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ORDER of the Ministry of Health of the Russian Federation dated 12-09-97 270 ON MEASURES TO IMPROVE THE ORGANIZATION OF ONCOLOGICAL CARE TO THE POPULATION (2019) Relevant in 2018

REGULATIONS ON THE EXAMINATION OFFICE OF AN OUTPATIENT POLYCLINIC INSTITUTION

1. Examination room<*>organized in in the prescribed manner in an outpatient clinic, as an independent unit or structural unit of this institution and operates in institutional mode.

2. The office is located in a separate room with good lighting, equipped with special equipment and tools.

3. The work in the office is carried out by the average medical worker, who has undergone special training in oncology and has the appropriate certificate.

4. Management and control over the activities of the office, the work and the level of professional training of specialists is carried out by the head of the structural unit, which includes the examination room, and in his absence - by the deputy chief physician for therapeutic work.

5. Methodological management of the work of the office is carried out by the district oncologist, and in the absence of one, by the territorial oncologist oncology clinic.

6. The office carries out:

Pre-medical survey of patients;

Conducting a preventive examination of patients who applied for the first time during the year to an outpatient clinic for early detection of chronic, precancerous and tumor diseases visible localizations;

It is mandatory to take swabs from all women who contact the office. cervical canal and cervix and sending them to the cytology laboratory for examination;

Referring persons with identified pathology to the appropriate specialist to clarify the diagnosis and organize treatment;

Accounting and registration of ongoing preventive examinations and results cytological studies according to established forms of primary medical documentation;

Carrying out sanitary educational work among citizens visiting the clinic.

Note:

Preventive examination of women includes examination of the skin and visible mucous membranes, examination and palpation of the mammary glands, examination and palpation of the thyroid gland, examination and palpation of the abdomen, peripheral lymph nodes, speculum examination of the cervix and vagina, bimanual examination of the uterus and appendages, digital examination of the rectum for women over 40 years of age and in the presence of complaints.

Preventive examination of men includes examination of the skin and visible mucous membranes, examination and palpation of the external genitalia, mammary glands, thyroid gland, abdomen, peripheral lymph nodes, digital examination of the rectum and area prostate gland.

Head of Department
medical organization
assistance to the population
A.I.VYALKOV
Head of Department
maternal and child health
D.I.ZELINSKAYA

Posted On 02/08/2018

OUTPATIENT POLYCLINIC INSTITUTION

ORGANIZATION OF THE EXAMINATION OFFICE

The examination room is organized in accordance with the established procedure in an outpatient clinic as an independent unit or structural unit of this institution and operates in institutional mode.

The office should be located in a separate room with good lighting and equipped with special equipment and tools. This office is staffed by a nursing assistant who has undergone special training in oncology and received the appropriate certificate.

The work of the office is supervised by the head of the structural unit or the deputy chief physician for medical work. Methodological guidance is provided by a district oncologist or an oncologist at a territorial oncology clinic.

The office conducts:

Pre-medical survey of patients;

Preventive examination of patients who come forward

transferred during the year to the outpatient department at

subject of early detection of chronic, pre-tumor and tumor diseases of visible localizations;

It is mandatory to take smears from the cervical canal and cervix from all women who contact the office and send them to the cytology laboratory for examination;

Referring persons with identified pathology to the appropriate specialist to clarify the diagnosis and organize treatment;

Accounting and registration of preventive examinations and results of cytological studies according to established forms

primary medical documentation;

Sanitary educational work among citizens visiting the clinic.

Preventive examination of women includes examination of the skin and visible mucous membranes, examination and palpation of the mammary glands, examination and palpation of the thyroid gland, peripheral lymph nodes, speculum examination of the cervix and vagina, bimanual examination of the skein and appendages, digital examination of the rectum women over 40 years of age and with complaints.

Preventive examination of men includes examination of the skin and visible mucous membranes, examination and palpation of the thyroid gland, mammary glands, peripheral lymph nodes, abdomen, external genitalia, digital examination of the rectum and prostate gland.

The oncology room is organized in accordance with the current staff standards in outpatient clinics in urban and rural areas. The work in the office is led by a doctor and paramedical worker who have undergone special training in oncology and have the appropriate certificates.

The functions of the oncology department include;

Providing advisory and diagnostic assistance for patients with malignant neoplasms or with suspicions of them, and if it is extremely important, referral of the patient to an oncology clinic;

Treatment of patients with malignant neoplasms according to the recommendations of oncology dispensaries and institutes;

Dispensary observation of patients with malignant neoplasms and some forms of precancerous diseases;

Consultations and home visits for patients with malignant neoplasms in need;

Monitoring the timely hospitalization of patients for special, palliative and symptomatic treatment, analysis of the reasons for refusal of hospitalization;

Registration of patients with malignant neoplasms and control of timely notifications about them to oncology dispensaries;

Analysis and analysis of errors with doctors in outpatient clinics;

Providing methodological assistance to doctors in organizing preventive examinations, clinical examination of patients with chronic diseases, sanitary and educational work among the population.

The children's oncology department performs the same functions and is organized as part of the outpatient department of the oncology dispensary, children's clinic, children's multidisciplinary hospital, and is a structural subdivision of these institutions.

The full-fledged activity of an oncologist at a polyclinic is unthinkable without the active participation of almost everyone medical personnel of this medical and preventive institution.

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Midwife job description

1. General Provisions

• 1.1 A midwife belongs to the category of specialists.
• 1.2 A person with secondary education is appointed to the position of midwife medical education in the specialty “Obstetrics” and (having; not having) (I, II, highest) qualification category(s).
• 1.3 Appointment to a position and dismissal from it are made by order of the head of the institution.
• 1.4 The midwife should know:
  • laws Russian Federation and other regulatory legal acts on health issues;
  • basic hygiene for women during pregnancy and after childbirth;
  • flow normal birth and their variants;
  • management of pregnancy during complications, basic methods of preventing and combating complications.
  • rules of asepsis and antiseptics, sanitary and anti-epidemic regime of obstetric institutions;
  • principles of prevention gynecological diseases, basics of contraception and healthy image life;
  • legislation on labor and labor protection of the Russian Federation;
  • internal labor regulations;
  • rules and regulations of labor protection, safety, industrial sanitation and fire protection;
• 1.5 The midwife reports directly to____________________

2. Job responsibilities of a midwife

The midwife performs the following job duties:

• 2.1 Conducts therapeutic and preventive sanitary and educational work, patient care in accordance with the profile of the department under the guidance of a doctor.
• 2.2 Conducts preparatory work for the diagnostic and treatment activities of an obstetrician-gynecologist and his own activities.
• 2.3 Provides therapeutic and diagnostic assistance to pregnant women, women in labor, postpartum women, gynecological patients as prescribed by a doctor or together with him in the department, at an appointment in a antenatal clinic, at home.
• 2.4 Renders medical care in case of uncomplicated childbirth, alone or with an obstetrician-gynecologist in case of labor pathology, postpartum period, conducts primary processing and if necessary primary resuscitation newborns.
• 2.5 Provides emergency pre-medical care in case of acute diseases and accidents in the field of activity, followed by calling a doctor or referring the patient to a medical institution.
• 2.6 Informs the obstetrician-gynecologist, senior midwife, head of department or doctor on duty about extreme situations in the condition of patients, incidents in the department, wards, offices.
• 2.7 Assists in some obstetric and gynecological operations.
• 2.8 Observes the health and development of children in the first year of life.
• 2.9 Provides home patronage to pregnant women, postpartum women, and gynecological patients with the implementation of organizational and therapeutic measures.
• 2.10 Conducts preventive examinations of women in order to identify gynecological diseases (together with a doctor or independently), work on family planning.
• 2.11 Takes measures to comply with the sanitary and hygienic regime (compliance with the rules of asepsis and antiseptics, proper storage, processing, sterilization of instruments, devices, dressings) in the department (antenatal clinic, office).
• 2.12 Draws up the established by the Ministry of Health of Russia medical documentation for the relevant department.

3. Rights of the midwife

The midwife has the right:

• 3.1 Receive necessary information to accurately fulfill their duties.
• 3.2 Give instructions to junior medical personnel to comply with the sanitary and epidemiological regime of the department (office).
• 3.3 Make proposals for improving the work of junior and nursing staff.
• 3.4 Be a member of the Council of Midwives and Nurses, take part in the work of professional medical associations.
• 3.5 Improve your qualifications.
• 3.6 Receive qualification category.

4. Responsibility of the midwife

The midwife is responsible for:

• 4.1 For improper performance or non-fulfillment of your job responsibilities provided for by this job description- within the limits determined by the current labor legislation Russian Federation.
• 4.2 For offenses committed in the course of carrying out its activities - within the limits determined by the current administrative, criminal and civil law Russian Federation.
• 4.3 For causing material damage - within the limits determined by the current labor and civil legislation of the Russian Federation.

Job Midwife in examination room Moscow

Job description for midwife in examination room and men's room). Midwives of the examination room are the early job description, Job description of the midwife of the examination room female midwife of the examination room EXAMPLE JOBS job description.

Job description for male examination room. Examination room This job description is for men and Works of the examination room;

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Job description; visits to the examination room, tonometry room.





Sample job description for a midwife Midwife in an examination room in her

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Job description nurse first aid room

This job description has been developed and approved in accordance with the provisions of the Labor Code of the Russian Federation and other regulations governing labor relations in the Russian Federation.

1. General Provisions

1.1. The nurse in the pre-hospital reception room belongs to the category of specialists and is directly subordinate.

1.2. A person with secondary education is appointed to the position of nurse in the pre-medical reception room. professional education and a qualification category with at least years of work experience.

1.3. A nurse in the pre-medical reception room is appointed and dismissed by order.

1.4. The nurse in the pre-hospital reception room should know:

Laws of the Russian Federation and other regulatory legal acts on healthcare issues;

Basic techniques and methods of providing pre-medical care;

Methods for determining blood glucose and cholesterol;

Computer basics;

Organizational structure of the institution;

Safety rules when working with medical instruments, equipment;

Internal labor regulations;

Rules on labor protection, industrial sanitation and fire safety.

1.5. Professionally important qualities: .

2. Job responsibilities

The nurse in the pre-hospital reception room is assigned the following job responsibilities:

2.1. Carrying out an initial appointment with patients who did not receive a certificate to see a doctor on the day of their visit, to resolve the issue of the need for urgent medical care.

2.2. Filling outpatient card patient.

2.3. Taking blood for express analysis of glucose and cholesterol levels.

2.4. Referring patients for laboratory and other tests who do not need a doctor’s appointment on the day of their visit.

2.5. Explaining to patients the procedure for preparing for instrumental, hardware, and laboratory tests.

2.6. Carrying out anthropometry, measuring arterial and eye pressure, body temperature, etc.

2.7. Participation in the organization and conduct of preventive medical examinations.

2.8. Tracking, together with reception staff, the timing of patients undergoing fluorographic examinations and visits to the examination room.

2.9. Preparation of necessary medical documentation: referrals for research, consultations, statistical certificates, extracts from medical records patients, health resort cards and etc.

2.10. Rendering first aid patients when the need arises.

2.11. Participation in health education work among patients.

2.12. Systematic professional development.

3. Employee rights

A nurse in a pre-hospital office has the right to:

3.1. IN in case of emergency call any specialist, including the head of the department, to the pre-medical reception room for consultation.

3.2. Request and receive necessary information and documents related to its activities.

3.3. Make proposals to the immediate supervisor to improve work related to the responsibilities provided for in this job description.

3.4. Take part in meetings that discuss issues related to the work of the pre-medical office.

3.5. On vocational training, retraining and improving their qualifications in the manner established Labor Code Russian Federation and other federal laws.

3.6. Require management to provide assistance in the performance of their professional duties and rights.

REGULATIONS ON THE EXAMINATION OFFICE OF AN OUTPATIENT POLYCLINIC INSTITUTION

For all social guarantees provided for by law.

3.8. Other rights provided for by labor legislation.

4. Responsibility of the employee

The nurse in the pre-hospital office is responsible for:

4.1. For failure to perform or improper performance of one’s job duties as provided for in this job description - within the limits determined by the current labor legislation of the Russian Federation.

4.2. For causing material damage to the employer - within the limits determined by the current labor and civil legislation of the Russian Federation.

4.3. For offenses committed in the course of carrying out their activities - within the limits determined by the current administrative, criminal, and civil legislation of the Russian Federation.

Head of HR department

Agreed:

Head of the legal department

I have read the instructions:

Midwives in the women's examination room

1. A midwife who has undergone special training is appointed to the position of midwife in the women’s examination room.

2. A midwife in a women’s examination room is appointed and dismissed by the chief physician of the clinic upon the recommendation of the head of the prevention department or antenatal clinic in the prescribed manner.

3. The midwife of the women’s examination room reports directly to the head of the department of prevention or antenatal clinic, and in their absence, to the chief nurse.

4. In her work, the midwife of the women's examination room is guided by the regulatory legal acts of the Republic of Belarus, the Regulations on the clinic, the Regulations on the women's examination room, orders and instructions of the chief physician, orders of the head of the prevention department (or antenatal clinic) and the chief nurse, and job descriptions.

5. The main tasks of the midwife in the women's examination room are early detection, precancerous and cancer diseases female genital organs and other visible locations (lip skin, mammary glands), as well as gynecological diseases among clinic visitors from the population living in the area where the clinic operates.

6. The midwife in the women’s examination room must:

6.1. conduct an examination of all women who come to the clinic for the first time during the year, regardless of age and nature of the disease;

6.2. collect material from the mucous membrane of the cervix using the superficial scraping method;

6.3. refer women with identified pathology or suspected disease to an obstetrician-gynecologist;

6.4. provide the office with the necessary instruments and medications;

6.5. observe the principles of deontology in their work;

6.6. participate in work to promote a healthy lifestyle among women;

6.7. systematically improve your qualifications by studying relevant literature, participating in conferences, seminars and taking advanced courses;

6.8. serve in deadlines reports on the work done to the medical statistics office;

6.9. maintain the necessary medical documentation of the office.

7. The midwife in the women’s examination room has the right:

7.1. make demands to the clinic administration for the creation necessary conditions in the workplace, ensuring high-quality performance of job duties;

7.2. take part in meetings (meetings) when discussing the work of the examination room;

Job description for midwife in examination room

receive the necessary information to carry out their functional responsibilities from the head of the prevention department, chief nurse;

7.4. require visitors to comply with the internal regulations of the clinic;

7.5. give instructions and supervise the work of junior medical staff in the examination room;

7.6. improve your qualifications at work and advanced training courses in the prescribed manner.

8. The midwife in the women’s examination room is responsible for failure to perform or improper performance of her duties, failure to comply with labor and performance discipline, internal labor regulations, medical ethics and deontology.

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Examination rooms are one of the forms of preventive examinations of the population.

1. The examination room is organized in an outpatient clinic.

2. The office is located in a separate room and equipped with special equipment.

3. The office is staffed by a nursing assistant who has undergone special training in oncology.

4. Preventive examination of women includes examination of the skin and visible mucous membranes, examination and palpation of the thyroid and mammary glands, abdomen, peripheral lymph nodes, speculum examination of the cervix and vagina, bimanual examination of the uterus and appendages, digital examination of the rectum for women over 40 years of age and presence of complaints. For all women who contact the office, smears are taken from the cervical canal and cervix and sent to the cytology laboratory.

5. Preventive examination of men includes examination of the skin and visible mucous membranes, examination and palpation of the thyroid gland, mammary glands, abdomen, peripheral lymph nodes, external genitalia, digital examination of the rectum and prostate gland.

2. Thyroid cancer. Epidemiology. Etiological factors. Clinic. Diagnostics. Treatment. Prevention.

Unlike other localizations, not only elderly people get sick, but also young people (20 – 40 years old), and even children.

Contributors to the disease: living in areas of endemic goiter, ionizing radiation, both externally and as a result of the incorporation of radioactive iodine, inflammatory diseases of the gland resulting in fibrosis, suffering from Riedel's goiter, Hashimoto's, recurrent euthyroid goiter; long-term treatment with thyrotoxic drugs for thyrotoxicosis.

Clinic:

TO early clinical symptoms, indicators of malignancy include: accelerated growth thyroid gland volume over the past 6 months;

thickening of the gland consistency; the appearance of tuberosity in the gland tissue.

To late clinical

symptoms include: hoarseness, indicating growth into the recurrent nerve; dysphagia, which is typical when a tumor grows into the esophagus; a feeling of suffocation, characteristic of germination and compression of the tracheal wall.

Diagnostics:

Preoperative diagnosis is established based on the clinical manifestations of the disease, ultrasound results of the thyroid gland, neck and fine-needle biopsy of the tumor. In addition, mandatory diagnostic methods include radiography of the chest organs in two projections, tomography of the neck and mediastinum, as well as laryngoscopy. According to individual indications, esophagography (esophagoscopy), bronchoscopy, computed tomography (MRI) of the neck and mediastinum, puncture or excisional biopsy of enlarged lymph nodes of the neck, osteoscintigraphy, scanning of the thyroid gland, radiography of bones, ultrasound of the abdominal organs and retroperitoneal space, angiography, phlebography and laboratory tests to identify markers of thyroid cancer: calcitonin, thyroglobulin, carcinoembryonic antigen. In some cases, it is advisable to study the concentration of TSH, triiodothyronine and thyroxine in peripheral blood.

Treatment: The main method of treating patients is to perform surgical interventions in combination with suppressive hormone therapy with L-thyroxine, as well as remote gamma therapy and courses of radioiodine therapy according to individual indications. In most observations, this approach leads to the cure of patients.

Differentiated forms (papillary, follicular cancer) in I - III stages predominantly operational - from resection to thyroidectomy. For metastases to lymph nodes - lymphadenectomy - case-fascial or according to Krail. After subtotal resections and extirpation of the gland, hormone replacement therapy is mandatory. Poorly differentiated cancer is treated preferentially chemoradiation method. It must be remembered that well-differentiated thyroid cancer is curable even if distant metastases(in the bones, lungs), therefore, referral to the oncology clinic for consultation and treatment should be carried out at this stage of the process. Treatment prescribed by endocrinologists or oncologists (usually hormone therapy) in cases where these patients are observed by general practitioners should not be canceled by them.

Early diagnosis is possible subject to a complete examination, including morphological examination of punctate in each case of detection of nodal processes in the thyroid gland.

PreventionTreatment of hypothyroid conditions.

3. Clinic and diagnosis of esophageal cancer.

Clinic. Manifestations of esophageal cancer are quite stable and uniform. V.G. In 1987, Laletin proposed a classification of clinical forms of esophageal cancer, according to which the following forms are distinguished:

1. Dysphagic – occurs in 75% of patients and is manifested by disturbances in the passage of food through the esophagus.

2. Painful (cervical, retrosternal, abdominal and vertebral) - occurs in 15% of patients and is characterized by pain, which in half of the cases is associated with eating.

3. Dyspeptic – noted in 5% of patients. It is characterized by nausea, belching, and vomiting. This form occurs predominantly in patients with a tumor of the lower thoracic or abdominal esophagus, often spreading to the cardia of the stomach.

4. Laryngeal-tracheal-bronchial – occurs in 5% of patients. The leading symptoms are hoarseness, difficulty breathing, coughing attacks when swallowing saliva and food.

Diagnostics. Consists of 2 stages: primary diagnosis, i.e. identifying a tumor, and clarifying diagnostics - establishing the nature and extent of the tumor process. Therefore, all studies are carried out in a certain sequence. At primary diagnosis study the history of the disease, conduct X-ray and endoscopic examinations with histological examination of the biopsy specimen. The most effective method of primary diagnosis is esophagoscopy with biopsy. Clarifying diagnosis of the tumor process is based on the integrated use of invasive and non-invasive diagnostic methods. The latter include computed tomography (CT), ultrasonography(ultrasound), positron emission tomography (PET). TO invasive methods refers to laparoscopy, the purpose of which is morphological confirmation of the presence of metastases in The lymph nodes abdominal cavity and detection of peritoneal carcinomatosis. The method of endoscopic ultrasonography, which makes it possible to assess the depth of tumor germination, the condition of the organs and lymph nodes surrounding the esophagus, is becoming increasingly important for clarifying diagnostics.