Technological maps for the provision of paid medical services. On approval of the technological map for medical services in the specialty "cardiology". Application. routing

The Law on the Contract System (44-FZ) determines the priority for calculating the initial (maximum) contract value (NMCC). The customer requests prices from potential suppliers of identical goods, works, and services. A message about this is posted in the Unified Information System (UIS).

1. Request data from at least five participants with relevant supply experience (at least three of them must provide the necessary information).
2. Place an application in the EIS.
3. Search in
4. Collect and analyze publicly available information.

How to compose a letter

A letter requesting price information is not an offer. These two concepts serve different purposes. The purpose of an offer is to propose to conclude a contract. The one who sends the offer fixes all the essential conditions, and the one who receives the offer either accepts them or refuses to sign the contract. The purpose of the request is to request pricing information.

• addressee and addressee data;
• date, place and originating number;
• topic of appeal;
• addressing the addressee (taking into account the rules of business correspondence);
• Basic information;
• offer to collaborate;
• thanks for the answer;
• signature, position, surname, first name and patronymic of the compiler.

Based on clauses 3.10.1-3.10.6 of the Methodological Recommendations, the request to provide price information is addressed to the potential supplier and contains:

1. with proper indication of the unit of measurement, quantity of goods (volume of work, service).
2. List of information for determination.
3. Basic provisions for the execution of the contract, requirements for the guarantee.
4. Deadlines for providing price information.
5. Notice that the procedure does not entail any obligations for the customer.

How to publish

Here are instructions on how to place a price request in the UIS:

1. Go to Personal Area and select the item “Requests for prices of goods, works, services” in the menu of the “Registers” block.

2. Click on the “Create” button.

3. Enter the data and attach the necessary files. After filling out the fields with the required information, make sure that they are filled in correctly using the “Save and Check” button.

4. Save, edit the information, or post it immediately. Click on the “Submit for placement” button.

5. Edit the information through the “Edit Project Menu” item on the “Preparation” tab.

6. Delete data if necessary. Select the menu item of the same name.

It is also possible to delete the project of the previous change operation. This function is available in the "Preparing Changes" stage.

7. After placing the procedure, the printed form is reflected in the form of two parts: upper and lower.

8. Click on the “Sign and Post” button. This will confirm consent to this action.

9. Edit information after posting. To do this, select the “Change” menu item.

10. Cancel publication using the button. The system will ask for a reason and documents. Save this information (via the save button) or post the change by clicking on “Submit for posting.” This step will be reflected as “Cancelled” status.

11. Edit the cancellation project. To do this, click on the “Open card” item. Go to the "Documents" tab. And then in the “Cancel request for prices” block, click on the “Edit” item.

12. Post the finished change by clicking on the “Submit for posting” button. On the “Posted” tab, look at the request card.

13. Delete the cancellation project through the “Open card” item. Go to the "Documents" tab. In the “Cancel” block, select “Delete”.

How is it different from other procedures?

Instructions on how to make a price request in the Unified Information System are confused with the organization of such determination methods as “request for price quotes” and request for prices under 223-FZ. This is a mistake: the first process is associated with the formation of the NMCC for the start of bidding, and the last is a full-fledged procedure for identifying a supplier.

At the Medical Center of the Bank of Russia, the solution to this problem was facilitated by the creation and use of technological map patient management - methodological manual for doctors, where the algorithm for providing medical care for certain diseases.

Stage 12. The section “Patient Education” lists the main tasks 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, 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 an 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: with a history of depression; those who have experienced the death of loved ones in the next 6 months; with alcohol or drug addiction
	Screening for depression is necessary: for early prescription of adequate therapy, prevention of chronic depression;
	These risk factors for depression were found in cross-sectional studies

Indicator 2

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

Calculation of the quality indicator 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 doctor
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:
Physical 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 well the diagnostic and treatment process for a particular patient corresponded to that developed in this medical institution technological process, quality indicators for this somatic nosology.

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

The Medical Center analyzes patients’ opinions on the achieved treatment results, which is one of the most important final stages of 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.

MINISTRY OF HEALTH OF THE RYAZAN REGION

ORDER

ON APPROVAL OF TECHNOLOGICAL CARDS AT CONSULTATION WITH SPECIALISTS

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

1. Approve technological maps:

To consult a general practitioner;

For consultation with a surgeon;

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

2. The chief doctors of state medical organizations of the Ryazan region provide paid medical services for consultations with specialist doctors in accordance with the approved technological maps.

3. Entrust control over the implementation of this order to Deputy Minister O.V. Mitin. in terms of organizing medical care for adults and to Deputy Minister of Health Bolshakova E.E. in terms of organizing obstetric and gynecological care.

Minister of Health
L.N.TYURINA

Application. TECHNOLOGICAL CARD FOR CONSULTATION WITH A THERAPIST

Application
to the order
Ministry of Health
Ryazan region
dated September 30, 2014 N 1551

	Executor		Equipment used
	Name	time for 1 procedure (min)	Name	operating time (min)	Name
Consultation with a general practitioner	Doctor therapist		electronic floor scales		pressure measuring apparatus
	Physician's nurse		peak output velocity meter (peak flow meter)		phonendoscope
			pulse oximeter		glucometer
					stadiometer
					hand magnifier
					measuring tape

TECHNOLOGICAL CARD FOR CONSULTATION WITH A SURGEON

(name of procedure, service)

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

TECHNOLOGICAL CARD FOR CONSULTATION WITH AN OBSTETRIC-GYNECOLOGIST

(name of procedure, service)

		Executor		Equipment used		Used medications, dressings, low-value equipment and tools			List of regulatory documents
		Name	time for 1 procedure (min)	Name	operating time (min)	Name	quantity per 1 procedure (grams, pieces) indicate	terms of use of tools (normative)
	Consultation with an obstetrician-gynecologist	Obstetrician-gynecologist, midwife		gynecological chair		set of gynecological instruments (speculum, Volkmann spoon)		once	Order of the Ministry of Health of the Russian Federation dated November 1, 2012 N 572-n “On approval of the procedure for providing medical care in the field of obstetrics and gynecology (except for the use of assisted reproductive technologies)”
	1. Collecting anamnesis, familiarization with medical documentation. 2. Preparing the patient for examination. 3. Conducting an examination, collecting smears. 4. Filling out medical documentation, patient information about the examination results					sterile gloves		once
						sterile swabs		once
						cito-brush		once
						slide		many times

Discipline/MDK

.

1. Subject:

Download:

Preview:

Technological map of the lesson

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______

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

Practical lesson. Combined lesson

1. Lesson objectives:

Common goal: The student masters the technique of 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.

1. 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

1. Information sources:

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 of medical care for patients with arterial hypertension in the Russian Federation.”
	Order of the Ministry of Health of the Russian Federation dated 05.08.03 No. 330 “On measures to improve clinical nutrition in medical institutions of the Russian Federation”
	Order of the Ministry of Health of Russia dated April 17, 2002 No. 123 “Protocol 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 for disinfectants, regulatory documents;

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

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

www.med-pravo.ru - regulations.

www.rosmedlib.ru – medical student library

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

Catalog of training modules by discipline.

1. Progress of the lesson:

No.	Lesson stage	Time	Methods training	Teacher's activities	Student activities
	Organizing time	20 minutes	Verbal method Creation of indicative bases	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	20 minutes	Activation of cognitive activity of students	Forms 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 class for professional activities	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		Watches the progress independent work students. 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	10 min			Conduct internal self-assessment of their understanding of new things educational material, draw appropriate conclusions
	Lesson results	30 min		Summarizes the lesson. Evaluates the work of individual students and the group as a whole, reading the grades given into the educational journal. Gives homework	Listen to the teacher Write down homework assignment
Total class time (min)		270min

1. Contents of the lesson

Technique for performing intradermal and subcutaneous injections.

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

1. 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 of your future profession, show sustained interest in it. OK 2, Organize your own activities based on the goal and methods of achieving it, determined by the manager OK 3; Analyze the work situation, carry out current and final monitoring, evaluation 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 Observe labor safety rules, fire safety and safety precautions. 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 activity, 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.		tests Control questions situational tasks

1. Homework (indicating extracurricular independent work)

. *Educational literature:

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

L2 Mukhina S. A., Tarnovskaya I. I., “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.

MINISTRY OF HEALTH OF THE RYAZAN REGION

ORDER

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

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

1. Approve the technological map:

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

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

3. Entrust control over the implementation of this order to Deputy Minister O.V. Mitin.

Minister
A.A.PRILUTSKY

Application. ROUTING

Consultation with a cardiologist (name of procedure, service)

		Executor		Equipment used		Used medications, dressings, low-value equipment and medical instruments			List of regulatory documents
		Doctor, nurse, nurse	Time for 1 procedure (min.)	Name	Operating time (min.)	Name	Quantity per 1 procedure (grams, pieces please indicate)	Period of use of the tools (normative)
	Initial appointment (examination, consultation) with a cardiologist: collection of anamnesis and complaints, examination, prescription and interpretation of the results of additional examination. Prescription of drug therapy. Preparation of medical documentation	Cardiologist		Medical floor scales		Blood pressure tonometer
						Phonendoscope
						Medical couch
						Stopwatch
						Medical thermometer
						Medical height meter
						Centimeter tape