DOH ADMINISTRATIVE ORDER NO. 2006-0037, December 19, 2006

AMENDMENT TO ADMINISTRATIVE ORDER NO. 163, S. 2004: RULES AND REGULATIONS GOVERNING THE REGISTRATION, LICENSURE AND OPERATION OF DIALYSIS CLINICS IN THE PHILIPPINES

National Administrative Register December 19, 2006
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Pursuant to Administrative Order No. 163 s. 2004: Rules and Regulations Governing the Registration, Licensure and Operation of Dialysis Clinics in the Philippines, the following provisions are hereby amended:

Under Section IV. POLICIES AND GUIDELINES

B.1.3    Dialysis Nurse must meet the following requirements:

•     Duly licensed
•     Current member of Renal Nursing Association of the Philippines (ReNAP) or its equivalent
•     Certified IV therapy nurse
•     Hospital/clinical work experience for one (1) year
•     Certificates of special training on dialysis for not less than thirty (30) days and on Basic and Advanced Life Support

The aforementioned provision is hereby amended to read as follows:

B.1.3    Dialysis Nurse must meet the following requirements:

•     Duly licensed

•     Current member of Renal Nursing Association of the Philippines (ReNAP) or its equivalent

•     Certified IV therapy nurse

•     Hospital/clinical work experience of at least six (6) months

•     Certificates of special training on dialysis for not less than thirty (30) days and on Basic Life Support

At least one nurse per shift must have Advanced Life Support training.

B.1.4    Technician shall have certificate of dialysis training and at least one (1) year experience in same field.

The aforementioned provision is hereby amended to read as follows:

B.1.4    A dialysis technician (optional)

B.2.1.1 Dialysis Service Complex

•     Dialysis Station shall be designed to provide adequate space area and safe treatment as well as to ensure the privacy of patients. The area shall not  be less than 8 meter2 to accommodate a chair or bed, the dialysis equipment and emergency equipment if needed. Separate dialysis machine shall be designated solely for use of  Hepatitis B and C patients.
x x x
•     Water treatment  area
•     Designated area for central sterilization
•     Pre-treatment area and consultation area

The aforementioned provision is hereby amended to read as follows:

B.2.1.1. Dialysis Service Complex

•     Dialysis Station shall be designed to provide adequate space area and safe treatment as well as to ensure the privacy of patients. The area shall not be less than two (2) meters by three (3) meters exclusive of passageway or corridor to accommodate a dialysis chair, a dialysis machine and emergency apparatus if needed. Separate dialysis machines shall be designated solely for use of Hepatitis B patients.

x x x

•     Water treatment area

B.2.3    Water supply for all purposes shall be adequate in volume and pressure. Water used for dialysis purposes must be analyzed for bacteria at least monthly, for chemicals at least every six months and treated as necessary in accordance with the provisions of Association for the Advancement of Medical Instrumentation (AAMI) to maintain a continuous water supply that is biologically and chemically compatible with acceptable dialysis techniques.

The aforementioned provision is hereby amended to read as follows:

B.2.3    Water supply for all purposes shall be adequate in volume and pressure. Water used for dialysis purposes must be analyzed for bacteria at least monthly, for chemicals at least every six months and treated as necessary to maintain a continuous water supply that is biologically and chemically compatible with acceptable dialysis techniques. The bacterial count shall be <200 col/cc. The following are the minimum chemicals to be analyzed: aluminum, chlorine, fluoride and copper.

B. 3   Equipment/Supplies

B.3.1    The clinic shall be adequately equipped with the following to provide quality service to the patients and personnel:

• Stethoscope – 3 units *
• Sphygmomanometer – 3 units *
• One each for regular, Hepatitis B+ and Hepatitis C+ patients
x x x
• E-cart with the following supplies:

• IV fluids
• IV line
• Insyte/abbocath
• Intubation set (endotracheal tubes, laryngoscope, ambubag)
• Emergency drugs such as:
• Dopamine IV infusion
• Isosorbide  dinitrate tablets
• Diazepam (tablets and IV)
• Hydrocortisone IV
• Diphenhydramine maleate 50 mg/amp
• Sodium Chloride 2% in 50 cc polyampule
• D50 W 50 cc vial
• Parenteral antihypertensive medications
• Others (Clonidine, Furosemide IV, Calcium Gluconate, Epinephrine, Lidocaine, Salbutamol, Nifedipine, Sodium Bicarbonate)
• Goose neck lamp
• Standby rechargeable light
• Sterilizer
• ECG machine
• Suction machine
• Defibrillator with cardiac monitor
• Stretcher
• Wheelchair
• Others
• Standby generator (at least 20 kva)
• Fire Extinguisher
• Ambulance or transport vehicle or contract with providers such as ambulance services
• Water treatment equipment

• Multi-media filter
• Bulk filters
• Carbon filter
• Softener
• Reverse Osmosis machine
• Storage tank for Reverse Osmosis
• Acceptable Disinfectant for re-use procedure
• Formalin (4%)
• Paracetic Acid (hydrogen peroxide + acetic acid)

The aforementioned provision is hereby amended to read as follows:

B.3.1 The clinic shall be adequately equipped with the following to provide quality service to the patients and personnel:

• Stethoscope(s)
• Sphygmomanometer (s)
x x x

• E- cart with the following supplies:

• IV fluids
• IV line
• Insyte/abbocath
• Intubation set (endotracheal tubes, laryngoscope, ambubag)
• Emergency drugs such as:

• Dopamine IV infusion
• Isosorbide dinitrate tablets
• Diazepam (tablets and IV)
• Hydrocortisone IV
• Diphenhydramine maleate 50 mg/amp
• Hypertonic Saline
• D50 W 50 cc vial
• Parenteral antihypertensive medications
• Others (Clonidine tablets, Calcium Gluconate, Epinephrine, Lidocaine, Salbutamol, Sodium Bicarbonate IV solution)

• Goose neck lamp
• Standby rechargeable light
• ECG machine
• Suction machine
• Defibrillator with cardiac monitor
• Stretcher
• Wheelchair
• Others

• Standby generator (at least 20 kva)
• Fire Extinguisher
• Ambulance or transport vehicle or contract with providers such as ambulance services
• Water treatment equipment

• Multi-media filter
• Bulk filters
• Carbon filter
• Softener
• Reverse Osmosis machine
• Storage tank for Reverse Osmosis

• Acceptable Disinfectant for re-use procedure

B.5.1    Patient Care

 x x x

• Transfer/referral slip

The aforementioned provision is hereby amended to read as follows:

B.5.1    Patient Care

 x x x

•     Transfer/referral slip (patient(s) that will be transferred or referred to another health facility)

B.5.2    Incident and Accident (logbooks)

• Complications related to dialysis procedure
• Complications related to vascular access
• Complications related to disease process
• Dialysis adequacy of each patient
• Outcomes
• Staff/patient’s hepatitis status

The aforementioned provision is hereby amended to read as follows:

B.5.2 Incident and Accident (logbooks)

• Complications related to dialysis procedure
• Complications related to vascular access
• Complications related to disease process
• Dialysis adequacy of patients on thrice weekly treatments
• Outcomes
• Staff/patient’s hepatitis status

B.5.5.   Administrative

• Minutes of the facility’s staff meetings
• Reports of inspections

The aforementioned provision is hereby amended to read as follows:

B.5.5.   Administrative

• Minutes of the facility’s staff meetings
• Reports of DOH inspections


Repealing Clause:

This order shall repeal and supersede Section IV Subsections B.1.3, B.1.4, B.2.1.1, B.2.3, B.3.1, B.5.1, B.5.2, B.5.5 and all other inconsistent administrative issuances.

Effectivity:

This Order shall take effect upon approval and publication in the official gazette or newspaper of general circulation.

Adopted: 19 Dec. 2006

(SGD.) FRANCISCO T. DUQUE III, M.D., MSC.
Secretary of Health

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