1. Conversation with the patient
3. Preparation for the study
4. Hand washing
6. Conducting research
A.A.KARPEEV
perforation of a hollow organ;
Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV
www.laparoscopy.ru
Order of the Ministry of Health and Medical Industry of the Russian Federation dated May 31, 1996 N 222 “On improving the endoscopy service in healthcare institutions of the Russian Federation” (with amendments and additions)
Order of the Ministry of Health and Medical Industry of the Russian Federation dated May 31, 1996 N 222
“On improving endoscopy services in healthcare institutions Russian Federation»
With changes and additions from:
The development of endoscopic technology in recent decades, based on the use of fiber optics, has significantly expanded the use of minimally invasive instrumental methods research in medical practice.
Currently, endoscopy has become quite widespread in both diagnosis and treatment. various diseases. IN medical practice A new direction has emerged - surgical endoscopy, which makes it possible to achieve a pronounced economic effect while maintaining the therapeutic result by significantly reducing the length of hospitalization and the cost of treating patients.
The advantages of endoscopic methods ensure the rapid development of this service in the Russian Federation.
Over the past 5 years, the number of endoscopy departments and rooms in medical institutions has increased by 1.7 times, and their equipment with endoscopic equipment has increased by 2.5 times.
From 1991 to 1995, the number of endoscopists increased 1.4 times; 35% of specialists have qualification categories (1991 - 20%).
The volume of research performed is constantly expanding and medical procedures. Compared to 1991, their number increased by 1.5 and 2 times, respectively. In 1995, 142.7 thousand operations were performed using endoscopic technology.
In a number of areas of the country, a 24-hour emergency endoscopic care service has been created, which can significantly improve performance indicators. emergency surgery, traumatology and gynecology. Computer programs have been developed and are being actively implemented to evaluate results endoscopic studies.
At the same time, there are serious shortcomings and unresolved problems in organizing the activities of the endoscopy service.
Only 38.5 percent of hospitals in rural areas, 21.7 percent of dispensaries (including 8 percent for tuberculosis), and 3.6 percent of outpatient clinics have endoscopy units.
Only 17 percent of the total number of endoscopy specialists work in health care institutions located in rural areas.
In the staffing structure of endoscopists, there is a high proportion of part-time doctors from other specialties.
The capabilities of endoscopy are underutilized due to unclear organization of the work of existing departments, the slow introduction into practice of new forms of management and labor organization of medical personnel, and the scattering of specialists involved in endoscopy among other specialized services, lack of highly effective endoscopic diagnostic and treatment programs and algorithms.
In some cases, expensive endoscopic equipment is used extremely irrationally due to poor training of specialists, especially in surgical endoscopy, lack of proper continuity in work with doctors of other specialties. The load on one endoscope with fiber optics is 2 times lower than the standard.
Certain difficulties in organizing the service are due to the lack of necessary regulatory framework, recommendations for optimizing the structure and staffing, nomenclature of studies in endoscopy units of various capacities.
The quality of endoscopic equipment produced by domestic enterprises does not fully meet modern technical requirements.
In order to improve the organization of the endoscopy service and increase the efficiency of its work, the rapid introduction of new diagnostic and therapeutic methods, including surgical endoscopy, as well as improving personnel training and technical equipment of departments with modern endoscopic equipment
1. Regulations on the chief freelance specialist in endoscopy of the Ministry of Health and Medical Industry of the Russian Federation and authorities health management subjects of the Russian Federation (Appendix 1).
2. Regulations on the department, unit, endoscopy room (Appendix 2).
3. Regulations on the head of the department, department, endoscopy room (Appendix 3).
4. Regulations on the endoscopist of the department, department, endoscopy room (Appendix 4).
5. Regulations on the head nurse of the department, endoscopy department (Appendix 5).
6. Regulations on the nurse of the department, department, endoscopy room (Appendix 6).
7. Estimated time standards for endoscopic examinations, therapeutic and diagnostic procedures, operations (Appendix 7).
8. Instructions for the use of estimated time standards for endoscopic examinations (Appendix 8).
9. Instructions for developing estimated time standards when introducing new equipment or new types of research and treatment (Appendix 9).
10. Qualification characteristics of the endoscopist (Appendix 10).
12. Methodology for calculating prices for endoscopic examinations (Appendix 12).
13. Journal of registration of studies performed in the department, department, endoscopy room - form N 157/u-96 (Appendix 13).
14. Instructions for filling out the Register of studies performed in the department, unit, endoscopy room - form N 157/u-96 (Appendix 14).
15. Addition to the list of forms of primary medical documentation(Appendix 15).
1. To the Ministers of Health of the republics within the Russian Federation, heads of health authorities and institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:
1.1. During 1996, develop and implement the necessary measures to form a unified endoscopy service in the territory, including diagnostic, therapeutic and surgical endoscopy, taking into account the profile of medical institutions and local conditions.
1.2. When planning a network of endoscopy units, pay special attention to their organization in institutions primary care, including rural health care.
1.3. Appoint the main freelance endoscopy specialists and organize their work in accordance with the regulations approved by this order.
1.4. Involve departments of research institutes in organizational, methodological and advisory work on endoscopy, educational universities and educational institutions of postgraduate training.
1.5. Organize the work of departments, departments, endoscopy rooms in accordance with this order.
1.6. Establish the number of personnel in departments, departments and endoscopy rooms in accordance with the volume of work based on the estimated time standards for endoscopic examinations.
1.7. Take the necessary measures to maximize the use of endoscopic equipment with fiber optics, ensuring the load on the device is at least 700 studies per year.
1.8. Ensure regular training of doctors of the medical network on topical issues endoscopy.
2. The Department of Organization of Medical Care to the Population (A.A. Karpeev) to provide organizational and methodological assistance to health authorities on the organization and functioning of endoscopy services in the territories of the Russian Federation.
3. Management educational institutions(Volodin N.N.) supplement the training programs for specialists in endoscopy in educational institutions postgraduate training, taking into account the introduction into practice of modern equipment and new research methods.
4. The Department of Scientific Institutions (Nifantev O.E.) to continue work on creating new endoscopic equipment that meets modern technical requirements.
5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of endoscopists in accordance with the approved standard programs.
6. Consider the order of the Ministry of Health of the USSR N 1164 of December 10, 1976 “On the organization of endoscopy departments (rooms) in medical institutions”, appendices NN 8, 9 to the order of the Ministry of Health of the USSR N 590 of April 25, 1986, to be considered invalid for institutions of the system of the Ministry of Health and Medical Industry of Russia. g. “On measures to further improve prevention, early diagnosis and treatment malignant neoplasms"and order of the USSR Ministry of Health N 134 of February 23, 1988 "On approval of estimated time standards for endoscopic examinations and therapeutic and diagnostic procedures."
By order of the USSR Ministry of Health of April 25, 1986 N 590, order of the USSR Ministry of Health of December 10, 1976 N 1164 was declared invalid
7. Entrust control over the execution of the order to Deputy Minister A.N. Demenkov.
222 order endoscopy
MINISTRY OF HEALTH AND MEDICAL INDUSTRY OF THE RUSSIAN FEDERATION
ORDER of May 31, 1996 N 222
ON IMPROVING ENDOSCOPY SERVICE IN HEALTH INSTITUTIONS OF THE RUSSIAN FEDERATION
INSTRUCTIONS FOR DEVELOPING ESTIMATED TIME STANDARDS FOR IMPLEMENTING NEW EQUIPMENT OR NEW TYPES OF RESEARCH AND TREATMENT
When introducing new diagnostic methods and technical means their implementation, which is based on different research methodology and technology, new content of medical staff’s work, the absence of estimated time standards approved by the Ministry of Health and Medical Industry of Russia, they can be developed on the spot and agreed with the trade union committee in those institutions where new methods are being introduced. The development of new calculation standards includes taking time measurements of the actual time spent on individual elements of labor, processing this data (according to the methodology outlined below), and calculating the time spent on the study as a whole. Before timing, a list of technological operations (main and additional) for each method is compiled. For these purposes, it is recommended to use the methodology applied in compiling a universal list of labor elements for technological operations. In this case, it is possible to use the “List” itself. “, adapting each technological operation to the technology of a specific new diagnostic or treatment method.
Timing is carried out using sheets of timing measurements, which consistently set out the names of technological operations and the time of their implementation. Processing the results of timing measurements includes calculating the average time spent, determining the actual and expert repeatability coefficient for each technological operation and the estimated time to complete the study under study.
UNIVERSAL LIST OF LABOR ELEMENTS FOR TECHNOLOGICAL OPERATIONS, RECOMMENDED WHEN DEVELOPING ESTIMATED TIME STANDARDS
1. Conversation with the patient
2. Study of medical documentation
3. Preparation for the study
4. Hand washing
5. Consultation with your doctor
6. Conducting research
7. Advice and recommendations for the patient
8. Consultation with the manager. department
9. Processing of the apparatus and instruments
10. Registration of honey. documentation
11. Registration of biopsy material
12. Entry in the log book
The average time spent on an individual technological operation is determined as the arithmetic average of all measurements. The actual repeatability factor of technological operations in each study is calculated using the formula:
where K is the actual repeatability coefficient of the technological operation; P is the number of timed studies using a specific research method in which this technological operation took place; N is the total number of the same timed studies. The expert coefficient of repeatability of a technological operation is determined by the most qualified doctor - an endoscopist who knows this technique, based on the existing experience in using the method and professional understanding of the proper repeatability of the technological operation. The estimated time for each technological operation is determined by multiplying the average actual time spent on a given timing operation by the expert coefficient of its repeatability. The estimated time to complete the study as a whole is determined separately for the doctor and nurse as the sum of the estimated time to complete all technological operations for this method. After approval by the order of the head of the medical institution, it is the estimated time limit for performing this type of research in this institution. To ensure the validity of local time standards and their correspondence to true time costs, independent of random reasons, the number of studies subject to timing measurements should be as large as possible, but not less than 20 - 25.
It is possible to develop local time standards only when the personnel of the department, department, office have mastered the methods well enough, when they have developed a certain automatism and professional stereotypes in performing diagnostic and therapeutic manipulations. Before this, research is carried out in the order of mastering new methods, within the time spent on other types of activities.
Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV
QUALIFICATIONS OF AN ENDOSCOPIST DOCTOR
The level of an endoscopist is determined taking into account the volume and quality of the work performed, the availability of theoretical training in the field of basic and related specialties, and the regularity of training in specialized educational institutions that have a special certificate. Grade practical training An endoscopist is carried out under the guidance of the endoscopic unit and institution at the specialist’s place of work. The general opinion is reflected in the performance characteristics from the place of work. Theoretical knowledge and compliance of practical skills with the current level of development of endoscopy are assessed during certification cycles conducted by endoscopy departments.
In accordance with the requirements of the specialty, the endoscopist must know, be able to, and master:
prospects for the development of endoscopy;
fundamentals of healthcare legislation and policy documents defining the activities of healthcare authorities and institutions in the field of endoscopy;
general issues of organizing planned and emergency endoscopic care in the country for adults and children, ways to improve endoscopic services;
organization of medical care in military field conditions during mass casualties and disasters;
etiology and ways of spreading highly infectious diseases and their prevention;
work of an endoscopist in the conditions of insurance medicine;
topographic anatomy of the bronchopulmonary apparatus, digestive tract, organs abdominal cavity and pelvis, anatomical and physiological characteristics childhood;
reasons for occurrence pathological processes, which the endoscopist usually encounters;
diagnostic and therapeutic capabilities of various endoscopic methods;
indications and contraindications for diagnostic, therapeutic and surgical esophagogastroduodenoscopy, colonoscopy, laparoscopy, bronchoscopy;
methods of processing, disinfection and sterilization of endoscopes and instruments;
principles, techniques and methods of pain relief in endoscopy;
clinical symptoms of major surgical and therapeutic diseases;
principles of examination and preparation of patients for endoscopic methods research and management of patients after research;
equipment for endoscopy rooms and operating rooms, safety precautions when working with equipment;
design and principle of operation of endoscopic equipment and auxiliary instruments used in various endoscopic studies.
collect anamnesis and compare the information obtained with the data of the available medical documentation for the patient in order to select the desired type of endoscopic examination;
carry out independently simple ways examinations: digital examination of the rectum for bleeding, palpation of the abdomen, percussion and auscultation of the abdomen and lungs;
identify the patient’s allergic predisposition to anesthetics in order to correctly determine the type of anesthesia under which endoscopic examination will be performed;
determine indications and contraindications for performing a particular endoscopic examination; — teach the patient how to behave correctly during an endoscopic examination;
choose the optimal type and type of endoscope (rigid, flexible, with end, end-side or just side optics) depending on the nature of the planned endoscopy;
master the methods of local infiltration anesthesia, local anesthesia pharyngeal ring and tracheobronchial tree;
knowledge of biopsy methods and the ability to perform them is required;
knowledge of medical documentation and research protocols;
ability to compile a report on the work done and analyze endoscopic activities.
3. Special knowledge and skills:
A specialist endoscopist must know prevention, clinical presentation and treatment, be able to diagnose and provide the necessary assistance for the following conditions:
intraorgan or intra-abdominal bleeding that occurred during an endoscopic examination;
perforation of a hollow organ;
acute cardiac and respiratory failure;
arrest of breathing and cardiac activity.
A specialist endoscopist must know:
clinic, diagnosis, prevention and principles of treatment of major lung diseases (acute and chronic bronchitis, bronchial asthma, acute and chronic pneumonia, lung cancer, benign lung tumors, disseminated lung diseases);
clinic, diagnosis, prevention and treatment of major diseases gastrointestinal tract(esophagitis, gastritis, ulcerative lesions of the stomach and duodenum, cancer and benign tumors of the stomach, duodenum and colon, diseases of the operated stomach, chronic colitis, hepatitis and cirrhosis of the liver, pancreatitis and cholecystitis, tumors of the hepato-pancreatoduodenal zone, acute appendicitis);
master the technique of esophagogastroduodenoscopy, colonoscopy, bronchoscopy, laparoscopy, using all techniques for a detailed examination of the mucous membrane of the esophagus, stomach, duodenum during esophagogastroduodenoscopy, all parts of the colon and terminal department ileum- during colonoscopy;
tracheobronchial tree, up to the bronchi of the 5th order - during bronchoscopy, serous integument, as well as the abdominal organs of the abdominal cavity - during laparoscopy;
visually clearly determine the anatomical boundaries of physiological narrowings and sections of the organs being studied;
correctly assess the responses of the sphincter apparatus of the organs being studied in response to the introduction of an endoscope and air;
under conditions of artificial lighting and some magnification, correctly distinguish macroscopic signs normal structure mucous, serous covers and parenchymal organs from pathological manifestations in them;
perform targeted biopsy from pathological foci of the mucous membranes of the serous integument and abdominal organs;
orient and fix the biopsy material for histological examination;
make brush strokes correctly - prints for cytological examination;
remove and take ascitic fluid, effusion from the abdominal cavity for cytological examination and culture;
based on the identified microscopic signs of changes in the mucous, serous covers or tissues of parenchymal organs, determine the nosological form of the disease;
clinic, diagnosis, prevention and treatment of major diseases of the pelvic organs (benign and malignant tumors uterus and appendages, inflammatory diseases of the appendages, ectopic pregnancy).
4. Research and manipulation:
bronchofibroscopy and rigid bronchoscopy;
targeted biopsy from mucous membranes, serous tissues and abdominal organs;
extraction foreign bodies from the tracheobronchial tree, upper gastrointestinal tract and colon during endoscopic examination;
local hemostasis during esophagogastroduodenoscopy;
endoscopic removal of benign tumors from the esophagus and stomach; — expansion and dissection of scar and postoperative narrowing of the esophagus;
papillosphincterotomy and virsungotomy and removal of stones from the ducts;
installation of a feeding tube;
drainage of the abdominal cavity, gall bladder, retroperitoneal space;
removal of pelvic organs during laparoscopy according to indications;
removal of abdominal organs during laparoscopy according to indications;
removal of retroperitoneal organs under endoscopic control according to indications.
Depending on the level of knowledge, as well as on the basis of work experience, quantity, quality and type of diagnostic tests performed, therapeutic interventions certification commission resolves the issue of assigning the appropriate qualification category to a doctor-endoscopist.
Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV
www.laparoscopy.ru
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Russian Federation
ORDER of the Ministry of Health and Medical Industry of the Russian Federation dated May 31, 1996 N 222 (as amended on June 16, 1997) “ON IMPROVEMENT OF ENDOSCOPY SERVICE IN HEALTH CARE INSTITUTIONS OF THE RUSSIAN FEDERATION”
(as amended by Order of the Ministry of Health of the Russian Federation dated June 16, 1997 N 184)
The development of endoscopic technology in recent decades, based on the use of fiber optics, has significantly expanded the use of minimally invasive instrumental research methods in medical practice.
Currently, endoscopy has become quite widespread both in the diagnosis and treatment of various diseases. A new direction has appeared in medical practice - surgical endoscopy, which makes it possible to achieve a pronounced economic effect while maintaining the therapeutic result by significantly reducing the length of hospitalization and the cost of treating patients.
The advantages of endoscopic methods ensure the rapid development of this service in the Russian Federation.
Over the past 5 years, the number of endoscopy departments and rooms in medical institutions has increased by 1.7 times, and their equipment with endoscopic equipment has increased by 2.5 times.
From 1991 to 1995, the number of endoscopists increased 1.4 times; 35% of specialists have qualification categories (1991 - 20%).
The scope of performed research and treatment procedures is constantly expanding. Compared to 1991, their number increased by 1.5 and 2 times, respectively. In 1995, 142.7 thousand operations were performed using endoscopic technology.
In a number of areas of the country, a 24-hour emergency endoscopic care service has been created, which can significantly improve performance in emergency surgery, traumatology and gynecology. Computer programs have been developed and are being actively implemented to evaluate the results of endoscopic studies.
At the same time, there are serious shortcomings and unresolved problems in organizing the activities of the endoscopy service.
Only 38.5 percent of hospitals in rural areas, 21.7 percent of dispensaries (including 8 percent for tuberculosis), and 3.6 percent of outpatient clinics have endoscopy units.
Only 17 percent of the total number of endoscopy specialists work in health care facilities located in rural areas.
In the staffing structure of endoscopists, there is a high proportion of part-time doctors from other specialties.
The capabilities of endoscopy are underutilized due to the unclear organization of work of existing departments, the slow introduction into practice of new forms of management and organization of work of medical personnel, the scattering of specialists involved in endoscopy among other specialized services, and the lack of highly effective endoscopic diagnostic and treatment programs and algorithms.
In some cases, expensive endoscopic equipment is used extremely irrationally due to poor training of specialists, especially in surgical endoscopy, and lack of proper continuity in work with doctors of other specialties. The load on one endoscope with fiber optics is 2 times lower than the standard.
Certain difficulties in organizing the service are due to the lack of the necessary regulatory framework, recommendations for optimizing the structure and staffing, and the range of studies in endoscopy units of various capacities.
The quality of endoscopic equipment produced by domestic enterprises does not fully meet modern technical requirements.
In order to improve the organization of the endoscopy service and increase the efficiency of its work, the rapid introduction of new diagnostic and treatment methods, including surgical endoscopy, as well as improving personnel training and technical equipment of departments with modern endoscopic equipment, I declare:
1. Regulations on the chief freelance specialist in endoscopy of the Ministry of Health and Medical Industry of the Russian Federation and health authorities of the constituent entities of the Russian Federation (Appendix 1).
2. Regulations on the department, department, endoscopy room (Appendix 2).
3. Regulations on the head of the department, department, endoscopy room (Appendix 3).
4. Regulations on the doctor - endoscopist of the department, department, endoscopy room (Appendix 4).
5. Regulations on the head nurse of the department, endoscopy department (Appendix 5).
6. Regulations on the nurse of the department, department, endoscopy room (Appendix 6).
7. Estimated time standards for endoscopic examinations, therapeutic and diagnostic procedures, operations (Appendix 7).
8. Instructions for the use of estimated time standards for endoscopic examinations (Appendix 8).
9. Instructions for the development of estimated time standards for the introduction of new equipment or new types of research and treatment (Appendix 9).
10. Qualification characteristics of the endoscopist (Appendix 10).
12. Methodology for calculating prices for endoscopic examinations (Appendix 12).
13. Journal of registration of studies performed in the department, department, endoscopy room - form N 157/u-96 (Appendix 13).
14. Instructions for filling out the Register of studies performed in the department, unit, endoscopy room - form N 157/u-96 (Appendix 14).
15. Addition to the list of forms of primary medical documentation (Appendix 15).
I order:
1. To the Ministers of Health of the republics within the Russian Federation, heads of health authorities and institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:
1.1. During 1996, develop and implement the necessary measures to form a unified endoscopy service in the territory, including diagnostic, therapeutic and surgical endoscopy, taking into account the profile of medical institutions and local conditions.
1.2. When planning a network of endoscopy units, pay special attention to their organization in primary care institutions, including rural healthcare.
1.3. Appoint the main freelance endoscopy specialists and organize work in accordance with the Regulations approved by this Order.
1.4. Involve departments of research institutes, educational universities and postgraduate educational institutions in organizational, methodological and advisory work on endoscopy.
1.5. Organize the work of departments, departments, endoscopy rooms in accordance with this Order.
1.6. Establish the number of personnel in departments, departments and endoscopy rooms in accordance with the volume of work based on the estimated time standards for endoscopic examinations.
1.7. Take the necessary measures to maximize the use of endoscopic equipment with fiber optics, ensuring the load on the device is at least 700 studies per year.
1.8. Provide regular training to medical doctors on current issues of endoscopy.
2. The Department of Organization of Medical Care to the Population (A.A. Karpeev) to provide organizational and methodological assistance to health authorities on the organization and functioning of endoscopy services in the territories of the Russian Federation.
3. The Department of Educational Institutions (Volodin N.N.) to supplement the training programs for training specialists in endoscopy in educational institutions of postgraduate training, taking into account the introduction into practice of modern equipment and new research methods.
4. The Department of Scientific Institutions (Nifantiev O.E.) to continue work on creating a new endoscopic
ORDER of May 31, 1996 N 222 ON IMPROVING ENDOSCOPY SERVICE IN HEALTH CARE INSTITUTIONS OF THE RUSSIAN FEDERATION
The development of endoscopic technology in recent decades, based on the use of fiber optics, has significantly expanded the use of minimally invasive instrumental research methods in medical practice. Currently, endoscopy has become quite widespread both in the diagnosis and treatment of various diseases. A new direction has appeared in medical practice - surgical endoscopy, which makes it possible to achieve a pronounced economic effect while maintaining the therapeutic result by significantly reducing the length of hospitalization and the cost of treating patients.
The advantages of endoscopic methods ensure the rapid development of this service in the Russian Federation. Over the past 5 years, the number of endoscopy departments and rooms in medical institutions has increased by 1.7 times, and their equipment with endoscopic equipment has increased by 2.5 times. From 1991 to 1995, the number of endoscopists increased 1.4 times; 35% of specialists have qualification categories (1991 - 20%). The scope of performed research and treatment procedures is constantly expanding. Compared to 1991, their number increased by 1.5 and 2 times, respectively. In 1995, 142.7 thousand operations were performed using endoscopic technology. In a number of areas of the country, a 24-hour emergency endoscopic care service has been created, which can significantly improve performance in emergency surgery, traumatology and gynecology. Computer programs have been developed and are being actively implemented to evaluate the results of endoscopic studies.
At the same time, there are serious shortcomings and unresolved problems in organizing the activities of the endoscopy service. Only 38.5 percent of hospitals in rural areas, 21.7 percent of dispensaries (including 8 percent for tuberculosis), and 3.6 percent of outpatient clinics have endoscopy units. Only 17 percent of the total number of endoscopy specialists work in health care facilities located in rural areas. In the staffing structure of endoscopists, there is a high proportion of part-time doctors from other specialties. The capabilities of endoscopy are underutilized due to the unclear organization of work of existing departments, the slow introduction into practice of new forms of management and organization of work of medical personnel, the scattering of specialists involved in endoscopy among other specialized services, and the lack of highly effective endoscopic diagnostic and treatment programs and algorithms. In some cases, expensive endoscopic equipment is used extremely irrationally due to poor training of specialists, especially in surgical endoscopy, and lack of proper continuity in work with doctors of other specialties. The load on one endoscope with fiber optics is 2 times lower than the standard. Certain difficulties in organizing the service are due to the lack of the necessary regulatory framework, recommendations for optimizing the structure and staffing, and the range of studies in endoscopy units of various capacities. The quality of endoscopic equipment produced by domestic enterprises does not fully meet modern technical requirements
1. Regulations on the chief freelance specialist in endoscopy of the Ministry of Health and Medical Industry of the Russian Federation and health authorities of the constituent entities of the Russian Federation (Appendix 1).
2. Regulations on the department, department, endoscopy room (Appendix 2).
4. Regulations on the doctor - endoscopist of the department, department, endoscopy room (Appendix 4).
5. Regulations on the head nurse of the department, endoscopy department (Appendix 5).
6. Regulations on the nurse of the department, department, endoscopy room (Appendix 6).
13. Journal of registration of studies performed in the department, department, endoscopy room - form N 157/u-96 (Appendix 13).
1.1. During 1996, develop and implement the necessary measures to form a unified endoscopy service in the territory, including diagnostic, therapeutic and surgical endoscopy, taking into account the profile of medical institutions and local conditions.
1.7. Take the necessary measures to maximize the use of endoscopic equipment with fiber optics, ensuring the load on the device is at least 700 studies per year.
2. The Department of Organization of Medical Care to the Population (A.A. Karpeev) to provide organizational and methodological assistance to health authorities on the organization and functioning of endoscopy services in the territories of the Russian Federation.
5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of endoscopists in accordance with the approved standard programs.
6. Consider as invalid for institutions of the Russian Ministry of Health and Medical Industry Order of the USSR Ministry of Health N 1164 of December 10, 1976 “On the organization of endoscopy departments (rooms) in medical institutions”, appendices N 8, 9 to Order of the USSR Ministry of Health N 590 of April 25, 1986 “On measures to further improve the prevention, early diagnosis and treatment of malignant neoplasms” and Order of the USSR Ministry of Health N 134 of February 23, 1988 “On approval of estimated time standards for endoscopic examinations and therapeutic and diagnostic procedures.”
Minister of Health and Medical Industry of the Russian Federation A.D. TSAREGORODTSEV
www.endoscopy.ru
Order 222 from 29021984
MINISTRY OF HEALTH AND MEDICAL INDUSTRY OF THE RUSSIAN FEDERATION
ORDER of May 31, 1996 N 222
ON IMPROVING ENDOSCOPY SERVICE IN HEALTH INSTITUTIONS OF THE RUSSIAN FEDERATION
INSTRUCTIONS FOR DEVELOPING ESTIMATED TIME STANDARDS FOR IMPLEMENTING NEW EQUIPMENT OR NEW TYPES OF RESEARCH AND TREATMENT
When introducing new diagnostic methods and technical means for their implementation, which are based on different research methodology and technology, new labor content of medical personnel, and the absence of estimated time standards approved by the Ministry of Health and Medical Industry of Russia, they can be developed on the spot and agreed upon with the trade union committee in those institutions where they are being introduced new techniques. The development of new calculation standards includes taking time measurements of the actual time spent on individual elements of labor, processing this data (according to the methodology outlined below), and calculating the time spent on the study as a whole. Before timing, a list of technological operations (main and additional) for each method is compiled. For these purposes, it is recommended to use the methodology applied in compiling a universal list of labor elements for technological operations. In this case, it is possible to use the “List” itself. “, adapting each technological operation to the technology of a specific new diagnostic or treatment method.
Timing is carried out using sheets of timing measurements, which consistently set out the names of technological operations and the time of their implementation. Processing the results of timing measurements includes calculating the average time spent, determining the actual and expert repeatability coefficient for each technological operation and the estimated time to complete the study under study.
UNIVERSAL LIST OF LABOR ELEMENTS FOR TECHNOLOGICAL OPERATIONS, RECOMMENDED WHEN DEVELOPING ESTIMATED TIME STANDARDS
1. Conversation with the patient
2. Study of medical documentation
3. Preparation for the study
4. Hand washing
5. Consultation with your doctor
6. Conducting research
7. Advice and recommendations for the patient
8. Consultation with the manager. department
9. Processing of the apparatus and instruments
10. Registration of honey. documentation
11. Registration of biopsy material
12. Entry in the log book
The average time spent on an individual technological operation is determined as the arithmetic average of all measurements. The actual repeatability factor of technological operations in each study is calculated using the formula:
where K is the actual repeatability coefficient of the technological operation; P is the number of timed studies using a specific research method in which this technological operation took place; N is the total number of the same timed studies. The expert coefficient of repeatability of a technological operation is determined by the most qualified doctor - an endoscopist who knows this technique, based on the existing experience in using the method and professional understanding of the proper repeatability of the technological operation. The estimated time for each technological operation is determined by multiplying the average actual time spent on a given timing operation by the expert coefficient of its repeatability. The estimated time to complete the study as a whole is determined separately for the doctor and the nurse as the sum of the estimated time to complete all technological operations using this method. After approval by the order of the head of the medical institution, it is the estimated time limit for performing this type of research in this institution. To ensure the reliability of local time standards and their correspondence to the true time spent, not dependent on random causes, the number of studies subject to time measurements should be as large as possible, but not less than 20 - 25.
It is possible to develop local time standards only when the personnel of the department, department, office have mastered the methods well enough, when they have developed a certain automatism and professional stereotypes in performing diagnostic and therapeutic manipulations. Before this, research is carried out in the order of mastering new methods, within the time spent on other types of activities.
QUALIFICATIONS OF AN ENDOSCOPIST DOCTOR
The level of an endoscopist is determined taking into account the volume and quality of the work performed, the availability of theoretical training in the field of basic and related specialties, and the regularity of training in specialized educational institutions that have a special certificate. The assessment of the practical training of an endoscopist is carried out under the guidance of the endoscopic unit and the institution at the specialist’s place of work. The general opinion is reflected in the performance characteristics from the place of work. Theoretical knowledge and compliance of practical skills with the current level of development of endoscopy are assessed during certification cycles conducted by endoscopy departments.
In accordance with the requirements of the specialty, the endoscopist must know, be able to, and master:
prospects for the development of endoscopy;
fundamentals of healthcare legislation and policy documents defining the activities of healthcare authorities and institutions in the field of endoscopy;
general issues of organizing planned and emergency endoscopic care in the country for adults and children, ways to improve endoscopic services;
organization of medical care in military field conditions during mass casualties and disasters;
etiology and ways of spreading highly infectious diseases and their prevention;
work of an endoscopist in the conditions of insurance medicine;
topographic anatomy of the bronchopulmonary apparatus, digestive tract, abdominal and pelvic organs, anatomical and physiological features of childhood;
the causes of pathological processes that an endoscopist usually encounters;
diagnostic and therapeutic capabilities of various endoscopic methods;
indications and contraindications for diagnostic, therapeutic and surgical esophagogastroduodenoscopy, colonoscopy, laparoscopy, bronchoscopy;
methods of processing, disinfection and sterilization of endoscopes and instruments;
principles, techniques and methods of pain relief in endoscopy;
clinical symptoms of major surgical and therapeutic diseases;
principles of examination and preparation of patients for endoscopic methods of examination and management of patients after examinations;
equipment for endoscopy rooms and operating rooms, safety precautions when working with equipment;
design and principle of operation of endoscopic equipment and auxiliary instruments used in various endoscopic studies.
collect anamnesis and compare the information obtained with the data of the available medical documentation for the patient in order to select the desired type of endoscopic examination;
independently carry out simple examination methods: digital examination of the rectum in case of bleeding, palpation of the abdomen, percussion and auscultation of the abdomen and lungs;
identify the patient’s allergic predisposition to anesthetics in order to correctly determine the type of anesthesia under which endoscopic examination will be performed;
determine indications and contraindications for performing a particular endoscopic examination; — teach the patient how to behave correctly during an endoscopic examination;
choose the optimal type and type of endoscope (rigid, flexible, with end, end-side or just side optics) depending on the nature of the planned endoscopy;
master the methods of local infiltration anesthesia, local anesthesia of the pharyngeal ring and tracheobronchial tree;
knowledge of biopsy methods and the ability to perform them is required;
knowledge of medical documentation and research protocols;
ability to compile a report on the work done and analyze endoscopic activities.
3. Special knowledge and skills:
A specialist endoscopist must know prevention, clinical presentation and treatment, be able to diagnose and provide the necessary assistance for the following conditions:
intraorgan or intra-abdominal bleeding that occurred during an endoscopic examination;
perforation of a hollow organ;
acute cardiac and respiratory failure;
arrest of breathing and cardiac activity.
A specialist endoscopist must know:
clinic, diagnosis, prevention and principles of treatment of major lung diseases (acute and chronic bronchitis, bronchial asthma, acute and chronic pneumonia, lung cancer, benign lung tumors, disseminated lung diseases);
clinic, diagnosis, prevention and treatment of major diseases of the gastrointestinal tract (esophagitis, gastritis, ulcerative lesions of the stomach and duodenum, cancer and benign tumors of the stomach, duodenum and colon, diseases of the operated stomach, chronic colitis, hepatitis and liver cirrhosis, pancreatitis and cholecystitis, tumors of the hepato-pancreatoduodenal zone, acute appendicitis);
master the technique of esophagogastroduodenoscopy, colonoscopy, bronchoscopy, laparoscopy, using all techniques for a detailed examination of the mucous membrane of the esophagus, stomach, duodenum during esophagogastroduodenoscopy, all parts of the colon and terminal ileum during colonoscopy;
tracheobronchial tree, up to the bronchi of the 5th order - during bronchoscopy, serous integument, as well as the abdominal organs of the abdominal cavity - during laparoscopy;
visually clearly determine the anatomical boundaries of physiological narrowings and sections of the organs being studied;
correctly assess the responses of the sphincter apparatus of the organs being studied in response to the introduction of an endoscope and air;
under conditions of artificial lighting and some magnification, it is correct to distinguish macroscopic signs of the normal structure of the mucous membranes, serous tissues and parenchymal organs from pathological manifestations in them;
perform targeted biopsy from pathological foci of the mucous membranes of the serous integument and abdominal organs;
orient and fix the biopsy material for histological examination;
correctly make smears - prints for cytological examination;
remove and take ascitic fluid, effusion from the abdominal cavity for cytological examination and culture;
based on the identified microscopic signs of changes in the mucous, serous covers or tissues of parenchymal organs, determine the nosological form of the disease;
clinic, diagnosis, prevention and treatment of major diseases of the pelvic organs (benign and malignant tumors of the uterus and appendages, inflammatory diseases of the appendages, ectopic pregnancy).
4. Research and manipulation:
bronchofibroscopy and rigid bronchoscopy;
targeted biopsy from mucous membranes, serous tissues and abdominal organs;
removal of foreign bodies from the tracheobronchial tree, upper gastrointestinal tract and colon during endoscopic examination;
local hemostasis during esophagogastroduodenoscopy;
endoscopic removal of benign tumors from the esophagus and stomach; — expansion and dissection of scar and postoperative narrowing of the esophagus;
papillosphincterotomy and virsungotomy and removal of stones from the ducts;
installation of a feeding tube;
drainage of the abdominal cavity, gall bladder, retroperitoneal space;
removal of pelvic organs during laparoscopy according to indications;
removal of abdominal organs during laparoscopy according to indications;
removal of retroperitoneal organs under endoscopic control according to indications.
Depending on the level of knowledge, as well as on the basis of work experience, quantity, quality and type of diagnostic tests performed and therapeutic interventions, the certification commission decides on assigning the appropriate qualification category to the endoscopist.
Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV
www.laparoscopy.ru
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ORDER of the Ministry of Health and Medical Industry of the Russian Federation dated May 31, 1996 N 222 “ON IMPROVING ENDOSCOPY SERVICE IN HEALTHCARE INSTITUTIONS OF THE RUSSIAN FEDERATION”
The development of endoscopic technology in recent decades, based on the use of fiber optics, has significantly expanded the use of minimally invasive instrumental research methods in medical practice.
Currently, endoscopy has become quite widespread both in the diagnosis and treatment of various diseases. A new direction has appeared in medical practice - surgical endoscopy, which makes it possible to achieve a pronounced economic effect while maintaining the therapeutic result by significantly reducing the length of hospitalization and the cost of treating patients.
The advantages of endoscopic methods ensure the rapid development of this service in the Russian Federation.
Over the past 5 years, the number of endoscopy departments and rooms in medical institutions has increased by 1.7 times, and their equipment with endoscopic equipment has increased by 2.5 times.
From 1991 to 1995, the number of endoscopists increased 1.4 times; 35% of specialists have qualification categories (1991 - 20%).
The scope of performed research and treatment procedures is constantly expanding. Compared to 1991, their number increased by 1.5 and 2 times, respectively. In 1995, 142.7 thousand operations were performed using endoscopic technology.
In a number of areas of the country, a 24-hour emergency endoscopic care service has been created, which can significantly improve performance in emergency surgery, traumatology and gynecology. Computer programs have been developed and are being actively implemented to evaluate the results of endoscopic studies.
At the same time, there are serious shortcomings and unresolved problems in organizing the activities of the endoscopy service.
Only 38.5 percent of hospitals in rural areas, 21.7 percent of dispensaries (including 8 percent for tuberculosis), and 3.6 percent of outpatient clinics have endoscopy units.
Only 17 percent of the total number of endoscopy specialists work in health care facilities located in rural areas.
In the staffing structure of endoscopists, there is a high proportion of part-time doctors from other specialties.
The capabilities of endoscopy are underutilized due to the unclear organization of work of existing departments, the slow introduction into practice of new forms of management and organization of work of medical personnel, the scattering of specialists involved in endoscopy among other specialized services, and the lack of highly effective endoscopic diagnostic and treatment programs and algorithms.
In some cases, expensive endoscopic equipment is used extremely irrationally due to poor training of specialists, especially in surgical endoscopy, and lack of proper continuity in work with doctors of other specialties. The load on one endoscope with fiber optics is 2 times lower than the standard.
Certain difficulties in organizing the service are due to the lack of the necessary regulatory framework, recommendations for optimizing the structure and staffing, and the range of studies in endoscopy units of various capacities.
The quality of endoscopic equipment produced by domestic enterprises does not fully meet modern technical requirements.
In order to improve the organization of the endoscopy service and increase the efficiency of its work, the rapid introduction of new diagnostic and treatment methods, including surgical endoscopy, as well as improving personnel training and technical equipment of departments with modern endoscopic equipment, I declare:
3. Regulations on the head of the department, department, endoscopy room (Appendix 3).
7. Estimated time standards for endoscopic examinations, therapeutic and diagnostic procedures, operations (Appendix 7).
8. Instructions for the use of estimated time standards for endoscopic examinations (Appendix 8).
9. Instructions for the development of estimated time standards for the introduction of new equipment or new types of research and treatment (Appendix 9).
10. Qualification characteristics of the endoscopist (Appendix 10).
12. Methodology for calculating prices for endoscopic examinations (Appendix 12).
14. Instructions for filling out the Register of studies performed in the department, unit, endoscopy room - form N 157/u-96 (Appendix 14).
15. Addition to the list of forms of primary medical documentation (Appendix 15).
1. To the Ministers of Health of the republics within the Russian Federation, heads of health authorities and institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:
1.2. When planning a network of endoscopy units, pay special attention to their organization in primary care institutions, including rural healthcare.
1.3. Appoint the main freelance endoscopy specialists and organize work in accordance with the Regulations approved by this Order.
1.4. Involve departments of scientific research institutes, educational universities and postgraduate educational institutions in organizational, methodological and advisory work on endoscopy.
1.5. Organize the work of departments, departments, endoscopy rooms in accordance with this Order.
1.6. Establish the number of personnel in departments, departments and endoscopy rooms in accordance with the volume of work based on the estimated time standards for endoscopic examinations.
1.8. Provide regular training to medical doctors on current issues of endoscopy.
3. The Department of Educational Institutions (Volodin N.N.) to supplement the training programs for training specialists in endoscopy in educational institutions of postgraduate training, taking into account the introduction into practice of modern equipment and new research methods.
4. The Department of Scientific Institutions (Nifantev O.E.) to continue work on creating new endoscopic equipment that meets modern technical requirements.
7. Entrust control over the execution of the Order to Deputy Minister A.N. Demenkov.
Minister of Health and
medical industry
Russian Federation
A.D.TSAREGORODTSEV
Appendix 1
dated May 31, 1996 N 222
1. General provisions
1.1. The main freelance specialist in endoscopy is a doctor - an endoscopist with a higher or first degree qualification category or academic degree and has organizational skills.
1.2. The chief freelance specialist organizes his work on the basis of a contract with the healthcare authority.
1.3. The chief freelance specialist works according to a plan approved by the leadership of the relevant healthcare authority and reports annually on its implementation.
1.4. The chief freelance specialist reports to the leadership of the relevant healthcare authority.
1.5. The chief freelance endoscopy specialist in his work is guided by these Regulations, orders and instructions of the relevant health authorities, and current legislation.
1.6. The appointment and dismissal of the chief freelance specialist is carried out in accordance with the established procedure and in accordance with the terms of the contract.
2. The main tasks of the chief freelance endoscopy specialist are the development and holding events, aimed at improving the organization and increasing the efficiency of diagnostic, therapeutic and surgical endoscopy in outpatient and inpatient settings, introducing new research and treatment methods, organizational forms and working methods, diagnostic and treatment algorithms, rational and efficient use material and human resources for health care.
3. The chief freelance specialist, in accordance with the tasks assigned to him, is obliged to:
3.1. Participate in the development of comprehensive plans for the development and improvement of the supervised service.
3.2. Analyze the state and quality of services in the territory, make the necessary decisions to provide practical assistance.
3.3. Take part in the preparation of regulatory and administrative documents, proposals to higher health authorities and other authorities for the development and improvement of the supervised service, as well as in the preparation and implementation of scientific and practical conferences, seminars, symposiums, classes in schools of excellence.
3.4. Ensure close interaction with other diagnostic services and clinical departments in order to expand capabilities and improve the level of treatment and diagnostic process.
3.5. To promote the introduction into the work of medical institutions of the achievements of science and practice in the field of diagnosis and treatment, effective organizational forms and methods of work, best practices, and scientific organization of work.
3.6. Determine the need for modern equipment and consumables, take part in the distribution of local budget funds allocated for the purchase of medical equipment and equipment.
3.7. Take part in expert assessment proposals for the production of medical equipment and instruments coming from enterprises and organizations with various forms of ownership.
3.8. Participate in the certification of doctors and paramedical workers involved in endoscopy, in the certification of the activities of medical personnel, in the development of medical and economic standards and price tariffs.
3.9. Participate in the development of long-term plans to improve the qualifications of doctors and nursing staff involved in endoscopy.
3.10. Interact with the specialized association of specialists in current problems service improvement.
4. The chief freelance specialist has the right:
4.1. Request and receive all the necessary information to study the work of medical institutions in the specialty.
4.2. Coordinate the activities of chief endoscopy specialists of subordinate health care authorities.
5. The chief freelance specialist, in order to improve the quality of medical care to the population in his specialty, in the prescribed manner organizes meetings of specialists from subordinate bodies and healthcare institutions with the involvement of the scientific and medical community to discuss scientific, organizational and methodological issues.
Head of Department
medical organization
assistance to the population
A.A.KARPEEV
Appendix 2
to the Order of the Ministry of Health and Medical Industry of the Russian Federation
dated May 31, 1996 N 222
1. Department, department, endoscopy room is structural unit medical and preventive institution.
2. The management of the department, department, endoscopy room is carried out by the head, appointed and dismissed in the prescribed manner by the head of the healthcare institution.
3. The activities of the department, department, endoscopy room are regulated by the relevant regulatory documents and this Regulation.
4. The main tasks of the department, department, endoscopy room are:
— the most complete satisfaction of the population’s needs for all main types of therapeutic and diagnostic endoscopy, provided for by specialization and the list of methods and techniques recommended for medical institutions at various levels;
— use in practice of new, modern, most informative methods of diagnosis and treatment, rational expansion of the list of research methods;
— rational and effective use of expensive medical equipment.
5. In accordance with the specified tasks, the department, department, endoscopy room carries out:
— mastering and introducing into the practice of their work methods of therapeutic and diagnostic endoscopy that correspond to the profile and level of the medical institution, new devices and devices, progressive research technology;
— carrying out endoscopic examinations and issuing medical reports based on their results.
6. The department, department, endoscopy room is located in specially equipped premises that fully meet the requirements of the rules for design, operation and safety.
7. The equipment of the department, department, endoscopy room is carried out in accordance with the level and profile of the medical institution.
8. The staffing of medical and technical personnel is established in accordance with the recommended staffing standards, the volume of work being performed or planned and, depending on local conditions, based on the estimated time standards for endoscopic examinations.
9. The workload of specialists is determined by the tasks of the department, department, endoscopy room, regulations on their functional responsibilities, as well as estimated time standards for conducting various studies.
10. In the department, department, endoscopy room, all necessary accounting and reporting documentation is maintained in accordance with approved forms and an archive medical documents in compliance with the storage periods established by regulatory documents.
Appendix 3
to the Order of the Ministry of Health and Medical Industry of the Russian Federation
dated May 31, 1996 N 222
In the following text - “head of department”.
1. Appointed to the position of head of the department qualified doctor- an endoscopist with at least 3 years of experience in the specialty and organizational skills.
2. The appointment and dismissal of the head of the department is carried out by the chief physician of the medical institution in the prescribed manner.
3. The head of the department reports directly to the chief physician of the institution or his deputy for medical issues.
4. In his work, the head of the department is guided by the regulations on the medical institution, department, department, endoscopy room, these Regulations, job descriptions, orders and other applicable regulatory documents.
5. In accordance with the tasks of the department, department, endoscopy room, the head carries out:
— organization of the unit’s activities, management and control over the work of its personnel;
— advisory assistance doctors - endoscopists;
- analysis complex cases and errors in diagnosis;
— development and implementation of new modern methods endoscopy and technical means;
— measures for coordination and continuity of work between departments of a medical institution;
— assistance in systematic improvement of personnel qualifications;
— control over the maintenance of medical records and archives;
— registration and submission in the prescribed manner of applications for the purchase of new equipment and consumables;
— development of measures to ensure the accuracy and reliability of ongoing research, providing for timely and competent maintenance medical equipment products and regular metrological control of measuring instruments used in the department;
— systematic analysis of qualitative and quantitative performance indicators, preparation and submission of work reports in a timely manner and the development on their basis of measures to improve the activities of the unit.
6. The head of the department is obliged to:
— ensure accurate and timely performance by staff of official duties and internal regulations;
— promptly communicate to employees orders and directives from the administration, as well as instructional, methodological and other documents;
- monitor compliance with labor safety rules and fire safety;
- improve your qualifications in the prescribed manner.
7. The head of the department has the right:
— take direct part in the selection of personnel for the department;
— carry out personnel placement in the department and distribute responsibilities between employees;
— give orders and instructions to employees in accordance with the level of their competence, qualifications and the nature of the functions assigned to them;
— participate in meetings and conferences where issues related to the work of the unit are discussed;
- represent employees subordinate to him for incentives or penalties;
— make proposals to the administration of the institution on issues of improving the work of the unit, conditions and remuneration.
8. The manager’s orders are binding on all department personnel.
9. The head of a department, department, or endoscopy room bears full responsibility for the level of organization and quality of work of the department.
Appendix 4
to the Order of the Ministry of Health and Medical Industry of the Russian Federation
dated May 31, 1996 N 222
In the following text - “doctor - endoscopist”.
1. A specialist with a higher medical education who has received the specialty “general medicine” or “pediatrics” and has completed the training program in endoscopy in accordance with qualification requirements and received a specialist certificate.
2. The training of an endoscopist is carried out on the basis of institutes and faculties for advanced training of doctors from among specialists in general medicine and pediatrics.
3. In his work, the endoscopist doctor is guided by the regulations on the medical institution, department, unit, endoscopy room, these Regulations, job descriptions, orders and other current regulatory documents.
4. The endoscopist is directly subordinate to the head of the department, and in his absence, to the head of the medical institution.
5. The orders of the endoscopist are mandatory for middle and junior medical personnel of the endoscopy department.
6. In accordance with the tasks of the department, department, endoscopy room, the doctor carries out:
— carrying out research and issuing conclusions based on their results;
— participation in the analysis of complex cases and errors in diagnosis and treatment, identification and analysis of the reasons for the discrepancy between the conclusions on endoscopy methods and the results of other methods diagnostic methods;
— development and implementation of diagnostic and therapeutic methods and equipment;
— high-quality maintenance of medical records and records, archives, analysis of qualitative and quantitative performance indicators;
— control over the work of nursing and junior medical personnel within their competence;
— control over the safety and rational use of equipment and equipment, their technically competent operation;
— participation in advanced training of nursing and junior medical personnel.
7. The endoscopist is obliged to:
— ensure accurate and timely fulfillment of their official duties and internal labor regulations;
- monitor compliance by nursing and junior medical staff with sanitation rules, economic and technical condition of the unit;
- submit work reports to the head of the endoscopy department, and in his absence, to the chief physician;
— comply with labor protection and fire safety rules.
8. An endoscopist has the right:
— make proposals to the administration on issues of improving the activities of the unit, organization and working conditions;
— participate in meetings and conferences that discuss issues related to the work of the endoscopy department;
9. The appointment and dismissal of an endoscopist is carried out by the chief physician of the institution in the prescribed manner.
Head of Department
medical organization
assistance to the population
A.A.KARPEEV
Appendix 5
to the Order of the Ministry of Health and Medical Industry of the Russian Federation
dated May 31, 1996 N 222
1. A qualified nurse with secondary medical education who has completed special training in endoscopy and has organizational skills.
2. In her work, the senior nurse of a department or department is guided by the regulations on the medical institution, department, endoscopy department, these Regulations, job descriptions, orders and instructions of the head of the department or department.
3. The senior nurse reports directly to the head of the department, endoscopy department.
4. The senior nurse is subordinate to the middle and junior medical staff of the department or department.
5. The main tasks of the head nurse of the department, endoscopy department are:
— rational placement and organization of work of nursing and junior medical personnel;
— monitoring the work of mid-level and junior medical personnel of the department, department, compliance by the above-mentioned personnel with internal regulations, sanitary and anti-epidemic regimes, the condition and safety of equipment and equipment;
— timely processing of requests for medications, consumables, equipment repair, etc.;
— maintaining the necessary accounting and reporting documentation of the department, department;
— implementation of measures to improve the qualifications of nursing staff of the department, department;
— compliance with labor protection rules, fire safety and internal labor regulations.
6. The senior nurse of the department, endoscopy department is obliged to:
— improve your qualifications in the prescribed manner;
- inform the head of the department, department about the state of affairs in the department, department and the work of nursing and junior medical personnel.
7. The senior nurse of the department, endoscopy department has the right:
- give orders and instructions to the middle and junior medical personnel of the department, department within their boundaries job responsibilities and monitor their implementation;
— make proposals to the head of the department or department to improve the organization and working conditions of mid-level and junior medical personnel of the department or department;
- take part in meetings held in the department or department when considering issues within its competence.
8. The order of the senior nurse is mandatory for execution by the middle and junior staff of the department or department.
9. The senior nurse of the department, endoscopy department is responsible for the timely and high-quality implementation of the tasks and responsibilities provided for by these Regulations.
10. The appointment and dismissal of a senior nurse of a department or department is carried out by the chief physician of the institution in the prescribed manner.
Head of Department
medical organization
assistance to the population
A.A.KARPEEV
Appendix 6
to the Order of the Ministry of Health and Medical Industry of the Russian Federation
dated May 31, 1996 N 222
In the following text - “nurse”.
1. Appointed to the position of nurse medical worker, having an average medical education and has undergone specialized training in endoscopy.
2. In her work, the nurse is guided by the regulations on the department, department, endoscopy room, these Regulations and job descriptions.
3. The nurse works under the direct supervision of the endoscopist and the head nurse of the department.
4. The nurse carries out:
- calling patients for examination, preparing them and participating in diagnostic, therapeutic and surgical interventions within the framework of performing the technological operations assigned to it;
— registration of patients and studies in the accounting documentation in the prescribed form;
— regulation of the flow of visitors, the order of research and pre-registration for research;
— general preparatory work to ensure the functioning of diagnostic and auxiliary equipment, ongoing monitoring of its operation, timely registration of faults, creation necessary conditions labor in diagnostic and treatment rooms and at your workplace;
- control over safety, consumption necessary materials(medicines, dressings, tools, etc.) and their timely replenishment;
- daily activities to maintain the proper sanitary condition of the premises of the department, department, office and your workplace, as well as to comply with hygiene requirements and sanitary and anti-epidemic regime;
— high-quality maintenance of medical records.
5. The nurse is obliged to:
— improve your skills;
— comply with labor protection, fire safety and internal labor regulations.
6. The nurse has the right:
- make proposals to the head nurse or doctor of the department, office on the organization of the work of the department and their working conditions;
— take part in meetings held in the department on issues within its competence.
7. The nurse is responsible for the timely and high-quality performance of his duties provided for by these Regulations and internal labor regulations.
8. The appointment and dismissal of a nurse is made by the chief physician of the institution in the prescribed manner.
Appendix 7
to the Order of the Ministry of Health and Medical Industry of the Russian Federation
dated May 31, 1996 N 222
1. Estimated time standards for endoscopic operations are intended for endoscopists performing these surgical interventions.
2. Estimated time standards for endoscopic surgery increase by the corresponding number of endoscopists performing it.
Appendix 8
to the Order of the Ministry of Health and Medical Industry of the Russian Federation
dated May 31, 1996 N 222
Estimated time standards for endoscopic examinations are determined taking into account the necessary ratio between the optimal labor productivity of medical staff and high quality and completeness of diagnostic and therapeutic endoscopic examinations.
This Instruction is intended for heads of departments and doctors of endoscopy departments to use it for the purpose of rational application of the calculated time standards approved by this Order of the Ministry of Health and Medical Industry of Russia.
The main purpose of the estimated time standards for endoscopic examinations is their use when:
— addressing issues of improving the organization of activities of departments, departments, endoscopy rooms;
— planning and organizing the work of medical personnel of these units;
— analysis of labor costs of medical staff;
— formation of staffing standards for medical staff of relevant medical institutions.
Specific gravity The work of medical staff in directly conducting endoscopic examinations (main and auxiliary activities, work with documentation) accounts for 85% of the working time of doctors and nurses. This time is included in the estimated time standards. Time for another necessary work and the personal time required is not taken into account in the standards.
For doctors, this means a joint discussion with attending physicians of clinical and instrumental data, participation in medical conferences, reviews, rounds, training and monitoring the work of staff, mastering methods and new equipment, working with archives and documentation, and administrative and economic work.
For nurses it is preparatory work at the beginning of the working day, caring for equipment, obtaining necessary materials and medications, issuing reports, putting the workplace in order after the shift.
Time required for endoscopic examinations, procedures or surgeries emergency indications, as well as the time of transitions (moving) for their implementation outside the department, department, endoscopy room is taken into account according to actual costs.
For heads of departments, divisions, and endoscopy rooms, a differentiated amount of work can be established for the direct implementation of research and operations, depending on local conditions - the profile of the institution, the actual or planned annual volume of work of the department, the number of medical personnel, etc.
When determining the estimated workload standards for doctors and nursing staff, it is recommended to be guided by the methodology for rationing the work of medical personnel (M., 1987, approved by the USSR Ministry of Health). In this case, the ratio of the above-mentioned working time costs is taken as a basis.
To account for the work of personnel in departments, departments, endoscopy rooms, the possibility of comparing their workload, etc., the calculated time standards and the determined workload standards for doctors and nursing staff are reduced to a common unit of measurement - conventional units. One conventional unit is 10 minutes of working time. Thus, the shift workload norm is determined based on the duration of the work shift established for the personnel.
In accordance with the clarification of the Ministry of Labor of the Russian Federation dated December 29, 1992 N 5, approved by Resolution dated December 29, 1992 N 65, the transfer of days off coinciding with holidays, is carried out at enterprises, institutions and organizations that apply various work and rest regimes, in which work is not carried out on holidays.
The standard working time for certain periods of time is calculated according to the five-day calculated schedule working week with two days off, Saturday and Sunday, based on the following duration of daily work (shift):
- with a 40-hour work week - 8 hours, on holidays - 7 hours;
- if the length of the working week is less than 40 hours - the number of hours obtained by dividing the established length of the working week by five days, on the eve of holidays, in this case, no reduction in working time is made (Article 47 of the Labor Code of the Russian Federation).
Based on an analysis of the work done by an individual employee and the department as a whole, decisions are made management decisions, aimed at improving the work of personnel, introducing more effective research methods to improve the quality and information content of the studies performed in order to most fully satisfy the need for this type of diagnostics.
Issues of use, rational placement and formation of the number of medical personnel are resolved on the basis of the objectively established or planned volume of work of the unit using recommended labor standards.
The actual or planned annual volume of activity for conducting endoscopic studies, expressed in conventional units, is determined by the formula:
T - actual or planned annual volume of activity for conducting endoscopic studies, expressed in conventional units; t1, t2, ti — time in conventional units in accordance with the approved estimated time standards for research (main and additional); n1, n2, ni - actual or planned number of studies during the year using individual diagnostic methods.
Comparison of the actual annual volume of activity with the planned one allows for an integral assessment of the unit’s activities, to get an idea of the labor productivity of its personnel and the efficiency of the unit as a whole.
Carrying out research on a larger scale throughout the year can be achieved by intensifying the work of medical staff or by increasing the amount of time used for core activities by significantly reducing the share of other necessary types of labor. If this is not the result of the use of automation tools for research and calculation of physiological parameters, methods for more rational organization of the work of doctors and nurses, then such intensification of work inevitably leads to a decrease in the quality, information content and reliability of conclusions. Failure to fulfill the plan for the volume of activity may be the result of improper planning, a consequence of defects in the organization of work and in the management of the department. Therefore, both failure to fulfill the plan and its excessive overfulfillment should be equally carefully analyzed by both the head of the office (department) and the management of the medical institution in order to identify their causes and take appropriate measures. Deviations of the actual volume of activity from the annual planned volume within +20% can be considered acceptable. -10%.
Along with the general indicators of the work performed, the structure of the studies performed and the number of studies on individual endoscopic methods are traditionally analyzed to assess the balance and adequacy of the structure, the sufficiency of the number of studies of the actual need for them.
The average time spent on one study is determined by:
REGULATIONS ON THE CHIEF EXTENSION SPECIALIST IN ENDOSCOPY OF THE MINISTRY OF HEALTH AND MEDICAL INDUSTRY OF THE RUSSIAN FEDERATION AND HEALTH MANAGEMENT BODIES OF THE SUBJECTS OF THE RUSSIAN FEDERATION
1. General provisions
1.1. The chief freelance specialist in endoscopy is appointed an endoscopist who has a higher or first qualification category or academic degree and has organizational skills.
1.2. The chief freelance specialist organizes his work on the basis of a contract with the healthcare authority.
1.3. The chief freelance specialist works according to a plan approved by the leadership of the relevant healthcare authority and reports annually on its implementation.
1.4. The chief freelance specialist reports to the leadership of the relevant healthcare authority.
1.5. The chief freelance endoscopy specialist in his work is guided by these Regulations, orders and instructions of the relevant health authorities, and current legislation.
1.6. The appointment and dismissal of the chief freelance specialist is carried out in accordance with the established procedure and in accordance with the terms of the contract.
2. Main tasks The main freelance specialist in endoscopy is the development and implementation of activities aimed at improving the organization and increasing the efficiency of diagnostic, therapeutic and surgical endoscopy in outpatient and inpatient settings, introducing new research and treatment methods, organizational forms and methods of work into the practice of medical institutions , diagnostic and treatment algorithms, rational and effective use of material and human resources in healthcare.
3. The chief freelance specialist, in accordance with the tasks assigned to him, is obliged to:
3.1. Participate in the development of comprehensive plans for the development and improvement of the supervised service.
3.2. Analyze the state and quality of services in the territory, make the necessary decisions to provide practical assistance.
3.3. Take part in the preparation of regulatory and administrative documents, proposals to higher health authorities and other authorities for the development and improvement of the supervised service, as well as in the preparation and conduct of scientific and practical conferences, seminars, symposiums, classes in schools of excellence.
3.4. Ensure close interaction with other diagnostic services and clinical departments in order to expand capabilities and improve the level of treatment and diagnostic process.
3.5. To promote the introduction into the work of medical institutions of the achievements of science and practice in the field of diagnosis and treatment, effective organizational forms and methods of work, best practices, and scientific organization of work.
3.6. Determine the need for modern equipment and consumables, take part in the distribution of local budget funds allocated for the purchase of medical equipment and equipment.
3.7. Take part in the expert assessment of proposals for the production of medical equipment and instruments coming from enterprises and organizations with various forms of ownership.
3.8. Participate in the certification of doctors and paramedical workers involved in endoscopy, in the certification of the activities of medical personnel, in the development of medical and economic standards and price tariffs.
3.9. Participate in the development of long-term plans to improve the qualifications of doctors and nursing staff involved in endoscopy.
3.10. Interact with the specialized association of specialists on current issues of improving the service.
4. The chief freelance specialist has the right:
4.1. Request and receive all the necessary information to study the work of medical institutions in the specialty.
4.2. Coordinate the activities of chief endoscopy specialists of subordinate health care authorities.
4.3. Make recommendations to the heads of healthcare authorities on the development and improvement of the service.
5. The chief freelance specialist, in order to improve the quality of medical care to the population in his specialty, in the prescribed manner organizes meetings of specialists from subordinate bodies and healthcare institutions with the involvement of the scientific and medical community to discuss scientific, organizational and methodological issues.
Appendix 2 to the Order of the Ministry of Health and Medical Industry of the Russian Federation of May 31, 1996 N 222
REGULATIONS ABOUT THE DEPARTMENT, DEPARTMENT, ENDOSCOPY ROOM
1. The department, department, endoscopy room is a structural unit of a medical and preventive institution.
2. The management of the department, department, endoscopy room is carried out by the head, appointed and dismissed in the prescribed manner by the head of the healthcare institution.
3. The activities of the department, department, endoscopy room are regulated by the relevant regulatory documents and these Regulations.
4. The main objectives of the department, department, endoscopy room are: - the most complete satisfaction of the population’s needs for all main types of therapeutic and diagnostic endoscopy, provided for by specialization and the list of methods and techniques recommended for medical institutions at various levels; - use in practice of new, modern, most informative methods of diagnosis and treatment, rational expansion of the list of research methods; - rational and effective use of expensive medical equipment.
5. In accordance with the specified tasks, the department, department, endoscopy room carries out: - mastering and introducing into the practice of its work methods of therapeutic and diagnostic endoscopy that correspond to the profile and level of the medical institution, new devices and apparatus, progressive research technology; - conducting endoscopic examinations and issuing medical reports based on their results.
6. The department, department, endoscopy room is located in specially equipped premises that fully meet the requirements of the rules for design, operation and safety.
7. The equipment of the department, department, endoscopy room is carried out in accordance with the level and profile of the medical institution.
8. The staffing of medical and technical personnel is established in accordance with the recommended staffing standards, the volume of work being performed or planned and, depending on local conditions, based on the estimated time standards for endoscopic examinations.
9. The workload of specialists is determined by the tasks of the department, department, endoscopy room, the regulations on their functional responsibilities, as well as the estimated time standards for conducting various studies.
10. In the department, department, endoscopy room, all necessary accounting and reporting documentation is maintained in accordance with approved forms and an archive of medical documents in compliance with the storage periods established by regulatory documents.
Head of the Department of Organization of Medical Care to the Population A.A. KARPEEV
Appendix 3 to the Order of the Ministry of Health and Medical Industry of the Russian Federation of May 31, 1996 N 222
REGULATIONS ON THE HEAD OF DEPARTMENT, DEPARTMENT, ENDOSCOPY OFFICE
1. A qualified endoscopist with at least 3 years of experience in the specialty and organizational skills is appointed to the position of head of the department. (In the following text - “head of department”).
2. The appointment and dismissal of the head of the department is carried out by the chief physician of the medical institution in the prescribed manner.
3. The head of the department reports directly to the chief physician of the institution or his deputy for medical issues.
4. In his work, the head of the department is guided by the regulations on the medical institution, department, department, endoscopy room, these Regulations, job descriptions, orders and other current regulatory documents.
5. In accordance with the tasks of the department, department, endoscopy room, the head carries out:
organization of the unit’s activities, management and control over the work of its personnel;
advisory assistance to endoscopists;
analysis of complex cases and diagnostic errors;
development and implementation of new modern endoscopy methods and technical means;
measures for coordination and continuity of work between departments of a medical institution;
promoting systematic staff training;
control over the maintenance of medical records and archives;
control over the safety and rational use of equipment and equipment, their technically competent operation;
registration and submission in the prescribed manner of applications for the purchase of new equipment and consumables;
development of measures to ensure the accuracy and reliability of the research carried out, providing for timely and competent maintenance of medical equipment products and regular metrological control of measuring instruments used in the department;
systematic analysis of qualitative and quantitative performance indicators, preparation and submission of work reports in a timely manner and development on their basis of measures to improve the activities of the unit.
6. The head of the department is obliged to:
ensure accurate and timely performance by staff of official duties and internal regulations;
promptly communicate to employees orders and directives from the administration, as well as instructional, methodological and other documents;
monitor compliance with labor protection and fire safety rules; - improve your qualifications in the prescribed manner.
7. The head of the department has the right:
take direct part in the selection of personnel for the department;
carry out personnel placement in the department and distribute responsibilities between employees;
give orders and instructions to employees in accordance with the level of their competence, qualifications and the nature of the functions assigned to them;
participate in meetings and conferences where issues related to the work of the unit are discussed;
represent employees subordinate to him for promotion or punishment;
make proposals to the administration of the institution on issues of improving the work of the unit, conditions and remuneration.
8. The manager’s orders are binding on all department personnel.
9. The head of a department, department, or endoscopy room bears full responsibility for the level of organization and quality of work of the department.
Head of the Department of Organization of Medical Care to the Population A.A. KARPEEV
Appendix 4 to the Order of the Ministry of Health and Medical Industry of the Russian Federation of May 31, 1996 N 222
REGULATIONS ON THE DOCTOR - ENDOSCOPIST OF THE DEPARTMENT, DEPARTMENT, ENDOSCOPY OFFICE
1. A specialist with a higher medical education who has received a specialty in general medicine or pediatrics, has completed a training program in endoscopy in accordance with the qualification requirements and has received a specialist certificate (hereinafter referred to as “doctor-endoscopist”) is appointed to the position of a doctor-endoscopist. .
2. The training of an endoscopist is carried out on the basis of institutes and faculties for advanced training of doctors from among specialists in general medicine and pediatrics.
3. In his work, the endoscopist doctor is guided by the regulations on the medical institution, department, unit, endoscopy room, these Regulations, job descriptions, orders and other current regulatory documents.
4. The endoscopist is directly subordinate to the head of the department, and in his absence, to the head of the medical institution.
5. The orders of the endoscopist are mandatory for middle and junior medical personnel of the endoscopy department.
6. In accordance with the tasks of the department, department, endoscopy room, the doctor carries out:
carrying out research and issuing conclusions based on their results;
participation in the analysis of complex cases and errors in diagnosis and treatment, identification and analysis of the reasons for the discrepancy between the conclusion on endoscopy methods and the results of other diagnostic methods;
development and implementation of diagnostic and therapeutic methods and equipment;
high-quality maintenance of medical records and records, archives, analysis of qualitative and quantitative performance indicators;
control over the work of nursing and junior medical personnel within their competence; - control over the safety and rational use of equipment and equipment, their technically competent operation;
participation in advanced training of nursing and junior medical personnel.
7. The endoscopist is obliged to:
ensure accurate and timely fulfillment of their official duties and internal labor regulations;
monitor compliance by middle and junior medical staff with sanitation rules, economic and technical condition of the unit;
submit work reports to the head of the endoscopy department, and in his absence, to the chief physician;
comply with labor protection and fire safety rules.
8. An endoscopist has the right:
make proposals to the administration on issues of improving the activities of the unit, organization and working conditions;
participate in meetings and conferences that discuss issues related to the work of the endoscopy department;
improve your qualifications in the prescribed manner.
9. The appointment and dismissal of an endoscopist is made by the chief physician of the institution in the prescribed manner.
Head of the Department of Organization of Medical Care to the Population A.A. KARPEEV
Appendix 5 to the Order of the Ministry of Health and Medical Industry of the Russian Federation of May 31, 1996 N 222
REGULATIONS ON THE SENIOR NURSE OF THE DEPARTMENT, ENDOSCOPY DEPARTMENT
1. A qualified nurse with a secondary medical education, who has undergone special training in endoscopy and has organizational skills, is appointed to the position of senior nurse of the department, endoscopy department.
2. In her work, the senior nurse of a department or department is guided by the regulations on the medical institution, department, endoscopy department, these Regulations, job descriptions, orders and instructions of the head of the department or department.
3. The senior nurse reports directly to the head of the department, endoscopy department.
4. The senior nurse is subordinate to the middle and junior medical staff of the department or department.
5. The main tasks of the head nurse of the department, endoscopy department are: - rational placement and organization of work of middle and junior medical personnel; - monitoring the work of mid-level and junior medical personnel of the department, department, compliance by the above-mentioned personnel with internal regulations, sanitary and anti-epidemic regime, condition and safety of equipment and equipment; - timely execution of requests for medicines, consumables, equipment repairs, etc.; - maintaining the necessary accounting and reporting documentation of the department, department; - implementation of measures to improve the qualifications of nursing staff of the department, department; - compliance with labor protection rules, fire safety and internal labor regulations.
6. The senior nurse of the department, endoscopy department is obliged to: - improve her qualifications in the prescribed manner; - inform the head of the department, department about the state of affairs in the department, department and the work of nursing and junior medical personnel.
7. The senior nurse of the department, endoscopy department has the right to: - give orders and instructions to the middle and junior medical personnel of the department, department within the limits of their official duties and monitor their implementation; - make proposals to the head of the department or department to improve the organization and working conditions of mid-level and junior medical personnel of the department or department; - take part in meetings held in the department or department when considering issues within its competence.
8. The order of the senior nurse is mandatory for execution by the middle and junior staff of the department or department.
9. The senior nurse of the department, endoscopy department is responsible for the timely and high-quality implementation of the tasks and responsibilities provided for by these Regulations.
10. The appointment and dismissal of a senior nurse of a department or department is carried out by the chief physician of the institution in the prescribed manner.
Head of the Department of Organization of Medical Care to the Population A.A. KARPEEV
Appendix 6 to the Order of the Ministry of Health and Medical Industry of the Russian Federation of May 31, 1996 N 222
REGULATIONS ON THE NURSE OF THE DEPARTMENT, DEPARTMENT, ENDOSCOPY OFFICE
1. A medical worker who has a secondary medical education and has undergone special training in endoscopy (hereinafter referred to as a “nurse”) is appointed to the position of a nurse.
2. In her work, the nurse is guided by the regulations on the department, department, endoscopy room, these Regulations and job descriptions.
3. The nurse works under the direct supervision of the endoscopist and the head nurse of the department.
4. The nurse carries out:
calling patients for examination, preparing them and participating in diagnostic, therapeutic and surgical interventions within the framework of performing assigned technological operations;
registration of patients and studies in accounting documentation in the prescribed form;
regulation of the flow of visitors, the order of research and pre-registration for research;
general preparatory work to ensure the functioning of diagnostic and auxiliary equipment, ongoing monitoring of its operation, timely registration of faults, creation of the necessary working conditions in diagnostic and treatment rooms and at your workplace;
control over the safety, consumption of necessary materials (medicines, dressings, instruments, etc.) and their timely replenishment;
daily activities to maintain the proper sanitary condition of the premises of the department, department, office and your workplace, as well as to comply with hygiene requirements and sanitary and anti-epidemic regime;
high-quality medical documentation.
5. The nurse is obliged to:
improve your skills;
comply with labor protection, fire safety and internal labor regulations.
6. The nurse has the right:
make proposals to the head nurse or doctor of the department or office on the organization of the work of the department and their working conditions;
take part in meetings held in the department on issues within its competence.
7. The nurse is responsible for the timely and high-quality performance of his duties provided for by these Regulations and internal labor regulations.
8. The appointment and dismissal of a nurse is made by the chief physician of the institution in the prescribed manner.
Head of the Department of Organization of Medical Care to the Population A.A. KARPEEV
Appendix 7 to the Order of the Ministry of Health and Medical Industry of the Russian Federation of May 31, 1996 N 222
ESTIMATED TIME STANDARDS FOR ENDOSCOPIC STUDIES, TREATMENT AND DIAGNOSTIC PROCEDURES, OPERATIONS
| № | Name of the study |
Time for 1 study, procedure, |
|||
| diagnostic | therapeutic and diagnostic | ||||
| adults | children | adults | children | ||
| 1. | Esophagoscopy | 30 | 40 | 60 | 70 |
| 2. | Esophagogastroscopy | 45 | 50 | 60 | 70 |
| 3. | Esophagogastroduodenoscopy | 55 | 60 | 70 | 80 |
| 4. | Esophagogastroduodenoscopy with retrograde cholangiopancreatography | 90 | 90 | 120 | 120 |
| 5. | Eunoscopy | 80 | 90 | 120 | 120 |
| 6. | Choledochoscopy | 60 | - | 90 | - |
| 7. | Fistulocholedocoscopy | 90 | - | 120 | - |
| 8. | Rectoscopy | 25 | 40 | 40 | 50 |
| 9. | Rectosigmoidoscopy | 60 | 60 | 90 | 90 |
| 10. | Rectosigmoidocolonoscopy | 100 | 120 | 150 | 150 |
| 11. | Epipharyngo-laryngoscopy | 40 | 45 | 45 | 50 |
| 12. | Tracheobronchoscopy | 60 | 65 | 80 | 85 |
| 13. | Thoracoscopy | 90 | 90 | 120 | 120 |
| 14. | Mediastinoscopy | 90 | 90 | 120 | 120 |
| 15. | Laparoscopy | 90 | 90 | 120 | 120 |
| 16. | Fistuloscopy | 60 | 70 | 90 | 90 |
| 17. | Cystoscopy | 30 | 30 | 60 | 60 |
| 18. | Hysteroscopy | 40 | 40 | 50 | 50 |
| 19. | Ventriculoscopy | 50 | 50 | 80 | 80 |
| 20. | Nephroscopy | 100 | 100 | 120 | 120 |
| 21. | Arthroscopy | 60 | 70 | 90 | 100 |
| 22. | Arterioscopy | 60 | 60 | 90 | 90 |
| № | Endoscopic operations - name |
Time for 1 operation (min.) |
|
| adults | children | ||
| 1. | On the abdominal organs (excluding hemicolectomy, gastrectomy, gastrectomy) | 210 | 210 |
| 2. | Hemicolectomy, gastrectomy, gastrectomy | 360 | 360 |
| 3. | On the organs of the chest cavity | 360 | 360 |
| 4. | On the pelvic organs | 210 | 210 |
| 5. | Retroperitoneal space | 210 | 210 |
| 6. | Mediastinum | 210 | 210 |
| 7. | Skulls | 210 | 210 |
1. Estimated time standards for endoscopic operations are intended for endoscopists performing these surgical interventions.
2. The estimated time norms for an endoscopic operation are increased by the corresponding number of endoscopists performing it.
Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV
Appendix 8 to the Order of the Ministry of Health and Medical Industry of the Russian Federation of May 31, 1996 N 222
INSTRUCTIONS FOR APPLICATION OF ESTIMATED TIME STANDARDS FOR ENDOSCOPIC STUDIES
Estimated time standards for endoscopic examinations are determined taking into account the necessary relationship between the optimal labor productivity of medical staff and the high quality and completeness of diagnostic and therapeutic endoscopic examinations. This Instruction is intended for heads of departments and doctors of endoscopy departments to use it for the purpose of rational application of the calculated time standards approved by this Order of the Ministry of Health and Medical Industry of Russia. The main purpose of the estimated time standards for endoscopic examinations is their use when:
addressing issues of improving the organization of activities of departments, departments, endoscopy rooms;
planning and organizing the work of medical personnel of these units;
analysis of labor costs of medical staff;
formation of staffing standards for medical staff of relevant medical institutions.
1. Use of estimated time standards for endoscopic examinations for planning and organizing the work of medical personnel of departments, divisions, and endoscopy rooms. The share of work of medical staff in directly conducting endoscopic examinations (main and auxiliary activities, work with documentation) is 85% of the working time for doctors and nurses. This time is included in the calculated time standards. Time for other necessary work and personal necessary time is not taken into account in the standards. For doctors, this means a joint discussion with attending physicians of clinical and instrumental data, participation in medical conferences, reviews, rounds, training and monitoring the work of staff, mastering methods and new equipment, working with archives and documentation, administrative and economic work. For nurses, this is preparatory work at the beginning of the working day, caring for equipment, obtaining the necessary materials and medications, issuing reports, putting the workplace in order after the shift. The time for carrying out endoscopic examinations, procedures or operations for emergency indications, as well as the time of transitions (moves) for their implementation outside the department, department, endoscopy room is taken into account according to actual costs.
For heads of departments, units, and endoscopy rooms, a differentiated amount of work can be established for the direct implementation of research and operations, depending on local conditions - the profile of the institution, the actual or planned annual volume of work of the department, the number of medical personnel, etc. When determining the estimated workload of doctors and It is recommended that nursing staff be guided by the methodology for rationing the work of medical staff (M., 1987, approved by the USSR Ministry of Health). In this case, the ratio of the above-mentioned working time costs is taken as a basis. To account for the work of personnel in departments, departments, endoscopy rooms, the possibility of comparing their workload, etc., the calculated time standards and the determined workload standards for doctors and nursing staff are reduced to a common unit of measurement - conventional units. One conventional unit is 10 minutes of working time.
Thus, the shift workload norm is determined based on the duration of the work shift established for the personnel. In accordance with the explanation of the Ministry of Labor of the Russian Federation dated December 29, 1992 N 5, approved by Decree dated December 29, 1992 N 65, the transfer of days off coinciding with holidays is carried out at enterprises, institutions and organizations that apply different work and rest regimes, with which work is not carried out on holidays.
The standard working time for certain periods of time is calculated according to the calculated schedule of a five-day work week with two days off, Saturday and Sunday, based on the following duration of daily work (shift):
with a 40-hour work week - 8 hours, on holidays - 7 hours;
if the length of the working week is less than 40 hours - the number of hours obtained by dividing the established length of the working week by five days, on the eve of holidays, in this case, no reduction in working hours is made (Article 47 of the Labor Code of the Russian Federation).
Based on an analysis of the work done by an individual employee and the department as a whole, management decisions are made aimed at improving the work of personnel, introducing more effective research methods that improve the quality and information content of the research performed in order to most fully satisfy the need for this type of diagnostics.
2. Use of estimated time standards for endoscopic examinations to account for and analyze the activities of a department, department, endoscopy room. Issues of use, rational placement and formation of the number of medical personnel are resolved on the basis of the objectively established or planned volume of work of the department using recommended labor standards. The actual or planned annual volume of activity for conducting endoscopic studies, expressed in conventional units, is determined by the formula:
T = t1 x n1 + t2 x n2 + ...... ti x ni, Where
T - actual or planned annual volume of activity for conducting endoscopic studies, expressed in conventional units;
t1, t2, ti - time in conventional units in accordance with the approved estimated time standards for research (main and additional);
n1, n2, ni - actual or planned number of studies during the year using individual diagnostic methods.
Comparison of the actual annual volume of activity with the planned one allows for an integral assessment of the unit’s activities, to get an idea of the labor productivity of its personnel and the efficiency of the unit as a whole. Carrying out research on a larger scale throughout the year can be achieved by intensifying the work of medical staff or by increasing the amount of time used for core activities by significantly reducing the share of other necessary types of labor. If this is not the result of the use of automation tools for research and calculation of physiological parameters, methods for more rational organization of the work of doctors and nurses, then such intensification of work inevitably leads to a decrease in the quality, information content and reliability of conclusions. Failure to fulfill the plan for the volume of activity may be the result of improper planning, a consequence of defects in the organization of work and in the management of the department.
Therefore, both failure to fulfill the plan and its excessive overfulfillment should be equally carefully analyzed by both the head of the office (department) and the management of the medical institution in order to identify their causes and take appropriate measures. Deviations of the actual volume of activity from the annual planned volume within +20% ... -10% can be considered acceptable. Along with the general indicators of the work performed, the structure of the studies performed and the number of studies on individual endoscopic methods are traditionally analyzed to assess the balance and adequacy of the structure, the sufficiency of the number of studies of the actual need for them.
The average time spent on one study is determined by:
WITH = (F : P) X c.u.,
where C is the average time spent on one study; F - total actual time spent (for basic and additional diagnostic procedures) in total for all studies performed using a specific diagnostic or therapeutic method (in conventional units); P is the number of studies performed using the same diagnostic technique.
The correspondence of the average time spent on research to the calculated time standards (in%) for a certain method is determined by the formula:
TO = (WITH : t)x 100
It is acceptable, along with the above, to use other traditional and non-traditional methods of analysis with the calculation and use of other indicators. Heads of institutions and chief specialists also need to monitor the rational use of medical personnel and, when determining staffing levels, be guided by the results of an annual or multi-year analysis of the actual or planned volume of activity of the department.
Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV
To the Order of the Ministry of Health and Medical Industry of the Russian Federation of May 311996 N 222
INSTRUCTIONS FOR APPLICATION OF ESTIMATED TIME STANDARDS FOR ENDOSCOPIC STUDIES
Estimated time standards for endoscopic examinations are determined taking into account the necessary relationship between the optimal labor productivity of medical staff and the high quality and completeness of diagnostic and therapeutic endoscopic examinations. This Instruction is intended for heads of departments and doctors of endoscopy departments to use it for the purpose of rational application of the calculated time standards approved by this Order of the Ministry of Health and Medical Industry of Russia. The main purpose of the estimated time standards for endoscopic examinations is their use when:
addressing issues of improving the organization of activities of departments, departments, endoscopy rooms;
planning and organizing the work of medical personnel of these units;
analysis of labor costs of medical staff;
formation of staffing standards for medical staff of relevant medical institutions.
1. Use of estimated time standards for endoscopic examinations for planning and organizing the work of medical personnel of departments, divisions, and endoscopy rooms. The share of work of medical staff in directly conducting endoscopic examinations (main and auxiliary activities, work with documentation) is 85% of the working time for doctors and nurses. This time is included in the estimated time standards. Time for other necessary work and personal necessary time is not taken into account in the standards. For doctors, this means a joint discussion with attending physicians of clinical and instrumental data, participation in medical conferences, reviews, rounds, training and monitoring the work of staff, mastering methods and new equipment, working with archives and documentation, and administrative and economic work. For nurses, this is preparatory work at the beginning of the working day, caring for equipment, obtaining the necessary materials and medications, issuing reports, putting the workplace in order after the shift. The time for carrying out endoscopic examinations, procedures or operations for emergency indications, as well as the time of transitions (moves) for their implementation outside the department, department, endoscopy room is taken into account according to actual costs.
For heads of departments, units, and endoscopy rooms, a differentiated amount of work can be established for the direct implementation of research and operations, depending on local conditions - the profile of the institution, the actual or planned annual volume of work of the department, the number of medical personnel, etc. When determining the estimated workload of doctors and It is recommended that nursing staff be guided by the methodology for rationing the work of medical staff (M., 1987, approved by the USSR Ministry of Health). In this case, the ratio of the above-mentioned working time costs is taken as a basis. To account for the work of personnel in departments, departments, endoscopy rooms, the possibility of comparing their workload, etc., the calculated time standards and the determined workload standards for doctors and nursing staff are reduced to a common unit of measurement - conventional units. One conventional unit is 10 minutes of working time.
Thus, the shift workload norm is determined based on the duration of the work shift established for the personnel. In accordance with the explanation of the Ministry of Labor of the Russian Federation dated December 29, 1992 N 5, approved by Decree dated December 29, 1992 N 65, the transfer of days off coinciding with holidays is carried out at enterprises, institutions and organizations that apply different work and rest regimes, with which work is not carried out on holidays.
The standard working time for certain periods of time is calculated according to the estimated schedule of a five-day work week with two days off, Saturday and Sunday, based on the following duration of daily work (shift):
with a 40-hour work week - 8 hours, on holidays - 7 hours;
if the length of the working week is less than 40 hours - the number of hours obtained by dividing the established length of the working week by five days, on the eve of holidays, in this case, no reduction in working hours is made (Article 47 of the Labor Code of the Russian Federation).
Based on an analysis of the work done by an individual employee and the department as a whole, management decisions are made aimed at improving the work of personnel, introducing more effective research methods that improve the quality and information content of the research performed in order to most fully satisfy the need for this type of diagnostics.
2. Use of estimated time standards for endoscopic examinations to account for and analyze the activities of a department, department, endoscopy room. Issues of use, rational placement and formation of the number of medical personnel are resolved on the basis of the objectively established or planned volume of work of the department using recommended labor standards. The actual or planned annual volume of activity for conducting endoscopic studies, expressed in conventional units, is determined by the formula:
T = t1 x n1 + t2 x n2 + ...... ti x ni, Where
T - actual or planned annual volume of activity for conducting endoscopic studies, expressed in conventional units;
t1, t2, ti - time in conventional units in accordance with the approved estimated time standards for research (main and additional);
n1, n2, ni - actual or planned number of studies during the year using individual diagnostic methods.
Comparison of the actual annual volume of activity with the planned one allows for an integral assessment of the unit’s activities, to get an idea of the labor productivity of its personnel and the efficiency of the unit as a whole. Carrying out research on a larger scale throughout the year can be achieved by intensifying the work of medical staff or by increasing the amount of time used for core activities by significantly reducing the share of other necessary types of labor. If this is not the result of the use of automation tools for research and calculation of physiological parameters, methods for more rational organization of the work of doctors and nurses, then such intensification of work inevitably leads to a decrease in the quality, information content and reliability of conclusions. Failure to fulfill the plan for the volume of activity may be the result of improper planning, a consequence of defects in the organization of work and in the management of the department.
Therefore, both failure to fulfill the plan and its excessive overfulfillment should be equally carefully analyzed by both the head of the office (department) and the management of the medical institution in order to identify their causes and take appropriate measures. Deviations of the actual volume of activity from the annual planned volume within +20% ... -10% can be considered acceptable. Along with the general indicators of the work performed, the structure of the studies performed and the number of studies on individual endoscopic methods are traditionally analyzed to assess the balance and adequacy of the structure, the sufficiency of the number of studies of the actual need for them.
The average time spent on one study is determined by:
C = (F: P) x cu,
where C is the average time spent on one study; F - total actual time spent (for basic and additional diagnostic procedures) in total for all studies performed using a specific diagnostic or therapeutic method (in conventional units); P is the number of studies performed using the same diagnostic technique.
The correspondence of the average time spent on research to the calculated time standards (in%) for a certain method is determined by the formula:
K = (C: t) x 100
It is acceptable, along with the above, to use other traditional and non-traditional methods of analysis with the calculation and use of other indicators. Heads of institutions and chief specialists also need to monitor the rational use of medical personnel and, when determining staffing levels, be guided by the results of an annual or multi-year analysis of the actual or planned volume of activity of the department.
Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV
