Part B - Health Facility Briefing & Design 157
Part B - Health Facility Briefing & Design 157
Part B - Health Facility Briefing & Design 157
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Health Facility Guidelines © TAHPI Part B: Version 5 Sep 2017 Page 2
Part B: Health Facility Briefing & Design Maternity Unit
Description
The Maternity Unit provides facilities for:
Antenatal care of mothers with complications during pregnancy
Assessment, management of labour, delivery and immediate post-delivery observation of
mothers
Postnatal care of mothers following birth – complicated or uncomplicated deliveries
Neonatal care by mothers under supervision from nursing and midwifery trained staff
Neonatal care of newborns requiring special care from specialist neonatal medical and
nursing staff.
This FPU will address Maternity inpatient accommodation and general care/ special care /
neonatal intensive care nursery areas.
Facilities and requirements for assessment, delivery and immediate postnatal care of mothers are
addressed in the separate Birthing Unit FPU in these Guidelines.
Terminology
In this FPU the following terminology may be used interchangeably:
2 Planning
Operational Models
Hours of Operation
All components of the Maternity Unit will operate on a 24 hour per day basis, with admissions at
any time of the day or night.
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Models of Care
Maternity care including antenatal care, delivery and postnatal care may be provided in a number
of different ways that will impact on the organisation and provision of facilities including:
Midwife-managed or midwife case load care, where care is delivered by a single midwife or
by a group/team of midwives, from both hospital and community settings
Obstetrician-led care, where an Obstetrician is the main provider of antenatal care and is
present for the birth. Nurses provide postnatal and sometimes intrapartum care.
General practitioner-led care, where a medical doctor provides the majority of the antenatal
care with referral to specialist obstetric care as needed. Obstetric nurses or midwives perform
intrapartum and immediate postnatal care but not at a decision making level as the Medical
doctor is present during the birth.
Shared care, which may include General Practitioners, Midwives, Obstetrician and/or
Consultants (such as Neonatal Specialists).
Woman Centred Care where women have the choice of delivery method, practitioner,
support person and location whether in hospital, in a Birthing Centre or at home.
General Practice Shared Care Model (GPSC) is a collaborative model that combines the
skills of midwives, GPs and Obstetricians to varying degrees. It is generally only applicable to
low risk pregnancies, as women with moderate to high risk pregnancy require more tailored
care (note: pregnancy risk can alter during the course of the pregnancy). A General
Practitioner provides most of the antenatal and postnatal care, while inpatient and outpatient
obstetric care is performed by hospital staff.
This traditional Obstetrical model is based on the patient being moved between areas
dedicated to the individual processes. Facilities enabling the successful collaboration
between caregivers should be considered.
Pregnancy Centred Programs for Antenatal Care, often used in conjunction with GPSC, is a
model where pregnancy centred care is concerned with group antenatal care and combines
regular health assessment with educational and support programs. The purpose of this type
of program is to offer a support network and increase continuity of care within the GPSC
Model. Group antenatal care requires access to a room that is large enough for 8-10 women
seated, plus space for examination (possibly an adjoining room).
Planning Models
There are several planning models applicable to the Maternity Unit providing for combinations of
birthing suite, antenatal and postnatal inpatient accommodation, general care nursery, special
care nursery and neonatal ICU. The different combinations demonstrate alternative management
options for neonatal care depending on the level of service provided by the facility and are
described below.
In this model, Special Care Nursery is provided as a component of a Neonatal ICU, providing
intensive care and step down care for neonates and concentrating specialist neonatal trained staff
in one area. Typically neonatal care may change between special care, high dependency and
intensive care, so maintaining flexibility and a close relationship between these areas without
transferring the baby is recommended. This model suits larger facilities where the numbers of sick
and critical neonates warrant a separate NICU/ SCN.
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intensive care unit which may be remote. This model suits facilities with no on-site NICU, where
critically ill neonates are transferred to a referral hospital for higher level care.
Inpatient Accommodation for maternity patients will be similar to general Inpatient accommodation
and a number of suitable options include single corridor models, double corridor or racetrack units
and combinations or L shaped, T shaped or Y shaped corridors.
For further information on Unit Planning options refer to Part B - Inpatient Unit - General in these
Guidelines.
All these models are demonstrated in the Functional Relationship Diagrams that follow. The
diagrams identify a typical racetrack model for Inpatient Unit accommodation.
Planning models for Birthing Unit are addressed in the Birthing Unit FPU in these Guidelines.
Functional Areas
The Maternity Unit will comprise the following Functional Areas or zones:
Entry/ Reception area (may be shared with Birthing Unit or provided at the Main Entry)
Maternity Inpatient accommodation; bed areas for antenatal and postnatal patients including:
- Bedrooms
- Ensuites and bathrooms
- Patient/ visitor lounge areas
Support Areas including:
- Beverage making facilities
- Bays for storage, Linen, blanket warmer as required, Resuscitation Trolley and mobile
equipment
- Cleaner’s room
- Clean Utility/ Medication Room
- Dirty Utility
- Disposal Room
- Handwashing facilities in corridors, at entries and exits
- Staff Station
- Storerooms for equipment and general supplies
Nursery areas:
- General Care Nursery for well babies
- Special Care Nursery for babies requiring closer observation and care
- Intensive Care for newborns requiring life support.
Nursery Support Areas
- Feeding Room for mothers to receive assistance with feeding from nursing staff
- Formula Room for holding milk supplies
- Clean and Dirty Utility Rooms
- Clean-up room for cleaning cots and mobile equipment
- Store rooms for equipment, consumable stock, sterils supplies
Staff Areas - areas accessed by staff, including administration and rest areas
Shared Areas, including Bathrooms, Treatment room, Visitors lounge and amenities that may
be shared with an adjacent unit
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Reception Area
The Reception is the receiving hub of the unit and may be used to control the security of the Unit.
A Waiting area for visitors may be provided with access to separate male/female toilet facilities
and prayer rooms. If immediately adjacent to the Unit, visitor and staff gowning and protective
equipment may also be located here for infection control during ward isolation.
Patient Accommodation
Patient rooms may be grouped together in zones corresponding to different levels of dependency.
Antenatal accommodation will preferably be separated from postnatal beds and be provided in
single bed rooms.
Postnatal accommodation may be arranged to provide a more relaxed environment of mother care
rooms, where women can gather, breastfeed and participate in informal education groups, located
further away from the staff observation posts and more clinical acute care rooms situated close to
the staff station to allow for effective staff observation and ease of access from the support areas.
A small, discreet group of rooms should be provided for women who have lost their baby or have
given their baby up for adoption. These women require ongoing psychological care, post-natal
medical care and support which is best provided within a quiet area of the maternity inpatient unit.
A number of larger postnatal rooms should be available to cope with multiple births, bariatric
patients and people with disabilities that require additional equipment such as a wheelchair.
Support Areas
Support Areas including Utility rooms, Disposal and Store rooms should be located conveniently
for staff access. Meeting Room/s and Interview rooms for education sessions, interviews with
staff, patients and families may be shared with adjacent areas where possible.
Staff Areas
Staff Areas will consist of:
Offices and workstations
Staff Room
Staff Station and handover room
Toilets, Shower and Lockers.
Offices and workstations will be required for administrative as well as clinical functions to facilitate
educational / research activities and will be provided according to approved staffing levels for the
Unit.
Staff Areas, particularly Staff Rooms, Toilets, Showers and Lockers may be shared with adjacent
Units as far as possible.
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Shared Areas
In addition to the shared Staff areas above, Shared Areas may include:
Patient Bathroom
Treatment Room
Public Toilets
Visitor Lounge
Nursery Areas
The General Care Nursery will accommodate well newborn babies as required for short term care.
The Nursery will include:
A bathing/ examination area where newborn babies may be examined, weighed and bathed
A Staff Station with direct observation of all cots in the Nursery and a resuscitation trolley in
close proximity; sterile stock and medications may be co-located with the Staff Station
Support rooms including Cleaner’s room, utilities, linen holding and storage areas.
The Intensive care Nursery includes facilities for critically ill newborns requiring life support and
monitoring, nursed in open intensive care cots or humidicribs. Parent support facilities should be
available including lounge and overnight stay room with ensuite for parents who stay for extended
periods with a sick neonate. Nurseries will require access to public amenities for parents
The Formula room should be located close to the Nurseries and include facilities for holding milk
supplies, both breast milk and prepared formula milk.
The formula room will include:
Bench with sink for rinsing equipment
Cupboards for storage
Refrigerator with freezer
Baby milk warmer or microwave oven.
Refer to Standard Components Room Data Sheets and Room Layout Sheets for additional
information.
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Part B: Health Facility Briefing & Design Maternity Unit
Functional Relationships
External
Principal relationships with other Units include ready access to:
Short term parking/drop off bay for dropping off expectant mothers
Drop off and parking bays for florist deliveries
Emergency Unit
Birthing Unit
Operating Unit
Neonatal ICU and Special Care Nurseries
Intensive Care Unit and HDU for mothers requiring advanced care
Diagnostic facilities such as Medical Imaging, Laboratories and Pharmacy
Supply, Housekeeping, Catering and Waste Handling Units
Outpatients/ Women’s Health Units and Community support services.
Notes:
The Maternity Unit must not be located so that access to one component is via another.
A Nursery must not open directly into another Nursery.
Internal
Optimum internal relationships in all models include:
Reception to supervise security to the entire unit with restricted access to Maternity Inpatient
accommodation, Birthing Unit and NICU/ SCN Nursery areas
The Staff Station and associated areas need direct access and observation of Patient Areas
Utility and storage areas need ready access to both patient and staff work areas
Nursery areas to be accessible from postnatal inpatient areas particularly the General Care
Nursery
Feeding and Formula rooms to be accessible to both Nursery and postnatal inpatient areas
Public Areas located in the entry area, prior to entry into restricted access zones
Shared support areas should be easily accessible from the Units served.
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Part B: Health Facility Briefing & Design Maternity Unit
In this model the postnatal inpatient unit and Birthing unit are located in close proximity with
controlled access and entry from the public access areas. General Care Nursery is incorporated
into the postnatal Inpatient Unit for maximum convenience of mothers.
Special Care Nursery is collocated with NICU and located separately to the Maternity Unit.
The advantage of this arrangement of neonatal care is that sick/ critical babies and specialist
neonatal trained staff are concentrated in one area. A disadvantage is that the location may be
less convenient for mothers who require frequent access for feeding and nursing sick babies.
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In the model above the postnatal inpatient unit is a standard configuration located in close
relationship with Birthing Unit. The general care and special care nurseries are located together,
separate from the inpatient unit.
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The fully integrated model provides for all components of Maternity unit located in close
juxtaposition. The General Care Nursery, Special Care Nursery, NICU are accessible from the
postnatal inpatient unit with close access to the Birthing Unit. Access to NICU is also available via
a staff/ service corridor for admissions directly from Birthing or Emergency Units.
The main advantage of this model is maximum convenience for patients and staff, where neonatal
care is clustered in one area better utilising specially trained staff.
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3 Design
Postnatal accommodation will generally include a combination of single and 2 Bed rooms and may
include communal areas where mothers can gather to socialise or attend educational sessions.
Nursery areas, Feeding Room and Formula rooms should be readily accessible to mothers in
postnatal accommodation.
Birthing Unit accommodation is addressed in the separate Birthing Unit FPU in these Guidelines.
Environmental Considerations
Acoustics
Inpatient Areas
Inpatient accommodation should be designed to minimise the ambient noise level within the unit
and transmission of sound between patient areas, staff areas and public areas. Consideration
should be given to the location of noisy areas or activity, preferably placing them away from quiet
areas including patient bedrooms. Acoustic treatment will be required to the following:
Patient bedrooms
Interview and Meeting rooms
Treatment rooms
Staff rooms
Toilets and Showers.
Nursery Areas
Sound levels within Nursery areas should be minimised to prevent harm and stress to newborn
and sick babies. Noise may be generated from air-conditioning, telephones, paging systems,
emergency call system, water sources such as taps to sinks and basins, monitors and alarms.
Sound levels for all services installed within the Nursery areas, particularly Special Care nurseries,
should be controllable to provide minimal noise intrusion, ideally less than 40 dB.
Within the nursery, sound absorption and insulation techniques should be applied to soften the
noise created by crying babies and their support equipment. This however should not reduce the
observation of babies or the access between staff and support areas.
Natural light should be available in Nursery areas. External windows will require shading and
babies must be positioned away from windows to prevent excessive light and radiant heat gain.
Artificial lighting must be colour corrected to allow staff to observe natural skin tones and
dimmable for night lighting.
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varying degrees of visibility and privacy. The patient acuity including high dependency or
intermediate care will be a major influence.
Interior Décor
Interior decor includes furnishings, style, colour, textures and ambience, influenced by perception
and culture. The décor of the Unit should be of a standard that meets the expectations of the
clients using the services and make every effort to reduce an institutional atmosphere.
Patient treatment and reception areas should be open and inviting with décor that is domestic and
casual rather than institutional. Access to outdoor areas is desirable.
Minimum dimensions, excluding such items as Ensuites, built-in robes, alcoves, entrance lobbies
and floor mounted mechanical equipment are similar to general Inpatient Units as follows:
Minimum room dimensions are based on overall bed dimensions (buffer to buffer) of 2250 mm
long x 1050 mm wide. Minor encroachments including columns and hand basins that do not
interfere with functions may be ignored when determining space requirements.
In multiple-bed rooms, the minimum distance between bed centre lines shall be 2400 mm.
Accessibility
Design should provide ease of access for wheelchair bound patients in all patient areas including
Lounge rooms and Nurseries. Waiting areas should include spaces for wheelchairs. Within the
inpatient accommodation one Bedroom and Ensuite should be provided with full accessibility
compliance; the quantity of accessible rooms to be determined by the service plan. Accessible
Bedrooms and Ensuites should enable normal activity for wheelchair dependant patients.
Doors
Doors used for emergency bed transfers within the Unit or to the Birthing or Operating Units must
be appropriately positioned and sized. A minimum of 1400mm clear opening is recommended for
doors requiring bed/trolley access. Also refer to Part C - Access, Mobility and OH&S of these
Guidelines.
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Ergonomics/ OH&S
Design of clinical spaces including Bed Rooms, Treatment rooms, Feeding Rooms, Formula
Rooms, Nurseries and Lounge areas must consider Ergonomics and OH&S issues for patient,
visitor and staff welfare.
Refer to Part C - Access, Mobility and OH&S of these Guidelines for more information.
The number of cots in the Nursery areas will be determined by the service plan dependent on the
number of beds in the Maternity inpatient areas and number of Birthing Rooms, expected numbers
of births and expected numbers of complicated deliveries resulting in babies requiring special or
intensive care.
The number of cots in a newborn Nursery should not exceed 16 cots. Where the operational
policy of the Maternity Unit includes rooming in of babies with mothers, then the number of cots in
a general care nursery should accommodate the expected number of babies that are not rooming
in with the mother.
The arrangement of spaces and zones shall offer a high standard of security through the control
over access and egress from the Unit, the provision of optimum observation for staff and grouping
of like functions into zones.
All Maternity Unit areas including inpatient areas, Nurseries and Birthing Unit must have restricted
access, and appropriate staff identification systems. Maternity Units are increasingly adopting a
baby tagging system. This involves a combination of the infant wearing a tag around the ankle
and sensor panels located at every access point to the unit (and perhaps the entire hospital or
facility).
Maternity Unit design should endeavour to limit the access and egress points to one, supervised
by staff with additional security measures including:
electronic access and egress
monitoring of all perimeter doors
CCTV monitoring of entries and exits
Duress alarms to all reception areas and staff stations in obscure but easily accessible
locations.
It is also important that the security systems installed do not interfere with emergency response
and transfer of patients and newborns for critical incidents.
Drug Storage
All components of the Maternity Unit will include lockable drug storage within the Clean Utility or
Medication room/s. Refer to Standard Components Clean Utility/ Medication and Store-Drugs
Data Sheets and Room Layout Sheets for further details.
Note: Storage for dangerous drugs must be in accordance with the relevant legislation.
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Milk Storage
To ensure the correct milk is provided to the right infant, breast milk storage freezers and fridges
should be lockable or located within a lockable formula room with access restricted to staff only or
to mothers under staff supervision.
Finishes
Finishes including fabrics, floor, wall and ceiling finishes, should be relaxing and non-institutional
as far as possible. The following additional factors should be considered in the selection of
finishes:
Acoustic properties
Durability
Ease of cleaning
Infection control
Fire safety
Movement of equipment.
As clinical observation of patients and neonates is essential, colours should be chosen carefully to
avoid an adverse impact on the skin colour, particularly for cyanosis and jaundiced babies.
Refer to Part C - Access, Mobility and OH&S of these Guidelines for more information on wall
protection, floor finishes and ceiling finishes.
Feeding areas will require privacy screening with sufficient space to allow a staff member to assist
the mother.
Curtains / Blinds
Each Bed Room and the Nursery areas shall have partial blackout facilities (blinds or lined
curtains) to allow patients and babies to rest during the daytime.
For specific information on fittings, fixtures and equipment typically included in the Unit refer to
Part C - Access, Mobility and OH&S of these Guidelines, the Room Layout Sheets (RLS) and
Room Data Sheets (RDS).
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Videoconferencing requirements
Communications rooms and server requirements.
The individual call buttons shall alert to an annunciator system. Annunciator panels should be
located in strategic points within the circulation area, particularly in Staff Stations, Staff Rooms,
and Meeting Rooms, and should be of the “non-scrolling” type, allowing all calls to be displayed at
the same time. The audible signal of these call systems should be controllable to ensure minimal
disturbance to patients and babies. The alert to staff members shall be done in a discreet manner
at all times.
To ensure confidentiality and reduce noise the ventilation ductwork should minimise transmission
of sounds throughout the Unit, particularly nursery areas.
Medical Gases
Reticulated oxygen, medical air and suction will be required to each Inpatient room and Nurseries
in accordance with Standard Components and guidelines for installation.
Hydraulics
Warm water supplied to all areas accessed by patients within the Maternity Unit and Nursery
areas must not exceed 43 degrees Celsius. This requirement includes all staff handwash basins
and sinks located within patient accessible and Nursery areas.
Infection Control
Hand Basins
Hand-washing facilities in corridors shall not impact on minimum clear corridor widths. In the
Maternity Unit at least one clinical handwashing basin is to be conveniently accessible to the Staff
Station and one should be located at the entry and exit to the Unit.
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Each nursery should have a hand basin at the point of entry for staff and parents. Within the
nursery, a minimum 1 hand basin, Type B should be provided per 4 cots in general care nurseries
and Type A, 1 per 2 cots in special care and intensive care nurseries; the distance between any
point in the nursery to the closest basin should not exceed 6 metres.
Handbasins are to comply with Standard Components - Bay - Hand-washing, Type A, B and Part
D - Infection Control in these Guidelines.
Isolation Rooms
At least one 'Class S - Standard' Isolation Room shall be provided for each Inpatient Unit.
The need for Negative Pressure Isolation rooms is to be evaluated by an infection control risk
assessment and will reflect the requirements of the Service Plan.
Negative Pressure and Standard Pressure Isolation cot spaces may be required according to the
Service Plan.
Standard Components
The Maternity Unit Inpatient accommodation will consist of Standard Components to comply with
details described in these Guidelines. Refer to Standard Components Room Data Sheets and
Room Layout Sheets nominated in the Schedules of Accommodation.
Non-Standard Components
Non Standard rooms are identified in the Schedules of Accommodation as NS and are described
below.
Bathing/ Examination
The Bathing / Examination area will be used for baby bathing, baby examinations, weighing and
baby bathing demonstrations for parents. The area may be located within or adjacent to the
neonatal general care or special care nursery. The Bathing/ Examination area will include a
bench with a baby examination area and baby weighing scales and a sink for baby bathing.
Storage will be required for clean baby linen, towels and dirty baby linen. A staff handwashing
basin should be located within easily access.
Requirements include:
The bay should not impede access within staff station areas
Racks should be provided for pneumatic tube canisters
Wall protection should be installed to prevent wall damage from canisters.
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The quantity of Negative Pressure or Positive Pressure Isolation rooms will be dependent on the
service plan for the unit.
The Lounge should be located with convenient access to the NICU inpatient area. The Lounge
will include:
Comfortable seating
Dining table and chairs
Kitchenette with facilities for preparing drinks and food reheating, (cooking facilities are not
included)
Television and telephone
An external outlook is essential. Acoustic treatment should be provided to minimise noise transfer
to adjacent areas.
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5 Schedule of Accommodation
The Schedule of Accommodation for a 25 bed Maternity Inpatient Unit at all RDL levels follows. Quantities and sizes of some spaces will need to be determined in
response to the service needs on a case by case basis.
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Note 1: Offices to be provided according to the number of approved full time positions within the Unit
Please also note the following:
Areas noted in Schedules of Accommodation take precedence over all other areas noted in the FPU.
Rooms indicated in the schedule reflect the typical arrangement according to the Role Delineation.
Exact requirements for room quantities and sizes will reflect Key Planning Units identified in the Service Plan and the Operational Policies of the Unit.
Room sizes indicated should be viewed as a minimum requirement; variations are acceptable to reflect the needs of individual Unit.
Staff and support rooms may be shared between Functional Planning Units dependent on location and accessibility to each unit and may provide scope to reduce duplication of
facilities.
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6 Future Trends
When planning for future developments the following trends should be considered:
Increased prevalence of obesity in society requiring bariatric facilities
Steep rise in caesarean births may result in more high dependency postnatal
accommodation
Increasing numbers of multiple births
Increasing numbers of pre-term deliveries and survival of pre-term babies
Demand for midwife led care throughout the pregnancy, birth and post-natal period
Expectation by families/carers that patient rooms can accommodate partners and family to
stay with the mother
Patient demand for control over heating, lighting and visitor access
Early discharge into community support programs
Ongoing development in electronic medical records and information technology
Infant and facility security systems developments.
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The International Health Facility Guidelines recommends the
use of HFBS “Health Facility Briefing System” to edit all
room data sheet information for your project.