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Standards for general practices (4th edition)

including Interpretive guide for Aboriginal and Torres Strait Islander health services

Standard 5.1 Facilities and access

Our practice provides a safe and effective environment for our practice team and patients.

Criterion 5.1.1

Practice facilities

Our practice facilities are appropriate for a safe and effective environment for patients and the practice team.

Indicators

► A. Our practice has at least one dedicated consulting/examination room for every member of our clinical team working in our practice at any time.

► B. Each of our consultation rooms (which may include an attached examination room/area):

  • is free from excessive noise
  • has adequate lighting
  • has an examination couch
  • is maintained at a comfortable ambient temperature
  • ensures patient privacy when the patient needs to undress for a clinical examination (eg. by the use of adequate curtains or screens and gowns or sheets).

► C. Our practice has a waiting area sufficient to accommodate the usual number of patients and other people who would be waiting at any given time.

► D. Our practice has toilets and hand cleaning facilities readily accessible for use by both patients and staff.

► E. Prescription pads, letterhead, administrative records and other official documents are accessible only to authorised persons.

► F. Our practice and office equipment is appropriate to its purpose.

► G. Our practice has one or more height adjustable beds.

H. Our practice waiting area caters for the specific needs of children.

Explanation

Key points

  • Practice facilities need to be safe for GPs, other practice staff and patients
  • Patients should have auditory and visual privacy (eg. by the use of curtains, screens, drapes or gowns)
  • Practices need to have one or more height adjustable beds
  • This criterion cross references to Criterion 5.1.3 Physical access.

Occupational health and safety

Health and safety requirements cover both consultation areas and all other areas of the practice. The practice facilities need to provide appropriate security for staff, patients and visitors.

Design and layout

The RACGP publication Rebirth of a clinic assists practices with the design and layout of practice facilities which are fit for purpose and address security needs. It is available at www.racgp.org.au/your-practice/business/design/architectural-design/.

Ideally, the practice layout should enable reception staff to see and monitor waiting patients to identify medical emergencies and reprioritise appointments as required.

While this criterion discusses consultation and examination ‘rooms’, it is acknowledged that some practices have consultation or examination ‘areas’ instead. Such consultation areas need to meet the same requirements for safety and appropriateness.

Ambient temperature

Consultation room temperature needs to be such that a patient undressed for an examination remains comfortable.

Privacy and patient dignity

The dignity of the patient should be protected by suitable visual and auditory privacy. Visual privacy can be afforded to patients during the clinical examination by the use of a gown or sheet and an adequate curtain or screen. This requirement includes situations in which there is a door opening to an area to which the public may have access and also when patients are required to undress/dress in the presence of the GP or practice nurse.

Location of toilets and hand cleaning facilities

Ideally, toilets should be located within the practice. Toilets not within the practice itself need to be within close proximity. Toilets need to be easily accessible and well signposted. Separate staff and patient toilets are desirable.

Washbasins need to be situated in close proximity to the toilets to minimise the possible spread of infection and need to be easily accessible to GPs, other staff and patients.

Height adjustable beds

The RACGP has been involved in ongoing discussions with consumer bodies, the disability sector and the Australian Human Rights Commission (AHRC) with respect to improving access to high quality general practice for people with a disability.

Height adjustable beds are especially necessary for patients with limited mobility and the College has therefore determined that each accredited practice must have one or more height adjustable beds.

Height adjustable beds may assist general practice teams to:

  • reduce the risks associated with patients getting on and off the examination couch, especially for people with impaired mobility
  • reduce the risk of misdiagnosis or nondetection of serious medical conditions through difficulty in conducting an examination if a patient is not able to be examined on a standard examination couch
  • reduce the risk of practice staff injuring themselves when examining patients or assisting patients on and off an examination couch
  • reduce risks associated with the practice’s legal responsibilities under the Disability Discrimination Act to ensure equal access for people with disability to the same range and quality of medical care as others.

Practices need to consider where a height adjustable bed may be best located. Many practices have told the RACGP that they have their height adjustable bed in a treatment room, rather than a consultation room.

The RACGP acknowledges that cost is a factor for some practices. The RACGP continues to advocate for infrastructure support for general practices in its representations to the Department of Health and Ageing.

Rebates for practice equipment that relates to occupational health and safety may be available through state and territory jurisdictions. Practices are advised to check jurisdictional WorkSafe websites for information on rebates that could apply.

In exceptional circumstances where the physical space of a practice is limited and a height adjustable bed cannot be accommodated, the practice needs to be able to demonstrate why it cannot accommodate a height adjustable bed, as well as how the practice safely manages examinations of patients with impaired mobility and protects the occupational health and safety of practice staff.

The disability sector has had experts review height adjustable beds available currently on the market to ensure they meet the needs of people with disabilities.

Services providing care outside normal opening hours

For services providing care outside normal opening hours that only provide visit based care, Indicators A, B, C, D, F, G and H are not applicable. However, all reasonable efforts should be made to protect the patient’s privacy during a consultation and these services need to refer to, and meet, the infection control criterion in these Standards (see Criterion 5.3.3 Healthcare associated infections).

While Indicator D is not applicable, services will need to ensure that effective hand cleaning (eg. with alcohol based hand rub) can occur when patients are seen outside the general practice.

Standard 5.1 Facilities and access

Our practice provides a safe and effective environment for our practice team and patients.

Criterion 5.1.1

Practice facilities

Our practice facilities are appropriate for a safe and effective environment for patients and the practice team.

In a nutshell

Your health service facilities need to meet OH&S requirements and ensure an appropriate environment where staff can provide effective patient care. Your facilities also need to afford safety, and auditory and visual privacy, for patients.

Key team members

  • Health service manager
  • Reception staff
  • Clinical staff

Key organisational functions

  • Occupational health and safety
  • Patient confidentiality and privacy
  • Quality and safe clinical practice

Indicators and what they mean

Table 5.1 explains each of the indicators for this criterion. Refer to Criterion 5.1.1 Practice facilities of the Standards for general practices for more information and explanations of some of the concepts referred to in this criterion. 

Table 5.1 Criterion 5.1.1 Practice facilities
IndicatorWhat this means and handy hints
▶ A. Our practice has at least one dedicated consulting/examination room for every member of our clinical team working in our practice at any time. There is at least one separate consulting or examination room, or area, for each member of your health service team providing patient consultations at any given time.
▶ B. Each of our consultation rooms (which may include an attached examination room/area):
  • is free from excessive noise
  • has adequate lighting
  • has an examination couch
  • is maintained at a comfortable ambient temperature
  • ensures patient privacy when the patient needs to undress for a clinical examination (e.g. by the use of adequate curtains or screens and gowns or sheets).
Your health service’s consultation or examination rooms need to be comfortable for your patients and to allow your clinical staff to provide appropriate healthcare. The rooms also need to afford audio and visual privacy for patients, and to ensure that their right to confidentiality and privacy in healthcare is maintained.

When a member of your clinical team consults or examines patients, patients need access to a room or area that ensures dignity and confidentiality.
▶ C. Our practice has a waiting area sufficient to accommodate the usual number of patients and other people who would be waiting at any given time. The layout at reception needs to be sufficiently large to accommodate the usual number of patients and any other people who may be waiting at any given time. It should also allow reception staff to easily monitor the area and identify medical emergencies and re-prioritise appointments as the need arises.
▶ D. Our practice has toilets and hand-cleaning facilities readily accessible for use by both patients and staff. Ideally, toilets would be placed within your health service. They would be readily accessible and well signposted. Where possible, toilets would be designed and placed with cultural and kinship protocols in mind to minimise breaches of your community’s cultural practices. Separate staff and patient toilets are also desirable.

Where toilets are not within the health service, they need to be within close proximity to the service, readily accessible and well signposted. There should be a safe and secure pathway from the main health service to the toilets. As with toilets within the health service, they should be designed and placed with cultural and kinship protocols in mind.

Washbasins and hand-cleaning facilities need to be situated in close proximity to the toilets to minimise spread of infection. They should also be easily accessible to doctors, other staff and patients.
▶ E. Prescription pads, letterhead, administrative records and other official documents are accessible only to authorised persons. Secure facilities, such as locked cabinets, need to be used to store prescription pads, letterheads, administrative records and other official documents. They should only be accessible to authorised staff members and kept secured and locked as required.
▶ F. Our practice and office equipment is appropriate to its purpose. In accordance with OH&S regulations and to support the delivery of safe and effective healthcare, office and clinic equipment should be ‘fit for purpose’, meaning that it should be the right equipment for what you want to use it for.

This means that your service needs to make sure it purchases the right equipment, and that it maintains and repairs or replaces that equipment, so that it continues to serve its purpose.
▶ G. Our practice has one or more height-adjustable beds. Height-adjustable beds are especially necessary for patients with limited mobility and this criterion requires that each health service has one or more height-adjustable beds.

See Criterion 5.1.1 Practice facilities of the Standards for general practices for a summary of the various risks that can be minimised by the use of height-adjustable beds.

In exceptional circumstances where the physical space at the health service is too small to accommodate a height-adjustable bed, the service needs to be able to demonstrate how it manages examinations for people with impaired mobility, and how it protects staff safety while doing so.

Rebates for health service equipment that relate to occupational health and safety may be available through government and other jurisdictions. It is highly recommended that your health service check the relevant WorkSafe websites of your state or territory for information on rebates that could apply.
H. Our practice waiting area caters for the specific needs of children. The specific needs of children who are in the waiting room need to be adequately catered for. This could include the provision of children’s sized furniture and equipment, toys and other quiet activities.

Case study

Below is a description of the ways in which an Aboriginal community controlled health service can provide facilities that are appropriate for a safe and effective environment for its patients and staff. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.

The service matches its clinical staff recruitment practices and roster (including for visiting specialists) with the availability of consultation rooms, so each of its clinical staff members has access to a separate, properly equipped consulting room when required.

Because its community is expanding and patient numbers are increasing, the service is already finding that consultation space is tight. It is now developing plans to expand the service facilities, including adding at least one more consultation room, to continue to ensure one fully equipped consultation room for each clinician at any given time.

Any time it plans to introduce new or additional services or programs, the service thinks about what space and equipment will be required, to make sure no existing clinical equipment or facilities are negatively affected.

The health service’s consulting rooms and areas have privacy screens for patients to undress for examinations and a privacy sheet or gown is provided for patients to cover themselves. There are examination lights and examination tables in each of the consulting rooms.

The service has a fully equipped mobile caravan to visit outlying areas and provide healthcare to patients who find it difficult to visit the service. This is rostered so that only one GP uses the consultation area in the caravan at any one time.

The service has at least one height-adjustable bed in all its locations, including in the caravan. Because of the many people of childbearing age in its community the service has chosen a model with a side rail that can be moved up and down and stirrups for gynaecological examinations when required. This is in addition to the basic RACGP requirement.

The waiting areas in all service locations provide items for children, such as wall-mounted interactive play panels (which are easily cleaned and do not have loose pieces that could cause hazards to children) and child-sized tables and chairs. The service has also worked with other ACCHSs to develop a number of waiting room activities for children. These include videos and colouring books featuring a variety of child-specific health promotion designed pages or quizzes about healthy lifestyles. The waiting areas also include both an inside and outside waiting area, for patients who prefer to wait outdoors.

The service has male and female patient toilets, including a disabled toilet located off the waiting room to cater for its many patients with a physical disability. All of the toilets have access to hand-washing facilities. The service equipment in its clinical area includes wheelchairs, patient slides and lift/walker belts for its patients, if required.

There are separate staff toilets with hand-washing facilities located within the building, to which patients do not have access.

The service has its electrical equipment inspected and tagged annually by an independent contractor.

All fire equipment is checked and tagged annually by an independent contractor.

Showing how you meet Criterion 5.1.1

Below are some of the ways in which an Aboriginal community controlled health service might choose to demonstrate how it meets the requirements of this criterion for accreditation against the Standards. Please use the following as examples only, because your service may choose other, better-suited, forms of evidence to show how it meets the criterion.

  • Ensure the physical layout of the service includes consulting rooms, toilets and hand-cleaning facilities.
  • Maintain a heating and cooling system.
  • Have patient privacy screens.
  • Have adequate signage.
  • Maintain at least one height-adjustable bed.
  • Provide children’s furniture and play equipment.

Related RACGP criteria

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