Optimization of the diagnostic and treatment process with the introduction of a technological chart for patient management. On approval of technological maps for medical services in ophthalmology Technological map of medical services sample
Discipline/MDK
.
1. Subject:
Download:
Preview:
Technological map classes
Discipline/MDK
PM. 04 Performing work in one or more occupations of workers and positions of employees,
MDK 04.03. Technology of medical services.
Specialty:____Nursing______
- Subject: Technique for performing intramuscular injections.
- Lesson no. 16 (Section 4)
- Location of the lesson: preclinical practice room “Technologies for the provision of medical services”
- Form and type of lesson:
Practical lesson. Combined lesson
- Lesson objectives:
General goal: The student is proficient in technology intramuscular injection on a phantom.
Specific goals:
The student must be able to:
- select the site for IM injection and create the most comfortable position for the patient during injection
- treat the patient's skin during injection
- draw a given dose of the drug from the ampoule of the bottle
- perform an intramuscular injection
- assess complications that the patient experienced during the injection
- train the patient and their family members to perform IM injections
- apply deontological communication skills with the patient when performing an injection
The student must know:
Anatomical areas for IM injections
- places for IM injections
- possible complications of intramuscular injections, measures to prevent them
- universal precautions when working with syringes, needles, contact with blood
- rules for handling syringes, needles, trays, cotton balls
Promote the formation of OK and PC
general competencies:
OK. 2 Organize your own activities, choose standard methods and ways of performing professional tasks, evaluate their implementation and quality.
professional:
PC 4. Provide medical services within the limits of their powers. Carry out the nursing process.
- Resources:
methodological: technological map of the lesson, supporting notes, slide accompaniment; control materials, handouts.
TSO
computer, TV;
Tools and equipment:. Manipulation tables. trays, syringes, cotton balls, antiseptics, gloves, containers for waste material, injection simulator
- Sources of information:
Main
Name | Publisher and year of publication |
||
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., Klyukova I.N. | Moscow Geotar-Media Publishing Group, 2012 |
Additional
Name | Publisher and year of publication |
||
“General nursing.” Textbook. | N.V. Turkina, A. Filenko | Partnership of scientific publications KMK 2007. |
|
Order of the Ministry of Health of the Russian Federation No. 342 of November 26, 1998 “On strengthening measures to prevent typhus and combat lice” | |||
Order of the Ministry of Health of Russia dated January 24, 2003 No. 4 “On measures to improve the organization medical care 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 therapeutic nutrition in medical and preventive institutions of the Russian Federation" | |||
Order of the Ministry of Health of Russia dated April 17, 2002 No. 123 “Protocol for the management of patients. Bedsores." | |||
OST 42-21-2-85. Sterilization and disinfection of medical products. Methods, means and modes; | |||
SanPiN 2.1.3. 2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities.” Approved by Resolution of the Chief Sanitary Doctor of the Russian Federation dated May 18, 2010 No. 58 |
Internet resources
http://dezsredstva.ru/ - guidelines To disinfectants, regulatory documents;
http://www.consultant.ru/- regulatory documents;
http://www.recipe.ru/ - regulatory documents;
www.med-pravo.ru – regulatory documents.
www.rosmedlib.ru – medical student library
http://www.fcior.edu.ru/ – FCIOR - Federal Center for Information and Educational Resources.
Catalog of training modules by discipline.
- Progress of the lesson:
No. | Lesson stage | Time | Methods training | Teacher's activities | Student activities |
Organizational moment | 20min | Verbal method Creation of indicative foundations | Announces the topic of the lesson, sets its goals and objectives, and briefly outlines the structure of joint work. Checks those present | Listen, understand, take notes |
|
Goal setting, updating of basic knowledge - | 40min. | Control of the initial level of knowledge | Distributes test tasks for incoming control and offers to complete them Analyzes the most common mistakes made when answering test questions | Perform tests assignments, marking the correct answers in writing |
|
Motivation for learning activities | 20min | Activation cognitive activity students | Forms the students’ need for cognitive activity: explains the need to study and master this topic, revealing the practical significance of the knowledge and skills acquired in the lesson for professional activity | Listen, take notes, perceive and understand cognitive tasks |
|
Learning new material | 40min. | Formation of skills and abilities; | explanation of the material using illustrations, diagrams, tables. | Learn new knowledge and skills. |
|
Generalization and systematization of knowledge (Mastering and consolidation of practical skills) | 120min | Monitors the progress of students' independent work. Provides assistance in overcoming emerging difficulties. Corrects students' actions and words. Analyzes and evaluates each work | They acquire new knowledge, skills and instructions from the teacher while performing practical tasks. Analyze, comparing the knowledge and skills acquired during the lesson with the professional competencies already formed in them |
||
Reflection | 10min | Conduct internal self-assessment of their understanding of new things educational material, draw appropriate conclusions |
|||
Lesson results | 30min | Summarizes the lesson. Evaluates the work of individual students and the group as a whole, reading the grades given into the educational journal. Gives homework | Listen to the teacher Write down homework assignment |
||
Total class time (min) | 270min |
- Contents of the lesson
Technique for performing intradermal and subcutaneous injections.
Possible complications associated with use medicines. Nurse tactics.
- Forms and methods of monitoring the development of OK and PC (assessment of knowledge and skills included in the competence):
Learning outcomes (OK and PC) | Main indicators for assessing results | Forms and methods of monitoring and evaluation |
general competencies: OK 1, Understand the essence and social significance his future profession, show a steady interest in her. OK 2, Organize your own activities based on the goal and methods of achieving it, determined by the manager OK 3; Analyze work situation, carry out current and final monitoring, assessment and correction of one’s own activities, and be responsible for the results of one’s work. OK 4; Search for information necessary to effectively perform professional tasks. OK 6. Work in a team, communicate effectively with colleagues, management, and consumers. OK 7 Treat historical heritage and cultural traditions with care, respect social, cultural and religious differences. OK 8 Comply with labor protection, fire 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 process of professional activities, advise the patient and his environment on issues of care and self-care. PC1.5, Prepare medical documentation. PC1.6, Provide medical services within the limits of their powers. PC2.1. 2.2, 2.4, 2.5. Provide a safe hospital environment for patients and staff, including infection control, industrial sanitation and personal hygiene in the workplace. |
|
|
- 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., “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 justification of each stage of the manipulation algorithm, development of execution technology.
On approval of technological cards for medical services in ophthalmology
Accepted Ministry of Health Ryazan region- 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:
- - consultation with an ophthalmologist,
- - appointment with an ophthalmologist (repeated),
- - study of color perception using polychromatic tables,
- - probing of the lacrimal ducts (and lavage),
- - measurement of the strabismus angle,
- - exophthalmometry,
- - skiascopy,
- - localization of ruptures of retinal foreign bodies,
- - selection of spectacle correction,
- - para- and retrobulbar injections of emoxypine,
- - para- and retrobulbar injections of dexazone,
- - examination of the fundus with a three-mirror Goldmann lens,
- - perimetry on the Förster perimeter (one color),
- - computer perimetry,
- - panretinal laser coagulation,
- - preventive, peripheral, delimiting laser coagulation of the retina,
- - iridotomy,
- - discission of secondary cataract,
- in accordance with the appendix to this order.
- 2. Chief doctors of state medical organizations Ryazan region to provide paid medical services for consultations with specialist doctors in accordance with approved technological maps.
- 3. Entrust control over the implementation of this order to Deputy Minister O.V. Mitin.
- I. o. minister
- V.I.GRACHEV
Application
to the Order of December 26, 2014 № 2124
Technological map
Technological map consultation with an ophthalmologist
-
Executor Equipment used 1 Collection of complaints and medical history Ophthalmologist 30 min. Slit lamp 5 min. Alcohol wipe 5 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Visual examination and palpation of the eyes. Ophthalmoscopy Ophthalmoscope 5 min. Non-sterile surgical cotton wool 3 g. 3 Examination of the anterior segment of the eye using the method of lateral illumination and the media of the eye in transmitted light Nurse 30 min. Binocular ophthalmoscope 5 min. Sterile medical gauze wipes 3 pcs. 4 Visometry. Biomicroscopy of the anterior segment of the eye using a slit lamp Automatic sign projector 5 min. Sterile cotton-gauze wipes 1 pc. 5 Examination of the fundus of the eye with a direct and indirect ophthalmoscope Mydriacyl 0.5%% 0.3 ml 6 Examination of the fundus with a binocular ophthalmoscope Cyclomel 1%% 0.5 ml 7 Tonometry of the eye Inocaine 0.4%% 0.5 ml 8 Determination of refraction using a set of trial lenses Levomycetin 0.25%% 0.5 ml 9 Prescription of treatment and recommendations for the patient Sulfacyl sodium 20%% 0.5 ml Collar head dye for tonometry 0.1 ml - TECHNOLOGICAL MAP
- Appointment with an ophthalmologist (repeated)
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Collection of complaints and anamnesis for eye pathology Ophthalmologist 30 min. Slit lamp 5 min. Alcohol wipe 2 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Visual examination and palpation of the eyes. Ophthalmoscopy Nurse of the ophthalmological department 15 min. Ophthalmoscope 5 min. Non-sterile surgical cotton wool 3 g. 3 Study of the anterior segment of the eye using the method of lateral illumination and the media of the eye in transmitted light Binocular ophthalmoscope 5 min. Sterile cotton-gauze wipes 1 pc. 4 Visometry. Biomicroscopy of the anterior segment of the eye using a slit lamp Automatic sign projector 5 min. Midriacil 0.5%% 0.3 ml 2. Standards of medical care for eye diseases (if available) Sulfacyl sodium 20%% 0.5 ml 5 Tonometry of the eye Levomycetin solution 0.25%% 1 ml 6 Determination of refraction using a set of trial lenses Collar head dye for tonometry 0.1 ml 7 Prescription of treatment and recommendations for the patient Inocaine 0.4%% 0.6 ml - TECHNOLOGICAL MAP
- Study of color perception using polychromatic tables
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Collection of complaints and medical history Ophthalmologist 20 min. Polychromatic tables 15 min. Alcohol wipe 2 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Explaining the research methodology to the patient Nurse 10 min. 3 Study of color perception using polychromatic tables 4 Evaluation and registration of the study result 2. Standards of medical care for eye diseases (if any) - TECHNOLOGICAL MAP
- Probing the lacrimal ducts (and lavage)
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Inspection of lacrimal openings visually and using a slit lamp by an ophthalmologist 20 min. Slit lamp 5 min. Levomycetin solution 0.25%% 0.3 ml 1. Order of the Ministry of Health of the Russian Federation of November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Probing the lacrimal ducts (and lavage) Nurse 10 min. Non-sterile surgical cotton wool 6 g. Alcohol wipe 1 pc. Inocaine 0.4%% 0.2 ml 2. Standards of medical care for eye diseases (if available) Sodium chloride solution 0.9%% 10 ml Disposable syringe 5 ml. 1 piece Disposable cannula for rinsing 1 pc. Examination gloves 1 pc. Surgical gloves 1 pc. - TECHNOLOGICAL MAP
- Measuring the strabismus angle
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Measuring the strabismus angle Ophthalmologist 10 min. Non-sterile surgical cotton wool 3 g. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” Alcohol wipe 2 pcs. 2. Standards of medical care for eye diseases (if any) - TECHNOLOGICAL MAP
- Exophthalmometry
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 History taking Ophthalmologist 10 min. Exophthalmometer 10 min. Alcohol wipe 2 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Visual examination of the eye 3 Exophthalmometry 4 Conclusion 2. Standards of medical care for eye diseases (if any) - TECHNOLOGICAL MAP
- Skiascopy
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 History taking Ophthalmologist 10 min. Slit lamp 10 min. Alcohol wipe 2 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Visometry. Biomicroscopy of the anterior segment of the eye using a slit lamp Nurse 10 min. Automatic sign projector 5 min. 3 Determination of refraction using a set of trial lenses 4 Skiascopy 5 Formulation of conclusion 2. Standards of medical care for eye diseases (if any) - TECHNOLOGICAL MAP
- Localization of ruptures of retinal foreign bodies
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 History taking Ophthalmologist 30 min. Slit lamp 5 min. Alcohol wipe 2 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Examination of the anterior segment of the eye using a slit lamp Nurse 30 min. Binocular ophthalmoscope 5 min. Non-sterile surgical cotton wool 3 g. 3 Examination of the fundus with a binocular ophthalmoscope Midriacil 0.5%% -15 ml 0.5 ml 4 Examination of the fundus with a Goldmann lens or a non-contact lens Cyclomed 1%% - 5 ml 0.5 ml 2. Standards of medical care for eye diseases (if any) 5 Localization of ruptures of retinal foreign bodies 6 Issuing a report to the patient Solcoseryl, gel 0.6 g. Korneregel 0.6 gr. - TECHNOLOGICAL MAP
- Selection of spectacle correction
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Visometry Ophthalmologist 20 min. Automatic sign projector 5 min. Alcohol wipe 2 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Selection of spectacle correction 2. Standards of medical care for eye diseases (if any) - TECHNOLOGICAL MAP
- Para- and retrobulbar injections of emoxypine
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Injection by ophthalmologist 5 min. Emoxypine solution 1%% 1 ml N 10 1 amp. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” Nurse 3 min. Non-sterile surgical cotton wool 50 gr. 3 gr. Alcohol wipe 2 pcs. Ethyl alcohol 70%% 1 gr. Insulin syringe 1 ml 1 pc. 2. Standards of medical care for eye diseases (if any) - TECHNOLOGICAL MAP
- Para- and retrobulbar injections of dexazone
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Injection by ophthalmologist 5 min. Dexamethasone 4 mg/ml 1 amp. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” Nurse 3 min. Non-sterile surgical cotton wool 3 g. Alcohol wipe 2 pcs. Ethyl alcohol 70%% 1 gr. 2. Standards of medical care for eye diseases (if any) Insulin syringe 1 ml 1 pc. - TECHNOLOGICAL MAP
- Examination of the fundus with a three-mirror Goldmap lens
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Examination of the periphery of the fundus with a three-mirror Goldmann lens Ophthalmologist 10 min. Three-mirror Goldmann lens Alcohol wipe 2 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” Korneregel 10 gr. Ch. gel 0.4 gr. Levomycetin 0.25%% 10 ml 0.5 ml Boric acid 2%% 10 ml 0.5 ml Midriacil 1%% 0.5 ml Inocaine 0.4%% 0.5 ml 2. Standards of medical care for eye diseases (if any) Purified sterile iodine 50 ml Chlorhexidine bigluconate, 0.05%% 50 ml - TECHNOLOGICAL MAP
- Perimetry on Förster perimeter (one color)
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 History taking Ophthalmologist 30 min. Förster perimeter 10 min. Alcohol wipe 2 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Visometry Nurse 30 min. Automatic sign projector 5 min. Sterile wipes 2 pcs. 3 Explaining the research technique to the patient Non-sterile gauze bandage 70 cm 4 Conducting the study 5. Evaluation of the study result and issuance of a conclusion 2. Standards of medical care for eye diseases (if any) - TECHNOLOGICAL MAP
- Computer perimetry
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Collection of complaints and anamnesis Ophthalmologist 10 min. Automatic sign projector 10 min. Alcohol wipe 2 pcs. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Visual examination of the eyes Ophthalmology nurse 40 min. Automatic perimeter 30 min. Alcohol wipe 2 pcs. 3 Corrected vision test using a set of trial lenses 4 Explaining the research methodology to the patient 2. Standards of medical care for eye diseases (if any) 5. Conducting research 6. Evaluation of the research result and issuance of a conclusion - TECHNOLOGICAL MAP
- Panretinal laser coagulation
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 2 Checking visual acuity IOP 3 Monitoring the level of blood glycemia Nurse working on laser systems 40 min. Automatic sign projector 5 min. Asparkam, tab. 4 pcs. 4 Instillation of mydriatic to dilate the pupil on the patient’s operated eye Slit lamp 5 min. Gauze bandage 50 cm 5 Carrying out local anesthesia Glucometer 2 min. Non-sterile surgical cotton wool 5 g. 2. Standards of medical care for eye diseases (if any) 6 Installing a contact lens on the patient’s eye Vidisik gel 2 g. 7 Carrying out laser coagulation Distilled sterile water 50 ml 50 g. 8 Rinsing the conjunctival cavity with antiseptic eye drops Gemaza 1.0 1 amp. Diacarb, 0.25 mg 1 pc. Inocaine 0.4%% 04 ml Dexamethasone 4 mg/ml 1 amp. Glucose test plate 1 pc. Korneregel 1 gr. 10 Prescription of treatment and recommendations for the patient Indocollir 0.5 ml Midriacil 1%% 0.5 ml Protective mask 2 pcs. Dicynone, 2 ml 1 1 amp. Alcohol wipe 5 pcs. Ethyl alcohol 70%% 2 gr. Cyclomed 1%% 0.5 ml Insulin syringe 1 ml 1 pc. Histochrome 0.02%% 1 amp. Disposable syringe 5 ml 1 pc. Dorzopt 2%% 0.3 ml Solution boric acid 2%% 0.5 ml - TECHNOLOGICAL MAP
- Preventive, peripheral, restrictive
- laser coagulation of the retina
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Anamnesis collection Ophthalmologist working on laser machines 40 min. Ophthalmic laser 30 min. Solcoseryl gel 0.6 g. 1. Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Checking visual acuity and IOP Nurse working on laser systems 40 min. Automatic sign projector 5 min. Asparkam, tab. 4 pcs. 3 Instillation of mydriatic to dilate the pupil on the patient’s operated eye Slit lamp 5 min. Gauze bandage 50 cm 4 Carrying out local anesthesia N/Sterile surgical cotton wool 5 g. 2. Standards of medical care for eye diseases (if any) 5 Installing a contact lens on the patient’s eye Vidisik gel 2 g. 6 Carrying out laser coagulation Distilled sterile water 50 ml 50 g. 7 Rinsing the conjunctival cavity with antiseptic eye drops Gemaz 1.0 drops 1 amp. Diacarb, 0.25 mg 1 1 pc. Inocaine 0.4%% 0.4 ml Dexamethasone 4 mg/ml 1 amp. 8 Instillation of anti-inflammatory drops Inocaine 0.4%% 0.5 ml Korneregel 1 gr. Indocollir 0.5 ml 9. Prescription of treatment and recommendations to the patient Midriacil 1%% 0.5 ml Oftan-decamethasone eye drops, 0.1%% 0.2 ml Protective mask 2 pcs. Sterile surgical gloves 2 pair Dicynone, 2 ml 1 1 amp. Levomycetin solution 0.25%% 5 ml 0.5 ml Alcohol wipe 5 pcs. Ethyl alcohol 0.5 2 gr. Cyclomed 1%% 0.5 ml Chlorhexidine bigluconate solution 0.05%% 50 ml Insulin syringe 1 ml 1 pc. Histochrome 0.02%% 1 amp. Disposable syringe 5 ml 1 pc. Diprospan, 1 ml injection suspension 1 amp. Dorzopt 2%% 0.3 ml Boric acid solution 2%% 0.5 ml Sterile medical gauze wipes 5 pcs. - TECHNOLOGICAL MAP
- Iridotomy
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Anamnesis collection An ophthalmologist working on laser machines 100 min. YAG device - laser ophthalmic surgical 80 min. Inocaine 0.4%% 0.5 ml 1. Order of the Ministry of Health of the Russian Federation of November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexal apparatus and orbit” 2 Checking visual acuity and IOP Nurse working on laser systems 80 min. Slit lamp 10 min. Disposable syringe 5 ml 1 pc. 3 Instillation of mydriatic to dilate the pupil Automatic sign projector 10 min. Diacarb, 0.25 mg 1 pc. 4 Carrying out local anesthesia Asparkam 1 pc. 2. Standards of medical care for eye diseases (if any) 5 Installing a contact lens on the patient’s eye Surgical non-sterile cotton wool 2 g. 6 Installing a contact lens on the patient’s eye Chlorhexidine Bigluconate solution 0.05%% 50 ml 8 Rinsing the conjunctival cavity with antiseptic eye drops Azopt 1%% 0.3 ml Solcoseryl gel 0.5 ml Levomecitin 0.25%% 0.5 ml Boric acid 20%% 0.5 ml Purified sterile water 50 ml 9 Instillation of anti-inflammatory drops Chlorhexidine bigluconate solution 0.05%% 50 ml Cornegonelle 0.6 gr. Midriacil 1%% 0.3 ml Diclof 0.3 ml Mask 3-layer 2 pairs Sterile surgical gloves 2 pair - TECHNOLOGICAL MAP
- Discision of secondary cataract
-
NN pp Contents of the technological process Executor Equipment used Used medications, dressings, low-value equipment and tools List of regulatory documentsname time for 1 procedure (min.) name operating time (min.) name quantity per 1 procedure (grams, pieces - indicate) terms of use of instruments (normative) 1 Anamnesis collection Ophthalmologist working on laser machines 60 min. YAG device - laser ophthalmic surgical ALOFmx 40 min. Inocaine 04%% 0.5 ml 1. Order of the Ministry of Health of the Russian Federation of November 12, 2012 N 902n “On approval of the procedure for providing medical care to the adult population for diseases of the eye, its adnexa and orbit” 2 Checking visual acuity and IOP Nurse working on laser systems 60 min. Slit lamp 10 min. Disposable syringe 5 ml 1 pc. 3 Examination of the patient at the slit lamp Automatic sign projector 10 min. Diacarb, 0.25 mg 1 pc. 4 Instillation of mydriatic to dilate the pupil Asparkam 1 pc. 2. Standards of medical care for eye diseases (if any) 5 Carrying out local anesthesia Surgical non-sterile cotton wool 2 g. 6 Installing a contact lens on the patient’s eye Chlorhexidine bigluconate solution 0.05%% 50 ml 7 Creating a discision hole using a laser perforator Tobrex 0.3%% (tobramycin) 0.5 ml 8 Rinsing the conjunctival cavity with antiseptic eye drops Azopt 1%% 0.3 ml Solcoseryl gel 0.5 ml Levomecitin 0.25%% 0.5 ml Boric acid 20%% 0.5 ml Purified sterile water 50 ml 9 Instillation of anti-inflammatory drops Chlorhexidine bigluconate solution 0.05%% 50 lm 10 Checking visual acuity, IOP and re-examination of the patient 11 Issuing a conclusion to the patient and preparing medical documentation Dexamethasone 0.1%% 0.5 Cornegonelle 0.6 gr. Midriacil 1%% 0.3 ml Diclofinac 0.3 ml Mask 3-layer 2 pairs Sterile surgical gloves 2 pair
Subject “Fundamentals of Life Safety” Class 7th grade.
Technological map for studying the section “Basics of first aid”.
Lesson topic: first aid and self-help.
– rules of first aid and self-help.
Teach to use acquired knowledge and skills
Main content of the topic
Terms of concept
General information about the rules, principles of first aid and self-help
Stopping bleeding, applying a hemostatic tourniquet, treating the wound, applying a bandage
Planned result
Cognitive skills:
- explain the meaning of new concepts and use them in an active dictionary;
Know the algorithm of actions when providing first aid and self-help
- comply with safety standards and rules when providing first aid and self-help;
-
use acquired knowledge
Regulatory skills:
- fulfill educational task using the plan and technological documentation;
-
fulfill educational action using conditional knowledge;
- carry out mutual verification and adjustment of the educational task.
Communication skills:
- adequately use speech means when working in a group;
Formulate understandable statements within the educational dialogue using terms;
- formulate your own opinion;
-
Recognize types of injuries and choose first aid and self-help methods;
- know what medical materials and supplies are needed in a particular case of first aid and self-help;
- select and apply;
Comply with safety standards and rules when providing first aid and self-help, sanitation and hygiene rules.
Organization of educational space
Posters:
- “Algorithm for providing first aid for a cut”; “Algorithm for providing first aid for a fracture,” “Types of wounds.” "Types of Fractures"
Cards: - “Instructions for the order of first aid”;
- “Types of dressings”
Crossword template:
Diagnostic task on the board.
Interactive material:
Electronic presentation: “Types of injuries”
Frontal;
Group work
Technology for studying the topic
Stage 1 : Self-determination for activity
One of the three girlfriends, while walking, received a foot injury - a cut. On the advice of one of her friends, the injured girl applied a cobweb to the wound and tied it with a piece of found fabric. What would you do?Students offered many different versions. The discussion showed the need for new knowledge. Suggested solution to the problem: it was necessary to use plantain, call ambulance, go home and seek advice and help from elders...
How to provide first aid if you receive a cut to the foot in autonomous, natural conditions?
In what order should assistance be provided in such a case? What will happen if you provide first aid the way the girls did?
Personal skills:
Show interest in studying the topic;
- demonstrate a desire to solve a problem that may be caused by a lack of first aid skills.
Stage 2: Educational and cognitive activity
Stimulate interest in the process andlearning the basics of medical knowledge.Update your knowledge:
- about the possibility and importance of timely provision of first aid;
- on the principle of operation and rules of first aid and self-help;
Introduce into the active dictionary the concepts: “medical material for first aid”, “types of dressings (list), wound treatment products (list)
Teach:
Use verbal means within educational dialogue;
- carry out the educational task according to plan, with mutual verification;
- complete the educational task using symbols on the packaging of medical materials and devices
Teacher's message
Today in class we will get acquainted with the basics of medical knowledge. "First aid and self-help." We will learn safe first aid and self-help techniques. With types of dressing material, types of injuries, bleeding, features of the use of a hemostatic tourniquet. (watch video material “Types of wounds”).
What wounds can most often be sustained at home? In what cases will you provide assistance yourself, and when will you call an ambulance?
-(watching video material about types of bleeding and ways to stop).
Applications medications when receiving a wound at home.
Demonstration of the “medical first aid kit” kit.
Independent work with the textbook: find and write down in your notebook the rules for the safe use of a first aid kit at home.
(presentation "First Aid Kit"
).
Discussion of the presentation.
- Today we will get acquainted with the rules for applying a hemostatic tourniquet
1
. Demonstration of a tourniquet.
-What can be used if there is no medical tourniquet?
Watch the video “Application of a hemostatic tourniquet”
Demonstration of applying a tourniquet
An example from one of the students.
Rules for the safe application of a tourniquet (for what time in summer and winter, if there is initially tissue on the limb, enclosing a note indicating the time of application)
Task: work in pairs - applying a hemostatic tourniquet
Personal skills
:
- show interest in the process of providing first aid
Cognitive skills:
-explain the meaning of new concepts and use them in an active dictionary.
Regulatory skills:
- carry out the educational task following the instructions;
Carry out the educational task according to plan, with mutual verification.
Communication skills:
Adequately use verbal means within the framework of educational dialogue.
Subject Skills:
Perform correct first aid procedures
Stage 3 Intellectual and transformative activities
selecting a task option: andinformative, improvisational, heuristic.choice of method of activity: individual or collective.
self-organization to complete the task:
-activity planning;
Personal skills:
Show interest in learning the basics of medical knowledge
Completing the task;
-presentation of performance results.
Using the handout:
First aid instructions for different situations“cut, “burn,” “bruise,” “open fracture with venous bleeding.”
It is possible to complete tasks in groups using issued cards.
Discussion of completed tasks.
Regulatory skills:
Complete the educational task in accordance with the plan.
Communication skills:
Use verbal means adequately to present the result.
Subject Skills:
- identify and select types of medical materials and items for a specific injury
- determine the cooking time in microwave oven using symbols;
- apply personal safety rules when providing first aid
Diagnostic task:
Using the crossword template on the board, guess the keyword that relates to the topic of the lesson. Questions:
1.
Type of injury when using hot cookware.
2. .
3. It will keep food fresh.
4. A device that can cut anything.
5. A device that helps curl your hair.
6. From it we learn news of the world.
1. LAMP
A
2. SAMOVAR
3. COLDAND
FLAX
4. COMB
AIN
5. PLABOUT
YKA
6. TVR Did you guess the word denoting the type of injury “BURN”
Stage 4 Reflective activity (student)
Introspection: Complete the sentences:1. It is important for me to know the rules of first aid because...
2. It is important for me to be able to choose medical material when providing first aid, because...
3. I learned how to stop bleeding correctly because it…..
4. To stop bleeding you need...
5. To ensure the safety of the wound it is necessary...
1) Self-esteem:
I completed the task on my own with excellent marks.
- I coped with the task well, but they helped me...
“I couldn’t complete the task the way I wanted.” I still need to learn...
2) Self-assessment of one’s own activities
Are you satisfied with your work in class?
If you are very happy, then raise your two hands.
If you are satisfied, raise your two hands and clasp them together in a handshake.
If you're not very happy, raise one hand.
Stage 5 Reflective activity (teacher)
Teacher self-analysis and self-assessmentForm an idea about types, principles and sequence of first aid
Enter
-
algorithm for preparing to safely provide first aid to another person
- rules for stopping bleeding;
Rules for applying a hemostatic tourniquet
– rules for treating wounds
Rules for applying a bandage.
Teach to use
acquired knowledge and skills in practical activities
Key skills
Cognitive skills:
-
use acquired knowledge when providing first aid.
Regulatory skills:
-
carry out educational activities using conventional signs
;
Communication skills:
-
come to a consensus in joint activities.
Correlate the result obtained with the goal.
- Evaluate the results of your activities.
At the Medical Center of the Bank of Russia, the solution to this problem was facilitated by the creation and use of a technological chart for patient management in diagnostic and treatment work - methodological manual for doctors, where an algorithm for providing medical care for certain diseases is defined.
Stage 12. The section “Patient Education” lists the main objectives of patient education at each stage and indicates the necessary activities.
Stage 13. The criteria for discharge from the hospital are listed, i.e., the expected results of treatment.
Stage 14. The time, place and method of assessing the correctness of the technological process are indicated, i.e. process control points are established.
Control points are characteristic areas of the process in which systemic (related to improper organization of work) deviations of the process from the design most often occur. Measuring the process at these points allows it to be monitored most effectively. The control point includes place, time, and object of assessment.
Step 15. Quality indicators are listed.
If accurate information about the characteristic system deviations of a process or its stage is not available, it is difficult to establish control points. Then, to evaluate the process, they resort to constructing a hypothesis that assumes the most likely deviations. To refer to these hypothetical deviations in medical technological processes, American researchers proposed using the term “quality indicators.”
Quality indicators are quantitative or qualitative indicators aimed at searching for possible deviations, the presence of which is assumed by the expert, but the significance of which for assessing the correctness of the process has not been proven.
Quality indicators for the flow chart for the management of somatic patients suffering from depressive disorders
Indicator 1
Indicator |
Clinicians should ask about the presence of depressive episodes in patients:
|
Screening for depression is necessary:
|
|
These risk factors for depression were found in cross-sectional studies |
Indicator 2
Indicator |
When diagnosing depression, specific comorbid disorders should be documented:
|
Rationale for introducing the indicator |
Timely detection of depression is necessary:
|
These comorbid disorders can cause depression. The doctor should take them into account when planning treatment for depression |
Calculation of the quality indicator Numerator - the number of patients for whom the quality indicator is met (in a controlled period of time).
The denominator is the number of patients being treated for depression (during the controlled period of time).
Step 16. Typical technological violations are indicated.
Stage 17. The application reflects the protocols of the main activities (for example, psychopharmacotherapy, risk assessment, physical rehabilitation, etc.).
Step 18. A list of references is presented (in the appendix).
Stage 20. A draft order is being prepared for the implementation of the technological map in a medical institution.
After the development of the technological map, at the final meeting of the working group, a final approval procedure is carried out and a corresponding protocol is drawn up.
Scheme of the technological chart of an inpatient patient
Name of nosological form_______________________________________________
Duration of hospitalization________ days +_______ days in the rehabilitation department
Parameter |
Patient management stage |
||
Reception department |
Hospital |
Rehabilitation department |
|
Duration of treatment |
|||
Attending physician |
|||
Specialist consultations |
|||
Physical data |
|||
Assessment of a parameter important for patient management tactics: |
|||
Manipulations and instrumental studies: |
|||
Laboratory research: |
|||
Disease prognosis, risk class assessment |
|||
Therapeutic measures: |
|||
Motor activity |
|||
Patient education |
|||
Discharge criteria (at the inpatient and rehabilitation stages): |
|||
Control points/quality indicators: |
|||
Typical technological violations: |
|||
Providing medical care based on the developed technological map 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 make the right clinical decisions. The flow chart is not a substitute for professional clinical judgment.
At the Medical Center, all technological maps are compiled in electronic format, which greatly facilitates working with them and allows you to make changes and additions without unnecessary difficulties.
Quality management of medical care using technological charts for patient management
Based on the information and 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 and heads of departments.
In inpatient treatment, ongoing assessments are performed while the patient is in the hospital. This is done so that treatment can be adjusted if there are violations. After the patient is discharged, the medical history along with the flow chart is transferred to a specialist to conduct a final expert assessment of how much the treatment and diagnostic process for a particular patient complied with the technological process developed in this medical institution and quality indicators for this somatic nosology.
One of the differences modern model quality of medical care is a focus on the needs and expectations of consumers, in particular, a focus on an objective study of the opinions of the patients themselves.
The Medical Center analyzes patients’ opinions on the achieved treatment results, which is one of the most important final stages quality control of the diagnostic and treatment process. At the final stage of the hospital stay, the patient is asked to answer questions in a questionnaire.
The final stage of quality management is making changes to the technological map based on the analysis of technological deviations - improving the process, its reengineering. Thus, the quality management process is continuous and closed.
The introduction of technological charts for patient management at the Medical Center made it possible to improve the quality of care provided: reduce the number of technological deviations by 3 times, achieve the desired treatment result for certain nosologies in 70% of patients, 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.