I. General part

The main tasks of the midwife in the examination room are early detection of gynecological, precancerous and cancer diseases female genital organs and other visible localizations(skin

Lips, mammary glands) among visitors to the clinic from among the population living in the area where the clinic operates, as well as

Workers and employees of attached enterprises.

The appointment and dismissal of a midwife in the examination room is carried out by the chief physician of the clinic in accordance with the current

Legislation.

The midwife of the examination room reports directly to the head of the prevention department, and in his absence, to the chief

Clinic doctor.

In her work, the midwife in the examination room is guided by

Instructions and orders local authorities health care, this job description, and methodological recommendations to improve preventive examinations of the population.

II. Responsibilities

To perform her functions, the midwife of the examination room

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.

2. Refer women with identified pathology or suspected disease to an obstetrician-gynecologist.

3. Provide the office with the necessary instruments and medications.

4. Observe the principles of deontology in your work.

5. Participate in sanitary education work

Among women.

6. Systematically improve your skills by studying

Relevant literature, sections in conferences, seminars.

7. Serve in deadlines progress reports

To the medical statistics office.

8. Maintain the necessary information medical documentation office.

The midwife in the examination room has the right:

Present demands to the clinic administration for the creation necessary conditions in the workplace, ensuring high-quality performance of their job responsibilities;

Take part in meetings (meetings) to discuss

Examination room work;

Receive necessary information to fulfill their functional responsibilities from the head of the prevention department,

Home nurse;

Require visitors to comply with the internal regulations of the clinic:

Master a related specialty;

Give instructions and supervise the work of the junior medical personnel examination room;

Improve your skills through on-the-job training, advanced training courses, etc. in the prescribed manner.

IV. Performance appraisal and responsibility

The assessment of the work of the midwife in the examination room is carried out by the head of the prevention department, the chief nurse, based on taking into account the performance of her functional duties,

Compliance with internal regulations, labor discipline,

Moral and ethical standards, social activity.

The midwife in the examination room is responsible for unclear and untimely implementation of all points of this instruction.

Types of personal liability are determined in accordance with

Current legislation.

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 department or the deputy chief physician for therapeutic 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

item early detection chronic, precancerous and tumor diseases 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 skin and visible mucous membranes, examination and palpation of the mammary glands, examination and palpation of the thyroid gland area, peripheral lymph nodes, speculum examination of the cervix and vagina, bimanual examination of the skein 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 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, and sanitary 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 unit of these institutions.

The full-fledged activity of an oncologist at a polyclinic is unthinkable without the active participation of almost all medical personnel of a given medical institution.

home > Job descriptions > Job description of a midwife

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 of 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-hospital medical care in case of acute diseases and accidents according to the profile of the 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 Prepares medical documentation established by the Ministry of Health of Russia for the relevant unit.

3. Rights of the midwife

The midwife has the right:

• 3.1 Receive the necessary information to accurately perform your 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 failure to fulfill one’s official duties 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;

Certificate of tax resident status sample.



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





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

I approve

Job description of a nurse in the pre-medical reception 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 out the patient's outpatient card.

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 patient medical records, 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 emergency cases, 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. For professional training, retraining and advanced training 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 the early detection of pre-tumor and cancer diseases of the female genital organs and other visible localizations (skin of the lips, mammary glands), as well as gynecological diseases among visitors to the clinic from among 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. submit timely 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 to create the necessary conditions in the workplace to ensure 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 perform their functional duties from the head of the prevention department and the 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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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<*>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.

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

3. Work in the office is carried out by a paramedical worker who has undergone special training in oncology and has the appropriate certificate.

4. Management and control over the activities of the office, work and level vocational training specialists are carried out by the head of the structural unit, which includes an examination room, and in his absence - by the deputy chief physician for medical 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 oncologist of the territorial 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 the 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 ongoing preventive examinations and results of 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 area 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 genital area, breast area, thyroid gland, abdomen, peripheral lymph nodes, digital examination of the rectum and prostate area.

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

Regulations on the examination room

1. The examination room (hereinafter referred to as the “office”) is organized in the prescribed manner in an outpatient clinic as an independent unit or structural unit of this institution and operates in the institutional mode for the purpose of identifying malignant neoplasms of visual localizations, precancerous and chronic diseases.

2. The office is located on the 1st floor of the clinic or on the floor where the main reception of patients is carried out in close proximity to the registry in a separate room with good lighting, and is equipped with special equipment and tools in accordance with the equipment sheet for the Examination Room, approved by this order.

3. The examination room is open throughout the working day outpatient department, in two shifts and provides examination of 4 patients per hour.

4. Work in the office is carried out by a medical worker with a secondary education (paramedic), who has undergone special training and has the appropriate certificate.

5. 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 clinic or the deputy chief physician for the clinic, in their absence - the deputy chief physician for medical work, who also controls the number of visits to the examination room once a week. The examination room employee, in turn, provides the responsible person with information about the number of visits to each area once a week.

6. Methodological management of the work of the office is carried out by the institution’s oncologist or the person responsible for the oncology service in medical organization based on this order.

1) an oncologist or a doctor responsible for the oncology service creates a register of suspicious cases based on data transmitted from the examination room and prescribes an examination of the patient in accordance with the order of the Ministry of Health No. 000 of 01.01.01 “On the provision of oncological care to adults”, monitors the result of the examination within 10 days, exchanges the information received with the examination room employee.

2) upon confirmation of the detection of a malignant neoplasm, the oncologist or the doctor responsible for the oncological service fills out form No. 000/U “Notification of a patient with the first time in life established diagnosis malignant neoplasm" (Order of the Ministry of Health of Russia dated January 1, 2001 No. 000 "On improving the state cancer registry system") and must mark the column "identified in the examination room."

7. An employee of the examination room carries out:

Patient survey;

Conducting a preventive examination of patients who applied for the first time during the year to an outpatient clinic for the early detection of chronic, pre-tumor and tumor diseases of visible localizations: the female population over 20 years old, the male population over 30 years old;

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

If a malignant neoplasm is suspected, refer patients to an oncologist or a doctor responsible for the oncology service in a medical organization to clarify the diagnosis and further routing;

Active contact with an oncologist or a doctor responsible for the oncology service in a medical organization to monitor the results of additional examinations once every 10 days after referral;

When pre-tumor or chronic diseases are detected, patients are referred to a doctor of the appropriate specialty with filling out the Register of Patients with Suspected Pre-tumor and chronic illness, identified in the examination room approved by this order;

Accounting and registration of inspections carried out in the examination room and their results in accordance with established accounting forms;

Analysis of examinations carried out in the examination room and their results in accordance with established reporting forms;

Carrying out sanitary education work among citizens visiting the examination room.

8. Accounting and reporting forms are filled out by each individual examination room or FAP and signed responsible persons. Reporting forms are submitted to the organizational and methodological department of the Kaluga Regional Clinical Oncology Center once a month - before the 5th day of the month following the reporting period in electronic form to the address: *****@***ru.

9. Patients with acute processes should not be sent to the examination room, sharp pain, high temperature, and diseases requiring emergency care, as well as patients registered with an oncologist. Patients with acute conditions undergo examination in the examination room as planned after the acute phenomena have subsided and the temperature has normalized.

10. 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, digital examination of the rectum for women.

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

12. In functional terms, medical and obstetric stations (hereinafter referred to as FAPs) are equivalent to examination rooms, combining the work of both women’s and men’s examination rooms. FAP workers form a card index of the registered population (female, over 20 years old and male, over 30 years old) and actively invite residents for inspection this year. FAP employees use recommended accounting and reporting forms in their work. If a case suspicious of a malignant neoplasm is identified, the patient is referred for further examination to a central district or city hospital to a local oncologist or a doctor responsible for the oncological service in a medical organization in accordance with the order of the Ministry of Health of the Kaluga Region No. 000 dated 01.01.01 “On providing oncological care to the adult population of the Kaluga region."

Approximate position

On the organization of the work of the examination room of an outpatient clinic in the Irkutsk region

Chapter 1. General provisions

1. This Approximate Regulation determines the organization of the activities of the examination room of an outpatient clinic in the Irkutsk region.

2. An examination room is created in an outpatient clinic to conduct a preventive examination of citizens, the initial division of citizens into healthy ones and those requiring examination on suspicion of a precancerous disease or a malignant tumor of external localization and their referral with identified diseases for further examination and rehabilitation to doctors of relevant specialties.

^ Chapter 2. Functions of the examination room

3. The examination room carries out:

A) pre-medical survey of patients

Note :

Before starting to examine the patient, the medical professional conducts a brief survey, paying attention to the appearance of weakness, fatigue, loss of appetite, presence of pain in the abdomen or lumbar region, in the mammary gland. The appearance of these signs may indicate cancer of the stomach, ovaries and breast in a woman, etc.

The medical worker finds out whether the patient has “wounds” in the mouth, sharp edges of broken teeth that injure the tongue and mucous membrane of the oral cavity; are there any increasing birthmarks or moles, skin ulcerations; Is there any discharge from the nipples? When interviewing, you should pay attention to the disorder in women menstrual cycle, the presence and appearance of pain and atypical bleeding intermenstrual period and menopause. The presence of constipation is also noted, alternating constipation with diarrhea, mucus and blood discharge from the rectum, an increase in the abdomen, and a decrease in the amount of urine.

When conducting a survey in the clinic, the medical worker in the examination room enters the obstetric and gynecological history into the anamnestic chart;

B) conducting a preventive examination of patients who applied for the first time during the year to an outpatient clinic for the early detection of chronic, pre-tumor and tumor diseases of visual localizations

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 intestines.

Preventive examination of men includes examination of the skin and visible mucous membranes, examination and palpation of the external genital area, breast area, thyroid gland, abdomen, peripheral lymph nodes, digital examination of the rectum and prostate area;

C) mandatory collection of smears from the cervical canal of the cervix from all women who contact the office and sends them to the cytology laboratory for examination (material for examination is collected with special cervix brushes)

Note :

For examination, the patient must undress completely.

^ Oral examination . The examination begins with the oral cavity. Using a spatula, examine the mucous membranes of the lips, cheeks, gums, and tongue. To examine the tongue, take its tip with a gauze pad and pull it outward. The purpose of the examination is to detect leukoplakia, cracks, and ulcerations of the mucous membrane.

Leukoplakias appear as white, rough plaques or dense white plaques that rise above the surface of the smooth, pink mucosa. More often they are located on the mucous membrane of the cheeks. Cracks and ulcerations occur on the lateral surfaces of the tongue, on the red border lower lip closer to the corner of the mouth, as well as in those areas of the oral mucosa that are constantly injured by the sharp edges of broken teeth and poorly fitted dentures. Easy vulnerability and bleeding of these areas is suspicious for the presence of precancerous diseases.

^ Examination of the skin . The medical worker sequentially examines the skin of the face, head, neck, torso and extremities in order to identify pigmented warts and nodular formations, ulcerations.

You should pay attention to the presence of long-term hyperemic areas of the skin with a rough surface and a tendency to ulceration, which are located in areas of the body exposed to irritating factors: friction with the edge of clothing, exposure to sun rays, chemical substances etc. Over time, nodular and warty formations may appear in these places. The most common location of precancer and cancer is the skin of the face.

A great danger for the presence of a malignant pigmented tumor of the skin - melanoma - are dark and bluish-purple spots and nodular formations that rise above the surface of the skin, prone to enlargement and ulceration. Such formations are often found on the skin of the abdomen, back, and lower extremities.

^ Palpation of lymph nodes . The healthcare professional palpates the peripheral lymph nodes in sequence: cervical, supraclavicular, axillary and inguinal. Palpation of the cervical and supraclavicular lymph nodes is carried out with the patient standing or sitting. In this case, the medical worker stands behind the patient. Palpation is carried out with both hands, with four fingers of each hand examining the cervical and supraclavicular areas, and the thumbs are located on the lateral surfaces of the neck. Palpation of the axillary lymph nodes is performed separately on each side. In this case, the medical worker stands in front of the patient, placing her hand on his shoulder from the examination side. The inguinal lymph nodes are palpated with the patient lying on the couch.

Normally, small lymph nodes of elastic consistency can be detected. Lymph nodes are a barrier to the spread of the malignant process. They can be the first place to detect tumor metastases. various localizations. Lymph nodes affected by metastases are dense, often immobile formations of varying sizes. In some cases, enlarged lymph nodes may be a manifestation of lymphogranulomatosis or leukemia - systemic diseases that affect the entire lymphatic system.

^ Palpation of the thyroid gland . Palpation of the thyroid gland can be done while standing in front or behind the patient. When the medical worker is positioned behind the patient, palpation is carried out with both hands, four fingers of both hands, with the thumbs located on the lateral surfaces of the neck. When the medical worker is positioned in front of the patient, palpation is performed thumbs both hands, with the remaining fingers located on the sides of the neck. During palpation, the patient should be asked to make a swallowing movement. This clearly reveals the size and consistency of the thyroid gland.

The thyroid gland is located at the level of the laryngeal cartilages and normally does not contain compactions or tumor formations. In the presence of precancerous diseases and tumors, diffuse or local compaction and asymmetry of the gland are noted due to an increase in its right or left lobe.

^ Examination of the mammary glands . Examination of the mammary (mammary) glands includes examination and palpation of them. When a medical professional examines the mammary glands, the patient should raise his hands and place them behind his head. Pay attention to the size and shape of the mammary (mammary) glands, the condition of the skin, nipples, and areola. Each gland is examined separately by placing the patient in a semilateral position and asking him to raise his arm. Changes are more easily identified when comparing one gland to another. Normally, the mammary (mammary) glands are the same size and shape. The nipples are located on the same line. Cracks, weeping, crusts, retraction and fixation of the nipple, skin resembling a lemon peel should be considered as signs of a malignant disease.

Palpation of the mammary (mammary) glands is always carried out in two positions of the subject: standing and lying down. They pass a “flat” palm over the mammary (breast) gland and feel it with their fingers to identify lumps and nodes in the breast tissue.

You need to feel the mammary (breast) glands carefully, sequentially examining each area. It is more convenient to examine large saggy breasts in a lying position, turning the patient slightly, first on one side and then on the other. By lightly pressing on the nipple, the health care professional should determine whether pathological discharge from the nipple.

Normally, the mammary glands are soft and do not contain any lumps. Malignant tumors are defined as dense, well-demarcated nodules or indurations without clear boundaries, often accompanied by nipple retraction and skin fixation. With proper palpation, tumors up to 1 cm in size can be detected. large sizes mammary (breast) glands, in which it is difficult to detect a tumor by palpation, it is advisable to refer the patient for mammography (ultrasound examination).

^ Examination and palpation of the abdomen . Examination of the abdomen is carried out with the patient standing and lying down, palpation is carried out while lying on the couch. You should pay attention to the size and shape of the abdomen, and the condition of the navel. An enlarged abdomen and its flattened shape may be signs of ascites. On palpation they can be detected tumor formations in the upper or lower sections abdomen, as well as in the navel area.

^ Examination of female genital organs . On a gynecological chair in good lighting, the vulvar mucosa is examined. The external genitalia are also palpated. A whitish color and dryness of the vulvar mucosa with a tendency to form cracks, as well as atrophy of the labia minora, are characteristic of kraurosis. Leukoplakia is detected in the form of white, rough plaques and plaques. These changes in the vulvar mucosa are considered precancerous diseases. Ulceration of the mucous membrane with thickening of the tissue may be a sign of vulvar cancer.

^ Inspection using mirrors . The cervix is ​​exposed with Sims spoon-shaped speculums and elevators. During examination, the size, shape of the cervix, the condition of its mucosa and the mucous membrane of the vaginal walls are determined. The presence of a border or foci of hyperemia around the external os of the cervix is ​​designated as “erosion.” The detection of white plaques and plaques indicates leukoplakia. Upon examination, formations resembling cauliflower, characteristic of cervical cancer.

^ Taking smears for cytological examination . During the examination of the cervix, smears are taken for cytological examination. From all women, regardless of the condition of the cervical mucosa, smears are taken using the superficial scraping method, which is performed with an Eyre spatula. The Eyre spatula is inserted with a longer “horn” into cervical canal, make a circular motion with a spatula clockwise. Taking material from the cervix should be gentle, without traumatizing the tissue. The resulting material is applied in a thin layer to one glass slide and evenly distributed over the surface with the same spatula. An air-dried smear indicating the woman’s name with a formalized referral must be sent to the cytology laboratory on the same day.

^ Bimanual gynecological examination . During a two-manual gynecological examination, the midwife should pay attention to the size and shape of the cervix, its density, size, shape, consistency and mobility of the uterus, the position of the uterus in the pelvis; the condition of the appendages, the presence of seals and tumors near the walls of the pelvis.

Magnification and dense consistency cervix, displacement of the uterus to one of the pelvic walls and limited mobility, shortening and thickening of the vaginal vaults may be signs of cervical cancer. An enlarged uterus and an uneven, knotty surface are usually characteristic of fibroids. Tumor formations in the area of ​​the appendages and in the posterior vaginal fornix are always suspicious for the presence of ovarian cancer.

^ Examination of the rectum. Digital examination of the rectum is mandatory when examining patients in the examination room. It can be performed with the patient positioned on a gynecological chair (couch). For rectal examination, a fingertip is used, which is placed on forefinger. Any changes in the intestinal wall - compactions, nodules, as well as traces of blood on the glove should be regarded as serious pathology, suspicious for cancer;

D) referral of patients with identified pathology to a medical specialist to clarify the diagnosis and organize treatment

Note :

If the patient has not undergone fluoroscopy this year chest or fluorography, the medical professional gives him a referral for a fluorographic examination.

The task of a medical professional is not to establish an accurate diagnosis of the disease. He should only suspect pathology and refer the patient to a doctor for an in-depth examination.

In the presence of pathological changes female genital organs, the patient is referred for further examination to the antenatal clinic. If pathology of the skin, oral cavity, thyroid gland, lymph nodes, mammary (breast) gland and rectum is detected, the medical worker refers patients for examination to a surgeon at a city (district) clinic. Having discovered obvious tumor formations of any organ, a medical professional must refer the patient directly to an oncologist (to an oncology clinic). In the referral issued to the patient, the medical professional indicates the presumed diagnosis for targeted further examination, as well as the address of the institution where the patient is referred. To ensure that the patient independently requests additional examination, it is necessary to clearly explain the importance of qualified medical supervision.

The medical professional must know exactly when medical institution it is necessary to refer a patient with a particular pathology for further examination, and who in this institution is responsible for this section of work;

E) accounting and registration of ongoing preventive examinations and results of cytological studies according to established forms of primary documentation

Note :

The results of the examination are recorded in the daily intake log. The following columns are filled in the journal: serial number on the day of admission, last name, first name, patronymic of the patient, age, address. In the following columns, the results of the examination of all localizations to be examined in the examination room are noted; skin, oral cavity (this includes examination of the lower lip and tongue), lymph nodes, thyroid gland, mammary (mammary) glands, genitals and rectum. Separate columns are allocated for marking the taking of smears from the cervix, the tentative diagnosis of a medical worker and the specified (medical) diagnosis.

Patients who have been examined in the examination room, if there is no pathology, are given a coupon indicating the date of the examination, which the patient must present to the doctor or the receptionist for pasting into the outpatient card. If a pathology is detected, it is advisable to mark the ticket in red.

Registration of the results of preventive examinations should be reflected in the file cabinet. The fundamental importance of the card index in recording the results of the inspection is that it allows:

A) visually monitor the number of women examined from total number subject to inspection;

B) actively call women for preventive examinations and at the same time regulate the flow of attendance in the examination room;

C) monitor and compare the results of annual preventive examinations using maps to identify visual locations of cancer.

The examination room file is created based on a list of women 30 years of age and older living in the clinic’s service area and subject to examination. Lists are compiled by local nurses or the medical community in contact with the prevention department. The cards are stored in the examination room in special boxes or cabinets, arranged by area in alphabetical order. Checking the payroll and replenishing cards for women over 30 years of age should be carried out annually.

Cards are divided into two main groups:

A) cards of patients who were not examined this year;

B) cards of those who were examined this year.

It is advisable to divide the cards of examined patients into two groups:

A) cards of those who have no pathology identified;

B) cards of those who have been diagnosed with pathology.

In this group, cards with a verified, “clarified” diagnosis are highlighted. When cancer is detected, they are marked in red.

At the beginning of each year, all cards should be listed under the heading "to be examined", with the exception of cards of those patients who have previously been diagnosed with cancer. These patients are subject to observation by an oncologist.

Using a card index, a medical worker monitors patients' visits to the examination room. In case of a bad visit, he informs the local doctor about this and invites patients for examination by phone or postcard. In such cases, the active call is recorded on the front side of the card.

At the end of the working day, a summary of the work done is compiled based on the cards.

The records of patients whose pathology was not detected during examination are transferred to the group of those who underwent examination in the current year. In these cards, after receiving the conclusion from the cytological laboratory, a note is made on the results of the study.

If a pathology is detected, the card is moved to a special box. Using these cards, the medical worker controls the patients' visits to the doctor. After the doctor has clarified the diagnosis, the final diagnosis is made on front side cards. If patients live in the clinic's service area but are not registered in the card index, the medical worker must fill out cards for them. The results of the examination of women under 30 years of age are recorded in a journal.

Direction to cytological examination during the initial preventive examination, it is drawn up on a white form, for repeated examinations - on a colored form. A repeat preventive examination is considered to be an examination performed one year after the initial one.

The result of the cytological analysis comes from the laboratory to the examination rooms, and medical workers mark it in the card of the examination room (if there is a card index) or in a journal.

If the answer is “erosion”, “inflammation”, “mild dysplasia”, “moderate dysplasia” and other non-tumor processes, the conclusion is sent by a medical professional to the antenatal clinic. With a cytological conclusion of “severe dysplasia”, “suspicion of cancer” and “cancer”, the tests are transferred from the examination room to the antenatal clinic or oncologist (to the oncology clinic). Cytological conclusions “cytogram without features” are transferred by a medical worker to the clinic’s reception desk for inclusion in outpatient records;

E) carrying out sanitary educational work among citizens visiting an outpatient clinic

Note :

For this purpose, local doctors and specialists of various profiles at appointments, as well as in lectures and conversations for the population on various issues, must explain to patients the importance of preventive examination in the examination room due to asymptomatic initial malignant tumors and precancerous diseases, the treatment of which prevents the development of cancer. An important role in explanatory work about the importance of preventive examinations belongs to the employees of the office for promoting a healthy lifestyle, the prevention department (office) of outpatient clinics.

It is advisable to highlight the tasks and meaning of the work of the examination room in a health education bulletin, which is posted on the floor of the clinic where the main appointment is conducted. In the hallways of the clinic there should be reminders and brochures about early diagnosis cancer and the appointment of an examination room.

^ Chapter 3. Organization of work of the examination room

4. The examination room is located in a separate room with good lighting, equipped with equipment and tools in accordance with the equipment standard.

5. Activities in the examination room are carried out by an average medical worker who has a diploma and certificate in the relevant specialty and has been trained in oncology.

7. To ensure maximum preventive examination of patients, the examination room should operate throughout the full working day of the outpatient clinic, i.e. in two shifts.

IN staffing table In an outpatient clinic, it is recommended to provide two rates of medical workers who should work in shifts.

8. Preventive examination in the examination room should be widespread.

9. Management and control over the activities of the examination room is carried out by the head of the structural unit that includes the examination room, and in his absence - by the deputy chief physician for medical affairs.

The methodological management of the work of the office is carried out by the district oncologist, and in his absence - by the oncologist of the oncology clinic located on the territory municipality Irkutsk region.

10. Attendance in the examination room is ensured by:

A) the availability in the outpatient clinic of information about the need for a preventive examination in the examination room, for which notices about the need for examination should be posted in an accessible place (next to the registry, in the self-registration room, in the prevention department and in the halls where patients are waiting to see a doctor) in the examination room, its location and opening hours;

B) obligatory referral of patients of an outpatient clinic to an examination room (registration workers, the prevention department, local doctors and doctors of various specialties are recommended to refer all patients (women 18 years of age and older) who initially applied to an outpatient clinic in the examination room for examination current year; district nurses and nurses working with doctors of various specialties when preparing outpatient cards for appointments must pay attention to the presence of a mark on the examination in the examination room and send patients who do not have an examination to the examination room. outpatient card such a mark);

C) actively calling patients for examination in the examination room.

11. In order to control attendance and workload of the examination room:

A) statisticians of an outpatient clinic once a quarter provide the manager with information on the number of patients who initially applied and compare it with the number of patients examined in the examination room (the percentage of those examined from the number of first-time visitors characterizes the coverage of patients with preventive examinations in the examination room);

B) employees of the registry and the office for centralized registration of the annual medical examination of the prevention department of an outpatient clinic institution once a year check the referral of patients to the examination room based on the marks in the outpatient cards and the dates of application to the outpatient clinic institution);

C) the head of the department (office) for outpatient prevention
the outpatient facility monthly checks the documentation of the examination room;

D) leader ( chief physician or his deputy for medical affairs) weekly hears information from local doctors about sending patients to the examination room by district.

^ Chapter 4. Populations of patients to be examined

12. The risk of developing malignant tumors of all locations increases with age. However, it should be remembered that in patients under 30 years of age, pretumor and background diseases are often found, and malignant tumors can also occur. Therefore, at present, patients over 18 years of age are subject to referral to the examination room.

Special attention attention should be paid to involving elderly women under dispensary observation in this outpatient clinic for various somatic diseases: hypertension, diabetes mellitus, glaucoma, chronic gastritis etc. This contingent of women, due to their age, decreased body reactivity and hormonal and metabolic processes most at risk for the occurrence of malignant tumors.

13. Patients with acute processes, severe pain, high fever, and diseases requiring emergency care should not be sent to the examination room. Such patients should undergo examination in the examination room after acute symptoms have subsided and the temperature has dropped. Women who are being treated by a gynecologist and who refuse to visit the examination room must submit a corresponding certificate.

^ Chapter 5. Clarification of diagnoses (reconciliation of identified pathology)

14. The effectiveness of the examination room is assessed based on the final diagnoses. Clarification of diagnoses (reconciliation of identified pathology) is carried out by a medical worker in the examination room once a month. To do this, the medical worker compiles a list of patients with identified pathology, indicating the last name, first name, patronymic, age and address, as well as the intended diagnosis established by the medical worker in the examination room (including cytology) and leaves room for entering a more precise diagnosis.

15. The lists include women:

A) with suspicion of malignant neoplasms of various localizations;

B) with precancerous diseases, targeted and diffuse seals in the mammary (breast) glands “mastopathy”, leukoplakia of the oral cavity, rectal polyps; in women, “erosion” of the cervix, polyps, leukoplakia, kraurosis of the vulva, tumor-like formations of the uterine appendages (“cysts”);

B) with benign tumors; uterine fibroids, lipomas of any location, enlarged thyroid gland.

16. Lists are compiled separately for patients referred to the antenatal clinic or to doctors at an outpatient clinic (surgeon or oncologist). If patients are sent directly to the oncology clinic, a separate list is also compiled for them.

17. The lists of identified pathologies do not include patients registered at the antenatal clinic or being treated for precancerous diseases or benign tumors.

18. Lists of women with identified pathology are transferred to the antenatal clinic to the senior midwife, men - to the oncology office of the outpatient clinic.

The list is a document that ensures continuity between the medical worker in the examination room and the doctors conducting further examination and treatment of patients in need. In order to timely call the patient to the antenatal clinic, outpatient clinic or oncology clinic, these lists must be transmitted at least once a month. No later than a month later, when submitting the next new list, the medical worker must receive the previous one indicating the final diagnoses.

19. Medical institutions that have received lists of patients from the examination rooms assigned to them are obliged to involve the patients indicated in the list for further examination and sanitation as soon as possible. By the end of the month, the date of the patient’s request for further examination and the updated diagnosis should be included in the list. By the end of the year, all patients referred by a medical worker in the examination room for further examination must be further examined and sanitized.

20. Actively attracting patients for further examination, patronage, telephone calls, as well as entering updated diagnoses into the lists of the examination room kept by the senior midwife and oncologist are the responsibility of medical workers in the local network. The same applies to additional examination of patients referred to an outpatient clinic to a surgeon, oncologist or to an oncology clinic.

21. It is necessary to provide patients who independently apply to a antenatal clinic or outpatient clinic in the direction of an examination room with a doctor’s appointment on the day of application.

22. The doctor must:

A) carefully examine such a patient;

B) when indicated, provide them with necessary examination;

C) in the absence of pathology, reassure the patient without undermining the authority of the medical worker in the examination room, and emphasize the need for preventive examinations in the future;

D) note in the outpatient card that the patient was referred from the examination room.

23. Based on the final medical diagnoses, as well as his own documentation, once a month, a medical worker in the examination room summarizes the digital results of the work performed, indicating the number and age composition of those examined (primary and repeat), the number of cytological studies performed, while the number of patients with different pathological conditions are indicated only for specified diagnoses.

When drawing up a report, it is also necessary to indicate the number of patients with identified pathology who were left without further medical examination. The medical worker in the examination room checks the requests of patients referred to them to specialists according to the lists submitted to them at the antenatal clinic, outpatient clinic, and oncology clinic.

24. Quarterly, the medical worker in the examination room draws up a report on all indicators for the head of the outpatient clinic and the district oncologist. Issues regarding the operation of the examination room should be discussed twice a year at medical and nursing conferences.

^ Chapter 6. Analysis of the work of the examination room

25. An analysis of the work of the examination room is carried out jointly with the head of the outpatient clinic, an obstetrician-gynecologist and an oncologist of the district or region.

26. To characterize the work of the examination room, it is recommended to use the following indicators:

A) attendance examination room, which is expressed by the number of patients examined reporting period and depends on the daily load of the examination room. If all modern requirements for the work of a medical worker in an examination room are met, the standard of work for a medical worker is calculated at the rate of 5 people per hour. When analyzing traffic, you should pay attention to age composition patients examined in the examination room, given that malignant tumors occur predominantly in patients 30 years of age and older;

B) important indicator work of the examination room is the ratio, expressed as a percentage, of the number of patients examined by a medical worker in the examination room to the number of patients who first applied to the outpatient clinic in the current year. In addition, it is important to determine preventive examination coverage in the examination room of patients 30 years of age and older living in the service area of ​​the outpatient clinic;

IN) volume of use of the cytological method is determined by the percentage of women from whom smears for cytological examination were taken during examination to the total number of those examined. This indicator to a certain extent characterizes the quality of the examination, since cytological examination helps to identify early forms of cervical cancer;

D) an important indicator of the performance of both the examination room and medical institutions where patients are sent for further examination is the percentage of patients involved in further examination, since this indicator ultimately determines the results of the examination room;

D) an indicator of the qualifications of medical workers examination rooms can serve percentage of confirmed or changed diagnoses . At large quantities unreasonable referrals of patients for further examination or omissions in the diagnosis of malignant tumors should raise the question of increasing the professional knowledge of the medical worker;

E) the main criterion for the operation of the examination room is detection of precancerous diseases and cancer . This indicator is expressed by the percentage of patients with precancerous diseases and cancer of various localizations identified in the examination room during the reporting period, in relation to all patients who underwent examination;

G) another important indicator of the operation of the examination room is percentage of active cancer detection , which is determined by the number of patients identified in the examination room in relation to all patients with cancer of a given localization, registered for the first time in the current year.

^ Chapter 7. Training and advanced training of medical workers in examination rooms

27. The quality performance of examination rooms depends on the experience of the medical worker, his special knowledge and oncological alertness. Therefore, in order to conduct a qualified, meaningful and targeted preventive examination, medical workers in examination rooms must undergo preliminary training in a specialized oncological institution.

28. It is advisable to carry out primary training in the form of a five-day seminar with lectures on the diagnosis of cancer of various visual localizations, in an examination room with a demonstration of patients of the corresponding profile and examination techniques. This form of primary training, despite short term, is more effective than the presence of medical workers in the workplace in an oncological institution. Both forms of training can be used to improve health care workers in examination rooms.

29. Training at a seminar or on the job does not exclude the need to improve the knowledge of health workers on a daily basis. An oncologist or oncogynecologist of a district or region should conduct methodological classes with medical workers in examination rooms to discuss diagnosis, examination, results and shortcomings of work. During these classes, it is advisable to instruct medical workers in examination rooms to prepare reports on various topics, and invite doctors of various profiles as co-speakers. On the base the best institutions It is advisable to periodically conduct a “School of Excellence” in the district.

30. Along with increasing professional knowledge, medical workers in the examination room must master the basics of medical deontology. IN medical workers It is necessary to instill daily responsibility for the work being done, a conscientious attitude to work and a polite, attentive and caring attitude towards patients.