CAPITOL MEDICAL CENTER, INC.

Quezon Avenue Corner, Scout Magbanua

Brgy. Paligsahan, Quezon City, Philippines
Tel No. 372-3825 loc. 4259

CMC – DMO – MEMO 2020 – 11

Date : April 23, 2020

To : Chairmen of Clinical Departments, Heads of Ancillary Units,

Infection Control Committee and MSO President.

From : LILIA P. LUNA, MD, FPOGS

Medical Director

Subject : Guidelines on Out-Patient Consultations

Please be informed that upon lifting of the EXTENDED COMMUNITY QUARANTINE, the following
guidelines on patient consultations will be implemented.
As per advise of Mr. Rhais Gamboa, we will have a point person to monitor thru a timeline relevant
activities and accomplishments per timeline. He also suggests that we do simulation of these
guidelines 2-3 days prior to start of OC. If clinics will open by May 4, 2020, we can do simulation
activities on April 29 and 30.

We request the submission to Lynard Longcop your NAMES, SECRETARY"S NAME, CLINIC ROOM
NUMBER in CM2 or CMC 5 AND OFFICE HOURS.

Let us all put our collective efforts in ensuring that these guidelines will be followed.

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 CAPITOL MEDICAL CENTER (April 22, 2020 version)

Phase 1: Recommended Guidelines on Resumption of OPD Services

(after the lifting of ECQ)

OPD TASK FORCE: Drs. Edna Mallorca, Shierly Del Rosario, Jet Conjares, Ben Felipe

Before starting OPD: Clinic preparation (during and after ECQ has been lifted)

Person responsible: Individual MDs

1. Modification of clinic layout withguidance of CMC hospital architect and/or relevant

WHO, CDC, DOH recommendation regarding minimizing exposure and infection
control:
a. Re-arrangement of office furniture like MD and secretary’s table, as well as
the patient’s seat, in compliance with rules on adequate distancing and a
unidirectional flow to help in foot traffic inside the clinic
b. Checking for strategic location of open windows to comply with a
unidirectional air flow. This takes into consideration the entry of fresh air with
opening of windows (if possible) or air conditioning units for appropriate
ventilation and exhaust fans (exit of clinic air to outdoor)

DIRECTION OF AIRFLOW: MD---patient—exhaust or outside

c. Installation of a room air purifying system (e.g. portable HEPA Sqair devices)
– optional
d. Adequate physical distancing of patient and companion inside the clinic of at
least 6 feet between people inside the clinic
e. Placement of alcohol/sanitizing agent dispenser in the clinic and in the
waiting area
f. Installation of physical barriers (e.g. acrylic shields on desktop) – optional
g. Placement of sodium hypochlorite foot baths(Sterimat brand) at clinic door--
optional

2. Acquisition of PPE for doctors and secretaries with minimum PPE recommendation of
surgical/n95 mask, goggles, face shields, and gloves

a. Body PPE such as reusable coveralls/hazmats or isolation gowns are

optional and depends on the risk of activities inside the clinic (if used, they
should be properly disinfected before next use)
b. CMC to provide adequate supply chain for PPE needs

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3. Relevant orientation of medical secretaries regarding infection control measures:

a. Proper use of PPE, e.g. fit testing for n95 masks. donning, and doffing of
body PPE
b. No touching of face
c. Frequent handwashing with soap and water and/or alcohol-based sanitizing
agents between patients and procedures
d. Scheduling and spacing of patients
e. Proper dusting, surface disinfection with sodium hypochlorite solution
f. Use of sealed plastic sandwich bags for receiving cash to be opened after 72
hours.
g. Use of folders to receive HMO LOA from patients to be opened and signed
after 72 hours.
h. Hand sanitizing of patient’s hands after LOA has been handed and before
seeing the doctor

4. For individual MDs

a. All consults will be on an appointment basis either thru the doctor/own

secretary/OPD hotline/telemedicine routes. This is to minimize traffic inside
the building.
b. Maximum of 12 patients per day per doctor to allow 15 min consultation per
patient (total of 3 hours per clinic time) with strictly 1 companion per patient.
Strictly no mask no entry.
c. Official Outpatient Consultation Hours would be from 9am to 4pm divided
into the 9-12nn AM Shift and 1-4pm PM Shift. There will be a time allowance
of 8-9am for clinic preparation and 4-5pm for clinic closing. Doors will be
closed by 5pm for maintenance and disinfection.
d. Each clinic will be allowed only one doctor in the morning and one in the
afternoon to be arranged in conjunction with cohorting guidelines below.

e. To be able to cohort and maintain physical distance between patients,

· OB and Pedia will hold clinics preferably on T-Th-S

· It is recommended that well checkups such as prenatal, well baby

check-ups, post confinement follow-ups be done on separate days
from sick check-ups.
·

· Internal Medicine and Surgery on M-W- F

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 HIGH RISK PATIENTS (>age 50, with co-morbids like DM,
malignancy, on chemo) to be seen in the afternoon only. Doctors need
to adjust with co-clinic occupants, OR

PULMO patients in the afternoon. NON-PULMO patients in the

morning.

f. MDs’ secretaries will set an appointment for all patients. Patients and their
companion will be pre-screened by MDs/secretaries at least a day before
regarding exposure and signs and symptoms of COVID. The list of patients
to be seen for the day will be coordinated with the Triage. Upon entry, the
patient will be screened by the Triage (thermal scan and history-taking). All
patients who develop symptoms after initial screening by the secretaries will
be diverted to the ER. ALL WILL BE INSTRUCTED TO WEAR MASKS.
g. Patients are instructed to come 15 minutes before the appointment to avoid
crowding at the corridors. If a patient arrives earlier, they will be advised to
stay in their car or to be back exactly at the appointed time. Patients are to
be discouraged from hanging out at the entrance of the building to wait.
h. Disinfection with sodium hypochlorite (1:10 solution) of frequently touched
surfaces is done at least every hour, and more intensive cleaning such as
the floor and tabletops after each clinic schedule by the medical secretary or
privately contracted CMC cleaner. Cleaning of each patient chair should be
done after each session. It is highly advised to have only one visitor chair
prepared for only the patient.

5. For CMC

a. Provision of at least 2-3 personnel with separate tables at the Triage area
located at CMC entrance and separate from the ER Triage
b. To smoothen entry of the MD’s, a fast lane and Pass Card is requested.
Pass Cards give the MD easier access into the building and not line up with
patients. The card will be granted and renewed on a weekly basis after
thorough interview by the Triage who will log in their temperature after a
thermal scan, during each entry.
c. Strict enforcement of the NO MASK NO ENTRY guideline.
d. Installation of multiple alcohol dispensers at the entrance/triage table, waiting
area and corridors and doctor’s offices, all with accompanying
posters/instructions for proper Hand Hygiene.
e. Placement and maintenance of sodium hypochlorite foot baths/Sterimats at
the different entrances and/or corridors in the MAB and 10th/11th floors

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 f. Provisions for a well-ventilated (preferably with entry of fresh air) waiting area
for MAB and 10th /11th floors with properly spaced seating and cohorting
g. Provisions for Triage Checklist Forms for both patient and companion,
individually filled and signed and collected then to be given at the end of shift
to the ICN. Appropriate stickers or wristband (good for 1 day) to be placed on
cleared patients and companions as a visible control measure inside CMC.
h. Roving guards to make sure all non-CMC people inside possess the control
sticker or wristband for the day and not linger inside CMC longer than
necessary.

6. For HMO

a. Initial approval of HMO will be at the Triage area. After consultation, approval
for laboratory and radiology requests may be done at the Central Station
(Lobby)
b. Walk-in patients may be accepted 1 week after the test-run of OPD Phase 1
depending upon the continuing evaluation of the process.

Since Covid 19 is here to stay, we are anticipating that CMC Administration in

cooperation with its Medical Community will thrust their efforts into making our hospital a
Bi-hospital that can be prepared for both Covid and Non-covid patients, who can safely,
confidently, harmoniously and effectively use the hospital facilities with no fear of infection.

Respectfully.

CMC OPD Task Force Group:

Jesse Noel V. Conjares, MD Shierly May D. Del Rosario, MD

Benjamin Felipe, MD Edna S. Mallorca, MD