plant to process raw water for the use of the clinic and quarters.


15.1 ROLE/FUNCTION

15.1.1 Overall management of the clinics.15.1.2 Human resource management.15.1.3 Management of finance including revenue collection.15.1.4 Management and control of stocks.15.1.4 Co-ordinate the training programme for the staff.

15.2 LOCATION

The administration office may be located away from the CE areas but easily accessible.

15.3 ORGANISATION

15.3.1 The officers-in-charge (Medical Officer of Health or Senior Medical Assistant) will be theoverall manager of the clinic.


223

15.3.2 For day to day operation, he/she will be assisted by nurse-in-charge and medicalassistant-in-charge.








Male and female staff changing rooms will be provided to cater the whole health clinic staff. Itshould have lockers for the staff to keep their personal items.

16.2 STAFFTOILETS


16.3 SOLAT/MEDITATIONROOM

Prayer rooms will be provided centrally for male and female staffs and client of the health clinic.Each room shall accommodate 5 staff/client. It should be located near the staff toilet.

16.4 LIBRARY


16.5 STAFFREST



Each working stationed staff will be provided with computer workstation. Computers should belocated that will allow good interactions between staff and clients.




Covered parking spaces will be provided for the clinic ambulance. Space for other clinic vehicles (4Wheel-Drive and boat) will be provided.


224

17. PUBLICAMENITIES


A fenced play area shall be located just outside the clinic waiting areas. An entrance will provided fromthe waiting area to the playground.

17.2 PARKINGSPACES


17.3 FOOD

Vending machines to be provided.

17.4 BALAIPELAWAT

This facility is for accompanying family members who lived far from the clinic, or having transportproblem. A living room, a bedroom (which can accommodate two beds) and a kitchenette willbe provided.

17.5 MULTIPURPOSECOURT

This court can be used for volleyball, takraw or badminton. It can also served as a helicopter pad whennecessary.

18. PLANNINGCONCEPT







18.7 The registration area will be easily visible and accessible from the entrance. Accessibility to waitingareas too should be easy. Receptionists shall be able to see waiting clients and should have maximumview of the entrance to consultation/examination rooms. Waiting areas of the individual consultationexamination rooms will be easily accessible for the patients.




225


18.7.4 The Treatment and Procedure rooms shall be best positioned between the Clean and DirtyUtility Rooms with free access for staff. This measure will also to ensure a clear flow of cleanand soiled items.



18.7.7 TheWaiting Area of the Pharmacywill be clearly segregated from the MainWaiting Area andwaiting area of the CE rooms.


18.5.2 The Sick Bay and Delivery room must have easy access to clients. It should have toiletsand area for staff located nearby.

18.5.3 Outdoor Play Area will be accessible for all children accompanying clients and rehabilitativclients.






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APPENDIX I



INTRODUCTION



DEPARTMENTALBRIEF





227

KEPERLUAN PERUBATAN

KLINIKKESIHATANJENIS6(SABAH&SARAWAK)

(dahulu digelar Klinik Desa dengan Pembantu Perubatan)

BAGI

RANCANGANMALAYSIAKE-8


Disember 2000


228








G) KKJENIS6 (SABAH&SARAWAK) <50KEDATANGANSEHARI


229




1.3 Ruang Pameran











2.7 Tandas Awam


2.9 Setor Ubat


3.1 Bilik Bersalin

3.2 Bilik Postnatal


4 WADPEMERHATIAN



5 UNITPENTADBIRAN


5.2 Bilik Server

6 KEMUDAHANANGGOTA

6.1 Bilik Rehat dan tandas


7 KEMUDAHANAWAM



7.3 Tempat letak kereta

KLINIK KESIHATAN JENIS 6(UNTUK SABAHDAN SARAWAK)

JADUAL RUANG




1.3 Ruang Pameran











2.7 Tandas Awam


2.9 Setor Ubat


3.1 Bilik Bersalin

3.2 Bilik Postnatal


4 WADPEMERHATIAN



5 UNITPENTADBIRAN


5.2 Bilik Server

6 KEMUDAHANANGGOTA



7 KEMUDAHANAWAM







1.3 Ruang Pameran











2.7 Tandas Awam


2.9 Setor Ubat


3.1 Bilik Bersalin

3.2 Bilik Postnatal


4 WADPEMERHATIAN



5 UNITPENTADBIRAN


5.2 Bilik Server

6 KEMUDAHANANGGOTA



7 KEMUDAHANAWAM







1.3 Ruang Pameran











2.7 Tandas Awam


2.9 Setor Ubat


3.1 Bilik Bersalin

3.2 Bilik Postnatal


4 WADPEMERHATIAN



5 UNITPENTADBIRAN


5.2 Bilik Server

6 KEMUDAHANANGGOTA



7 KEMUDAHANAWAM





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7.4 Balai pelawat8 SETORDANLAIN-LAIN8.1 Ruang letak kenderaan / bot8.2 Bilik Pencuci / Ruang membasuh pakaian/linen8.3 Setor Am8.4 Setor bahan mudah terbakar8.5 Kawasan Pengumpulan Sisa Domestik8.6 Unit Generator8.7 Unit Rawatan Air9 KOMPLEKSKUARTERS9.1 Kuarters9.2 Taman Permainan Kanak-kanak9.3 Gelanggang Permainan


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BRIEF OF REQUIREMENTSHEALTH CLINIC TYPE 6 (SABAH & SARAWAK)

1. INTRODUCTION(To be elaborated by each Project)- Background about the project- Situational Analysis

- Projected Workload- NOTE : Further customisation of space if necessary must be elaborated

2. MASTERPLAN(To be elaborated by each project)- Zoning- Land Utilisation- Scope of Services

- present and future expansion- Access, Traffic Flow- Transportation- Environmental impact

3. THEKLINIKKESIHATAN TYPE6- (SABAH&SARAWAK)

3.1. Role Statement

These clinics were previously Klinik Desa run by Medical assistants and Community Nurse. It shall now becalled Klinik Kesihatan Type 6 - Sabah and Sarawak, with information Technology requirements spelt out.It will be run by not more than 5 personnel.

These clinics are located away from the town, and some can only be assessed through river or loggingroad. Traditionally, they provide maternal and child care, out-patient care and low-risk delivery. They usuallyhave observation �ward� with cooking facility for the accompanying family member. Patient may be kept forobservation before being transferred to the nearest hospital or while waiting for �high-tide�. The clinic wasalso being the referral centre for Wakil Kesihatan Kampung / Primary Health Care Volunteers scheme.

Physically, they are raised-wooden building with a common waiting area, and functional rooms. Theground level may be used for social purpose by the staff and community. There are also adequate quarters,separated from the clinic building. Most of these clinics do not have public water and electricity supply. Theyuse petrol-fuelled machine to generate electricity and get clean water supply from Community WaterScheme provided by the Ministry of Health and the community.

The Health Clinic will provide promotive, preventive, curative and rehabilitative services for less than50 attendances per-day. Apart from the general out-patient services, the clinic will focus it�s services for thespecial target groups i.e. mothers, children (0 - 12 years old), adolescence, elderly, well adults, productivewomen, family and workers. There will be provision for treatment and resuscitation in the clinic facility.


3.1.1 Promotive, Preventive, Curative and Rehabilitative services through Family Health Programmewhich covers Outpatient services, Maternal and Child Health, Family Planning and to some extendAdolescent Health, Geriatric Health, Mental Health and Well Adult clinic.

3.1.2 Clinical support services include mini-pharmacy and mini-laboratory.

3.1.3 Non-medical support services including ambulance, engineering, linen, waste holding andcleaning services will be provided.


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3.1.4 Staff and client support services such as meeting room and staff change will also be provided.



3.1.7 Public amenities such as car parks, playground and toilets will be provided.






b) Infant and Child HealthTarget groups are babies (0 to 1 years), toddlers (1 to 4 years) and pre-schoolers (5-6years). These functions will include development assessment, immunisation, growthmonitoring etc. and specific activities for children with special needs such as disabledchildren and children of poor families will be facilitated.


3.2.3 FamilyPlanningThis service includes counselling, examination and supply of pills, condoms and urine pregnancy

3.2.1 Well Adult (Well Men andWell Women health appraisal)Well Adult service will provide risk assessment, early detection and health education activitiessuch as detection of breast and cervical cancer. Risk assessment activities will include examinationof blood pressure and BMI.


3.2.3 Geriatric HealthCare of the elderly includes day care nursing, nutritional assessment, physical examination,regular health screening (similar to health screening in well adult clinic) and accident preventivecare.

3.2.4 CommunityMental HealthMental health activities will look into promotion and prevention aspect and risk assessment apartfrom curative care.

3.2.5 NutritionThe nutrition clinic provides advice and counselling to the pregnant and lactating mothers, mother�s/parent�s of infants, toddlers, pre-schoolers and malnourished children.



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3.2.7 Clinical Support ServicesLaboratory and Pharmacy. test.

3.2.8 Non-clinical Support ServicesInformation technology, ambulance, transport, biomedical and facility engineering, linen, wasteholding and cleaning services.


3.3. Operation andManagementThe Health Clinic will operate from Monday to Friday between 8.00 am - 4.30 pm and on Saturday from8.00 am - 12.30 pm.


Overall management will be by the Medical Assistant. This officer will report to the local Medical Officer ofHealth.





a) Services stated in paragraph 3.2.1 to 3.2.9 will be provided through an integrated clinic oropen system. They do not function as isolated clinics or session except occasionally whenthere is pre- selected group to be serviced.

b) Services will be provided to walk-in clients.c) Referrals will be made to the nearest clinic with medical officers or hospitals.

4.1.2. Nutrition

These activities will be provided to mothers, children and client with special nutritional needs, e.g.diabetic and hypertensive client, obesity etc. It includes diet counselling, health education andcooking demonstration.

4.1.4. Delivery andPost-NatalDeliveries will be conducted by community nurse or public health nurse. For cases with low risks.They will be kept in the post-natal ward after delivery and will be discharged once stabilised.

4.1.5. Sick BaysSick bays are for patients who require observations. They will be kept for not more than 2 days.

4.2. Workflow


Clients will enter the clinic via the main entrance. Adequate signs and direction will be madeavailable. All clients will be met at the registration counter before proceeding to the respectiverooms or units.


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4.2.1.1 Client

Client will take a queue-number using their smart-card or identity card. They will wait intheWaiting Area for registration by a Registration Counter. Client will be identified by theRegistration counter as new or follow-up case. Retrieval of client�s record will be madethrough the Record room. This process will be computerised. Registration fee may becollected here during the registration.

Clients will then wait in the waiting area until they are called for consultation. All client willbe called for consultation using digital call system*.

Following examination and consultation by paramedical staff, client may undergotreatment in the Procedure or Treatment Room. Laboratory investigation will beperformed by the Medical Assistant at the

Laboratory desk, in the Consultation room. Client may also be referred to other clinics oradmitted to the nearest hospital.

After completion of examination, investigation, consultation and treatment, client willcollect the prescribed drugs from the mini-pharmacy desk in the Consultation room.Appointment for the next visit will be done by the consulting staff.

4.2.2. Staff Flow


4.2.2.2 Staff shall also register before leaving the clinic.

4.2.3 Material Flow

4.2.3.1 Sterile and sterilised items: Bulk sterile items will be collected from the CSSD of thehospital and be brought and stored at the dedicated cupboard in the Store.

4.2.3.3 Non-Medical Item: Domestic, general and stationary goods will be brought from theIntegrated Store of the hospital or direct purchase from the vendor to the Store of theclinic. Linen will be drawn from the off site laundry and stored in linen cupboards of theGeneral Store prior to distribution.

4.2.3.4 Pharmaceuticals: Pharmaceutical items will also be brought to the Drug Store. Drugsthat require pre-packing or preparation will be made and stored in the Drug Store.Poison drugs will be kept in poison cabinets.


4.2.3.6 Waste will be kept in the sorted bags according to the type of waste by the clinical staff.These bagswill be collected at theDirtyUtility Room and sent to theWasteHoldingAreaaccording to types of bags. These wastes will then be collected company contracted todispose them.

4.2 Supplies


2 months supply of pharmaceutical products will be delivered from Integrated Store of thedesignated hospital or direct from supplier to the clinic�s Drug Store.

Other supplies such as stationary will be delivered from the Integrated Store or supplier on arequisition basis to the Store.


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Sterile packs will be taken from the Store to the rooms on �top-up� basis. Regular supply ofsterilised items to the clinic will be from the contracted company.

4.4. Other Services


Linen will be supplied from the laundry off site/privatised on a �top-up� basis to the Store. Whereit cannot be contracted, washing and drying areawill be provided.


General cleaning services of the clinic will be privatised. The cleaning services will include all thevarious cleaning methods for the rooms, corridors, toilets, public areas, landscape, office, meetingrooms, balai pelawat etc.



4.4.3 Disposal and Waste Services (contracted-out)Dirty Utility Room for waste holding will be provided before sending waste to the Waste HoldingArea for collection by the company contracted for the waste disposal.






The administrative Health Office will be the base or hub which will provide IT service to healthclinics that are connected to it. These clinics will be connected with ISDN/leased lines to the healthoffice. The use of �web-base� system is also being explored, to look for the most cost-effectivenetwork. Users of the workstations will be connected to the database at the �hub�.




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4.4.5.1 IT System



4.4.5.2 IT System � coverage

The system will have the following functional coverage :a) Registrationb) Appointmentc) Queuingd) Micro cost accountinge) Clinical information systemf) Human resource management systemg) Office automationh) Health Education and Informationi) Health Statistics and general information

4.4.5.3 IT System� technology


5. REGISTRATIONCOUNTERANDMAINWAITINGAREA

5.1. ROLE/FUNCTION

5.1.1. Reception of inquiry5.1.2. Registration of clients5.1.3. Tracing of records (Linkage to record office)5.1.4. Collection of fees5.1.5. Attending telephone calls5.1.6. Waiting space for clients

5.2. LOCATION

The reception area will be accessible through the main entrance. The counter should be designed andlocated so that the staff can easily oversee client entering the clinic and oversee the main waiting area.

5.3. ORGANISATION

Registration will be conducted by the health attendant.


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5.4.1. Client Circulation

Client will enter the department via the main entrance of the clinic. Client will take a queu-umber

using their smart-card or identity card. They will wait in the Waiting Area for registrationby a Registration Counter. Client will be identified by the Registration counter as new or followup case. Retrieval of client�s record will be made through the Record room. This process willbe computerised.

Clients will then wait in the waiting area until they are called for consultation or other purposes.


a) Clients are registered at the reception counter. The whole process of registration will becomputerised.

b) For the clients who have an appointment, medical records will be retrieved electronically.Some �hard-copy� record e.g. x-ray film, old medical record, will be retrieved manually from therecord room.

c) Once clinic session ends, the �hard-copy� records will be sent back to the record room whileelectronic record will be stored in the computer.

5.5. COMPONENTSOFREGISTRATIONCOUNTER,MAINWAITINGAREAANDSPACEREQUIREMENTS

5.5.1. Entrance

The main entrance shall be easily accessible to client and staff. It should be comfortable toallow 2 clients in and out at any one time.

5.5.2. Registration counter / Information counter

Clients will be registered here. It should accommodate at least 2 clients at any one time. Itshould be built as 1 sitting and 1 standing counters. Clients� queries and calls (telephone)will be attended at the information counter. The health attendant will attend to all queries.



5.5.6 Waiting Area

Client and accompanying relatives will wait before and after registration before directed toconsultation room. It should accommodate at least 20 clients (including accompanying persons),at any point of time. The clients include outpatients and preventive care.

5.5.7 ExhibitionArea



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Adequate Male and Female client�s toilets will be accessible from the waiting area. 1 toilets for thedisabled will also be provided (designed for adult and child).


A area will be provided for mothers to breast-feed their babies. A worktop with washing facilitiesis required for nappy changing. This facility should be accessible from the waiting areas and nearto public toilets.


It will be located near the main. It will be able to accommodate 1 trolley and 1 wheel chair.

5.5.12 Play area



6.1. ROLE/FUNCTION



6.1.3. The services include out-patient curative care, maternal and child health care, well adult clinic,geriatric care, family planning, adolescent health and community mental health.

6.1.4. All clients will be seen and managed by the paramedical staff.

6.1.5. Clients who need further treatment will be referred to the doctor, Family Medicine Specialist orother specialists at the nearby clinic or hospital.




6.2. LOCATION

It shall be located at the same floor of the main entrance, easily accessible from the registration collectionarea. Interconnecting doors or staff corridor must connect these CE rooms.

6.3. ORGANISATION

6.3.1. The CE rooms staff shall be headed by the medical assistant.




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6.4.3. Clients who need specialist services will be referred to Family Medicine Specialist, OccupationalHealth specialist or other specialists at nearest clinic/hospital.


6.5.1 Entrance


6.5.2 Waiting area

After registration and screening, clients will wait at the Main Waiting area as mentioned before,before being called for consultation.


Adequate number of rooms shall be provided depending on workload. Paramedics shall seepatients. A digital call system* shall be used to call patients. Each consultation room shall be ableto accommodate 4 persons and basic equipment e.g. examination couch with drawing screens,paramedic�s tables and chairs, x-ray illuminator. Eye and hearing examination ill also be donehere.

Each rooms will equipped with laboratory and drug benches. The labs will be able to do simpletests e.g. urine examination, Hb, ESR, UPT and dry chemistry. Some staining for BFMP and AFBcan also performed here.

The drug bench is for supplying drug to the patients.


Number of rooms needed is based on the norms of 50 clients/room/day. On an average the Type6-SABAH & SARAWAK should have at least 3 rooms. These rooms are for paramedics whoattends to patients, and for the visiting doctor.


This room can be directly accessible to the public, either through the main or alternative entrance.This room is for injections, dressing, treatment for asthmatic patient, rehydration and resuscitation.Adequate and lasting worktops and built-in cabinets should be installed. It should alos cater forperforming minor surgical procedures such as circumcision, incision and drainage etc. It shallhave a hand-washing facility and interconnecting doors with other CE rooms.





6.5.9 Drug Store

2 months stocks of pharmaceutical item will be held here. Supplies will be bought in by theconcession company on regular basis and upon request. Certain drugs will be kept in therefrigerator. Suggested store size is at least 4 X 4 m.


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Pre-packing of drugs will be done here. It will be located in the drug store. Pre-packed drugs willbe stored in the drug-bench of the consultation room. Pre-packing will be done by the HealthAttendant under the supervision of the Medical Assistant. High tap, deep aluminium basin and 3'skirting tiles are needed.

7. HEALTHEDUCATION

7.1. ROLE/FUNCTION

To provide health education in the form of individual/group teaching and demonstration.

7.2. LOCATION

A room shall be located near the CE rooms for group counselling, with facilities for cooking demonstration.

7.3. ORGANISATION







7.5.2. HealthEducation andCookingDemonstrationRoom

Health education, group counselling and nutrition education will be given by health personnel inthis room. Models, flip charts and other audio-visual aids will be used for this purpose. This roomwill have space for a maximum of 20 persons. Portable kitchenette, with actual cooking tools andutensil will be placed here.

8. SICKBAY

8.1. ROLEFUNCTION.


8.2. LOCATION


8.3. ORGANISATION



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8.5.1. General ward � Each ward for male and female. Each ward will have 1 bed with side tableand dripstand.


8.5.3. Toilets are located near these wards.

9. DELIVERYROOM

9.1. ROLE/FUNCTION

The delivery room will be used in conducting all patients in labour.

9.2. LOCATION

The labour room will be located where it is accessible to the public for delivery of low risk cases i.e.white and green tags.

9.3. ORGANISATION

9.3.1. The cases conducted will be assessed by on-call community nurse and conducted if inlabour.

9.3.2. The cases that are beyond the staff scope of activities as yellow tag, will be referred to thenearest hospital.

9.3.3. Cases that cannot be conducted in health clinic will be referred to the nearest hospital.




9.4.3. Emergency trolley for resuscitation is required for emergency management of obstetricand neonatal resuscitation cases.


9.4.5. 2 Single beds for patients after delivery will be made available. Attached with theroom should be a toilet cum bathing area.


9.4.7. Holding stores, clean and dirty utilities will be shared with that of the consultationrooms.

9.4.8. Sterilisation area and wash area should be made available for after delivery wash.


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10.1. ROLE/FUNCTION



10.2 LOCATIONOFSERVERROOM


10.3 ORGANISATION

10.3.1 The IT services will be under the responsibility of the Medical Assistent.


10.4.1 All identified providers an rooms will have access to computers to key data and or attendingto patients.





10.4.6 Data and information will not be issued to any unauthorised persons or outsiders. Nocommercialisation f data is allowed.


10.4.8 Clients will be made accessible to health information and education. A person will be madein charge to answer any queries if any by clients. The state or district health office must pre-approve the contents before putting on the web page.




A room to fit in servers, telecommunications facilities and a table top for working area for 2persons at any one time


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11. STORES

11.1 GENERALSTORE


11.2 CLEANERSAREA

An area will provide sufficient space for the storage of cleaning materials and equipment. It will beplaced at strategic location eg. each level of the multi-storey building.



11.4 DIRTYUTILITYROOM




11.6 GENERATORUNIT

A set of generator will be placed here to generate electricity for the use of the clinic and quarters.

11.7 WATERTREATMENTUNIT

A mini-water treatment plant to process raw water for the use of the clinic and quarters.


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12.1 ROLE/FUNCTION

15.1.1 Overall management of the clinics.15.1.2 Human resource management.15.1.3 Management and control of stocks.

12.2 LOCATION

The administration office may be located away from the CE areas but easily accessible.

12.3 ORGANISATION

15.3.1 The officers-in-charge (Medical Assistant) will be the overall manager of the clinic.






13.COMMONSTAFFFACILITIES

13.1 STAFFTOILETS

Staff toilets for male and female staff will be located at strategic places i.e. one at each level.Waterhosesto be fixed in each cabinet.

13.2 SOLAT/MEDITATIONROOM

Prayer rooms will be provided centrally for male and female staffs and client of the health clinic. Eachroom shall accommodate 5 staff/client. It should be located near the staff toilet.

13.3 STAFFREST

A common staff rest area at strategic area. Storage space as lockers for staff belongings be attached.It should accommodate 5 staff at any one time.




Covered parking spaces will be provided for the clinic ambulance. Space for other clinic vehicles (4Wheel-Drive and boat) will be provided.


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14. PUBLICAMENITIES

14.1 PLAYGROUND/PLAYAREA*

A fenced play area shall be located just outside the clinic waiting areas. An entrance will provided fromthe waiting area to the playground.

14.2 PARKINGSPACES


14.3 BALAIPELAWAT

This facility is for accompanying family members who lived far from the clinic, or having transportproblem. A living room, a bedroom (which can accommodate two beds) and a kitchenette will beprovided.

14.4 MULTIPURPOSECOURT

This court can be used for volleyball, takraw or badminton. It can also served as a helicopter pad whennecessary.


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15. PLANNINGCONCEPT

15.1 In all clinics, the availability of services could be on flexible basis, to be in-step with need,populationgrowth etc.



15.4 Several services will be contracted-out e.g. laundry, cleaning, security, waste disposal andengineering services.

15.5 A security station* will be provided for 24 hours security.



15.7.1 Public toilets will be close to the waiting area. There will be provision for a toilet for the handicapped.

15.7.2 Central Medical Records room will be adjacent to the Reception/Registration Area allowing easycommunication between these two rooms.

15.7.3 The basic concept of the Health Clinic design is the provision of standard Consultation/ExaminationRooms. The layout of these rooms will ensure maximum privacy, especially when door is opened aswell as interconnecting passage for staff use.

15.7.4 The Treatment and Procedure rooms shall be best positioned between the Clean and Dirty UtilityRooms with free access for staff. This measure will also to ensure a clear flow of clean and soileditems.

15.7.5 The Health Education facilities can be located away from the main Consultation/Examination Area asit is a shared facility for the use of the clinic.

15.7.6 The components of the Laboratory will be grouped together and should have its own waiting area.

15.7.7 TheWaiting Area of the Pharmacy will be clearly segregated from the Main Waiting Area and waitingarea of the CE rooms.


15.5.9 The Sick Bay and Delivery room must have easy access to clients. It should have toilets andarea for staff located nearby.




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15.512 Security to the centre will be devised to enable staff to work after normal office hours and clinics to beopened to public for Health Promotion activities after working hours.

15.5.13 Materials and Supplies flow will not interfere with the patients flow. It should have separate entranceto the various units.



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APPENDIX I



INTRODUCTION



DEPARTMENTALBRIEF




keperluan perubatan klinikkesihatan

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