Technological map of medical services sample. On the approval of technological maps at the consultation of medical specialists

MINISTRY OF HEALTH OF THE RYAZAN REGION

ORDER

ON APPROVAL OF TECHNOLOGICAL CHARTS AT CONSULTATIONS OF DOCTORS SPECIALISTS

In order to equalize the cost of paid medical services of the same name provided by state medical organizations of the Ryazan region, I order:

1. Approve technological maps:

For a consultation with a general practitioner;

For a consultation with a surgeon;

For a consultation with a gynecologist in accordance with the annex to this order.

2. To the chief doctors of state medical organizations of the Ryazan region to provide paid medical services on consultations of specialists in accordance with the approved technological maps.

3. To impose control over the execution of this order on the Deputy Minister Mitin O.V. regarding the organization of medical care for adults and the Deputy Minister of Health Bolshakova E.E. regarding the organization of obstetric and gynecological care.

Minister of Health
L.N.TYURINA

Appendix. TECHNOLOGICAL CARD FOR THE CONSULTATION OF A THERAPIST

Appendix
to order
ministries of health
Ryazan region
dated September 30, 2014 N 1551

	Executor		Used equipment
	Name	time for 1 procedure (min)	Name	running time (min)	Name
Therapist's consultation	Therapist		electronic floor scales		pressure measuring apparatus
	Physician's Nurse		peak output rate meter (peak flowmeter)		phonendoscope
			pulse oximeter		glucometer
					stadiometer
					hand magnifier
					measuring tape

TECHNOLOGICAL CARD FOR THE CONSULTATION OF A SURGEON

(name of procedure, service)

	Executor		Used equipment		Used medicines, dressings, low-value equipment and tools			List of regulatory documents
	Name	time for 1 procedure (min)	Name	running time (min)	Name	quantity per 1 procedure (grams, pieces)	terms of use of tools (normative)
surgeon's consultation	Surgeon		work table		stadiometer			Order of the Ministry of Health of the Russian Federation dated 12/15/2012 "On approval of the procedure for providing medical care to the adult population in the profile" surgery "
	Surgeon's Nurse		work chair		tonometer
					negatoscope
			cabinet for dressings and medicines		stethophonendoscope
			medical filing cabinet		medical thermometer
			shadowless lamp		table lamp
			laser device for resection and coagulation
			ambu bag		tape measure
			surgical aspirator
			radiosurgical knife
			container for storing sterile instruments
			operating table
			dressing table
			tool table
			manipulation table
			small surgical kit
			medical instrument sterilizer
			dry-heat cabinet for sterilization of medical instruments
			fridge
			bactericidal air irradiator
			medicine safe
			personal computer with printer, Internet access
			splint for the treatment of fractures of the clavicle
			splint for fixing the hand and fingers
			wire splint for upper and lower limbs
			transport splint for lower limbs
			head holder (Schanz collar)
			portable resuscitation kit
			containers for disinfection of instruments
			containers for collecting household and medical waste

TECHNOLOGICAL CARD FOR CONSULTATION OF AN OB/GYNECOLOGIST

(name of procedure, service)

		Executor		Used equipment		Used medicines, dressings, low-value equipment and tools			List of regulatory documents
		Name	time for 1 procedure (min)	Name	running time (min)	Name	quantity per 1 procedure (grams, pieces) specify	terms of use of tools (normative)
	Consultation of an obstetrician-gynecologist	Obstetrician-gynecologist, midwife		gynecological chair		a set of gynecological instruments (mirror, Volkmann's spoon)		once	Order of the Ministry of Health of the Russian Federation of November 1, 2012 N 572-n "On approval of the procedure for providing medical care in the field of obstetrics and gynecology (with the exception of the use of assisted reproductive technologies)"
	1. Collection of anamnesis, familiarization with medical documentation. 2. Preparing the patient for examination. 3. Conducting an examination, taking smears. 4. Filling out medical documentation, patient information about the results of the examination					sterile gloves		once
						sterile swabs		once
						cito brush		once
						slide		repeatedly

Discipline / MDK

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1. Subject:

Download:

Preview:

Technological map of the lesson

Discipline / MDK

PM. 04 Performance of work in one or more professions of workers and positions of employees,

MDK 04.03. Technology for the provision of medical services.

Specialty: ____ Nursing ______

1. Subject: Technique for performing intramuscular injections.
2. Lesson no. 16 (Section 4)
3. Venue of the lesson: preclinical practice room "Technologies for the provision of medical services"
4. Form of conduct and type of lesson:

Practical lesson. Combined lesson

1. Lesson objectives:

Common goal: The student owns the technique of intramuscular injection on a phantom.

Specific goals:

The student must be able to:

• choose a place for an intramuscular injection and create the most comfortable position for the patient during the injection
• treat the patient's skin during injection
• draw up the prescribed dose of the drug from the ampoule of the vial
• perform an IM injection
• to assess the complications that arose in the patient during the injection
• to teach the patient and their family members how to perform an IM injection
• apply deontological communication skills with the patient during the injection

The student must know:

Anatomical areas for intramuscular injections

• places for i / m injections
• possible complications of intramuscular injections, measures for their prevention
• universal precautions for handling syringes, needles, contact with blood
• rules for handling syringes, needles, trays, cotton balls

Contribute to the formation of OK and PC

general competencies:

OK. 2 Organize their own activities, choose typical methods and methods for performing professional tasks, evaluate their performance and quality.

professional:

PC 4. Provide medical services within their powers. Implement the nursing process.

1. Resources:

methodical: technological map of the lesson, reference notes, slide accompaniment; control materials, handouts.

TSO

computer, TV;

Tools and equipment:. manipulation tables. trays, syringes, cotton balls, antiseptics, gloves, waste containers, injection simulator

1. Information sources:

Main

	Name		Publisher and year of publication
	A practical guide to the subject "Fundamentals of Nursing".	Mukhina S. A., Tarnovskaya I. I.
	Fundamentals of nursing.	Obukhovets T.P., Sklyarova T.A., Chernova O.V.	Rostov n/a: Phoenix, 2014.
	Fundamentals of nursing. manipulation algorithms.	Ostrovskaya I.V., Shirokova N.V., Klyuykova I.N.	Moscow Publishing group Geotar-Media, 2012

Additional

	Name		Publisher and year of publication
	"General Nursing". Textbook.	N.V. Turkina, A. Filenko	Association of Scientific Publications KMK 2007.
	Order of the Ministry of Health of the Russian Federation No. 342 of November 26, 1998 "On strengthening measures for the prevention of typhus and the fight against pediculosis"
	Order of the Ministry of Health of Russia dated January 24, 2003 No. 4 “On measures to improve the organization of medical care for patients with arterial hypertension in the Russian Federation”.
	Order of the Ministry of Health of the Russian Federation dated 05.08.03 No. 330 "On measures to improve clinical nutrition in medical institutions of the Russian Federation"
	Order of the Ministry of Health of Russia dated April 17, 2002 No. 123 “Protocol of patient management. Bedsores."
	OST 42-21-2-85. Sterilization and disinfection of medical devices. Methods, means and modes;
	SanPiN 2.1.3. 2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities." Approved by the Decree of the Chief Sanitary Doctor of the Russian Federation dated May 18, 2010 No. 58

Internet resources

http://dezsredstva.ru/ - guidelines for disinfectants, regulatory documents;

http://www.consultant.ru/- regulations;

http://www.recipe.ru/ - regulations;

www.med-pravo.ru - regulations.

www.rosmedlib.ru – medical student library

http://www.fcior.edu.ru/ - FCIOR - Federal Center for Information and Educational Resources.

Catalog of training modules by disciplines.

1. Lesson progress:

No. p / p	Lesson stage	Time	Methods learning	Teacher activity	Student activities
	Organizing time	20 minutes	verbal method Creation of indicative bases	Announces the topic of the lesson, sets its goals and objectives, briefly outlines the structure of joint work. Checks those present	Listening, understanding, summarizing
	Goal-setting, updating of basic knowledge -	40min.	Control of the initial level of knowledge	Distributes tests-tasks for input control and offers to complete them Analyzes the mistakes most often made when answering test questions	Perform test tasks, marking the correct answers in writing
	Motivation for learning activities	20 minutes	Activation of cognitive activity of students	Forms the need of students for cognitive activity: explains the need to study and master this topic, revealing the practical significance of the knowledge and skills acquired in the classroom for professional activities	Listen, take notes, perceive and realize cognitive tasks
	Learning new material	40min.	Formation of skills and abilities;	explanation of the material using illustrations, diagrams, tables.	They acquire new knowledge and skills.
	Generalization and systematization of knowledge (Mastering and consolidating practical skills)	120min		Supervises the progress of students' independent work. Provides assistance in overcoming difficulties. Corrects the actions and words of students. Analyzes and evaluates each work	They learn new knowledge, skills and instructions from the teacher in the course of performing practical tasks. They analyze by comparing the knowledge and skills gained during the lesson with the professional competencies already formed in them.
	Reflection	10 minutes			Conduct an internal self-assessment of their understanding of the new educational material, draw appropriate conclusions
	Lesson results	30 min		Summarizes the lesson. Evaluates the work of individual students and the group as a whole, reading out the marks put in the educational journal. Sets homework	Listen to the teacher Write down homework
Total class time (min)		270min

1. Lesson content

Technique for performing intradermal and subcutaneous injections.

Possible complications associated with the use of drugs. Nursing tactics.

1. Forms and methods of controlling the development of OK and PC (assessment of knowledge and skills included in the competence):

Learning Outcomes (OK and PC)	Main indicators for evaluating the result	Forms and methods of control and evaluation
general competencies: OK 1, Understand the essence and social significance of your future profession, show a steady interest in it. OK 2, Organize your own activities based on the goal and ways to achieve it, determined by the head OK 3; Analyze the working situation, carry out current and final control, evaluate and correct their own activities, be responsible for the results of their work. OK 4; Search for information necessary for the effective performance of professional tasks. OK 6. Work in a team, communicate effectively with colleagues, management, consumers. OK 7 Carefully treat the historical heritage and cultural traditions, respect social, cultural and religious differences. OK 8 Comply with labor protection, fire safety and safety regulations. professional: PC 1.1, 1.2, 1.4, Observe the principles of professional ethics: communicate effectively with the patient and his environment in the course of professional activities, advise the patient and his environment on care and self-care. PC1.5, Prepare medical documentation. PC1.6, Provide medical services within their powers. PC2.1. 2.2, 2.4, 2.5. Provide a safe hospital environment for patients and staff, including infection safety, industrial sanitation, and personal hygiene in the workplace.		tests test questions situational tasks

1. Homework (indicating extracurricular independent work)

. * Educational literature:

L1 Mukhina S.A., Tarnovskaya I.I., Theoretical foundations of nursing: Textbook. - 2nd ed., Rev. and additional - Moscow, Geotar-Media Publishing Group, 2010 (2011).

L2 Mukhina S. A., Tarnovskaya I. I., “A practical guide to the subject “Fundamentals of Nursing” Moscow, Geotar-Media Publishing Group, 2010 (2011).

L1. p.355-361

L2. p.500-510

Extracurricular independent work- Theoretical substantiation of each stage of the manipulation algorithm, development of the execution technology.

MINISTRY OF HEALTH OF THE RYAZAN REGION

ORDER

ON APPROVAL OF THE TECHNOLOGICAL CARD FOR MEDICAL SERVICE IN THE SPECIALTY "CARDIOLOGY"

In order to equalize the cost of paid medical services of the same name provided by state healthcare institutions of the Ryazan region, I order:

1. Approve the technological map:

Consultation with a cardiologist in accordance with the appendix to this order.

2. The chief physicians of medical organizations of the state health care system of the Ryazan region shall provide paid medical services in the specialty "cardiology" in accordance with the approved technological map.

3. To impose control over the execution of this order on the Deputy Minister O.V. Mitin.

Minister
A.A.PRILUTSKY

Appendix. ROUTING

Consultation with a cardiologist (name of procedure, service)

		Executor		Used equipment		Used medicines, dressings, low-value equipment and medical instruments			List of regulatory documents
		Doctor, nurse, nurse	Time for 1 procedure (min.)	Name	Working time (min.)	Name	Quantity for 1 procedure (grams, pieces specify)	The period of use of tools (normative)
	Primary reception (examination, consultation) of a cardiologist: collection of anamnesis and complaints, examination, appointment and interpretation of the results of additional examination. Prescribing drug therapy. Registration of medical documentation	Cardiologist		Scales medical floor		Blood pressure monitor
						Phonendoscope
						Medical couch
						Stopwatch
						Medical thermometer
						Medical stadiometer
						Tape centimeter

At the Medical Center of the Bank of Russia, the solution of this problem was facilitated by the creation and use in the treatment and diagnostic work of a patient management flow chart - a methodological manual for doctors, which defines the algorithm for providing medical care for certain diseases.

Step 12. In the "Education of the patient" section, the main tasks of patient education at each stage are listed, the necessary activities are indicated.

Step 13. The criteria for discharge from the hospital, i.e. the expected results of treatment, are listed.

Stage 14. The time, place and method of assessing the correctness of the flow of the technological process are indicated, i.e., the control points of the process are set.

Checkpoints are characteristic sections of the process in which systemic (associated with improper organization of work) deviations of the process from the project most often occur. Measuring the process at these points allows you to monitor it most effectively. The control point includes the place, time, object of evaluation.

Step 15. Quality indicators are listed.

If there is no accurate information about the characteristic systemic deviations of a process or its stage, it is difficult to set control points. Then, to evaluate the process, they resort to constructing a hypothesis that assumes the most probable deviations. To denote these hypothetical deviations in medical technological processes, American researchers have proposed using the term "quality indicators".

Quality indicators - quantitative or qualitative indicators aimed at finding possible deviations, the presence of which is assumed by an expert, but whose significance for assessing the correctness of the process has not been proven.

Quality indicators for the technological map of the management of somatic patients suffering from depressive disorders

Indicator 1

Indicator	Clinicians should ask about the presence of depressive episodes in patients: with a history of depression; who have experienced the death of loved ones in the next 6 months; with alcohol or drug addiction
	Screening for depression is necessary: for early appointment of adequate therapy, prevention of chronic depression;
	These risk factors for depression were found in cross-sectional studies.

Indicator 2

Indicator	When diagnosing depression, specific comorbid disorders should be documented: alcohol (drug) dependence; taking medications; somatic disorders
Rationale for the introduction of the indicator	Timely detection of depression is necessary: for the appointment of adequate therapy, prevention of chronic depression; prevention of complications of treatment due to the patient's dependence on psychoactive substances; reducing symptoms of depression; reduction of periods of incapacity for work
	These comorbid disorders can cause depression. The doctor should take them into account when planning treatment for depression.

Calculation of the quality indicator The numerator is the number of patients in whom the quality indicator is met (in the controlled period of time).

The denominator is the number of patients treated for depression (in a controlled period of time).

Stage 16. Typical technological violations are indicated.

Step 17. The application reflects the protocols of the main activities (for example, psychopharmacotherapy, risk assessment, physical rehabilitation, etc.).

Step 18. A bibliography is presented (attached).

Stage 20. A draft order is being prepared for the implementation of a technological map in a medical institution.

After the development of the technological map at the final meeting of the working group, the final approval procedure is carried out and the corresponding protocol is drawn up.

Scheme of the technological map of an inpatient

Name of the nosological form _______________________________________

Duration of hospitalization _______ days + _______ days in the rehabilitation department

Parameter	Stage of patient management
	reception department	hospital	Rehabilitation department
Duration of treatment
Attending doctor
Expert advice
Physical data
Evaluation of an important parameter for the tactics of managing a patient:
Manipulations and instrumental studies:
Laboratory research:
Disease prognosis, risk class assessment
Therapeutic measures:
Physical activity
Patient Education
Criteria for discharge (at the inpatient and rehabilitation stages):
Control points / quality indicators:
Typical technological violations:

The provision of medical care based on the developed flow chart allows you to coordinate the actions of all participants in the process of providing medical care. The information presented in it is advisory in nature and is intended to help practitioners in making the right clinical decisions. The roadmap is not a substitute for professional clinical thinking.

In the Medical Center, all technological maps are compiled in electronic format, which greatly facilitates the work with them, allows you to make changes and additions without unnecessary difficulties.

Quality management of medical care using flow charts of patient management

Based on the information-analytical knowledge base, a patient management project is created and its management is organized according to the developed technological map. The implementation of the medical technological process is monitored during the current and final examination, the completeness, timeliness and effectiveness of medical care are monitored, as well as the degree of compliance with technological discipline and the patient's opinion. The examination is carried out by leading specialists, heads of departments.

In inpatient treatment, the current examination is performed while the patient is in the hospital. This is done so that treatment can be adjusted in the presence of violations. After the patient is discharged, the medical history together with the technological map is transferred to the specialist for a final expert assessment of how the treatment and diagnostic process for a particular patient corresponded to the technological process developed in this medical institution, quality indicators for this somatic nosology.

One of the differences of the modern model of the quality of medical care is the focus on the needs and expectations of consumers, in particular, the focus on an objective study of the opinions of the patients themselves.

The Medical Center analyzes the opinions of patients on the achieved results of treatment, which is one of the most important final stages of quality control of the diagnostic and treatment process. At the final stage of the stay in the hospital, the patient is asked to answer the questions of the questionnaire.

The final stage of quality management is making changes to the technological map based on the analysis of technological deviations - process improvement, its reengineering. Thus, the quality management process is continuous and closed.

The introduction of patient management flow charts at the Medical Center made it possible to improve the quality of care provided: to reduce the number of technological deviations by 3 times, to achieve the desired result of treatment for individual nosologies in 70% of patients, to increase patient satisfaction several times (currently it is 95-98% ).

The technological approach to the provision of medical care is universal: the technological map can be used for any nosology and in any medical institution at various stages of medical care.