Order of the Ministry of Health of the USSR of September 23, 1981 No. 1000 "On measures to improve the organization of the work of outpatient clinics"
Order of the Ministry of Health of the USSR dated July 12, 1989 No. 408 "On strengthening measures to reduce the incidence of viral hepatitis in the country"
Order of the Ministry of Health of the USSR dated March 23, 0978 No. 288 "On approval of the instructions on the sanitary and anti-epidemic regime of the hospital"
Order of the Ministry of Health of the Republic of Belarus dated February 2, 1996 No. 60-D "On conducting a medical examination for HIV (AIDS)"
Order of the Ministry of Health of the Russian Federation of August 16, 1994 No. 170 "On measures to improve the prevention and treatment of HIV-infected patients in the Russian Federation"
Order of the Ministry of Health of the Republic of Belarus dated September 12, 2003 No. 585-D “On streamlining the examination for HIV infection”
Order of the Ministry of Health of the Russian Federation dated May 16, 2003 No. 205 "On amendments and additions to the order of the Ministry of Health of the Russian Federation dated January 1, 1997 No. 330 "Use and prescription of narcotic drugs""
Order of the Ministry of Health of the USSR dated January 29, 1987 No. 149 "On additional measures to strengthen the fight against drug addiction"
Order of the Ministry of Health of the USSR dated 06/02/1987 No. 747 "Instructions for accounting for medicines and dressings in medical facilities"
Order of the Ministry of Health of the USSR of August 30, 1991 No. 245 "On the standards for the consumption of ethyl alcohol in health facilities"
Order of the Ministry of Health of the Russian Federation of November 26, 1998 No. 342 "On strengthening measures for the prevention of typhus and the fight against pediculosis"
Order of the Ministry of Health of the RSFSR of December 19, 1994 No. 286 "On the procedure for admission to the implementation professional activity"
Order of the Ministry of Health of the Republic of Belarus dated December 20, 1996 No. 534-D "On measures for the development of medical prevention in the Republic of Belarus"
Order of the Ministry of Health of the Russian Federation of September 23, 2003 No. 455 "On improving the activities of health authorities and institutions for the prevention of diseases in the Russian Federation"
Order No. 36 of the Ministry of Health of the Russian Federation of February 30, 1997 "On improving measures for the prevention of diphtheria"
Order No. 475 of the Ministry of Health of the USSR of August 16, 1989 "On measures to further improve the prevention of acute intestinal infections in the country"
Order of the Ministry of Health of the Russian Federation of March 21, 2003 No. 109 "On the improvement of anti-tuberculosis measures in the Russian Federation"
Order of the Ministry of Health of the Russian Federation of March 14, 1996 No. 90 "On the procedure for conducting preliminary and periodic medical examinations"
Order of the Ministry of Health of the USSR dated May 30, 1986 No. 770 "On the procedure for conducting a general medical examination" (as amended on September 12, 1997)
Order of the Ministry of Health of the USSR dated June 10, 1985 No. 770 OST 42-21-2-85 "Methods, means, pre-sterilization cleaning regime, sterilization and disinfection medical devices"
Order of the Ministry of Health of the USSR dated July 31, 1978 No. 720 "On improving medical care patients with purulent-surgical diseases and strengthening measures to combat nosocomial infections"
Order of the Ministry of Health of the Republic of Belarus dated 06.02.1995 No. 105-D "On measures to reduce hepatitis and immunoprophylaxis against hepatitis B".
Order of the Ministry of Health of the Republic of Belarus dated 04.12.98 No. 740-D "On the organization of a hospital for replacing technologies (the introduction of a "hospital at home")"
Order of the Ministry of Health of the Russian Federation of May 23, 1995 No. 131 "Regulations on the certification of paramedical workers"
Order of the Ministry of Health of the Russian Federation of January 27, 1998 No. 25 "On strengthening measures to prevent influenza and other acute respiratory infections"
Order of the Ministry of Health of the Russian Federation of June 27, 2001 No. 229 "On the national calendar of preventive vaccinations and the vaccination schedule for epidemiological indications"
Order of the Ministry of Health of the Republic of Belarus dated 1996 No. 535-D "On strengthening measures to reduce the incidence of tick-borne encephalitis in the Republic of Belarus"
Order No. 675-U of the Ministry of Health of the Russian Federation of August 25, 1998 "On additional measures for the prevention of measles and whooping cough"
Order of the Ministry of Health of the Russian Federation of March 21, 2003 No. 117 "On the elimination of measles in the Russian Federation by 2010"
Order of the Ministry of Health of the Russian Federation of October 26, 1999 No. 386 "On additional measures for the prevention of mumps and measles"
Federal Law of the Russian Federation "On Compulsory Medical Insurance of Citizens of the Russian Federation" dated June 28, 1991 No.
Order of the Ministry of Health of the Republic of Belarus dated 09.12.2004 No. 916-D "On the introduction of new forms accounting documentation in primary health care facilities."
Order of the Ministry of Health and social development RF dated November 22, 2004 No. 255 "On the procedure for providing primary health care citizens who are eligible to receive social services"
Order of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004 No. 256 "On the procedure for medical selection and referral of patients for san-resort treatment"
Order of the Ministry of Health and Social Development of the Russian Federation of April 11, 2005 No. 273 "On the aftercare (rehabilitation) of patients in a sanatorium"
SanPiN 3.1.5.2826 - 10 "Prevention of HIV infection"
SanPiN 2.1.3.2630 - 10 "Sanitary - epidemiological requirements to the treatment of medical waste"
Order of the Ministry of Health of the Russian Federation of November 20, 2002 No. 350 "On the improvement of outpatient care for the population."
Organization of the work of a nurse in a urological office
To fulfill my functional duties, I am guided by orders No. 1000 of September 23, 1981 "On measures to improve the organization of the work of outpatient clinics" and according to Appendix No. 47 to this order "On functional duties nurses."
The nurse works under the guidance of a urologist, chief and senior nurse of the polyclinic.
The outpatient work of a nurse in a urological office is as follows:
Workplace preparation.
Daily polyclinic reception of urological patients with a doctor, fulfillment of doctor's prescriptions.
Care of urological patients at home.
Working with a dispensary group of patients, where Special attention given to the disabled and veterans of the Great Patriotic War.
Preparation and participation in carrying out planned manipulations.
Daily bandaging of urological patients.
Preparation of dressing material for sterilization.
Sanitary and educational work.
Preparation for work of urological instruments.
Providing emergency assistance.
Invitation of D-patients for examination.
Work with outpatient cards.
Reception work
Before the start of the appointment, I prepare the office for work: I prepare forms for referrals, outpatient cards, and paste the test results into outpatient cards.
During the reception, I keep a register of admitted patients, record manipulations, fill out statistical coupons. In addition, I keep a log of the movement of dispensary patients, a log of hospitalization, a log of referrals for a consultation at the ROD, a log of sanitary and educational work. I write out referrals for examinations, consultations, hospitalizations.
I write down the manipulations in the manipulation journal, measure the temperature, examine for pediculosis, scabies, fill out the medical examination sheet in the outpatient card.
First of all, patients with acute urological diseases, patients with high fever, disabled people and participants in the Second World War, pregnant women are invited to the reception.
Cabinet equipment
The urology office has everything necessary equipment for receiving patients:
Germicidal lamps No. 2.
Sterile table No. 1.
Couch for examining patients.
Doctor's table with accessories for cystoscopy No. 2.
Medical cabinets for solutions and dressings.
Bixes, containers and containers for solutions.
Rack for containers.
Tanks for collecting class A and class B waste.
In the manipulation room, there are two sinks (for hands, for tools) with an elbow tap.
Tightly closed curbstones for solutions.
Gynecological chair.
Sanio air sterilizer.
Ultraviolet chamber for storage of sterile instruments "UFK 3".
Refrigerator single-chamber (sviyaga).
In intensive care units, as well as in the operating room, I strictly observe sanitary and epidemiological and hygienic conditions.
Sanitary-anti-epidemiological and hygienic regimes are a whole complex of organizational, sanitary-hygienic and anti-epidemic measures that prevent the occurrence of nosocomial infection (HAI), purulent-septic processes, viral hepatitis and others. infectious diseases, as well as measures aimed at preventing injuries, and, accordingly, the possible infection of medical workers (based on the system for recording and recording injuries and emergencies associated with blood). To carry out preventive measures in case of an emergency, the treatment room has an emergency first aid kit, which includes:
Ø Alcohol 70%-100.0 ml.,
Ø Iodine solution 5%.
Ø Bactericidal plaster.
Ø Dressing material.
Ø Fingertips.
Ø Sterile distilled water.
Ø Tanks for pointing solutions.
Ø Disposable syringes (pipettes).
Actions medical worker in an emergency:
Ø in case of cuts and punctures immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% alcohol solution of iodine;
Ø in contact with blood or other biological fluids on the skin this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;
Ø when blood and other biological fluids of the patient get on the mucous membrane of the eyes, nose and mouth: rinse the mouth with plenty of water and rinse with 70% ethyl alcohol solution , the mucous membrane of the nose and eyes are washed with plenty of water (do not rub);
Ø when blood and other biological fluids of the patient get on the dressing gown, clothes: remove work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving;
Ø get started as soon as possible antiretroviral drugs for post-exposure prophylaxis of HIV infection.
Every Monday in our department general cleaning is carried out:
Daily routine cleaning is carried out twice a day.
After the transfer of the patient, all care items are processed: a tray, a vessel, bottles from under the drains. Processing of beds, mattresses, bedside tables, stools, oilcloths.
I disinfect used syringes, needles, systems in 2%
solution "Nick-Police" exposure 15 minutes. Stitching and cutting objects after processing are disposed of in a separate container;
I carry out disinfection and pre-sterilization treatment
instrumentation solution "Nika-Politsid" 2% exposure 15 minutes;
I carry out disinfection of anesthesia and respiratory equipment;
I carry out quartz treatment and ventilation of the wards;
I carry out a phenolphthalein and azopyram test for control
the quality of pre-sterilization cleaning of instruments with a record in the special. magazine.
Due to the high risk of occupational infection, in order to comply with the sanitary and epidemiological regime and safety regulations, we work in special clothing using a mask, gloves and goggles. modern technology hand treatment, all expendable materials disposable: this helps reduce the risk of developing nosocomial infections
In my work I am guided by the orders:
According to sanitary epidemiological mode:
1. Federal Law of March 30, 1999 No. 52-FZ “On the sanitary and epidemiological well-being of the population”.
2. Federal Law No. 157-FZ of September 17, 1998 “On Immunoprophylaxis of Infectious Diseases”.
3. Federal Law No. 38-FZ of March 30, 1995 “On Preventing the Spread of Disease Caused by the Human Immunodeficiency Virus (HIV) in the Russian Federation”.
4. Decree of the Government of the Russian Federation No. 825 dated July 15, 1999 “On approval of the list of works, the performance of which is associated with a high risk of contracting infectious diseases and requires mandatory preventive vaccinations”
5. SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations implementing medical activity»
6. SanPiN 2.1.7.2790-10 "Sanitary and epidemiological requirements for the management of medical waste"
9. SP 3.1.5.282-10 "Prevention of HIV infection"
10. SP 3.1.958-00 “Prevention of viral hepatitis. General requirements to the epidemiological surveillance of viral hepatitis.
11. SP 3.1.1.2341-08 "Prevention of viral hepatitis B".
12. SP 3.1.2.1108-02 "Diphtheria prevention".
13. SP 3.1.1.1117-02 "Prevention of acute intestinal infections".
14. SP 3.1.1.2137-06 "Prevention of typhoid fever and paratyphoid fever".
15. SP 3.1.1381-03 "Prevention of tetanus".
16. SP 3.1.1295-03 "Prevention of tuberculosis".
17. SP 3.1.2.1319-03 "Influenza Prevention".
18. SP 3.1.3.2352-08 "Prevention of tick-borne viral encephalitis".
19. Order of the Ministry of Health of the USSR dated March 23, 1976 No. 288 “On approval of the instructions on the sanitary and anti-epidemic regime of hospitals”.
20. Order of the Ministry of Health of the USSR dated April 14, 1979 No. 215 “On measures to improve the organization and improve the quality of specialized medical care for patients with purulent surgical diseases”.
21. Order of the Ministry of Health of the Russian Federation dated August 16, 1994 No. 170 “On measures to improve the prevention and treatment of HIV infection in the Russian Federation”.
22. Order of the Ministry of Health of the Russian Federation of September 30, 1995 No. 295 “On the Enactment of the Rules for Mandatory Medical Examination for HIV and the List of Employees individual professions, industries, enterprises, institutions and organizations that undergo a mandatory medical examination for HIV”
23. OST 42-21-2-85 "Sterilization and disinfection of products medical purpose(Methods, means and modes)”, approved by the Order of the Ministry of Health of the USSR dated 10.06.85 No. 770.
24. Order of the Ministry of Health of the Russian Federation of March 21, 2003 No. 109 “On the improvement of anti-tuberculosis measures in the Russian Federation”.
25. Order of the Ministry of Health of the USSR dated 16.08.89. No. 475 "On measures to further improve the prevention of AII incidence in the country."
26. Order of the Ministry of Health of the USSR dated July 12, 1989 No. 408 “On measures to reduce the incidence of viral hepatitis in the country”.
27. Order of the Ministry of Health of the Russian Federation dated November 26, 1998 No. 342 “On strengthening measures for the prevention of epidemic typhus and the fight against pediculosis”.
28. Order of the Ministry of Health of the Russian Federation dated April 24, 2003 No. 162 “On approval of industry standards. Patient management protocol. Scabies"
29. Order of the Ministry of Health and Social Development of the Russian Federation of April 12, 2011 No. 302n “On Approval of Lists of Harmful and (or) Dangerous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations (examinations) of employees employed in hard work and at work with harmful and (or) hazardous conditions labor"
30. MU 3.1.2313-08 "Requirements for the disinfection, destruction and disposal of single-use injection syringes."
31. MU - 287-113 of December 30, 1998 "On disinfection, pre-sterilization cleaning and sterilization of medical devices"
32. Guidelines R.3.5.1904-04 "Use of ultraviolet germicidal radiation for disinfection of indoor air and surfaces".
33. Instructions for the use of disinfectants used in the work.
The work of the surgical department uses a fairly large amount of narcotic drugs used to relieve pain in patients in the postoperative period. In my work, I use normative documents:
Ø Order of the Ministry of Health of the Russian Federation No. 330 dated 11/12/1997. “On measures to improve the storage, prescribing and use of narcotic medicines and psychotropic substances”;
Ø Order No. 1008n "on the invalidation of some annexes to order No. 330";
Ø FZ-No. 3 dated 08.01.98. " the federal law on narcotic drugs and psychotropic substances”;
Ø Decree of the Government of the Russian Federation of 06.08.98. No. 892 "on approval of the rules for the admission of persons to work with narcotic substances and psychotropic substances";
Ø order No. 785 "List of medicines subject to subject-quantitative accounting in pharmacies (organizations), organizations wholesale trade medicines, medical institutions and private practitioners”;
Ø order No. 703 "addition to order 785";
Ø order No. 127 of the Ministry of Health of the Russian Federation of 03.28.03. "on the approval of instructions for the destruction of narcotic drugs, psychotropic substances included in lists 2 and 3 of the list of narcotic drugs, psychotropic substances and their precursors, subject to control in the Russian Federation, the further use of which in medical practice is recognized as inappropriate";
Ø order No. 110 of the Ministry of Health of the Russian Federation dated 12.02.07. “On the procedure for prescribing and prescribing medicines, medical devices and specialized health food products”;
Ø order No. 747 "on approval" of the "instruction for accounting for medicines, dressings and medical products in medical and preventive health care institutions, consisting of the state. budget";
Ø Order of the Ministry of Health of the Russian Federation No. 245 dated 30.08.91. "On the norms of consumption of ethyl alcohol for healthcare institutions, education and social security»;
Ø order No. 109 dated 12.02.07. “On making changes to the procedure for dispensing medicines approved by Order No. 785”;
Ø order No. 706n "Rules for the storage of medicines";
Ø p.p. No. 1148 "Rules for the storage of narcotic drugs and psychotropic substances"
Ø Government Decree No. 681 dated June 30, 1998 “on approval of the list of narcotic drugs, psychotropic substances and their precursors subject to control in Russian Federation».
Ø Decree of June 9, 2010 N 419 on the provision of information on activities related to the circulation of precursors of narcotic drugs and psychotropic substances, and the registration of operations related to their circulation
Ø By Decree of the Government of the Russian Federation of December 29, 2007 N 964, a list of potent substances for the purposes of Article 234 and other articles of the Criminal Code of the Russian Federation
All documents related to the circulation of narcotic drugs, psychotropic substances and their precursors, poisonous and potent substances must be filled out with the utmost care, corrections are not allowed.
has not entered into force Edition from 15.11.2012
| Document name | ORDER of the Ministry of Health of the Russian Federation of November 15, 2012 N 922n "ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE TO ADULTS IN THE PROFILE "SURGERY" |
| Type of document | order, order, rules, standard |
| Host body | Ministry of Health of the Russian Federation |
| Document Number | 922N |
| Acceptance date | 01.01.1970 |
| Revision date | 15.11.2012 |
| Registration number in the Ministry of Justice | 28161 |
| Date of registration in the Ministry of Justice | 17.04.2013 |
| Status | has not entered into force |
| Publication |
|
| Navigator | Notes |
ORDER of the Ministry of Health of the Russian Federation of November 15, 2012 N 922n "ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE TO ADULTS IN THE PROFILE "SURGERY"
Appendix 7
1. These Rules establish the procedure for organizing the activities of the surgical department, which is a structural unit medical organization.
2. The surgical department of a medical organization (hereinafter referred to as the Department) is created as structural subdivision medical organization.
3. The department is headed by the head, appointed to the position and dismissed from the post by the head of the medical organization, in which the Department was created.
4. A specialist who meets the Qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by order of the Ministry of Health and Social Development of the Russian Federation dated July 7, 2009 N 415n, is appointed to the position of head of the Department and surgeon, in the specialty "surgery".
5. The structure and staffing of the Department are approved by the head of the medical organization in which the department was created, and are determined based on the volume of ongoing medical and diagnostic work and bed capacity, taking into account the recommended staff standards, provided for in Appendix N 8 to the Procedure for the provision of medical care to the population in the profile "surgery", approved by this order.
6. The equipment of the Department is carried out in accordance with the equipment standard provided for in Appendix No. 9 to the Procedure for the provision of medical care to the population in the field of "surgery", approved by this order.
examination room;
doctor's office;
wards for patients, including single rooms (isolator);
operating room or operating room;
dressing room;
dressing room (for purulent wounds);
procedural;
dressing (gypsum);
manager's office.
Zakonbase: In electronic document the numbering of paragraphs corresponds to the official source.
sisterly;
office of the head nurse;
storage room for medical equipment;
Room of the hostess;
buffet and distributing;
dining room
Room for collecting dirty linen;
shower room and toilet for medical workers;
showers and toilets for patients;
room for sanitation;
sanitary room.
8. The main functions of the Department are:
provision of specialized, including high-tech, medical care by performing operations using surgical (including microsurgical) methods based on medical care standards;
preparation and implementation of diagnostic procedures in stationary conditions;
Development and implementation in clinical practice modern methods diagnosis, treatment, rehabilitation and prevention of diseases and conditions requiring surgical treatment;
development and implementation of new medical technologies related to the treatment of patients with diseases in the profile of "surgery";
development and implementation of measures aimed at improving the quality of diagnostic and treatment work in the Department of Surgery;
Implementation of rehabilitation of patients with diseases on the profile of "surgery" in stationary conditions;
carrying out examination of temporary incapacity for work;
Providing advice to medical specialists from other departments of a medical organization on the prevention, diagnosis and treatment of diseases and pathological conditions requiring surgical treatment;
maintaining accounting and reporting documentation, providing in due course reports on the activities of the Branch, the maintenance of which is provided for by the legislation of the Russian Federation.
9. The Department, in order to ensure its activities, uses the capabilities of the medical diagnostic and auxiliary units of the medical organization, within which the Department is organized.
10. The department can be used as a clinical base for medical educational organizations secondary, higher and additional vocational education and scientific organizations.
Appendix No. 8
to the Procedure for the provision of medical
assistance to the adult population on the profile
"surgery", approved by order
Ministry of Health
Russian Federation
dated November 15, 2012 N 922н
The nurse, in addition to performing medical work and caring for the sick, maintains medical records.
1. Journal, or notebook appointments.
2. Journal of reception and transfer of duty.
3. A sheet of records of the movement of patients and hospital beds.
5. Register of medicines of list A and B.
6. Summary of the condition of the patients of the help desk.
7. Journal of accounting for expensive and acutely scarce drugs.
8. Journal of dressings.
9. Journal of copying materials and alcohol.
10. Journal of disinfection treatment of instruments.
I. Journal of pre-sterilization treatment of instruments.
12. Journal of general cleaning.
13. Journal of quartzization.
14. Register of post-injection complications. In addition, she must be able to fill out a statistical coupon (form No. 30).
15. Journal of emergency tetanus prophylaxis.
Journal or appointment book. The nurse prescribes the prescribed drugs, as well as the studies that need to be performed by the patient, in the prescription book, which indicates the full name. patient, room number, manipulations, injections, laboratory and instrumental studies. It duplicates the entry data in the appointment sheet. Be sure to put the dates and the signature of the nurse.
Journal of reception and transfer of duties. Most often, the transfer of duty is done in the morning, but it can also be done in the afternoon, if one nurse works in the first half of the day, and the second - in the second half of the day and at night. The nurses receiving and handing over the duty go around the wards, check the sanitary and hygienic regime, examine the seriously ill and sign in the register of reception and transfer of duty, which reflects the total number of patients in the department, the number of seriously ill and feverish patients, the movement of patients, urgent appointments, the state of medical equipment, items care, emergencies. The journal must have clear, legible signatures of the nurses who accepted and passed the duty.
The nurse on duty in the morning fills out the “Patient Movement Record Sheet” (form No. 007u).
The ward nurse, checking the list of appointments, makes a "portion" every day (if there is no dietary sister). The portioner should contain information about the number of different dietary tables and types of unloading and individual diets. For patients admitted in the evening or at night, the portioner is made up by the nurse on duty. Information from ward nurses on the number of diets is summarized by the head nurse of the department, they are signed by the head of the department, then transferred to the catering department.
Register of medicines of list A and B. Medicines included in list A and B are stored separately in a special cabinet (safe). On the inside of the safe there should be a list of these medicines. Drugs are usually stored in the same safe, but in a special compartment. The safe also stores extremely scarce and expensive funds. Handing over the keys to the safe is recorded in a special register. To account for the consumption of medicines stored in a safe, special journals are kept. All sheets in these magazines should be numbered, laced, and the free ends of the cord should be sealed on the last sheet of the magazine with a paper sheet indicating the number of pages. This sheet is stamped and signed by the head of the medical department. To account for the consumption of each drug from list A and list B, a separate sheet is allocated. This magazine is also kept in a safe. Annual records of drug consumption are maintained by the head nurse of the department. The nurse has the right to administer a narcotic analgesic only after the doctor records this appointment in the medical history and in his presence. About the injection made, a mark is made in the medical history and in the prescription sheet. Empty ampoules from under narcotic analgesics are not thrown away, but are transferred together with unused ampoules to a nurse starting the next duty. When transferring duty, they check the correspondence of entries in the accounting log (the number of used ampoules and the balance) with the actual number of filled used ampoules. When using the entire stock of narcotic analgesics, empty ampoules are handed over to the head nurse of the department and new ones are issued in return. Empty ampoules from narcotic analgesics are destroyed only by a special commission approved by the head of the medical department.
The journal of accounting for acutely scarce and expensive funds is compiled and maintained according to a similar scheme.
Summary of the status of patients for the reference table. This summary is compiled daily by the night nurse, most often early in the morning, before the shift. It contains the names of patients, the numbers of their wards, as well as their state of health.
The dressing journal indicates the date, types of dressings, the number of patients who received dressings, and also puts a daily signature.
The journal for writing off alcohol and dressings is located in surgical room or in the dressing room. This journal is numbered and laced, signed by the senior nurse and head of the department. To the attention of the nurse - the consumption of alcohol by order No. 245 of August 30, 1991.
Surgical office - 1200 g per 1 thousand people (1 person - 1.2 g of alcohol).
Oncology room - 1000 g per 1 thousand people (1 person - 1 g of alcohol).
Urologist's office - 1200 g per 1 thousand people (1 person - 1.2 g of alcohol). To apply a compress, 20-30 g of alcohol is required. Burn treatment - 20-40 g of alcohol.
Similarly, the consumption of cotton wool, bandages, furacilin is taken into account. Logs of disinfection treatment of instruments, pre-sterilization treatment of instruments are compiled and maintained to control the relevant activities (table).
Orders for work in the surgical room
Instruction on labor protection for a nurse at school. AGREED APPROVED. Chairman of the trade union director. Order. General provisions health and safety instructions for nurses. An employee hired by a school as a nurse must pass medical checkup, special training, introductory safety briefing, initial briefing for a nurse - at the workplace, re-briefing - at least once every 6 months, unscheduled (in case of changes in the working conditions of a nurse, safety violations, accidents).
Employees with a secondary medical education in their specialty are allowed to independently perform work. Persons who have studied the labor protection instructions for the school nurse, as well as the job description of the nurse at the school, are allowed to perform duties. The employee has the right to refuse the work entrusted to him if a situation has arisen that is dangerous for his personal health, or for the people who surround him, and the environment.
An employee is obliged to strictly comply with the requirements and internal regulations of a general educational institution: observe discipline; take care of equipment, tools, devices, medicines, materials and overalls; keep one's own clean workplace and territory; periodically undergo medical examinations. When performing the duties of a nurse at a school, exposure to harmful production factors is possible: electric shock when turning on electric lighting, using faulty electrical outlets; electric shock when working with a bactericidal quartz lamp, medical or other electrical equipment; violation of visual acuity in case of insufficient illumination of the workplace of a nurse; damage to the mucous membrane of the eyes due to failure to comply with the instructions and requirements for the use of bactericidal quartz lamps; injections, cuts in the provision of medical care to victims. It is forbidden to smoke and drink alcohol in the workplace. Fire safety regulations must be strictly observed. It is also necessary to observe the rules of personal hygiene: eat only in the dining room; perform work in perfectly clean overalls; when performing injections, use rubber gloves; one.
All employees of the department (office) are re-instructed at least as often as the knowledge of the personnel of the department (office) on safety measures according to the program. The results of the briefing are recorded in the appropriate journal, knowledge of this labor protection instruction for the nurse is checked. Maintaining the necessary sanitary and epidemiological regime in the surgical department is impossible without the following components They are contained in the RTM
The nurse is obliged to follow the instructions for labor protection in the medical office. The medical office of the institution must be equipped and equipped with tools in accordance with the approved list of equipment and tools for the medical office. For violation of the requirements of this instruction on labor protection for a nurse, a medical worker working at a school is held liable in accordance with the legislation of the Russian Federation. Occupational safety requirements for a nurse before starting work.
Before starting work in the medical office of the school, the nurse must put on clean overalls: a medical gown, a hat or scarf, a gauze bandage-mask. The overalls of the nurse must be clean and ironed, fastened with all buttons or tied.
Inspect the premises, make sure that the electric lighting in the medical and treatment rooms of the school is working. Ventilate the room of the medical office, treatment room. Check the integrity of electrical outlets and the serviceability of other electrical appliances. It is necessary to carefully check the availability of all medicines and the serviceability of medical equipment.
Before starting work, the nurse of the educational institution must thoroughly wash their hands with soap and water. Safety requirements during the work of a nurse. The school nurse is obliged to: Accurately and promptly follow the instructions of the doctor; be sensitive and attentive to sick children, monitor the personal hygiene of students; use equipment and tools professionally, accurately and carefully; Report all technical malfunctions to the director of the educational institution. It is forbidden for the school nurse to use medical equipment and devices not intended. To avoid injury and the occurrence of dangerous situations, the nurse must comply with the following requirements: do not leave switched on and operating equipment unattended; do not allow persons who have not undergone appropriate training to work with medical equipment; work only on serviceable medical equipment and serviceable tools; constantly monitor the expiration date of the drugs used; observe the rules of electrical safety and fire safety; do not perform work that is not part of your duties. Sterilize medical instruments only in specialized rooms (treatment room). When working with medical equipment, observe safety measures: do not connect to the electrical network and do not disconnect devices from it with wet and damp hands; do not violate the sequence of turning on and off the equipment, do not violate technological processes; strictly follow the instructions for using electrical appliances available in the medical office; do not leave unattended devices, quartz lamps, ovens, etc., turned on in the medical office;
Each student is required to undergo a safety briefing at the clinical base of the department, before starting training and conducting practical classes. Conducting practical classes at the clinical bases of the department, in the departments of the surgical profile. Safety instructions for working in the surgical department. File description: Added: 04/20/2016 Downloads: 1603 File status: available File public: Yes File uploaded: raulLAN44. Typical instruction on labor protection for personnel of operating units (approved by Job description nurses of the surgical department: This job description was developed and approved by them; - internal rules work schedule; — rules and regulations of labor protection, safety and fire protection; — 1st and 2nd surgical departments. Standard safety instructions for working in sterilization rooms (Approved by the Ministry of Health of the USSR on 14.10. Each student is required to undergo a safety briefing in the hospital. Before starting work in the hospital department, it is necessary to change clothes.
An instruction on labor protection for an obstetrician is urgently needed. To work in the gynecological department (hereinafter referred to as the "department"). Surgical instruments used in various HEALTH AND SAFETY INSTRUCTION Nursing post of the surgical department, Contents. Repeated briefing on labor protection should be carried out at least in time when working in the surgical department, in maternity, etc. Participates in surgical operations, provides members of the surgical team with the necessary tools, materials, equipment. Complies with internal regulations, fire safety and safety regulations.
This job description defines official duties, rights and responsibility (head of the department, deputy chief physician). Safety and fire safety rules at the workplace and in the department. Basic requirements, orders, instructions for infectious safety and prevention of nosocomial infections in a surgical hospital. Instructions for students on safety precautions when working in medical institutions in 2. Before starting work in the hospital department, you must change clothes. Dress code: medical gown, surgical suit, medical cap. All newly hired workers must undergo an introductory briefing on labor protection. The results are recorded in the entry log. My 422039-05 (technics for the collection and transport of surgical and biomaterials in microbiological laboratories) institutions). Instructions GBUZ SO *&SOKB N*.
The head of the department is obliged to develop safety instructions for each type of equipment, which must be approved by the administration of the health facility and agreed with the trade union committee.
Standard instruction on labor protection for department personnel, labor protection for a ward nurse (reception-quarantine. The job description of a nurse (nurse) is local act, in which the activities of the department to which it is attached (surgical, radiological Compliance with safety precautions when working with equipment in the operating room. When working with electrical equipment, follow the operating rules and safety precautions set out in the instructions, which 9. Infections of the skin and subcutaneous tissue - only for obstetric and surgical hospitals, departments of neonatal pathology Instructions for safety precautions Obligations of the student in the surgical department: I. To ensure a safe environment for the patient in the hospital.
To protect yourself from injuries to your hands in the process of opening the ampoule, you must first file the ampoule with a nail file and then break off its nose with your fingers protected with gauze or cotton. Know the evacuation routes in case of fire, the procedure for emergency know how to use a powder fire extinguisher when necessary. During work, the nurse must observe the rules of personal hygiene, the requirements of the labor protection instruction for the school nurse, be careful with medicines. Occupational safety requirements at the end of the work of a nurse. Disconnect all electrical equipment from the electrical network.
Ventilate the medical office. Tidy up your workspace. Take off your overalls and hide them in the designated place. Tightly close the window, transom. Close the medical and treatment room with a key.
reachpriority.weebly.com
I.V.SHATKIN
Appendix No. 21
to the order of the Ministry
health care of the USSR
dated 23.09.1981 N 1000
www.zakonprost.ru
Organization of the work of the surgical department and the surgical room of the polyclinic
In our country, medical care is organized according to the territorial principle, however, with the development of insurance and private medicine, this principle, especially in relation to planned care, is beginning to change.
Organizations of surgical care
Feldsher-obstetric station - provides emergency first aid, carries out the prevention of diseases and injuries to residents of one or more rural settlements.
The district hospital provides emergency and urgent medical care for acute surgical diseases and injuries, carries out work on their prevention, manages the work of feldsher-obstetric stations located in this area of the district.
District hospital - provides surgical care to all patients with acute surgical diseases and trauma, conducts planned treatment of the most common surgical diseases (hernia, gastric ulcer, cholecystitis, etc.)
The regional hospital - in addition to the volume of care provided in district hospitals, provides specialized surgical care: urological, traumatological, oncological, etc.
City hospitals provide emergency and planned surgical care to residents of city districts.
Surgical departments of medical universities - in addition to providing surgical care, they conduct scientific development certain branches of surgery.
Scientific research institutes, in accordance with their profile, provide special surgical care, carry out the scientific development of surgical problems.
Inpatient surgical care is provided in three types of surgical departments: general, specialized and highly specialized (centers).
General surgical departments are organized as part of district and city hospitals. They provide the main types of qualified inpatient surgical care to a large part of the country's population. Various diseases are treated here, among which more than 50% are acute surgical pathologies and 20-40% are injuries and diseases of the musculoskeletal system.
Specialized departments are opened in regional and city hospitals and serve from 50 thousand to 3 million people. They are intended to provide patients with surgical care in the relevant specialty. The organization of specialized departments is based on similar principles that contribute to the concentration of patients on a certain basis:
* · for a disease of one organ system - departments of vascular surgery, lung surgery, proctological, urological, etc.;
* By nosological forms, taking into account localization - burn departments, surgery for genitourinary and osteoarticular tuberculosis, etc.;
* by sections of surgical pathology - oncological departments, emergency surgery, purulent surgery, etc.;
* by the peculiarities of the methods of operations - plastic surgery;
* by age characteristics — pediatric surgery.
General surgical departments are opened, as a rule, for 60 beds or more, specialized departments for 25-40 beds. A significant part of city and regional hospitals are clinical, as surgical clinics of medical institutes operate on their basis. Surgical beds are also available in special clinics of medical institutes that are not part of the city network, in research institutes subordinate to ministries and departments, and in institutes of the Russian Academy of Medical Sciences.
Organization of emergency and urgent surgical care. In cities, it is carried out according to the scheme: emergency medical care (health center or clinic) - surgical hospital. In the countryside: feldsher-obstetric station, district hospital - surgical department of the district hospital. Surgical departments have round-the-clock duty of surgeons, anesthesiologists and operating nurses to provide emergency surgical care.
ORGANIZATION OF THE WORK OF THE SURGICAL DEPARTMENT
Departments of the surgical profile should be located in the same building with the emergency room, operating unit, department intensive care and resuscitation, since they are functionally dependent on each other. Ward departments are organized for 60 or more beds. According to SNiP (Building Norms and Rules, 1971), departments in new hospitals are planned from two impassable sections, which are separated by halls. The section should have 30 beds. The ward section provides for: a post for a nurse on duty (4 m 2), a treatment room (18 m 2), a dressing room (22 m 2), a canteen (with at least 50% of the number of beds), a room for sorting and temporary storage of dirty linen , cleaning items (15 m 2), bathroom (12 m 2), enema (8 m 2), restroom (men's, women's, for staff). Along with this, the department needs: the head's office (12 m 2), the staff's room (10 m 2 for each doctor, in addition to one additional 4 m 2), the head nurse's room (10 m 2), the hostess (10 m 2). The clinics provide offices for professors, associate professors, assistants and study rooms for 10-12 people.
Chamber - the main place of stay of the patient in a medical institution. In the wards of the surgical department, 7 m 2 is allocated per bed. Most of the wards in the section are planned for 4 beds, 2 - two-bed wards, 2 - one-bed wards. The optimal number of beds in the ward is 3. Before entering the ward, a gateway is planned, which is provided as a small front room, where there are built-in individual wardrobes for patients and an entrance to the toilet, with a washbasin, bath or shower. The rooms are equipped with beds of a metal structure, to which a transfusion stand and a skeletal traction device can be attached. Most beds should be functional. The interior of the room is complemented by a bedside table, a common table, chairs, and a waste paper basket. The temperature in the room should be at 20°C. Optimum air humidity is 50-60%, air mobility is about 0.15 m/s. Chambers should be well lit by natural light, windows should not be oriented to the north. The ratio of the area of windows and the floor should be 1:6. Provides general and local electric lighting. Each bed has a nurse call system.
The post of the ward nurse is placed in the corridor so as to provide a good overview of the wards. The post is located in the center of the section. It is equipped with cabinets for storing medicines, tools, care items and documentation (lists of medical appointments, handovers, etc.).
When placing patients, it is necessary to take into account the characteristics of the contingent, so clean and purulent departments should be allocated. This will make the treatment more effective, and most importantly, prevent complications.
Surgical departments should be provided with forced ventilation, and separate rooms with supply and exhaust ventilation or conditioned air. The premises of surgical departments are subject to wet cleaning, using disinfectants, twice a day: in the morning after the patients wake up and in the evening before bedtime. Once a month it is necessary to carry out general cleaning, with wet disinfection of mattresses and pillows. Air samples should be taken monthly for bacteriological examination.
Labour Organization medical staff regulated by the “Model internal regulations”, on the basis of which rules are drawn up for various institutions depending on their purpose. Each surgical department has a daily routine, which is aimed at creating rational working conditions for medical personnel and optimal conditions for the recovery of patients.
Special requirements are imposed on the personnel of the surgical department: the human qualities of the personnel are no less important than their qualities as specialists. It is necessary to impeccably follow the principles of medical deontology and ethics. Deontology (Greek deon - due, logos - teaching) - a set of ethical and organizational norms for the fulfillment by health workers of their professional duties. The main elements of deontology are aimed at creating a special psychological climate in the surgical department. The main function of the psychological climate in a surgical facility is to create conditions for the speedy, high-quality and reliable recovery of patients. Two main goals follow from this:
* Minimize the effect of factors slowing down and qualitatively worsening the process of patients' recovery;
* Maximize the extent to which patients perceive a healthier lifestyle.
WORK ORGANIZATION
SURGICAL DEPARTMENT OF THE POLYCLINIC
The polyclinic provides reception of patients with surgical diseases and treatment of those who do not need inpatient treatment. Most patients visit the department repeatedly for dressings and medical procedures.
The surgical department of the polyclinic should be located, if there is no elevator, on the first or second floor. This facilitates visiting them by patients with diseases of the lower extremities and the delivery of stretcher patients. With one working surgeon, the department should include: a doctor's office, a dressing room, an operating room, a sterilization room, and material rooms. With a large number of working surgeons, the operating room, sterilization room, material room can be shared, but the office and dressing room should be separate for each doctor. The surgeon's office should have a table, 2 stools, a couch for examining patients, which is best placed behind a screen, a negatoscope, etc.
The walls must be smooth and in all rooms at least two meters high must be painted with oil paint, the walls of the operating room must be covered with tiles. All rooms in the surgical department must have wash basins. Premises of the surgical room must be especially carefully protected from pollution. The contingent of patients changing during the reception, the delivery of patients in clothes contaminated after injuries contributes to the introduction of dirt into the surgical room. Therefore, it is necessary to frequently wipe the floors of offices and dressing rooms with a wet method, using antiseptic liquids that are devoid of an unpleasant odor. Wet current cleaning of the premises (floor, walls) should be carried out after each appointment. At the end day job The office is completely cleaned.
The work of a surgeon in a clinic is significantly different from the work of a surgeon in a hospital. Unlike an inpatient surgeon, an outpatient surgeon has significantly less time for each patient and often lacks the ability to accurately distribute his work hours, especially where there is no separate trauma room. The appeal of patients for emergency surgical care (dislocations, fractures, injuries) requires stopping the current appointment and providing first aid to the victim, however, this does not relieve the surgeon from providing assistance to all other patients scheduled for admission.
The surgeon participates in consultations with doctors of other specialties, resolves issues of planned and emergency hospitalization of patients, issues of working capacity, employment. In addition to medical, advisory work, a polyclinic surgeon conducts medical examinations of certain groups of patients (varicose veins, thrombophlebitis, osteomyelitis, hernia, after surgery for gastric ulcers, etc., as well as disabled WWII), participates in preventive work on the site, in the work of engineering and medical teams. The polyclinic surgeon maintains contact with the hospital, where he sends patients, and also provides aftercare after discharge from the hospital. In some cases of emergency surgery, the doctor has to visit patients at home, where, in the absence of additional research methods, he is obliged to make the correct diagnosis and decide on the tactics of further treatment of the patient. An error in diagnosis and delay in providing the necessary assistance can lead to fatal consequences. To carry out this work, the surgeon must be the organizer of the medical and surgical process, implementing the principle of N.I. Pirogov on the importance of organization in medicine and surgery in particular.
The nature of the work of the surgical office requires that all personnel are well aware of their duties and master the methods of their work. The nurse of the surgical office should be knowledgeable in the field of asepsis and antisepsis, comply with her requirements in work and monitor compliance with them by other employees and patients, help the doctor in organizing the reception of patients. The nurse of the surgical department should be trained in the rules of cleaning, washing instruments, and the technique of preparing material for sterilization. She must skillfully help the doctor and nurse during certain manipulations (help with undressing, dressing, etc.). Be aware of the danger of violating the rules of asepsis (be able to open bottles with sterile linen, supply a sterilizer with instruments, a basin for washing hands, etc.).
When conducting a lesson in the surgical office of the polyclinic, students, together with the surgeon working in the office, receive primary and secondary patients, participate in their examination, get acquainted with the rules for filling medical documents(outpatient card, dispensary card, coupons and referrals) and selection of patients for hospitalization. The most interesting and thematic patients are dealt with in more detail with the teacher. In the course of admission, students get acquainted with the procedure for issuing and extending sick leave.
Thus, in the classroom in the clinic, students get acquainted with the contingent of patients that they do not see in the hospital, and also consolidate practical skills (bandaging, immobilization, injections, etc.).
ORDER of the Ministry of Health of the USSR dated September 23, 1981 N 1000 (as amended on December 22, 1989) “ON MEASURES TO IMPROVE THE ORGANIZATION OF WORK OF OUTPATIENT AND POLYCLINIC INSTITUTIONS”
Annex N 20
1. Surgical, otolaryngological, ophthalmological and neurological departments (offices) are organized as part of the city polyclinic.
2. The head of the department (office) is a specialist who has received special training in the relevant specialty.
3. Control over the work of the department (office) is carried out by the management of the polyclinic.
4. Doctors of departments (offices) work in contact with doctors - specialists of a different profile and, first of all, with general practitioners - district (territorial and shop medical districts).
5. Doctors of departments (offices) in their work are guided by this regulation, orders, instructions and instructions of the Ministry of Health of the USSR and current legislation.
6. The main tasks of departments (offices) are to carry out disease prevention measures, early detection of patients and their effective treatment in a polyclinic and at home according to their profile.
7. In accordance with these tasks, doctors of departments (offices) carry out:
– regular outpatient appointments according to the schedule approved by the administration of the polyclinic;
- dynamic observation and active treatment of patients until their recovery, remission or hospitalization;
- control over the timeliness of the implementation of diagnostic and therapeutic procedures by patients under supervision in this department (office);
- timely referral of patients, if indicated, to VTEC;
- consultations of patients in the directions of other doctors - specialists, incl. at home;
- timely identification of persons subject to medical examination according to the profile of this department (office), and taking them for dynamic observation;
– conducting an examination of temporary disability with the issuance of sick leave in accordance with applicable law;
— carrying out sanitary-educational work and hygienic education of the population.
8. The department (office) has the necessary space for placement, in accordance with sanitary and hygienic standards and requirements, as well as medical equipment, tools and inventory.
Head of the Main Department
medical and preventive care
I.V.SHATKIN
Appendix No. 21
to the order of the Ministry
health care of the USSR
dated 23.09.1981 N 1000
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The surgical department of the polyclinic maintains the following medical documentation:
Outpatient card (form No. 025/U and form No. 025/U-04);
Research referral forms;
Journal of registration of patients;
Journal of referrals to the hospital;
Operations log;
Journal of dispensary patients;
Journal of registration of injuries and anti-tetanus vaccinations;
Journal of blood directions for Hbs-antigen and Wasserman reaction;
AIDS referral log;
Register of infectious post-injection complications;
Journal of dressing quartzing;
Journal of quartzization of the operating room;
Journal of quality control of pre-sterilization processing of instruments;
Journal of control of the autoclave;
Logbook for monitoring the operation of a dry-heat cabinet.
There are a lot of documents, but they are all necessary. In case of careless filling or not keeping records of one or another type of activity, the development of complications in patients, violations of the order of work in the clinic and hospital are possible. We have already dwelled on the importance of filling out an outpatient card of the patient. Once again, it must be emphasized that this card is kept throughout the life of each patient of the polyclinic. It includes all types of examination and treatment of the patient, all identified intravital diagnoses. This is the basic legal document of an outpatient. According to its analysis, all types of examinations are carried out. Hence the importance correct design diagnosis of the patient, determining the timing of temporary disability. It should be emphasized that the doctor of the polyclinic can issue a sick leave personally for up to 30 days, then the patient, if necessary, is sent to the control and expert commission.
Research referral forms must be printed in a typographical manner. If the medical institution, for economic reasons, cannot do this, then they must be written by hand in advance. This will save time for patient care.
The patient register is necessary to compile a register of the provision of medical care, which is compiled monthly and sent to Insurance companies. The salary of a medical worker in a polyclinic directly depends on the volume and quality of treatment of patients. There were cases when the workers of certain rooms of the polyclinic were reduced wage due to the small number of patients treated.
The journal of referrals to the hospital is divided into two headings: referrals for emergency and planned patients. Once again, it should be emphasized that emergency patients in the clinic may not be examined in full. At the same time, all planned patients are subject to laboratory, radiological and ultrasound research to reduce the length of stay in the hospital before surgery.
The transaction log must be filled out clearly. Each protocol of operations describes the nature of the intervention, the existing complications.
The journal of dispensary patients should show the dynamics of the treatment of registered patients. It should reflect the timing of follow-up examinations, therapeutic measures taken and their effectiveness.
The register of injuries and tetanus toxoid vaccinations is filled out individually for each patient. It is very important to reflect in it the volume of tetanus toxoid vaccinations, the need for revaccination.
Registers of blood referrals for Hbs-antigen, AIDS and syphilis are maintained to identify the incidence of the population, to prevent infection of others and medical personnel. It is desirable that all patients treated by the surgeon undergo these studies additionally.
The register of post-injection complications is necessary for the detection of iatrogenic diseases and the implementation of anti-epidemic measures in those medical institutions where a non-sterile injection was made. Each disease is reported to the epidemiological service.
Journals of quartzization of the dressing room, operating room, control of the operation of the autoclave, dry-heat cabinet, quality of pre-sterilization processing of instruments are necessary to comply with the basic rules of asepsis and antisepsis, and prevent the development of a hospital infection.