Healthcare Services (Acute Hospital Service) Regulations 2023

grant clinical privileges to a medical practitioner or dentist employed or engaged by the licensee in accordance with the framework mentioned in paragraph (1); (b)regularly review the clinical privileges granted to the medical practitioner or dentist to ensure that he or she continues to have the necessary professional qualifications, experience, competency and skills to be granted those clinical privileges; and (c)ensure that the medical practitioner or dentist only provides care or treatment or performs procedures within the scope of the clinical privileges granted.

every approved permanent premises is open to patients and operating at all times;

every approved permanent premises is designed and built in a manner that provides a proper, safe and conducive environment for the treatment of every patient, including a patient who suffers from a physical disability; (c)every approved permanent premises is adequately and properly equipped to address the mobility requirements of every patient, including a patient who suffers from a physical disability; and

a security system is established and implemented at every approved permanent premises to ensure the safety of the personnel, patients and visitors at every approved permanent premises.

ensure that there is a process to facilitate prompt access to adequate supplies of equipment, materials and other supplies which are necessary for the provision of any acute hospital service in a proper, effective and safe manner; and

where there is any instruction manual for any equipment or material mentioned in sub‑paragraph (a) — ensure that the instruction manual is made available for reference by any personnel who uses or intends to use the equipment or material.

the emergency water supply, power and lighting are sufficient to ensure that any procedure that has commenced may be safely completed; and

where any life support equipment is used, the life support equipment is connected to an emergency power supply at all times during its use.

there is a bed available for each patient who undergoes a relevant procedure, for the patient to rest and recover after the relevant procedure;

the approved permanent premises includes an area that is designated for the use of patients recovering after an operation;

there is sufficient resuscitative equipment in the area mentioned in sub‑paragraph (b); and

there is adequate space for the movement of personnel for the monitoring of patients and treatment of complications.

there is an adequate number of medical practitioners at each of the licensee’s approved permanent premises to assess every patient at those premises and provide medical care or intervention, if necessary; and

every patient is assigned an attending medical practitioner who has overall responsibility for the patient’s general medical condition.

any change in the patient’s medical condition or the occurrence of any incident, that requires the patient to receive a new or different type of care, treatment or procedure;

any change in the patient’s care plan that will result in the patient receiving a new or different type of care, treatment or procedure.

either —

ensure that sufficient supplies of anaesthetic, anaesthetic delivery equipment and patient monitoring devices are kept and maintained at every approved permanent premises; or

establish, implement and regularly review processes to ensure that the licensee may obtain the supplies mentioned in sub‑paragraph (i) at any time;

establish, implement and regularly review processes and procedures to determine whether a particular anaesthetic is suitable to be administered on a patient;

before administering any type of anaesthetic to cause any anaesthesia in a patient, properly inform the patient of the risks and benefits of, and (if any) the alternatives to, the anaesthesia;

having satisfied the condition mentioned in sub‑paragraph (c) in respect of a patient, keep and maintain proper and accurate records of this fact;

where any anaesthetic is administered to a patient for the purpose of conducting a surgical or any other bodily invasive procedure on the patient — ensure that the patient is regularly monitored throughout the procedure by the person who administered the anaesthetic, using the appropriate patient monitoring device; and

establish, implement and regularly review processes and procedures to ensure the continued monitoring and care of the patient mentioned in sub‑paragraph (e) after completion of the procedure mentioned in that sub‑paragraph.

be capable of providing any intensive care service to a neonate in a proper, effective and safe manner; (b)designate an area at the approved permanent premises (that is separate and apart from the area mentioned in paragraph (1)) for the provision of any intensive care service to a neonate; and

ensure that the area mentioned in sub‑paragraph (b) is appropriately equipped to ensure the provision of any intensive care service to a neonate in a proper, effective and safe manner.

present at every approved permanent premises; and

who have the appropriate qualifications, experience and competency to provide timely and appropriate nursing care to the licensee’s patients.

in accordance with the policies and procedures mentioned in paragraph (3) and the approved standards of nursing practice; and

under the supervision of a registered nurse.

the assignment of a suitable nurse who possesses the appropriate qualifications, experience, competency and skills, to take charge of the nursing care of a patient, taking into account the patient’s medical needs and condition;

the prompt recognition of any untoward change in a patient’s condition to facilitate any appropriate intervention by a medical practitioner or another personnel with the necessary qualifications, experience, competency and skills; and

the determination of the care, treatment or procedure that needs to be provided to a patient according to the change in the patient’s medical needs and condition.

within a reasonable period of time after a patient is admitted by the licensee to any approved permanent premises, a registered nurse assesses the nursing needs of the patient;

a nursing care plan is proposed for the patient;

the nursing care plan includes measures to continuously evaluate the patient for the purpose of determining, at any time, the patient’s state of health and the quality of nursing service provided to the patient;

a nurse is charged with the implementation of the nursing care plan for the patient;

every nursing service is carried out in accordance with the nursing care plan; and

the implementation of the nursing care plan and the patient’s response to any nursing service are documented, in accordance with the approved standards of nursing practice.

the storage, preparation, dispensing and administration of any medicinal product or health product;

the proper and accurate keeping and maintenance of records relating to the storage, preparation, dispensing and administration of any medicinal product or health product;

the prevention of any mix up, contamination, or early degradation of any medicinal product or health product that is stored or used at the approved permanent premises;

the measures to prevent any medicinal product or health product that has been recalled from its manufacturer, from being dispensed or distributed; and

informing every patient who has been dispensed or administered or has consumed the medicinal product or health product mentioned in sub‑paragraph (d) of the recall.

there is an adequate supply of medicinal products and health products at every approved permanent premises where a pharmaceutical service is provided; and

the medicinal products and health products are properly stored at the approved permanent premises.

establish, implement and regularly review emergency procedures which would ensure —

the rapid and accurate assessment of any person who is in need of any resuscitation service (called in this regulation the patient); and

the timely delivery of any resuscitation service to the patient to stabilise or resuscitate the patient;

for every approved permanent premises, ensure that adequate and appropriate facilities, equipment and drugs for the implementation of any emergency procedure are readily available in all areas where patients receive accommodation, care or treatment;

ensure that only resuscitation drugs that have not passed their expiry dates and are fit for use and resuscitation equipment that is fit for use are made available for use in the provision of any resuscitation service; and

ensure that every personnel who provides any resuscitation service to a patient is adequately trained —

to provide the resuscitation service in a proper, effective and safe manner; and

in the use of the equipment that is needed to deliver the resuscitation service.

ensure that every surgical operation, invasive procedure or endoscopic procedure that needs to be carried out in an aseptic environment is carried out in an operating theatre at the licensee’s approved permanent premises;

ensure that every operating theatre is appropriately designed, built, furnished and equipped to enable the provision of any surgical service in a proper, effective and safe manner;

before conducting any surgical procedure on a patient, ensure that the medical practitioner or dentist who is to conduct the surgical procedure properly informs the patient of the risks and benefits of, and (if any) the alternatives to, the surgical procedure;

having satisfied the condition mentioned in sub‑paragraph (c) in respect of a patient, keep and maintain proper and accurate records of this fact;

minimise the risk of infection of the surgical site of the patient on which any surgical procedure is conducted; and

ensure that only the appropriate surgical procedure is conducted on a patient and the surgical procedure is conducted in a proper, effective and safe manner.

in relation to surgical procedures — perioperative measures to minimise the risk of any surgical site infection;

processes to ensure that the correct surgical procedure is performed on the correct patient at the correct surgical site and (where applicable) the correct implant, prosthesis or invasive device is inserted into the patient.

every patient is triaged and assessed in a timely manner by a healthcare professional with the appropriate qualifications, experience, competency and skills; and

the appropriate care or treatment is provided to, or the appropriate procedure is conducted on, the patient in accordance with the results of the triage.

at all times, at least one medical practitioner who is registered under section 22 of the Medical Registration Act 1997 as a specialist in the branch of emergency medicine, is present at every approved permanent premises at which the emergency department service is or is to be provided; and

the provision of any emergency department service to any patient is under the supervision of the medical practitioner mentioned in sub‑paragraph (a).

at all times, at least one medical practitioner who is registered under section 22 of the Medical Registration Act 1997 as a specialist in paediatric medicine and has received such training in emergency medicine as may be specified by the Director‑General, is present at every approved permanent premises at which the emergency department service is or is to be provided; and

the provision of any emergency department service to any child is under the supervision of the medical practitioner mentioned in sub‑paragraph (a).

ensure the prompt deployment of personnel with the necessary qualifications, experience, competency and skills at every approved permanent premises to ensure the provision of the emergency department service to any patient in a proper, effective and safe manner; (b)ensure that the provision of any nursing service in support of the provision of an emergency department service to a patient is supervised by a registered nurse who is the licensee’s personnel and —

has obtained such qualification in emergency nursing, as may be specified by the Director‑General; and

has at least 2 years of full‑time work experience in providing nursing care as a registered nurse, in support of the provision of any emergency department service (whether by the licensee or another licensee).

for every approved permanent premises where an emergency department service is or is to be provided, designate separate areas at the approved permanent premises as the ambulance unloading bay and the resuscitation area;

ensure that the ambulance unloading bay is located near to, and is easily accessible from, the resuscitation area;

designate an area within the emergency department as the area at which patients with different patient acuity are treated and observed; and

ensure that there is a bed available for each patient at the resuscitation area.

physically segregate and manage any patient who has a highly infectious disease or is contaminated with a hazardous material; and

provide prompt resuscitation service and management of a patient who has a time‑sensitive condition.

implement protocols for the recognition of any deterioration in a patient’s condition, provision of medical care and escalation for further medical care;

ensure that every medical practitioner, registered nurse and enrolled nurse employed or engaged by the licensee for the provision of the renal dialysis service is familiar with the signs and symptoms of patient deterioration and is able to identify these signs and symptoms;

ensure that any deterioration in a patient’s condition is brought to the attention of the appropriate personnel in a timely manner; and

ensure that all dialysis machines are equipped with the appropriate equipment or device —

to enable the licensee’s personnel to visually monitor the clinical and dialysis parameters of a patient undergoing haemodialysis; and

that will give an audiovisual alarm if there is any machine fault detected, or if the patient’s clinical or dialysis parameters fall outside of the acceptable range during haemodialysis.

every part of any equipment (other than any part designed for single use only) is appropriately disinfected or sterilised in accordance with the specifications by the manufacturer of the equipment before and after it is used for dialysis;

each equipment is installed, and used or operated properly, in accordance with the instructions of the manufacturer of the equipment; and

in relation to a licensee who provides haemodialysis —

where reusable dialysers are used — the dialysers are cleaned and prepared for reuse in the manner required or recommended in the manufacturer’s operator manual for the dialyser;

any dialyser must only be used for one patient;

each dialysis machine is drained, rinsed and disinfected after each dialysis, at the end of each day and at any other interval required or recommended in the manufacturer’s operator manual for the dialysis machine; and

where there is a blood leak, the affected dialysis machine is rinsed and disinfected in the manner required or recommended in the manufacturer’s operator manual for the dialysis machine.

the water used for haemodialysis is treated by reverse osmosis;

there are protocols and procedures on the collection and testing of the water and dialysis fluid;

the water and dialysis fluid are regularly tested for chemical and microbiological contaminants;

appropriate methods are used for the collection and testing of the water and dialysis fluid;

the water treatment equipment and haemodialysis water distribution systems are appropriately designed, built, and maintained to prevent treated water from being contaminated or exposed to the risk of being contaminated;

water treatment systems are isolated from the potable water supply;

the water treatment equipment and haemodialysis water distribution system include pressure gauges, flow meters, sample ports, and other ancillary equipment necessary to allow monitoring of the performance and the system as a whole;

there are protocols and procedures for the regular disinfection of all water treatment equipment and haemodialysis water distribution systems; and

records of each disinfection are kept.

before a patient starts receiving haemodialysis, the patient must be tested to determine the level of each of the patient’s liver markers and for each specified infectious disease, unless the patient is assessed by a medical practitioner to be in a critical condition and requires haemodialysis without delay;

any patient who at any time has a liver marker which level is above the normal range or tests positive for any specified infectious disease is referred to an appropriate medical practitioner;

every specified patient receives haemodialysis in a different room or a physically segregated area from a patient who is not a specified patient;

for any period during which a licensee provides haemodialysis to a specified patient, any machine or equipment that has been used for a specified patient is not used for a patient who is not a specified patient;

where a dialyser has been used by a patient who has a specified infectious disease — the dialyser is not reused; and

where a dialysis machine has been used by a patient who has a specified infectious disease — the dialysis machine undergoes complete chemical disinfection after each such use, and the chemical disinfection is performed in accordance with the manufacturer’s recommendations.

only as a service that is incidental to the provision of an acute hospital service;

at the licensee’s approved permanent premises; and

by a personnel of the licensee, who has the appropriate qualifications, skills and competencies to conduct the ultrasound imaging.

using testing material in respect of which —

the expiry date has not passed; and

the personnel who is administering the test does not suspect or have any reason to suspect that the testing material is no longer fit for use; and

in accordance with the instructions specified by the manufacturer of the testing material.

by the licensee under a clinical laboratory service licence; or (b)by a clinical laboratory service licensee who is permitted to provide the service at the approved permanent premises.

the test is not a specified test; and

the conduct of the test is by —

a clinical laboratory service licensee; or (ii)a person who operates a clinical laboratory outside Singapore that is accredited by an accreditation body approved by the Director‑General.

by the licensee under a radiological service licence; or (b)by a radiological service licensee who is permitted to provide the service at the approved permanent premises.

the radiological examination is not a specified examination; and

the conduct of the radiological examination is by a radiological service licensee.

where the licensee is approved to provide an emergency department service — a plain radiography examination, an ultrasound imaging, a computed tomography or a magnetic resonance imaging; or

in any other case — a plain radiography examination.

establish an infection prevention and control programme (called in this regulation the IPC programme) that satisfies the conditions mentioned in paragraph (2);

appoint an infection prevention and control committee to assist the licensee in establishing, implementing and regularly reviewing the IPC programme;

ensure that the infection prevention and control committee comprises the appropriate number of personnel with the appropriate qualifications, skills and competencies for the purpose of carrying out the licensee’s functions mentioned in sub‑paragraph (b); (d)keep proper and accurate records of —

the implementation of the IPC programme; and

every infection prevention and control activity carried out at the approved permanent premises;

ensure that only equipment, material or articles that are reprocessed through high‑level disinfection or sterilisation in accordance with the specifications by the manufacturer of the equipment, material or articles (as the case may be) and are not subsequently contaminated, are used in any endoscopic, operative or any other invasive procedure on a patient;

ensure that every equipment, material or article that is used in every endoscopic, operative or any other invasive procedure is —

reprocessed through high‑level disinfection or sterilisation in accordance with the specifications by the manufacturer of the equipment, material or article, as the case may be; and

kept and stored under the appropriate conditions to ensure that the equipment, material or article remains fit for use until it is used in the next endoscopic, operative or invasive procedure; and

ensure that every equipment that is used to reprocess or sterilise any other equipment, material or article is checked regularly and maintained properly in accordance with the specifications by the manufacturer of the equipment, so as to ensure its proper and effective operation.

standard operating procedures relating to the infection prevention and control of any infection at the licensee’s approved permanent premises;

policies and guidelines relating to the prevention, identification, control and management and elimination of any infection that is acquired in or brought into the licensee’s approved permanent premises, including the practice of good hand hygiene and in the use of personal protective equipment;

policies and the appropriate processes for the training and competency assessment of the licensee’s personnel to ensure that the personnel are familiar with and are able to comply with the matters mentioned in sub‑paragraphs (a) and (b);

surveillance plans to monitor every incident at the licensee’s approved permanent premises that involves an epidemiologically important organism or an infection that is acquired at the approved permanent premises;

plans to carry out regular audits on the personnel, patients and environment of the licensee’s approved permanent premises to ensure that the IPC programme is being implemented effectively.

an emergency at the approved permanent premises;

a medical emergency in Singapore.

establish and equip an operationally‑ready emergency response team to manage an emergency mentioned in that paragraph; (b)establish, implement and regularly review processes and procedures to control and manage an emergency, including any radiation emergency or incident;

with respect to a radiation emergency or incident, establish, implement and regularly review processes and procedures to prevent, identify, control and manage any radiation emergency or incident, including strategies to isolate every area or patient who is affected by radiation, setting up isolation facilities for every affected patient, and the use of equipment to prevent, control and manage the spread of radiation;

review the processes and procedures mentioned in sub‑paragraph (b) annually;

train every personnel who is in the emergency response team in the processes and procedures mentioned in sub‑paragraph (b); and

participate in any exercise specified by the Director‑General that is for the purpose of evaluating the emergency preparedness and response capabilities of the healthcare system in Singapore.

the consultation fee that is applicable to the patient; and

the ward charges.

represent to any person or give any person the impression that the licensee is an approved institution; or

otherwise mislead any person as to whether the licensee is an approved institution.

an approved medical institution within the meaning of regulation 2(1) of the Central Provident Fund (Medisave Account Withdrawals) Regulations (Rg 17);

an approved medical institution approved by the Minister under the MediShield Life Scheme Act 2015;

an accredited medical institution under any public scheme providing financial assistance that is established by the Government.

the estimated price range of the fees for the care, treatment or procedure;

the fee benchmark for the same or similar care, treatment or procedure that is published on the website of the Ministry of Health at https://www.moh.gov.sg (if available); (c)whether any part of the fees mentioned in sub‑paragraph (a) may be —

deducted from any medisave account; (ii)reimbursed under the MediShield Life Scheme; or

reduced by any subsidy or grant under a public scheme; and

any other benefit that the MediShield Life Scheme provides to the patient in respect of the care, treatment or procedure, if any.

to a fine not exceeding $20,000 or to imprisonment for a term not exceeding 12 months or to both; and

in the case of a continuing offence, to a further fine not exceeding $1,000 for every day or part of a day during which the offence continues after conviction.