In the intensive care wards, as well as in the operating room, I strictly observe the sanitary-epidemiological and hygienic regimes.
Sanitary-anti-epidemiological and hygienic regimes are a whole complex of organizational, sanitary-hygienic and anti-epidemic measures that prevent the occurrence of nosocomial infection (HAI), purulent-septic processes, viral hepatitis and other infectious diseases, as well as measures aimed at preventing injuries, and, respectively, the possible infection of medical workers (based on the system of accounting and registration of injuries and emergencies associated with blood). To carry out preventive measures in case of an emergency, the treatment room has an emergency first aid kit, which includes:
Ø Alcohol 70%-100.0 ml.,
Ø Iodine solution 5%.
Ø Bactericidal plaster.
Ø Dressing material.
Ø Fingertips.
Ø Sterile distilled water.
Ø Tanks for pointing solutions.
Ø Disposable syringes (pipettes).
Actions of a medical worker in an emergency:
Ø in case of cuts and punctures immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% alcohol solution of iodine;
Ø in contact with blood or other biological fluids on the skin this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;
Ø when blood and other biological fluids of the patient get on the mucous membrane of the eyes, nose and mouth: rinse the mouth with plenty of water and rinse with 70% ethyl alcohol solution , the mucous membrane of the nose and eyes are washed with plenty of water (do not rub);
Ø when blood and other biological fluids of the patient get on the dressing gown, clothes: remove work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving;
Ø get started as soon as possible antiretroviral drugs for post-exposure prophylaxis of HIV infection.
Every Monday in our department general cleaning is carried out:
Daily routine cleaning is carried out twice a day.
After the transfer of the patient, all care items are processed: a tray, a vessel, bottles from under the drains. Processing of beds, mattresses, bedside tables, stools, oilcloths.
I disinfect used syringes, needles, systems in 2%
solution "Nick-Police" exposure 15 minutes. Stitching and cutting objects after processing are disposed of in a separate container;
I carry out disinfection and pre-sterilization treatment
instrumentation solution "Nika-Politsid" 2% exposure 15 minutes;
I carry out disinfection of anesthesia and respiratory equipment;
I carry out quartz treatment and ventilation of the wards;
I carry out a phenolphthalein and azopyram test for control
the quality of pre-sterilization cleaning of instruments with a record in the special. magazine.
Due to the high risk of occupational infection, in order to comply with the sanitary and epidemiological regime and safety rules, we work in special clothes using a mask, gloves and goggles. The department has introduced modern hand treatment technology, all consumables are disposable: this helps to reduce the risk of nosocomial infections
In my work I am guided by the orders:
According to sanitary epidemiological mode:
1. Federal Law of March 30, 1999 No. 52-FZ “On the sanitary and epidemiological well-being of the population”.
2. Federal Law No. 157-FZ of September 17, 1998 “On Immunoprophylaxis of Infectious Diseases”.
3. Federal Law No. 38-FZ of March 30, 1995 “On the Prevention of Distribution in Russian Federation disease caused by the human immunodeficiency virus (HIV).
4. Decree of the Government of the Russian Federation of July 15, 1999 No. 825 “On approval of the list of works, the implementation of which is associated with a high risk of contracting infectious diseases and requires mandatory preventive vaccinations”
5. SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities"
6. SanPiN 2.1.7.2790-10 "Sanitary and epidemiological requirements for the management of medical waste"
9. SP 3.1.5.282-10 "Prevention of HIV infection"
10. SP 3.1.958-00 “Prevention of viral hepatitis. General requirements for epidemiological surveillance of viral hepatitis”.
11. SP 3.1.1.2341-08 "Prevention of viral hepatitis B".
12. SP 3.1.2.1108-02 "Diphtheria prevention".
13. SP 3.1.1.1117-02 "Prevention of acute intestinal infections".
14. SP 3.1.1.2137-06 "Prevention of typhoid fever and paratyphoid fever".
15. SP 3.1.1381-03 "Prevention of tetanus".
16. SP 3.1.1295-03 "Prevention of tuberculosis".
17. SP 3.1.2.1319-03 "Influenza Prevention".
18. SP 3.1.3.2352-08 "Prevention of tick-borne viral encephalitis".
19. Order of the Ministry of Health of the USSR dated March 23, 1976 No. 288 “On approval of the instructions on the sanitary and anti-epidemic regime of hospitals”.
20. Order of the Ministry of Health of the USSR dated April 14, 1979 No. 215 “On measures to improve the organization and improve the quality of specialized medical care for patients with purulent surgical diseases”.
21. Order of the Ministry of Health of the Russian Federation dated August 16, 1994 No. 170 “On measures to improve the prevention and treatment of HIV infection in the Russian Federation”.
22. Order of the Ministry of Health of the Russian Federation dated September 30, 1995 No. 295 “On the Enactment of the Rules for Mandatory Medical Examination for HIV and the List of Employees of Certain Professions, Industries, Enterprises, Institutions and Organizations Who Undergo Mandatory Medical Examination for HIV”
23. OST 42-21-2-85 "Sterilization and disinfection of medical devices (Methods, means and modes)", approved by the Order of the Ministry of Health of the USSR dated 10.06.85 No. 770.
24. Order of the Ministry of Health of the Russian Federation of March 21, 2003 No. 109 “On the improvement of anti-tuberculosis measures in the Russian Federation”.
25. Order of the Ministry of Health of the USSR dated 16.08.89. No. 475 "On measures to further improve the prevention of AII incidence in the country."
26. Order of the Ministry of Health of the USSR dated July 12, 1989 No. 408 “On measures to reduce the incidence of viral hepatitis in the country”.
27. Order of the Ministry of Health of the Russian Federation dated November 26, 1998 No. 342 “On strengthening measures for the prevention of epidemic typhus and the fight against pediculosis”.
28. Order of the Ministry of Health of the Russian Federation dated April 24, 2003 No. 162 “On approval of industry standards. Patient management protocol. Scabies"
29. Order of the Ministry of Health and Social Development of the Russian Federation of April 12, 2011 No. 302n “On approval of the lists of harmful and (or) hazardous production factors and work, during the performance of which mandatory preliminary and periodic medical examinations (examinations) are carried out, and the Procedure for conducting mandatory preliminary and periodic medical examinations ( surveys) of workers engaged in hard work and work with harmful and (or) dangerous working conditions”
30. MU 3.1.2313-08 "Requirements for the disinfection, destruction and disposal of single-use injection syringes."
31. MU - 287-113 of December 30, 1998 "On disinfection, pre-sterilization cleaning and sterilization of medical devices"
32. Guidelines R.3.5.1904-04 "Use of ultraviolet germicidal radiation for disinfection of indoor air and surfaces".
33. Instructions for the use of disinfectants used in the work.
The work of the surgical department uses a fairly large amount of narcotic drugs used to relieve pain in patients in the postoperative period. In my work, I use normative documents:
Ø Order of the Ministry of Health of the Russian Federation No. 330 dated 11/12/1997. “on measures to improve the storage, prescribing and use of narcotic drugs and psychotropic substances”;
Ø Order No. 1008n "on the invalidation of some annexes to order No. 330";
Ø FZ-No. 3 dated 08.01.98. " the federal law on narcotic drugs and psychotropic substances”;
Ø Decree of the Government of the Russian Federation of 06.08.98. No. 892 "on approval of the rules for the admission of persons to work with narcotic substances and psychotropic substances";
Ø order No. 785 “List of medicines subject to subject-quantitative accounting in pharmacies (organizations), drug wholesalers, medical preventive institutions and private practitioners;
Ø order No. 703 "addition to order 785";
Ø order No. 127 of the Ministry of Health of the Russian Federation of 03.28.03. “on the approval of instructions for the destruction of narcotic drugs, psychotropic substances included in lists 2 and 3 of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, the further use of which in medical practice is recognized as inappropriate”;
Ø order No. 110 of the Ministry of Health of the Russian Federation dated 12.02.07. “On the procedure for prescribing and prescribing medicines, medical devices and specialized health food products”;
Ø Order No. 747 "on approval" of instructions for accounting for medicines, dressings and medical products in medical and preventive healthcare institutions, which are state-owned. budget";
Ø Order of the Ministry of Health of the Russian Federation No. 245 dated 30.08.91. "On the norms of consumption of ethyl alcohol for healthcare, education and social security institutions";
Ø order No. 109 dated 12.02.07. “On making changes to the procedure for dispensing medicines approved by Order No. 785”;
Ø order No. 706n "Rules for the storage of medicines";
Ø p.p. No. 1148 "Rules for the storage of narcotic drugs and psychotropic substances"
Ø Government Decree No. 681 dated 06/30/1998 "on approval of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation."
Ø Decree of June 9, 2010 N 419 on the provision of information on activities related to the circulation of precursors of narcotic drugs and psychotropic substances, and the registration of operations related to their circulation
Ø By Decree of the Government of the Russian Federation of December 29, 2007 N 964, a list of potent substances for the purposes of Article 234 and other articles of the Criminal Code of the Russian Federation
All documents related to the circulation of narcotic drugs, psychotropic substances and their precursors, poisonous and potent substances must be filled out with the utmost care, corrections are not allowed.
Treatment of surgical patients is carried out in specially equipped and equipped surgical departments. With the correct organization of work in small district hospitals (for 25-50 beds), where there may not be a surgical department, it is possible to provide emergency surgical care and conduct minor elective operations. In such hospitals, there are special rooms for sterilization, operating room and dressing room.
One of the main tasks of deploying the department is to ensure the prevention of nosocomial infection ( VBI).
The surgical department usually consists of patient rooms; operating block; "clean" and "purulent" dressings; treatment room (for performing various injection procedures and decentralized sterilization of surgical instruments, syringes and needles); manipulation room; sanitary unit (bath, shower, toilet, hygienic room for women); pantry for distribution of food and dining room for patients; the office of the head of the department; staff room; linen, etc.
Halls are equipped with upholstered furniture designed for patients to relax.
In large hospitals or clinics, several surgical departments are created, each with at least 30 beds. The profiling of surgical departments should be based on the medical principle, i.e. features of the contingent of patients, diagnostics of the treatment of diseases and equipment of the wards. Usually there are clean, "purulent" and traumatic departments. Specialized surgical departments (oncological, cardiological, urological, etc.) can be allocated.
Depending on the profile of the surgical department, rooms for medical and diagnostic services are allocated in it.
Wet cleaning of the premises is carried out at least 2 times a day. The second cleaning is carried out after the end of dressings and other manipulations using one of the disinfectants (0.75% chloramine solution and 0.5% detergent, 1% chloramine solution, 0.125% sodium hypochloride solution, 1% aqueous solution of chlorhexidine bigluconate , 1% perform solution).
The wards of the medical department should be spacious, bright, based on no more than 6 people, with an area of 6-7 m 2 per one regular bed. More comfortable are wards with 2-4 beds.
The walls of the wards are painted with oil paint, the floors are covered with linoleum, equipped with functional beds, bedside tables, chairs. For seriously ill patients there are bedside tables. A refrigerator is installed in the ward to store products given to patients by relatives. All hospital furniture should be easy to clean.
Surgical departments should be equipped with water supply, central heating, sewerage and supply and exhaust ventilation.
Seriously ill patients and patients suffering from urinary and fecal incontinence, emitting fetid sputum, are placed in small (for 1-2 people) wards.
For every 25-30 beds in the department there is a nursing station, equipped accordingly. Arrange it so that the nursing staff can see all the chambers. The post should have a connection with the seriously ill, as well as a list of telephone numbers of all hospital departments, including the locksmith on duty, electrician, etc.
Particularly important in the work of the surgical department is the separate placement of patients with purulent-septic processes and patients who do not have inflammatory processes (prevention of nosocomial infections).
Surgical activity of a nurse
Work in the clinic. The surgical nurse of the polyclinic carries out her activities in the surgical room (surgical department), where patients with surgical diseases are treated that do not require their stay in the hospital. This is a large group of patients with mild purulent-inflammatory diseases. The majority of patients with surgical diseases are examined in a polyclinic and sent for surgical treatment to a hospital. Here, the treatment of the operated patients is also carried out and their rehabilitation takes place.
The main tasks of the nurse of the surgical office are to fulfill the treatment and diagnostic appointments of the surgeon in the clinic and participate in the organization of specialized medical care for the population living in the area of the clinic, as well as workers and employees of attached enterprises. The appointment and dismissal of a nurse in a surgical office is carried out by the chief physician of the polyclinic in accordance with applicable law.
Nurse The surgical office reports directly to the surgeon and works under his supervision. In her work, the nurse is guided by the job description, as well as methodological recommendations for improving the activities of the nursing staff of an outpatient clinic.
The work of a nurse in a polyclinic is diverse. Surgical Nurse:
Prepares workplaces before an outpatient appointment with a surgeon, controlling the availability of the necessary medical instruments, inventory, documentation, checking the serviceability of equipment and office equipment;
Receives from the Central Sterilization Department (CSO) the necessary surgical material for work in the operating room and dressing room;
Covers a sterile table for instruments and dressings for 5-10 dressings and emergency operations;
Transfers to the registry the self-recording sheets of patients, coupons for an appointment with a doctor for the current week;
Brings before the start of the reception from the card depository the medical cards of outpatients, selected by the registrars in accordance with the self-recording sheets;
Receives research results in a timely manner and pastes them into the medical records of outpatients;
Regulates the flow of visitors by fixing the appropriate time in self-registration sheets for repeat patients and issuing coupons to them;
Reports to the card storage on all cases of transfer of medical records of outpatients to other offices for making an appropriate entry in the substitute card;
Takes an active part in the reception of patients, if necessary, helps patients prepare for a doctor's examination;
Assists the surgeon in outpatient operations and dressings. In this regard, she must be fluent in desmurgy, make dressings, injections and venipunctures, possess the skills of an operating nurse, know the methods of preventing surgical infection (strictly observe asepsis and antisepsis);
Explains to patients the methods and procedure for preparing for laboratory, instrumental and hardware studies;
By issuing a request for medicines and dressings, he receives them from the main medical nurse in the clinic;
After receiving and performing operations and dressings, the nurse puts the operating room, dressing room in order, washes and dries surgical instruments, replenishes stocks of medicines;
Draws up medical documentation under the supervision of a physician: referrals for consultations and auxiliary rooms, statistical coupons, sanatorium cards, extracts from medical records of outpatients, sick leave certificates, certificates of temporary disability, referrals to the control and expert commission (CEC ) and medical and social expertise (MSEC), journals of outpatient operations, daily static reports, a diary of the work of nursing staff, etc .;
Participates in the conduct of sanitary and educational work among patients;
Systematically improves his skills by studying the relevant literature, participation in conferences, seminars.
The surgical nurse has the right to:
Present requirements to the administration of the polyclinic to create the necessary conditions at the workplace to ensure the high-quality performance of their duties;
Take part in meetings (meetings) when discussing the work of the surgical office, receive the necessary information to perform their functional duties from the surgeon, the head nurse of the department (responsible for the office), the head nurse;
Require visitors to comply with the internal regulations of the polyclinic; master a related specialty;
Give instructions and supervise the work of the junior medical staff of the surgical room;
Improve their qualifications at the workplace and improvement courses in the prescribed manner.
The evaluation of the work of a nurse in a surgical office is carried out by a surgeon, a chief (senior) nurse based on the performance of her functional duties, compliance with internal regulations, labor discipline, moral and ethical standards, and social activity. The nurse in the surgical room is responsible for the performance of their duties. Types of personal responsibility are determined in accordance with the current legislation.
Work in a surgical hospital
Ward (post) nurse - the name of the position of a paramedical worker. In accordance with the Order of the Ministry of Health of the Russian Federation of August 19, 1997 No. 249, a person with the specialty "Nursing" and "Nursing in Pediatrics" can be appointed to this position.
It contains the Regulations on the Nursing Specialist. The knowledge, skills and manipulations listed in it constitute a training program for a specialist in this specialty, as well as his certification (an exam for the right to work independently) and attestation (checks for assigning a qualification category). The regulation on a nursing specialist can be considered as the basis for compiling the job description of a ward nurse.
The position of a ward nurse is accepted by persons with a completed medical education and admitted to medical activities in this position in the prescribed manner. They are accepted and dismissed by the chief physician of the hospital on the proposal of the chief nurse. Before starting work, a nurse undergoes a mandatory medical examination.
The ward nurse is directly subordinate to the head of the department and the head nurse of the department. Works under the direction of the resident of the department and the head nurse, and during their absence - the doctor on duty. Directly subordinate to the ward nurse are nurses - cleaners of the wards she serves.
The ward nurse of the department works according to the schedule drawn up by the senior nurse, approved by the head of the department, deputy chief physician of the relevant profile and agreed with trade union committee. Changing the work schedule is allowed only with the consent of the head nurse and the head of the department.
The ward nurse should be a model of discipline, cleanliness and tidiness, treat patients with care and sensitivity, supporting and strengthening their morale; accurately and clearly follow all the instructions of the doctors and the medical manipulations assigned to her (permitted to be performed by the average medical worker); constantly improve their medical knowledge by reading specialized literature, attending and participating in industrial training at the department and in the hospital, studying at least 1 time in 5 years at advanced training courses for paramedical workers in the profile of the work performed, master all related specialties departments to ensure full interchangeability of nurses; adhere strictly to the principles medical deontology, ethics, keep medical secrets.
In the evening, report all emergencies to the responsible doctor on duty at the hospital, know his phone number, he is located.
The keys to the fire escapes must be kept in a designated place at the nurse's post. The passage to the stairs must be free.
Sister should know phone numbers:
Doctor on duty in the admissions department;
Head of the department (home phone);
Head nurse of the department (home phone).
The ward nurse of the department is obliged to:
To carry out the reception of newly admitted patients in the department;
Conduct an examination for the presence of pediculosis (monitoring the work of the admissions department of the hospital), assess the general hygienic condition of the patient (bathing, changing clothes, trimming nails, etc.);
Transport or accompany the patient to the ward, provide him immediately upon admission with individual care items, a glass, a spoon for taking water (medicine);
To acquaint with the location of the premises of the department and the internal regulations and daily routine, the rules of personal hygiene in the hospital;
Collect material from patients for laboratory tests (urine, feces, sputum, etc.) and organize their timely sending to the laboratory: timely receipt of the results of the study and pasting them into the medical history;
To prepare case histories, refer patients as prescribed by doctors for clinical diagnostic, functional studies, to operating rooms, dressing rooms and, if necessary, their transportation, together with the junior medical staff of the department, control over the return of case histories to the department with the results of the study ;
Prepare towels, special means to disinfect the hands of a doctor, to take a direct part in the bypass of patients by a doctor-intern or doctor on duty, to inform them of information about changes in the state of health of patients;
To measure the body temperature of patients in the morning and evening, and, as prescribed by the doctor and at other times of the day, keep a record
temperature in the temperature sheet, counting the pulse and respiration; measure the daily amount of urine, sputum, enter these data into the medical history;
Carry out planned monitoring, organization of care for bedridden and seriously ill patients, prevention of bedsores;
Conduct active monitoring of cleanliness and order in the wards, personal hygiene of patients, timely bathing, change of linen - underwear and bedding;
Make a personal appearance to the patient at his first call;
To monitor the patient's compliance with the diet established by the doctor, the compliance of the products brought to the sick relatives with the permitted assortment, daily monitoring of the condition of bedside tables, refrigerators in the wards;
To carry out the preparation of portion requirements for diet tables to the head nurse for their transfer by her for the preparation of diets;
Distribute food to patients of the department, feeding patients;
Monitor the implementation of the rules of work by junior service personnel;
Make notes in the sheet of medical appointments about their fulfillment with a signature for the fulfillment of each appointment;
To be humane, to behave tactfully in the presence of agonizing patients, to carry out the correct documentation, packing and transfer of the body of the deceased for transportation to the pathoanatomical department; patient care during this period is entrusted to medical personnel of another post;
Take a direct part in health education work among patients and the population on topics sanitary and hygienic, patient care, disease prevention, healthy lifestyle, etc.;
To receive and transfer patients only at the bedside of the patient;
Carry out regular (at least 1 time in 7 days) examination of patients for the presence of pediculosis (with a note about this in the relevant document), as well as the organization (if necessary) of anti-pediculosis measures;
Every morning, transfer to the head nurse the list of medicines required for fasting, patient care items, and also do this during the shift;
Compile at night a list of patients of your post, information about them according to the scheme approved in the hospital, transfer the information received in the morning to the hospital's admissions department for information desk (8.00);
Carry out quartzization of the wards assigned to the post, as well as other premises according to the schedule developed by the head nurse of the department together with the hospital epidemiologist;
Work without the right to sleep and not leave the department without the permission of the head nurse or the head of the department, and during their absence - the doctor on duty;
Know and ensure readiness to provide first-aid medical care in case of deterioration of the patient's condition, emergency conditions, ensure correct and prompt transportation.
The ward nurse must be able to:
Monitor the patient's condition and assess it correctly;
Proper work and fulfillment of the duties of the nurse assigned to the post;
Preservation of medical and household inventory post;
Compliance with internal regulations by patients and visitors.
Rights
The ward sister has the right:
Make comments to the patient of the wards served by her about non-compliance with the recommendations of the doctor and the regime of the institution;
Make proposals to the head of the department, the head nurse on encouraging the post nurse or imposing a penalty on her;
Receive the information necessary for the accurate performance of their duties;
Require the head nurse of the department to provide the post with the necessary inventory, tools, patient care items, etc .;
Make proposals for improving the work of nurses of the department;
Pass certification (re-certification) in order to assign qualification categories;
Participate in events held for paramedics of the hospital.
The work of an operating nurse
A person with a secondary education who has undergone special training in working in the surgical dressing unit is appointed to the position of an operating nurse. Appointed and dismissed by the head doctor of the hospital on the proposal of the head nurse in accordance with the current legislation. Directly reports to the senior operating nurse, in the process of preparing for the operation during its implementation - to the surgeon and his assistants, during the period of duty - to the doctor on duty of the department (hospital). In his work, he is guided by the rules of the instruction for the section of work being performed, orders and instructions from higher officials.
Responsibilities
The chief operating nurse distributes the work among the operating nurses. Practice shows that in order to increase responsibility and better organize work, it is advisable to allocate a certain area of work to each nurse, for example, one nurse is responsible for the quality of sterilization, the other for the order in instrument cabinets, etc. In the most critical operations, the senior operating nurse can take part herself.
Each operating room nurse must:
To be fluent in the technique of preparing both suture and dressing material;
To be able to help the doctor with endoscopic and laparoscopic studies, master the technique of hemotransfusion, as well as other manipulations;
Ensure full equipment of the operation;
Be in constant readiness for planned and emergency operations;
Submit to the responsible surgeon and not leave work without the permission of the senior in the duty team (if the operating sister is part of the duty team, consisting of different specialists);
Responsible for the aseptic preparation of the patient entering the operation, as well as for the asepsis of the operating unit - everyone who is in the operating room is subordinate to it,
Own the technique of pre-sterilization preparation and sterilization of all types of materials;
Know all typical operations, monitor their progress and provide the necessary qualified assistance to the surgeon;
Be able to correctly and timely submit instruments to the surgeon;
Keep a strict count of instruments, wipes, swabs before, during and after the operation;
Ensure that the records of the operation performed are timely and made in the generally accepted form in a special operational journal;
Monitor the safety and serviceability of equipment, take care of the replenishment and repair of faulty equipment, as well as the absolute cleanliness of the operating unit and the dressing room, the serviceability of conventional and emergency lighting;
Systematically replenish the operating room with the necessary medicines, dressings and surgical linen, select the necessary sets of instruments;
The senior operating nurse conducts monthly sterility checks using the bacteriological control method.
Work in the treatment room
The treatment room is designed for taking blood for various studies, performing all types of injections, intravenous administration of medicinal substances, preparing for transfusion of blood, its components, blood substitutes.
The sequence of actions of a nurse:
Prepare containers for disinfection of used tools and materials;
Hand over the prepared biks with the material to the CSO the day before;
Deliver sterile bixes from the CSO;
Prepare labeled trays for intravenous and intramuscular injections;
Prepare sterile bixes for work;
Put on a mask, carry out hygienic hand antisepsis, put on sterile gloves;
Cover the sterile trays with a sterile diaper using sterile tweezers and divide the tray into three conditional zones:
1 - the area on which, with the help of tweezers, put sterile balls, - under the top layer of a sterile diaper;
2 - area for sterile syringes filled with injection solutions and closed with a needle with a cap;
3 - the area in which to place the sterile forceps to work on the tray.
After the end of blood sampling from all patients, throw the diaper into a bag for dirty linen,
Close the sterile tray.
Note. Perform all procedures and manipulations only with sterile gloves, except for cleaning the office. Work not related to injections must be performed in another medical gown (stored separately). Cleaning of the treatment room is carried out using disinfectants. Current cleaning is carried out during the working day. Final cleaning - at the end of the working day, general cleaning - once a week, cabinet quartzization - every 2 hours for 15 minutes.
The work of a dressing nurse
Dressing room - a specially equipped room for the production of dressings, examination of wounds and a number of procedures performed in the process of treating wounds. In the dressing room, injections, transfusions and minor operations (primary surgical treatment of small wounds, opening of superficially located abscesses, etc.) can also be performed.
Modern dressing rooms are deployed both in hospitals and outpatient clinics.
The number of dressing rooms and tables is determined by the number of beds in ZhGU and its profile. The area of the dressing room is calculated at the rate of 15-20 m 2 per dressing table.
The dimensions of the outpatient dressing room are determined depending on the estimated throughput of the institution.
In dressing rooms, walls, floors and ceilings should be suitable for mechanical cleaning during cleaning.
The dressing room is equipped with an appropriate set of items, equipped with the necessary surgical instruments, medications and dressings.
The dressing nurse is responsible for maintaining asepsis in the dressing room, and directs her work during dressings. The working day begins with an inspection of the dressing room. After that, the nurse receives a list of all dressings for the day, sets their order.
After making sure that the dressing room is ready, the nurse covers the sterile instrumental and material dressing table.
Sequencing:
The nurse puts on a mask, having tucked her hair under a cap before that, washes and disinfects her hands, puts on a sterile gown and gloves;
By pressing the pedal, he opens the bix with sterile linen, takes out a sterile sheet, unfolds it so that it remains two-layered, and covers the mobile table with it;
A grid with sterile instruments and other items removed from the sterilizer is placed on this table;
The dressing table is first covered with a sterile oilcloth, then in 4 layers with sheets so that the edges hang 30-40 cm down;
The upper two-layer sheet is thrown back to the back of the table and pins or hemostatic clamps are attached to it at the corners;
With a sterile forceps, the nurse transfers the instruments from the grid to the dressing table and lays them out in a certain order according to their intended purpose;
On the table there should be tweezers, hemostatic forceps, nippers, needle holders, forceps, button-shaped and grooved probes, kidney-shaped basins, syringes, glasses for solutions, catheters, drains, scissors, Farabef hooks, three-four-pronged hooks, ready-made stickers, napkins, turundas and balls;
With a sheet folded in half, the nurse closes the dressing table;
The edges of the lower and upper sheets are fastened with toes at the back and sides;
A tag is attached in the far left corner, on which the date, time of setting the table and the name of the nurse are indicated. The table is considered sterile for 1 day.
An approximate layout of instruments and material on the dressing table is shown in fig. one.
Organization of dressings
The ward nurse and nurse help the patient take off their outer clothing and lie down on the dressing table, then cover it with a clean sheet. When dressing, the attending physician must be present - he does the most responsible dressings personally.
After each dressing, the medical staff washes their hands with soap and water, wipes them with a sterile towel or sheet and treats them with alcohol using an alcohol ball.
Each dressing is carried out with the help of tools.
Sequencing:
Remove the old bandage with tweezers; along the wound, holding the skin with a dry ball and preventing it from reaching for the bandage, remove its surface layers; it is recommended to peel off a dried bandage with a ball dipped in a 3% hydrogen peroxide solution; it is better to remove a firmly dried bandage on the hand and foot after a bath from a warm 0.5% solution of potassium permanganate;
Examine the wound and its surrounding area;
The skin around the wound is freed from purulent crusts with sterile gauze balls, then the skin around the wound is treated with alcohol from the edge of the wound to the periphery;
Change tweezers; toilet the wound with sterile wipes (removal of pus by blotting, washing with hydrogen peroxide, furacilin solution and other antiseptics);
The wound is dried with sterile wipes;
Treat the skin around the wound with a 5% iodine solution;
With the help of tweezers and a probe, wounds are drained with rubber tubes (tampons and turundas moistened with antiseptics or water-soluble ointments);
Apply a new bandage;
Fix the bandage with a sticker, bandage, etc.
After removing the old dressing and finishing the dressing, the nurse washes her hands (with gloves) with soap, soaping them twice, rinsing them with running water and wiping them with an individual towel. During dressings of patients with suppurative processes, the nurse puts on an additional oilcloth apron, which is disinfected after each dressing by wiping with a rag moistened with a 3% solution of chloramine, 0.05% solution of neutral anolyte, 0.6% solution of neutral sodium hypochlorite.
Used gloves are thrown into a container with a disinfectant solution, and hands are hygienically processed. Instruments after dressings are also disinfected in solutions. The couch (table for dressings) is disinfected after each dressing with rags moistened with disinfectant. The used dressing before destruction is subjected to preliminary disinfection for two hours with one of the disinfecting solutions: 3% chloramine solution, 0.5% activated chloramine solution, etc.
When treating surgical patients with drainages in hollow organs or purulent cavities, the drainage tube and the wound around it are taken care of by the doctor during dressing. Once a day, the guard sister changes all connecting tubes, which are subjected to disinfection, pre-sterilization cleaning and sterilization. Banks with discharge are changed to sterile. The contents of the cans are poured into the sewer. After emptying, the jars are immersed in a disinfectant solution, washed and sterilized. Banks for the drainage system can not be placed on the floor, they are tied to the patient's bed or placed next to the stands.
In the structure of the surgical department, it is necessary to have two dressing rooms (for "clean" and "purulent" dressings). If there is only one dressing room, the treatment of purulent wounds is carried out after clean manipulations, followed by a thorough treatment of the room and all equipment with disinfectant solutions.
During the dressing of patients with suppurative processes, the nurse puts on an oilcloth apron, which, after each dressing, wipes with a rag soaked in 0.25% sodium hypochlorite solution, with an interval of 15 minutes, followed by an exposure time of 60 minutes, and treats the hands. 80% ethyl alcohol, 0.5% solution of chlorhexidine bigluconate in 70% ethyl alcohol, 0.5% (with 0.125% active chlorine) solution of chloramine are used as hand disinfectants. The working solution of these drugs is prepared by the pharmacy of the healthcare facility. A container with a solution is installed in the dressing room.
When disinfecting hands with ethyl alcohol or chlorhexidine, the drug is applied to the palmar surfaces of the hands in an amount of 5-8 ml and rubbed into the skin for 2 minutes. Hands are treated with chlorhexidine solutions in the pelvis. Pour 3 liters of solution into the basin. Hands are immersed in the preparation and washed for 2 minutes. The solution is suitable for 10 hand treatments.
dressing room cleaning
Well-coordinated work in the dressing room is ensured by a clear daily routine, a strict sequence of manipulations. Provides ongoing cleaning in the course of dressings.
After dressings are completed and dressings are collected in specially allocated containers, a final wet cleaning is carried out using disinfectants. Infected dressings are subject to disinfection and disposal. General cleaning is carried out at least once a week. Cleaning in the dressing room is carried out similarly to cleaning in the operating room (p. 494).
Preparation of the dressing room for further work
After cleaning, the dressing nurse, together with the nurse, prepare and put dressing material, linen and kits for venesection, tracheostomy, etc. into the biks. The nurse hands over biks to the sterilization room.
For round-the-clock readiness of the dressing room for urgent dressings, the nurse sterilizes the necessary set of instruments in a dry-heat cabinet and covers the instrumental dressing table, creates the necessary stock of instruments. In addition, at night and on weekends, the dressing nurse leaves biks with sterile material and linen in a conspicuous place. An inscription is made on each bix indicating when to spend its contents.
Before leaving work, the dressing nurse should take steps to ensure that:
Jars filled with antiseptic and disinfectant solutions;
There was a sufficient number of bandages, sterile material;
At any time it was possible to sterilize the necessary tools.
In addition, the nurse should check whether the dressing room has the necessary medicines for the next day and, if necessary, prescribe them at the pharmacy. At the end of the work, the dressing nurse turns on the bactericidal lamps and leaves the dressing room, locking the door with a key. The keys to the cabinets and to the dressing room in the absence of a dressing nurse should be kept by the duty nurse of the surgical department, who must turn off the bactericidal lamps 8-9 hours after they are turned on.
NURSING PROCESS IN PATIENTS WITH SURGICAL DISEASES
Nursing reform has begun in Russia.
Today, there are many models of nursing care. In many countries of the world, practicing nurses use several of them at the same time.
It is necessary to comprehend the already developed models and choose those that are necessary for a particular patient. The model helps to focus the examination of the patient on its goals and interventions.
When planning care, individual elements can be selected from various models.
In our country, nurses planning to apply the nursing process within the WHO Regional Office for Europe are recommended to use a model that takes into account the physiological, psychological and social needs of the patient and his family. The use of the WHO model is to carry out the transfer of nursing care from a state of illness to a state of health. To provide assistance, the sisters assess a person’s health and find out his needs for self-help, home help, and professional help. As part of the nursing reform in Russia, it is necessary to approve the professional ideology of nursing. This is possible when the nursing staff masters a new type of activity - the implementation of the nursing process.
The nursing process is understood as a systematic approach to the provision of nursing care, focused on the needs of the patient. Its purpose is to prevent problems and emerging difficulties. Nursing examination concerns the physical, psychological, social, spiritual, emotional needs of the patient.
The purpose of the nursing process for the surgical patient is to prevent, alleviate, reduce or minimize the problems and difficulties that arise in him.
Such problems and difficulties in surgical patients are pain, stress, dyspeptic disorders, disorders of various body functions, lack of self-care and communication. The constant presence of the sister and contact with the patient makes her the main link between him and the outside world. When caring for surgical patients, the nurse sees the feelings that they and their families experience and expresses sympathy. The sister should alleviate the patient's condition, help in recovery.
The ability of self-care in patients with surgical pathology is severely limited, so timely attentive nursing care to perform the necessary elements of treatment will be the first step towards recovery. The nursing process enables the nurse to professionally and professionally solve the patient's problems related to his recovery.
The nursing process is a method of organizing and delivering nursing care. The essence of nursing is caring for a person and how the sister provides this care. This work should not be based on intuition, but on a thoughtful and formulated approach, designed to meet the needs and solve the problem of the patient.
At the heart of the nursing process is the patient as a person requiring an integrated approach. One of the indispensable conditions for the implementation of the nursing process is the participation of the patient (members of his family) in making decisions regarding the goals of care, the plan and methods of nursing intervention. Evaluation of the result of care is also carried out jointly with the patient (members of his family).
The word "process" means the course of events. In this case, this is the sequence undertaken by the nurse in providing nursing care to the patient, aimed at meeting the physical, mental, social, spiritual, emotional needs of the patient.
The nursing process consists of five successive steps:
1. Nursing examination of patients.
2. Diagnosis of his condition (determination of needs) and identification of the patient's problems, their priority.
3. Planning nursing care aimed at meeting the identified needs (problems).
4. Implementation (implementation) of the nursing intervention plan.
5. Evaluation of the effectiveness of the results of nursing intervention and new care planning.
Nursing examination concerns the various needs of the patient, his assessment and the relationship of information, which is then recorded in the nursing history.
Since information about the patient can be subjective and objective, the nurse should conduct a survey of the patient and a conversation with him, his family, roommates, other medical workers (attending physician), etc., as well as an examination of the patient (to assess the state of his tissues and organs), use the data of his medical history, outpatient card, the results of consultations of specialists and additional research methods (ECG, EEG, ultrasound, X-ray and endoscopic examination, etc.).
Analyzing the data obtained, the nurse at the second stage of the nursing process formulates a nursing diagnosis (to establish existing and potential problems that arise in the patient in the form of body reactions to his condition (disease), factors contributing to or causing the development of these problems; personal characteristics patient, contributing to the prevention or resolution of these problems).
When a nurse identifies a patient's problem, she decides which health care provider can help the patient.
Problems that a nurse can resolve or prevent on her own are a nursing diagnosis.
Nursing diagnosis, unlike medical diagnosis, is aimed at identifying pain, hyperthermia, weakness, anxiety, etc., as an identification of the body's response to the disease. The nurse needs to formulate diagnoses very precisely and establish their priority and significance for the patient.
The medical diagnosis may remain unchanged throughout the illness. Nursing diagnosis can change every day and even during the day as the body's response to illness changes. Nursing diagnosis involves nursing treatment within the competence of a nurse.
The medical diagnosis is associated with the pathophysiological changes that have arisen in the body, while the nursing diagnosis is associated with the patient's ideas about his state of health.
A nursing diagnosis is a clinical diagnosis made by a professional nurse that characterizes the patient's existing or potential health problems, which the nurse, due to her education and experience, can and has the right to treat. So, for example, pain, bedsores, fear, difficulties in adaptation are different types of nursing diagnosis. In 1982, a definition appeared: “Nursing diagnosis is a patient’s health condition (current or potential), established as a result of a nursing examination and requiring intervention on her part.”
For the first time, an international classification of nursing diagnoses was proposed in 1986 and supplemented in 1991. In total, the list of nursing diagnoses includes 114 key items, including hyperthermia, pain, stress, social self-isolation, insufficient self-hygiene, lack of hygiene skills and a nurse conditions, anxiety, reduced physical activity, reduced individual ability to adapt and overcome stress reactions, overnutrition, high risk of infection, etc.
Terminology and a classification system for nursing diagnoses have been developed, following the example of medical ones, otherwise nurses will not be able to communicate in a professional language that is understandable to everyone.
There are several classifications of nursing diagnoses. Physiological, psychological, social, as well as real (shortness of breath, cough, bleeding) and potential (risk of bedsores) nursing diagnoses are distinguished.
Currently, they use the diagnoses developed at the level of a medical facility or an educational institution.
There can be several nursing diagnoses, so the sister highlights the diagnoses to which she will respond first. These are the problems that the patient is currently concerned about. For example, a 30-year-old patient with acute pancreatitis is under observation. The patient is on strict bed rest. The patient's problems that are bothering him at this time are girdle pain, stress, nausea, indomitable vomiting, weakness, lack of appetite and sleep, lack of communication.
With the passage of time and the progression of the disease, potential problems may appear that currently do not exist in the patient: infection, the risk of developing purulent peritonitis, necrosis and purulent fusion of the pancreas. In these cases, the patient will require emergency surgery. Priorities are needed to prioritize nursing interventions and rationally allocate a sister's effort, time, and resources. There should not be many priority problems - no more than 2-3.
Let's look at them in terms of our patient's priorities. Of the existing problems, the first thing that a nurse should pay attention to is pain, indomitable vomiting, and stress. Other problems are secondary. Of the potential problems that will first need to be addressed when they arise, the priority is the fear of the upcoming operation.
The order of problem solving should be determined by the patient himself. It is quite obvious that in cases of life-threatening situations, the sister herself must determine which problem she will solve in the first place.
Initial problems can sometimes be potential problems. If the patient has several problems, it is impossible to satisfy them at the same time. Therefore, when developing a care plan, the nurse should discuss with the patient (his family) the priority of problems.
In the third stage, the nurse should plan care for each priority problem, she forms the goals and plan of care.
Goals should be:
Real, achievable (you can not set unattainable goals);
With specific deadlines for achieving each goal (short-term and long-term);
In the formulation of the term patient, not sister (the patient will demonstrate the ability to use the inhaler by a certain date).
Each goal includes three action components, a criterion (date, time, distance), a condition (with the help of something or someone). Thus, the goal is what the patient and nurse want to achieve as a result of the implementation of the care plan. Goals should be patient-centered and written down in simple words so that each sister understands them unambiguously.
Goals provide only a positive result:
Reduction or complete disappearance of symptoms that cause fear in the patient or anxiety in the sister;
Improved well-being;
Expanding the possibilities of self-care within the framework of fundamental needs; changing attitudes towards their health.
After setting the goals, the nurse draws up a plan for the implementation of the goals (providing medical care - caring for the patient) so that the patient and his family can adapt to the changes that are possible due to health problems. The plan must be specific; general phrases and reasoning are unacceptable.
In particular, a sample individual care plan for our patient with acute pancreatitis might look like this:
The solution to existing problems is to administer an anesthetic, relieve the patient's stress by talking, give a sedative, administer an antiemetic, talk more often with the patient, give sleeping pills, etc.;
Solving potential problems - hunger, cold and rest, the introduction of antibiotics, treatment of peritonitis, if necessary, surgery to convince the patient that it is the only way to treat peritonitis, instill confidence in her successful outcome.
Planning is carried out on the basis of nursing intervention standards. It is impossible to take into account all the variety of clinical operations in the standard, so they cannot be applied thoughtlessly.
The care plan is necessarily recorded in the nursing history of the disease, which ensures its continuity, control, and consistency.
The sister is obliged to coordinate her plan with the patient, who must actively participate in the treatment process.
Having planned all the activities, the nurse puts them into practice. This will be the fourth step in the nursing process, the implementation of the nursing intervention plan. Nursing interventions recorded in the care plan - a list of actions that the nurse takes to solve the problems of a particular patient.
A care plan may list several possible nursing interventions for the same problem. This allows both the nurse and the patient to feel confident that different actions can be taken to achieve the set goals, and not just a single intervention.
Nursing interventions should be:
Based on scientific principles;
Concrete and clear so that any sister can perform this or that action;
Real for the allotted time and qualifications of the sister;
Aimed at solving a specific problem and achieving a set goal.
Nursing actions imply three types of nursing interventions: dependent, independent, interdependent.
With dependent intervention, the actions of the sister are carried out at the request or under the supervision of a doctor. However, the sister in this case should not automatically follow the instructions of the doctor. She is obliged to determine the correct dose, take into account contraindications to prescribing the drug, check whether it is compatible with others, etc. Clarification of appointments is within the competence of the sister. A nurse who performs an incorrect or unnecessary prescription is professionally incompetent and equally responsible for the consequences.
With independent intervention, the actions of the sister are carried out on their own initiative. This is assisting the patient in self-care, teaching the patient various methods of treatment and self-care, organizing leisure activities, advising the patient about his health, monitoring the patient's reactions to illness and treatment.
In interdependent intervention, the nurse cooperates with other medical professionals, the patient and his relatives, taking into account their plans and possibilities. Nursing intervention is carried out by the sister in accordance with the established nursing diagnosis in order to achieve a certain result. Its purpose is to provide appropriate patient care, i.e. rendering assistance to him in the fulfillment of vital needs; training and counseling, if necessary, for the patient and his family.
The patient's need for assistance can be temporary, permanent, rehabilitating, depending on the type and severity of the injury. Temporary assistance is designed for a short period of time, when there is a lack of self-care during exacerbations of diseases and after surgical interventions, etc. Constant assistance to the patient is required throughout life during reconstructive operations on the esophagus, stomach, intestines, etc.
It is known that rehabilitation should begin immediately after surgery in order to prevent possible complications and help the patient and his relatives to function normally in a new difficult life situation for them. Rehabilitation is a long process, sometimes lasting a lifetime. An important role in this process is assigned to the nurse, acting as a nurse, working as part of a patient care team, in collaboration with his relatives, in order to meet all the needs of the patient.
An example of rehabilitation assistance is massage, exercise therapy, breathing exercises, and conversation with the patient. Among the methods of implementing measures for the care of a patient with surgical diseases, a conversation with the patient and advice that a nurse can give in a particular situation play an important role. Advice is emotional, intellectual and psychological help that helps the patient prepare for present or future changes arising from the stress that is always present during an aggravation of the disease. Nursing care is needed to help the patient solve emerging health problems, prevent potential problems and maintain his health.
At the final (fifth) stage of the process, the result of nursing intervention (care) is evaluated. Its purpose is to assess the quality of the assistance provided, evaluate the results obtained and summarize.
Important at this stage is the patient's opinion about the conducted nursing activities. During evaluation, the nurse judges the success of the care steps by testing the patient's response and comparing it to the expected response.
The evaluation shows whether the final goal has been achieved. An assessment of the entire nursing process is carried out if the patient is discharged, if he was transferred to another medical institution, or if he was exported.
Evaluation is performed continuously, in non-emergency patients - at the beginning and at the end of the shift. If the goal is not achieved, the nurse must find out the reason, for which she analyzes the entire nursing process to identify an error. As a result, the goal itself can be changed, the criteria (terms, distances) can be revised, the nursing intervention plan can be adjusted.
Thus, the nursing process plays an important role in the care and treatment of a patient with surgical diseases.
It helps the nurse to understand the importance and significance of her activities in the process of treating the patient. Most of all in this process, the patient wins. The more information the nurse collects, the more she will know about her ward both in terms of the disease and in terms of psychological. This helps her to more accurately identify the patient's problems and facilitate the relationship with him. The outcome of the disease often depends on the relationship between the nurse and the patient, on their mutual understanding.
The effectiveness of nursing care can be determined, first of all, by establishing whether the goals set jointly with the patient have been achieved, if they are measurable and realistic. They are recorded in the form of the patient's behavioral reactions, his verbal reaction, and the sister's assessment of certain physiological parameters. The time or date of the assessment is indicated for each problem identified. For example, when evaluating the effect of an analgesic drug, the evaluation is carried out after a short period of time, when performing other problems, after a long time; in the formation of bedsores and assessment of their condition - daily. The nurse, together with the patient, predicts when they will be able to achieve the expected result and evaluate it.
Distinguish between objective assessment (the patient's response to nursing care) and subjective assessment (the patient's opinion about achieving the goal). As a result of the assessment, the achievement of the goal, the lack of the expected result, or the deterioration of the patient's condition, despite ongoing nursing interventions, can be noted. If the goal is achieved, a clear entry is made in the care plan: "Goal achieved."
In determining the effectiveness of nursing intervention, the patient's own contribution, as well as the contribution of his family members, to the achievement of the goal should be discussed with the patient.
A care plan is only worthwhile and successful if it is corrected and revised when necessary. This is especially true when caring for the seriously ill, when their condition changes rapidly.
Reasons for changing the plan:
The goal is achieved, the problem is removed;
The goal has not been reached;
The goal has not been fully achieved;
A new problem has arisen or the old one has ceased to be so relevant.
The nurse, when conducting an ongoing evaluation of the effectiveness of nursing care, should constantly ask herself the following questions:
Do I have all the necessary information?
Have I correctly prioritized existing and potential problems?
Can the expected result be achieved?
Are the right interventions chosen to achieve the goal?
Does the care provide positive changes in the patient's condition?
Does everyone understand what I write in terms of care?
The implementation of the planned action plan disciplines the nurse and the patient. Evaluation of the results of nursing intervention enables the nurse to establish the strengths and weaknesses in her professional activity.
So, the final assessment, being the last stage of the nursing process, is just as important as the previous stages. Critical evaluation of a written care plan can ensure that high standards of care are developed and maintained.
With regard to medical activities, the standard is a developed purposeful regulatory document of an individual plan for the implementation of the appropriate type of qualified surgical nursing care for a specific patient, for the performance of medical manipulations by her - a model of an algorithm for sequential nurse actions that ensure safety and quality nursing procedures.
At present, at the initiative of the Russian Nurses Association, work has begun on the regulation of the professional activities of paramedical workers in accordance with the “Basic Provisions for Standardization in Healthcare”. For the first time, an attempt was made to develop comprehensive standards for the specialty "Nursing". These standards contain the mandatory minimum requirements for quality medical services provided by nursing staff with a basic level of secondary vocational education in the specialty. These standards need to be introduced into the practice of performing the nursing process and approbation in various regions of Russia.
Methodological approaches to making nursing diagnoses
When organizing a workflow, a working version of the classification of nursing diagnoses is needed. It is based on violations of the basic processes of the body's vital functions (already existing or possible in the future), which made it possible to distribute various nursing diagnoses into 14 groups.
These are diagnoses associated with disruption of processes:
Movements (decrease in motor activity, impaired coordination of movements, etc.);
Breathing (shortness of breath, productive and non-productive cough, suffocation, etc.);
Blood circulation (edema, arrhythmia, etc.);
Nutrition (nutrition, significantly exceeding the needs of the body, deterioration in nutrition due to a violation of taste sensations, anorexia, etc.);
Digestion (impaired swallowing, nausea, vomiting, constipation, etc.);
Urinary excretion (urinary retention acute and chronic, urinary incontinence, etc.);
All kinds homeostasis(hyperthermia, hypothermia, dehydration, decreased immunity, etc.);
Behavior (refusal to take medication, social self-isolation, suicide, etc.);
Perceptions and sensations (impaired hearing, vision, taste, pain, etc.);
Attention (arbitrary and involuntary);
Memory (hypomnesia, amnesia, hypermnesia);
Thinking (decrease in intelligence, violation of spatial orientation);
Changes in the emotional and sensitive areas (fear, anxiety, apathy, euphoria, negative attitude towards the personality of the medical worker providing assistance, to the quality of the manipulations, loneliness, etc.);
Changes in hygiene needs (lack of hygiene knowledge, skills, lack of care for one's health, problems with medical care, etc.) -
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Introduction
FamousPolishdoctorwrote:"Whomnottoucheshumanneed,whonothassoftnessincirculation,atwhomnot enoughstrengthwill,toeverywhereandsunewheredominateaboveyourselfthatletbetterelectsanotherprofessionforhenevernotbatchildrengoodmedicalworker."
SAKHALIN REGIONAL ONCOLOGICAL DISPENSARY is a medical institution that combines a hospital with 302 beds and a polyclinic.
Leads medical institution- OVSYANNIKOV. V.G
Chief Nurse-ZHAROVTSEVA.N.A
The medical base of the oblonkodispanser includes
1-oncological-department of abdominal surgery-40 beds
2-oncological-department of head and neck tumors - 40 beds
3-oncological-department of oncogynecology -40 beds
4-oncological-department of thoracic surgery-30 beds
5-oncological-department of mammology-40 beds
6th department of chemotherapy - 30 beds
7- urological department -30 beds
8-radiological department
It should be noted that the ONCOLOGICAL DISPENSARY is the only one in the entire Sakhalin region and accepts patients from all regions. Oncology is a special "branch" of medicine and requires greater ethics in working with patients.
Today, the institution is a close-knit, qualified team capable of using the most high-tech technologies in treatment. medical equipment.
Medical workers are able to provide medical care in many areas, not only within the walls of the hospital, but also in extreme conditions, during emergencies, during sports competitions at the federal level.
Surgicaldepartmenthospital deployed with 40 beds.
In the department, patients with pathology of the gastrointestinal tract, trauma with damage to the internal organs of the abdominal cavity and patients with purulent-septic diseases receive treatment.
Currently, the department is located on the 2nd floor of a 3-storey building. The department includes: 14 wards, of which 5 have 2 beds, the rest have 4, each equipped with a shower and toilet, a treatment room, a dressing room, 2 manipulation rooms, a sanitary room, a nurse's post, a head nurse's office, and at the other end of the corridor , there is a staff room and a buffet.
Branchcarries outthe followingfeatures:
Providing diagnostic, therapeutic and preventive care to patients with cancer;
Providing advice to doctors of other departments of a medical organization in resolving issues of diagnosis and provision of medical care to patients with oncological diseases;
Development and implementation of measures to improve the quality of medical and preventive work of the department;
Participation in the process of improving the professional qualifications of staff on the issues of diagnosis and provision of medical care to patients with oncological diseases;
Introduction into clinical practice of modern methods of diagnosis, treatment and rehabilitation of patients with cancer;
Carrying out an examination of temporary disability;
Conducting conferences on the analysis of the causes of deaths in the treatment of patients with oncological diseases together with the pathoanatomical department;
Implementation of sanitary and hygienic and anti-epidemic measures to ensure the safety of patients and staff, to prevent the spread of nosocomial infection;
Maintaining accounting and reporting documentation, submitting reports on their activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by law.
Dressingtoofficesurgicalbranches- it is mine workplace. For ease of cleaning, the floor is covered with ceramic-granite tiles, the walls are tiled, the ceiling and doors are painted with light-colored oil paint. There is a centralized supply of cold and hot water, heating, electricity and ventilation. Artificial lighting is provided by a fluorescent lamp located above the dressing table and lighting fixtures. The wiring is hidden and there is a ground loop. There are two sinks for washing hands and washing tools. Doors of cases and doors are covered with plastic.
Equipmentdressingcabinet: table for instruments and dressings - 1 pc. Ultralight - for storage of sterile instruments 1 pc., Dry-heat cabinet for sterilization of instruments 1 pc., Germicidal lamp - 1 pc.; tripod; Hemostatic tourniquets - 2 pcs.; Chairs and stools - 3 pcs.; Bench stands - 2 pcs.; operating table / gynecological chair - 1 pc.; tool cabinet - 1 pc.; medicine storage cabinet - 1 pc.; desktop - 1 piece; table for medical documentation - 1 pc.; tongs for collecting contaminated dressings - 2 pcs.; containers for disinfectant solutions - 8 pcs.; buckets for class A and B waste: dry white bag; medical yellow bag - 2 pcs.; mobile reflector lamp - 1 piece; aprons made of oilcloth and plastic - 4 pcs.; goggles - as a means of eye protection - 4 pcs.; disposable sterile gowns, gloves, hats, masks, shoe covers - in abundance; disposable sterile underwear - in abundance; ready sterile material - in abundance; containers for preparing working solutions of disinfectants, measuring containers for diluting disinfectants, brushes, ruffs - for processing tools, a bedside table for storing detergents and disinfectant detergents. Anti-shock and anti-AIDS first aid kits with instructions for their use, also, next to the office, there is a sanitary room for the dressing room, where there is cleaning equipment for current and general cleaning - buckets for washing floors and walls - 2 pcs, containers for processing furnishings, surfaces -2 pcs, mops for washing floors and walls - 2 pcs and containers for diluting disinfectants.
Toolsdressingcabinet: maskites; Volkman's spoons; disposable sets for pleural puncture; suture material, anatomical, surgical and pawl tweezers - 8 pcs.; hemostatic clamps - 8 pcs.; abdominal scalpels -3 pcs.; pointed scalpels - 2 pcs.; pointed scissors -2 pcs.; pointed eye scissors - 1 pc.; blunt-pointed scissors, curved along the plane, - 2 pcs.; lamellar hooks - 1 pair; general surgical needle holders - 2 pcs.; different surgical needles - 10 pcs.; forceps - 2 pcs.; long tweezers - 2 pcs.; bulbous and grooved probe - 1 pc.; kidney-shaped trays; different cuvettes - 5 pcs. Sterile disposable dressing trays with ready-made dressings are also available.
REQUIREMENTS FOR THE PLACEMENT OF THE EQUIPMENT OF THE DRESSING ROOM.
The room of the dressing room is conditionally divided into two zones: clean and conditionally clean.
In a clean area: a table with sterile instruments, a dry-heat cabinet, a cabinet for medicines and instruments are placed.
In a conditionally clean area: the rest of the equipment is placed, the nurse's work table, an operating and dressing table, a table with disinfectants, a sink, etc.
A RESPONSIBILITY.
The dressing nurse is responsible for:
1. lack of sanitary and hygienic regime in the dressing room.
2. safety of instruments, suture material, equipment.
3. violation of the rules of asepsis.
4. disruption and delay of dressings due to one's own fault.
5. lack of knowledge about the course of dressings.
Mydofficialresponsibilities:
In the dressing room, bandaging and monitoring of postoperative wounds are carried out, minor operations and punctures are performed. As well as:
1. Manipulations prescribed by the attending physician are performed, which are allowed to be performed by paramedical personnel.
2. Seriously ill patients are escorted to the ward after the manipulations.
3. Instruments and dressings are being prepared for sterilization.
4. Systematic sanitary and hygienic control of the dressing room is carried out.
5. Systematic replenishment, accounting, storage and consumption of medicines, dressings, instruments and linen is provided.
6. The junior medical staff of the dressing room is instructed and their work is controlled.
7. Regulatory medical documentation is maintained in accordance with the nomenclature of cases.
8. Collection, disinfection and disposal of medical waste is carried out.
9. Measures are being taken to comply with the sanitary and hygienic regime in the premises, the rules of asepsis and antiseptics, the conditions for sterilizing instruments, and the prevention of post-infectious complications, hepatitis, HIV infection. 10. Immediately inform your immediate supervisor about any accident that occurred at work, about signs of an occupational disease, as well as about a situation that poses a threat to life and health of people. If necessary, perform the functions of an operating room nurse when performing simple surgical interventions performed in the dressing room.
Volumeperformedwork.
My working day starts with a tour of the dressing room. I, as a dressing nurse, check whether the staff on duty used the dressing room at night. In case of emergency intervention or unscheduled dressing, the used and contaminated dressing material is removed into buckets with lids (yellow bag - Class B waste), the used tools are soaked in a disinfectant solution.
I check whether wet cleaning has been carried out using disinfectants, I take sterile instruments from the CSO, arrange bixes with the material, and install the medicines received from the pharmacy the day before.
I get a list of all dressings for the day, set their order. First of all, I bandage patients with a smooth postoperative course (removal of sutures), then with granulating wounds. After making sure that the dressing room is ready, I proceed to the processing of the hands.
After processing the hands, I proceed to putting on a sterile gown. Opening the lid of the bix, I check the type of indicator. Taking the robe, I carefully unfold it, holding the edges of the collar on my outstretched arm with my left hand so that it does not touch the surrounding objects and clothes, I put the robe on my outstretched right hand. With this hand I take the left edge of the gate and put it on my left hand, stretching them forward and up. The assistant ties the ribbons on the robe from the back. Next, I tie the ribbons on the sleeves, as well as the belt, taking it by the free ends, without touching the dressing gown and hands. Then I put on sterile gloves.
When I put on a sterile gown and gloves, I proceed to prepare a sterile table. A sterile table is being prepared, which is covered with a sterile sheet in one layer, so that it hangs 15-20 cm below the table surface. The second sheet is folded in half and placed on top of the first. After laying out the tools (material), the table is covered with a sheet (folded in 2 layers), which should completely cover all objects on the table, and is tightly fastened with clips to the bottom sheet. The sterile table is covered for 6 hours. In cases where the instruments are sterilized in individual packaging, there is no need for a sterile table or it is covered immediately before manipulations.
Dressings are carried out in a mask, cap and sterile gloves, which are changed for each patient. All items from the sterile table are taken with forceps or long tweezers, which are also subject to disinfection and sterilization.
Analysis of work for the reporting period:
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Pleural puncture |
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Bandaging of postoperative patients |
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Laparocentesis |
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Opening of purulent parapractitis |
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Opening panaritiums and phlegmons |
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Opening of abscesses |
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Applying compresses |
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CHOLECYSTOSTOMY |
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CYSTOSTOMES |
2. Knowledge and skills of the certified specialty
During my work, I have mastered the following manipulations:
o Maintaining medical records.
ü Monitoring compliance with the rules of asepsis and antisepsis in the dressing room.
l Cleaning the dressing room.
b Preparation of linen, dressings, masks for sterilization.
b Preparation of surgical packings.
l Preparation of instruments and equipment for sterilization.
l Ensuring patient safety.
l Disinfection in the dressing room.
ü Participation in all types of punctures.
b Acquisition of sets of surgical instruments.
b Preparation of suture material.
b Imposition of all types of dressings.
l Provision of various methods of hemostasis.
b Providing assistance in terminal conditions.
l Modern methods of processing the surgical field.
b Implementation various kinds positioning the patient on the operating table.
b Usage individual funds protection.
b Preparation of disinfectants.
ü Supply of instruments during the operation and dressing.
b Collection and disposal. used materials and tools.
Manipulations are performed in a certain sequence: removing the bandage applied earlier; primary skin toilet around the wound; initial examination and toilet of the wound; re-examination of the wound; performing diagnostic or therapeutic procedures; re-toilet of the skin, bandaging.
The primary toilet of the skin is performed in order to remove blood, pus, etc. from the skin surrounding the wound (for wounds of the hairy areas of the body, hair is shaved off). The toilet is performed with gauze (or cotton) balls soaked in ethyl alcohol, etc .; the skin is treated in the direction from the edges of the wound to the periphery in order to protect it from contamination and infection.
When examining aseptic wounds with sutures, pay attention to the appearance of local signs of inflammation (hyperemia, edema, eruption of sutures, necrosis). In the absence of inflammation and necrosis, the wound along the suture line is lubricated with 5% alcohol solution of iodine or 1% alcohol solution of brilliant green, 3-5% potassium permanganate solution, chlorhexidine bigluconate solution and a dry aseptic bandage is applied from gauze napkins, which are fixed with an aseptic sticker, tubular or ordinary bandage.
In case of suppuration of the wound, the sutures are removed completely or partially, while paying attention to the nature of the discharge. When evaluating the wound process, the condition of the wound is of great importance. With the development of a putrefactive infection, the surface of the wound is characterized by dryness, lack of granulations, the presence of necrotic tissues, gray muscles; crepitation of tissues is rare, indicating the presence of gas in them. With an anaerobic infection, the edges of the wound are edematous, and finger pressure does not leave a trace in the edematous tissues, muscle swelling, traces of bandage depression, eruption of the stitches, crepitus are noted. The slightest suspicion of an anaerobic infection is an alarming signal and requires the necessary urgent measures.
Pleuralpuncture: My duties include assisting the doctor during the thoracentesis. The puncture of the pleural cavity is carried out with a diagnostic therapeutic purpose. The patient is placed in a comfortable sitting position, with the emphasis of the shoulder girdle on the back of the chair or lying on its side. Hands are treated with alcohol 70% or skin antiseptic "CLEAN", we put on sterile gloves. We treat the puncture site with iodine, alcohol using cotton balls. The doctor performs local anesthesia with a 0.5% novocaine solution. The fluid is aspirated using a disposable pleural puncture kit. After the procedure, the puncture site is treated and a sterile dressing is applied. The pleural contents are immediately sent to the laboratory in a special labeled jar.
ATdressingofficemeongoingnextdocumentation:
* Journal of registration and control of the operation of the bactericidal installation;
* Journal of accounting for general cleaning;
* Journal of sterilization;
* Journal of quality control of pre-sterilization cleaning (azopyramic and phenolphthalein samples);
* Journal of dressings;
* Journal of small surgical operations;
* Journal of biopsy;
* Journal of dressings and consumables;
* Journal of receipt of medicines from the head nurse;
* Journal of emergency situations.
Holdinganti-epidemicactivities.
The department has a dressing room for dressing clean and purulent wounds. To do this, it was necessary to single out the so-called clean and purulent dressings, first of all, clean dressings are carried out. After each dressing of patients with signs of suppuration or with purulent wounds, the sheet on the dressing table is replaced, so we use disposable underwear as soon as possible. Dressings are carried out according to the schedule, which is approved by the head of the department. The schedule is posted in a conspicuous place - on the office door.
Prevention of the development of postoperative purulent-septic infections consists of a set of measures aimed at breaking the chain of occurrence of the epidemiological process. One of the important sections of this complex is the observance of the sanitary-hygienic and anti-epidemiological regime in the dressing room.
WorksindressingofficewhichII'm doingdaily:
1. I process my hands, process them at a hygienic level, put on sterile clothes and open the Bix.
2. Using sterile tweezers (forceps), carefully unfold the lining diaper so that its ends remain inside the bix. The tweezers are stored in a sterile bag, in a sterile bix, the tweezers are changed after 1 hour.
3. The sterile table is covered for 6 hours of work.
4. For each patient, an individual dressing is covered. The set of styling depends on the dressing profile or minor operation.
5. After dressing, all used tools are placed in a container with a disinfectant for 30 minutes and closed with a lid.
6. After dressing each patient, the dressing table oilcloth is wiped with a rag moistened with a disinfectant solution.
7. Used balls, tampons are disinfected, after which they are collected in yellow disposable plastic bags, which, after filling, are sealed and removed from the disposal compartment.
8. After every 2 hours of intensive work, the dressing room is closed for 30 minutes for ongoing cleaning, ventilation and quartzing. At the same time, the sheet on the dressing table is replaced.
9. The work of the dressing room is carried out in accordance with the schedule approved by the head of the department, the schedule is posted on the door of the office.
10. In the treatment of surgical patients with drainage: all connecting tubes and jars for discharge are changed daily to sterile ones, used ones are disinfected; jars for the drainage system are not placed on the floor, they are tied to the patient's bed or placed next to a stand.
11. Sterile gloves change:
In case of contamination with blood or other discharge from the wound and with instrumental dressing - after each patient! Preliminary hygienic hand antisepsis is carried out.
The sterile dressing tray in the ward is only covered for one patient!
Asepsis is violated if, during dressing, a sterile napkin is moistened by pressing it against the neck of the vial or pouring from the vial. Pour the sterile solution into a glass or tray and dip the tissue into it. If the dressing is ointment, then the napkin should be put in a sterile tray and the ointment should be applied with a sterile spatula, then given to the doctor.
PREPARATION OF KITS FOR STERILIZATION IN A DRY CABINET.
The cabinet, before placing products into it, is wiped with a disinfectant solution twice, with an interval of 15 minutes.
Tools on the bars are placed in one row, with open locks no more than 10 pieces.
Stericons 180 degrees, are laid in each installation, for each lattice, 5 pieces in the middle and on the sides of the lattice.
Sterilization time is 60 minutes, after which the instruments are placed on the ULTRALIGHT-STERILE TABLE, which is also treated once a week with a disinfectant, distilled water and 6% hydrogen peroxide.
ALGORITHM FOR PREPARING BIKS FOR STERILIZATION AND TRANSPORTATION IN THE CSO.
Bix is wiped with a disinfectant solution twice with an interval of 15 minutes.
Beaks are lined with a large napkin, which should hang from the outside by 2/3 of the height of the beaks, put an indicator on the bottom. Products packed in calico or kraft paper are laid out vertically or on edge, the distance between the packages is equal to the thickness of the palm, so that steam can evenly penetrate between the products. In the middle of the bix we put the indicator at 132 degrees, cover the products with a large napkin and put another indicator on top, close the bix and attach a tag on the handle, which indicates the material laid in the bix. The bix windows are open, we deliver the biks to the CSO in two bags. When opening the bag, pay attention to the date of sterilization, the color of the indicator should be brown. Products in bix must be dry. WET PRODUCTS ARE NOT STERILE.
GENERAL REQUIREMENTS FOR THE ORGANIZATION OF THE STORAGE OF MEDICINAL PRODUCTS IN THE DRESSING ROOM ORDER-523 dated 03 07 1968. hospital dressing room organization
Storage of medicinal products for external and internal use should be carried out on separate shelves, which should be marked appropriately from the pharmacy. ready-made with precise and clear designation on the label (internal, external).
PACKAGING, LOSSING, TRANSFERING, AS WELL AS REPLACEMENT OF LABELS IS PROHIBITED.
EXPIRY DATES OF MEDICINES MANUFACTURED IN THE PHARMACY:
Order of the Ministry of Health of the Russian Federation - 214 dated July 16, 1997.
Injection solutions in vials, hermetically sealed - 30-90 days.
Opened vials 6 hours.
Ointments for 10 days.
Hydrogen peroxide 10 days.
Potassium permanganate 10 days.
ALGORITHM OF ACTION IN ANAPHILACTIC SHOCK.
Anaphylactic shock - is a consequence of an allergic reaction of an immediate type, accompanied by a life-threatening violation of all body systems (respiratory, cardiovascular, nervous, endocrine, etc.). The development of shock is provoked by any drugs (antibiotics, sulfonamides, vitamins, etc.).
CLINICAL SIGNS:
Against the background or immediately after the administration of the drug (serum), etc.
There was weakness, dizziness.
Difficulty breathing, feeling short of breath.
Restlessness, feeling of heat all over the body.
Dry mouth, difficulty swallowing (sometimes vomiting)
The skin is pale, cold, moist.
Breathing is frequent, shallow.
· Systological pressure 90 mm Hg. and below.
In severe cases, depression of consciousness and breathing.
· Later convulsions appear, consciousness is obscured.
The skin is covered with itchy patches (urticaria).
NURSE TACTICS:
· Urgently call a doctor.
· Give the patient a stable lateral position, raise the foot end.
Give humidified oxygen.
Measure blood pressure, heart rate.
Prepare medicines from the anti-shock first aid kit.
FIRST AID KIT (ANTI-SHOCK KIT):
1 Adrenaline 0.1% -1.0
3 Isotonic solution 0.9% sodium chloride
4 Dropper
5 Syringes 5.0 10.0 20.0
6 Rubber harness
PROTECTION OF MEDICAL PERSONNEL FROM INFECTION.
COMPOSITION OF THE FIRST AID KIT IN EMERGENCIES WITH BLOOD.
1 Alcohol 70%-200 ml
2 Alcohol solution of iodine 5% 15 ml
3 sterile bandage 2 pcs
4 Sterile wipes 10 pcs
5 Bactericidal adhesive plaster 5 pcs
The first aid kit for HIV prevention should be stored in a separate labeled container.
INSTRUCTIONS ON THE ACTION OF A MEDICAL WORKER IN EMERGENCY SITUATION.
In order to avoid infection with parenteral viral hepatitis, HIV infection, you should follow the rules for working with piercing and cutting objects.
1. In case of cuts and injections, immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% iodine solution.
2. If blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol.
3. If blood and other biological fluids of the patient get on the mucous membranes of the eyes, nose and mouth, rinse the mouth with plenty of water and rinse with 70% alcohol, rinse the mucous membranes of the eyes and nose with plenty of water, do not rub!!!
4. If blood and other biological fluids of the patient get on the dressing gown, clothes: take off work clothes and immerse in a disinfectant solution and in a bix for autoclaving.
5. Start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection.
For the purpose of emergency prevention of HIV infection, azidomycin is prescribed for one month. The combination of azidomycin and lamivudine enhances antiviral activity and overcomes the formation of resistant stamps. If there is a high risk of contracting HIV infection (deep cut, visible blood on damaged skin and mucous membranes from patients infected with HIV), for the appointment of chemoprophylaxis, you should contact the territorial centers for the fight and prevention of AIDS.
Persons exposed to the threat of HIV infection are under the supervision of an infectious disease specialist for 1 year with a mandatory examination for the presence of an HIV infection marker.
Personnel who had contact with material infected with the hepatitis B virus in different parts of the body according to the 0-1-2-6 months scheme, followed by monitoring of the hepatitis marker (at least 3-4 months after the administration of immunoglobulin). If the contact occurred in a previously vaccinated health worker, it is advisable to determine the anti-HBs in the blood serum. In the presence of an antibody concentration in the titer of 10 IU / l and above, vaccination is not carried out; in the absence of antibodies, it is advisable to simultaneously administer 1 dose of immunoglobulin and a booster dose of the vaccine.
Qualitativecontrolperholdingmanipulation
Qualitative indicators include the results of washings from environmental objects carried out in the surgical department regularly throughout the year. Washouts determined the presence of opportunistic and pathogenic forms (Table No. 1), as well as the sterility of medical instruments and dressings (Table No. 2).
Table No. 1
Conclusion: during the year there was not a single positive result. The department carries out high-quality disinfection in accordance with SanPiN 3.1.5.2826-10, industry standard 42-21-2-85 and orders No. 288, No. 254.
Table number 2
Conclusion: During the year there was not a single positive washout for sterility, which indicates the high-quality processing and sterilization of medical instruments and dressings.
Table No. 3
Conclusion: during the year there was not a single positive result.
ATthe presenttimeforfulfillmentsanitary and anti-epidemicmode,Sosameforstreamliningworkintherapeutic and prophylacticinstitutionsoperatesleblowingthe documentsandorders:
W Industrystandard42-21-2 - 85 determining the methods, means and mode of disinfection and sterilization of medical devices.
W Order№1204 dated 11/16/87 "On the medical and protective regime in medical institutions."
W AtkazMOHUSSRfrom12.07.89 № 408 "On measures to reduce the incidence of hepatitis viruses in the country."
W Order№ 288 “On the Sanitary and Epidemiological Regime of a Medical and Preventive Institution.
W Federallaw“On the prevention of the spread in the Russian Federation of a disease caused by the human immunodeficiency virus (HIV infection) dated February 24, 1995.
W OrderMOHRFfrom26.11.98 G№ 342 "On strengthening measures for the prevention of epidemic typhus and the fight against pediculosis."
W OrderMOHUSSR№ 254 dated 09/03/1991 "On the development of disinfection in the country."
W OrderMOHRF№ 109 dated March 21, 2003 "On the improvement of anti-tuberculosis measures in the Russian Federation."
W OrderMOHRF№ 229 dated June 27, 2001 "On the national calendar of preventive vaccinations and the vaccination schedule for epidemic indications."
W SanPiN2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities."
W SanPiN2.1.7.2730-10 from09.12.10 of the year- "Sanitary and epidemiological requirements for the treatment of medical waste."
W SanPiN3.1.5.2826-10 from11.01.11 of the year- “Prevention of HIV infection”.
3. Health education activities
Work on medical prevention and promotion of a healthy lifestyle for the population is carried out on the basis of the order of the Russian Federation No. 455 of September 29, 2003. 4 hours of budgetary time are worked out for medical prevention of the population.
Are used various forms works: conversations, design of health corners, sanitary bulletins, lectures.
I am supposed to work 44 hours a year on sanitary and educational work. The most convenient form of work is conversations. After each conversation, I make a note in the register for the conduct of sanitary and educational work. I constantly hold conversations not only with the patient, but also with their relatives to promote a healthy lifestyle.
One of the main goals of the work of a nurse is continuous improvement, observance of ethics and deontology in relation to patients and colleagues. The nurse should promote the preservation and promotion of health, encourage a healthy lifestyle. By virtue of his profession, instill in patients the rules of self-care, hygiene. The significance of these measures prevents chronic diseases and their complications. The study of the activities of nursing staff showed that this category of workers has sufficient work experience, high qualifications, great responsibility and independence.
Sanitary - educational work in the department I spend constantly. I form the need for patients to give up bad habits, motivation for recovery, the ability and skills to self-monitor their health, to provide first aid in case of exacerbation. Main topics of conversation:
v Varicose veins of the lower extremities.
v About the dangers of smoking.
v Proper intake of tablet medicines.
v Teaching patients how to care for a colostomy and how to change colostomy bags.
v Diet for diabetes mellitus.
Sanitary bulletins were issued in 2014 on the topics: “Prevention of hemorrhoids”, “Phlegmon” and others.
Conclusion
The hospital is constantly working to improve the skills of nursing staff. Every year, advanced training courses for nurses are held on the basis of the SBMK SAKHALIN BASIC MEDICAL COLLEGE. The main staff of nurses has qualification categories and work experience of more than twenty years.
Once a month, conferences are held on the issues of compliance with the sanitary and epidemiological regime in the department, processing of equipment and tools, problems of providing first aid, etc.
Kindsraiseprofessionalqualifications
I raise my professional level by attending sister conferences, getting to know new technologies. The department holds monthly thematic conferences, where we are introduced to new protective equipment, innovations in dressings or equipment, etc. The department is constantly studying new orders and instructions, as well as classes on topics. For example:
§ Organization of the work of the dressing room. Bix laying, sterile table setting. Tool processing.
§ Types of desmurgy.
§ Technique for dressing postoperative wounds.
§ Care of stoma (intestinal). Features depending on the location of the overlay. Means for skin treatment.
§ Care of drainage tubes. Types of drains. The need to flush the drainage tubes.
§ Care of wounds: purulent and clean. Types of bandages.
The nurses of the department are fluent in the technique of central vein catheterization, all types of dressings, maintaining medical records, etc. All staff are instructed every six months with exams in sanitary and epidemiological regime. Continuous training is provided to familiarize functional responsibilities department employees.
self-education
In the modern world, there is a sufficient amount of professional literature that contains all the material that a medical worker needs to know. Thanks to this, self-education becomes accessible to a wide range of people. The development of communications, the media, the Internet, television allows you to perceive new information and use it in professional activities. Large selection of medical journals for nursing staff: "Nursing", "Medical Bulletin", "Nurse", etc. provides the necessary information from which one can draw experience from other regions of Russia. Attending nursing conferences, seminars, talks is also an integral part of my self-education.
Planningwork
Every day in the department, the head of the department and the head nurse, before the start of the working day, hold planning meetings, at which the dressing plan for the day is specified, all current affairs are discussed, problems are identified and decisions are made to eliminate them.
Mentoring
I conduct training for junior medical staff in compliance with the rules of the sanitary and epidemiological regime, work with disinfectants, labor protection rules.
Students practice on the basis of the department medical school. I teach them dressings. I try to ensure that during the practice, future nurses receive the basic knowledge and skills of nursing.
Privateprofessionalplan
b Confirm qualification category majoring in Nursing.
ü Constantly improve their professional level of knowledge, skills and abilities through self-education, participation in hospital-wide, intra-departmental conferences, technical studies, seminars.
l Actively participate in the life of the department and the hospital.
ü Constantly use the library with medical literature on the specifics of the department, as well as read the magazines "Nursing", "Nursing".
ü Take an active part in the training of young professionals
Offers
According to the specifics of the work of the department, patients are admitted both planned and urgent. For postoperative patients and patients with limb amputation, functional beds, bed reusable and disposable underwear are needed.
For patients who have temporarily lost their motor function, individual wheelchairs and crutches are required.
An important role is played appearance employee, it is necessary to allocate medical gowns and suits.
1. Provide with disposable medical products, consumables in full.
2. Computerization of medical records.
3. Continue the planned work on the passage of studies, advanced training of the medical staff of the department.
4. Pay special attention to: improvement of working and rest conditions, moral and material encouragement of department employees.
5. Implement a program for the exchange of experience of nurses from other regions of the Sakhalin region.
Dressing nurse FISHCHUK E.B.
Senior Nurse IVANOVA S.N.
Chief Nurse ZHAROVTSEVA N.A.
Bibliography
1. Official website of the NB FGBUZ "YUOMTS FMBA of Russia".
2. Petrovskaya S.A. Handbook of the main (senior) nurse. Moscow: Dashkov i K, 2007.
3. Yu.P. Lisitsyn "Guide to social hygiene and healthcare organization". 1987.
4. Handbook "Prevention of nosocomial infections in the work of nursing staff." 2010
5. Methodological letters and orders of the Ministry of Health of the USSR and the RSFSR, job description.
6. Barykina N.V., Chernova O.V. Nursing in surgery: workshop. Rostov n/a: Phoenix, 2007.
7. Dvoinikov S.I. Fundamentals of nursing. M.: Academy, 2007.
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medical history and management
appointment sheets,
log,
transaction log;
log books for narcotic and potent drugs (Regulated by order of the Ministry of Health of the Russian Federation dated November 12, 1997 No. 330 “On measures to improve the accounting, prescribing and use of narcotic drugs”);
non-normative service documentation (alphabetical journal, analysis journal, prescription selection journal, etc.)
Organization of dressing work
In any surgical department, it is necessary to deploy two dressing rooms: “clean” and “purulent”, placing them as isolated as possible from each other, from the wards and from service units. In departments specialized in the treatment of patients with proctological diseases, anaerobic infections and other diseases associated with massive environmental infection with highly pathogenic microorganisms, it is advisable to deploy a third dressing room for these groups of patients. Dressings in each of these dressing rooms should be made first in the "cleaner" patients, then in the "more purulent". Patients with putrefactive processes, intestinal fistulas, and anaerobic infections are bandaged last. This principle of operation ensures the longest possible preservation of aseptic conditions in the dressing room and prevents cross-infection between patients.
Instruments and sterile dressings in the dressing room are stored on the “sterile table”, located in the place farthest from the front door and dressing tables. The "sterile table" is closed at least once every 6 hours. The dressing nurse cleans her hands and puts on a sterile gown as in preparation for the operation, covers the table with two layers of sterile sheets, puts sterile instruments and dressings on it, and covers it with two layers of sterile sheets on top. The edges of the sheet are fixed with special linen clips, for which you can lift the top sheet without touching it and the contents of the table. An oilcloth label is attached to one of these clips, on which the date and time of the last table overlap and the signature of the honey are indicated. the sister who made it. Instruments and dressing material are served from the “sterile table” by the dressing nurse with a sterile instrument (usually a forceps is used), which is stored separately in 6% hydrogen peroxide or on the “sterile table” itself, in the corner, on a specially laid diaper or oilcloth.
Currently, dressing rooms are additionally equipped with UV bactericidal chambers for storing sterile medical instruments. (Chamber "Ultra-light" is designed to store tools for 7 days).
The staff in the dressing room wears changeable gowns, caps, 4-layer gauze masks and disinfected (non-sterile) rubber gloves. In recent years, due to the increase in the incidence of viral hepatitis and HIV, the use of goggles or face shields is recommended. Before performing dressings, staff wash their hands under a tap with soap and water, then put on gloves. At the same time, the hands do not become sterile, therefore, manipulations in the wound are performed only with tools. Between individual dressings, gloved hands are washed under a tap with soap. If the gloves come into contact with blood or wound discharge, they must be replaced. Immediately after use, gloves are disinfected in accordance with OST 42-21-2-85. If it is necessary to perform manipulations with hands, they are prepared as before the operation, and sterile gloves are put on.
There should be two washbasins (sinks) in the dressing room: “for hands” and “for gloves”. Three labeled towels should hang next to each, which are changed every day: “for doctors”, “for a nurse”, “for a nurse”. This is due to the fact that, due to the production duties, the hands of the junior honey. personnel, as a rule, are more contaminated than the hands of nurses and doctors, and the requirements for cleanliness of the hands of a dressing nurse are the highest. In the "purulent" dressing room, oilcloth aprons are additionally put on, which the nurse wipes with a 3% solution of chloramine after each dressing.
The doctor performing the dressing should not approach the "sterile table". Tools and dressings are supplied from it only by the dressing sister. The doctor takes it from his sister's forceps without touching the latter. The used dressing material is collected in trays disinfected for 1 hour in a 3% chloramine solution and placed in a closed container (bucket with a lid), where it is poured with chloramine solution to a concentration of 6%, taking into account the volume of dressing material for 1 hour.
In the dressing room is carried out:
pre-cleaning is carried out before the start of the working day: horizontal surfaces are wiped with a disinfectant solution to collect dust that has settled overnight;
cleaning after each dressing: the surface of the dressing table and the floor around it are treated with a disinfectant solution;
daily final wet cleaning using a disinfectant solution, which is used to treat equipment, floors and walls to the height of human growth;
general cleaning is carried out once a week, during which all equipment and the room, including the ceiling, are washed with detergents and a 3% solution of chloramine.
All dressing rooms should be equipped with powerful (150-300 W) ultraviolet lamps, which should be treated for at least 2 hours a day. It is advisable to leave the UV lamps on for all non-working hours.
healthcare……………………………………………………2
2. Typical instruction filling out the primary
medical documentation of treatment and prophylactic
(Form No. 039-3/y)………………………………………….6
offices (form No. 028 / y)………………………………...7
hospital (form No. 008/y)………………………
2.5...2... Temperature sheet (Form No. 004/
y)…………...9
2.5...3... . "Statistical map of the retired
hospital "(form No. 066 / y)……………………
3. The procedure for filling out the "Consolidated record of the doctor
surgical department, office "……………………….... 11
Application…………………………………………………………...………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
List of used literature……………………………...……13
1. On approval of forms of primary medical
documentation of healthcare institutions. Order of the Ministry of Health of the USSR dated 04.10.1980 No.
No. 1030 (Extraction)
In order to streamline the maintenance and use of primary
medical documentation in healthcare institutions, bringing
medical documentation to a unified system of standards forms,
ensuring the completeness and reliability of information reflecting
activities of health care institutions.
APPROVE:
List and samples of forms of primary medical documentation
(appendix to the order).
I ORDER:
intradepartmental statistical reporting and streamlining accounting in
bodies, institutions and enterprises of the system of the Ministry
health care of the USSR" and other orders of the Ministry of Health
USSR, published before 1.10.80 in terms of approving the forms of primary
medical documentation, with the exception of orders of the USSR Ministry of Health,
which are approved for experimental work
temporary accounting forms, the period of application of which did not expire before 1.10.80
2. Typical instructions for filling out primary forms
medical documentation of treatment and prophylactic
institutions in the provision of surgical care.(without laboratory documents) Approved by the order of the Ministry
health care of the USSR No. 1030 dated 04.10.80 (Extract)
destination. Inpatient medical records
allow you to control the correct organization of the treatment process
and are used to issue reference material upon request
departmental institutions (court, prosecutor's office, examination, etc.).
Passport part, diagnosis of the sending institution and diagnosis,
established by doctors upon admission of the patient to the hospital
13. Journal of recording surgical interventions in the hospital f. 008/u.
14. Cards of an inpatient
15. Journal of registration of transfusion of transfusion media f. 009/u.
16. Journal of registration of narcotic and psychotropic drugs
17. Journal of verification of measuring instruments
18. Book of complaints and suggestions
20. Minutes of the meetings of the bonus commission
21. Minutes of production meetings and meetings
24.Schedule of work of the head nurse of the department
25. Plan of study of middle and junior medical personnel
26.Schedules for the medical examination by the staff of the department
27. Timesheets and work schedules of department employees
28. Requirements for obtaining medicines
29.Journal on the examination of the quality of work of middle and junior medical personnel
30. Journal of advanced training of nursing staff
31. Journal of subject-quantitative accounting and write-off of medicines
32. Journal of accounting for the consumption of alcohol
33. Journal of Humanitarian Aid
34. Journal of accounting for dressings
35. Journal of accounting systems
36. Journal of syringes
37. Journal of accounting for the sterilization of medical instruments
38. Accounting log material assets
39. Journal of accounting of administrative rounds
40. Journal of quartzization
43. Journal of accounting for sanitary and educational work f. No. 38 / y.
44. Log of the movement of patients
45. Journal of blood sampling for HIV, HBS antigen
47. Journal of taking blood for alcohol
48. Journal of taking swabs into the tank. laboratory
49. Journal of examination of patients for pediculosis
50. Journal of accounting for azopyram samples
51. Journal of accounting briefing on labor protection and safety
52. Journal of daily control on labor protection and safety
53. Journal of safety knowledge testing for personnel with electrical safety group 1
54. Journal of entry to work and departure from work of employees of the department
55. Nomenclature of cases.
II. Indicators of performance and defects characterizing the activity of the 2nd surgical department of the hospital for 2 years
| Name of indicators and methods of their calculation | Years 2013 2014 | |
| Performance indicators | ||
| 1. Average number of bed days per year Number of bed days actually spent by patients in a year Number of average annual beds | 307,2 | 298,7 |
| 2. Average duration of treatment Number of bed-days spent by patients per year Number of dropped out patients | 7,3 | 7,3 |
| 3. Surgical activity (in %) ×100 Number of used patients from the department | 46,6 | 46,9 |
| 4. Lethality (in%) ×100 Number of patients who left the department | 2,6 | 1,77 |
| 5.Bed turnover Number of patients used (half the sum of admissions, discharges and deaths) Average annual number of beds | 20,5 | |
| 6. Postoperative mortality (in %) × 100 Number of all operated patients per year | 6,9 | 3,9 |
| Defect rates | ||
| 1. Discrepancy between clinical and pathoanatomical diagnoses (in %) The number of discrepancies between clinical and pathoanatomical diagnoses (per year)×100 Number of autopsies of the deceased in the surgical department (per year) | 6,25 | 4,3 |
| 2. Postoperative mortality in diseases requiring emergency surgical care (in % of the number of operations) The number of deaths from diseases requiring emergency surgical care× 100 Number of operated patients requiring emergency surgical care | ||
| 3. Nosocomial purulent-septic infection - postoperative complications (in % of the number of operations) ×100 Number of operated patients |
| Indicators | ||
| Number of bed-days spent by patients per year | ||
| Number of average annual beds | ||
| Number of retired patients (discharged + deceased) | ||
| Number of operated patients per year | ||
| Number of patients used (half sum of admissions, discharges and deaths) | ||
| Number of patients who died per year | ||
| Number of deaths after surgery per year | ||
| Number of discrepancies between clinical and pathoanatomical diagnoses (per year) | ||
| The number of post-mortem autopsies of the deceased in the surgical department (per year) | ||
| The number of deaths from diseases requiring emergency surgical care | ||
| Number of operated patients requiring emergency surgical care | ||
| Number of postoperative complications (per year) |
Calculation of indicators for 2013.
Performance indicators:
1. Average number of days of bed operation per year = 12288/40 = 307.2
2. Average duration of treatment =12288/1684=7.3
3. Surgical activity = (392/842) × 100 = 46.6
4. Lethality = (44/1684) × 100 = 2.6
5. Bed turnover =842/40=21
6. Postoperative mortality = (27/392) × 100 = 6.99
Defect indicators:
1. Discrepancy between clinical and pathoanatomical diagnoses =2/32×100=6.25
2. Postoperative mortality in diseases requiring emergency surgical care =(0/101)×100=0
3. Nosocomial purulent-septic infection - postoperative complications =(0/861)×100=0
The nurse, in addition to performing medical work and caring for the sick, maintains medical records.
1. Journal, or notebook appointments.
2. Journal of reception and transfer of duty.
3. A sheet of records of the movement of patients and hospital beds.
5. Register of medicines of list A and B.
6. Summary of the condition of the patients of the help desk.
7. Journal of accounting for expensive and acutely scarce drugs.
8. Journal of dressings.
9. Journal of copying materials and alcohol.
10. Journal of disinfection treatment of instruments.
I. Journal of pre-sterilization treatment of instruments.
12. Journal of general cleaning.
13. Journal of quartzization.
14. Register of post-injection complications. In addition, she must be able to fill out a statistical coupon (form No. 30).
15. Journal of emergency tetanus prophylaxis.
Journal or appointment book. The nurse prescribes the prescribed drugs, as well as the studies that need to be performed by the patient, in the prescription book, which indicates the full name. patient, room number, manipulations, injections, laboratory and instrumental studies. It duplicates the entry data in the appointment sheet. Be sure to put the dates and the signature of the nurse.
Journal of reception and transfer of duties. Most often, the transfer of duty is done in the morning, but it can also be done in the afternoon, if one nurse works in the first half of the day, and the second in the afternoon and at night. The nurses receiving and handing over the duty go around the wards, check the sanitary and hygienic regime, examine the seriously ill and sign in the register of reception and transfer of duty, which reflects the total number of patients in the department, the number of seriously ill and feverish patients, the movement of patients, urgent appointments, the state of medical equipment, items care, emergencies. The journal must have clear, legible signatures of the nurses who accepted and passed the duty.
The nurse on duty in the morning fills out the “Patient Movement Record Sheet” (form No. 007u).
The ward nurse, checking the list of appointments, makes a "portion" daily (if there is no dietary sister). The portioner should contain information about the number of different dietary tables and types of unloading and individual diets. For patients admitted in the evening or at night, the portioner is made up by the nurse on duty. Information from ward nurses on the number of diets is summarized by the head nurse of the department, they are signed by the head of the department, then transferred to the catering department.
Register of medicines of list A and B. Medicines included in list A and B are stored separately in a special cabinet (safe). On the inside of the safe there should be a list of these medicines. Drugs are usually stored in the same safe, but in a special compartment. The safe also stores extremely scarce and expensive funds. Handing over the keys to the safe is recorded in a special register. To account for the consumption of medicines stored in a safe, special journals are kept. All sheets in these magazines should be numbered, laced, and the free ends of the cord should be sealed on the last sheet of the magazine with a paper sheet indicating the number of pages. This sheet is stamped and signed by the head of the medical department. To account for the consumption of each drug from list A and list B, a separate sheet is allocated. This magazine is also kept in a safe. Annual records of drug consumption are maintained by the head nurse of the department. The nurse has the right to administer a narcotic analgesic only after the doctor records this appointment in the medical history and in his presence. About the injection made, a mark is made in the medical history and in the prescription sheet. Empty ampoules from under narcotic analgesics are not thrown away, but are transferred together with unused ampoules to a nurse starting the next duty. When transferring duty, they check the correspondence of the entries in the logbook (the number of used ampoules and the balance) with the actual number of filled used ampoules. When using the entire stock of narcotic analgesics, empty ampoules are handed over to the head nurse of the department and new ones are issued in return. Empty ampoules from narcotic analgesics are destroyed only by a special commission approved by the head of the medical department.
The journal of accounting for acutely scarce and expensive funds is compiled and maintained according to a similar scheme.
Summary of the status of patients for the reference table. This summary is compiled daily by the night nurse, most often early in the morning, before the shift. It contains the names of patients, the numbers of their wards, as well as their state of health.
The dressing journal indicates the date, types of dressings, the number of patients who received dressings, and also puts a daily signature.
The journal for writing off alcohol and dressings is located in the surgical room or in the dressing room. This journal is numbered and laced, signed by the senior nurse and head of the department. To the attention of the nurse - the consumption of alcohol by order No. 245 of August 30, 1991.
Surgical office - 1200 g per 1 thousand people (1 person - 1.2 g of alcohol).
Oncology room - 1000 g per 1 thousand people (1 person - 1 g of alcohol).
Urologist's office - 1200 g per 1 thousand people (1 person - 1.2 g of alcohol). To apply a compress, 20-30 g of alcohol is required. Burn treatment - 20-40 g of alcohol.
Similarly, the consumption of cotton wool, bandages, furacilin is taken into account. Logs of disinfection treatment of instruments, pre-sterilization treatment of instruments are compiled and maintained to control the relevant activities (table).
Orders for work in the surgical room
Instruction on labor protection for a nurse at school. AGREED APPROVED. Chairman of the trade union director. Order. General provisions health and safety instructions for nurses. An employee hired by a school as a nurse must pass medical checkup, special training, introductory safety briefing, primary briefing for a nurse - at the workplace, repeated briefing - at least once every 6 months, unscheduled (if the working conditions of the nurse change, safety violations, accidents occurred).
Employees with a secondary medical education in their specialty are allowed to independently perform work. Persons who have studied the labor protection instructions for the school nurse, as well as the job description of the nurse at the school, are allowed to perform duties. The employee has the right to refuse the work entrusted to him if a situation has arisen that is dangerous for his personal health, or for the people who surround him, and the environment.
An employee is obliged to strictly comply with the requirements and internal regulations of a general educational institution: observe discipline; take care of equipment, tools, devices, medicines, materials and overalls; keep your workplace and territory clean; periodically undergo medical examinations. When performing the duties of a nurse at a school, exposure to harmful production factors is possible: electric shock when turning on electric lighting, using faulty electrical outlets; electric shock when working with a bactericidal quartz lamp, medical or other electrical equipment; violation of visual acuity in case of insufficient illumination of the workplace of a nurse; damage to the mucous membrane of the eyes due to failure to comply with the instructions and requirements for the use of bactericidal quartz lamps; injections, cuts in the provision of medical care to victims. It is forbidden to smoke and drink alcohol in the workplace. Fire safety regulations must be strictly observed. It is also necessary to observe the rules of personal hygiene: eat only in the dining room; perform work in perfectly clean overalls; when performing injections, use rubber gloves; one.
All employees of the department (office) are re-instructed at least as often as the knowledge of the personnel of the department (office) on safety measures according to the program. The results of the briefing are recorded in the appropriate journal, knowledge of this labor protection instruction for the nurse is checked. Maintaining the necessary sanitary and epidemiological regime in the surgical department is impossible without the following components They are contained in the RTM
The nurse is obliged to follow the instructions for labor protection in the medical office. The medical office of the institution must be equipped and equipped with tools in accordance with the approved list of equipment and tools for medical office. For violation of the requirements of this instruction on labor protection for a nurse, a medical worker working at a school is held liable in accordance with the legislation of the Russian Federation. Occupational safety requirements for a nurse before starting work.
Before starting work in the medical office of the school, the nurse must put on clean overalls: a medical gown, a hat or scarf, a gauze bandage-mask. The overalls of the nurse must be clean and ironed, fastened with all buttons or tied.
Inspect the premises, make sure that the electric lighting in the medical and treatment rooms of the school is working. Ventilate the room of the medical office, treatment room. Check integrity electrical sockets and serviceability of other electrical appliances. It is necessary to carefully check the availability of all medicines and the serviceability of medical equipment.
Before starting work, the nurse of the educational institution must thoroughly wash their hands with soap and water. Safety requirements during the work of a nurse. The school nurse is obliged to: Accurately and promptly follow the instructions of the doctor; be sensitive and attentive to sick children, monitor the personal hygiene of students; use equipment and tools professionally, accurately and carefully; Report all technical malfunctions to the director of the educational institution. It is forbidden for the school nurse to use medical equipment and devices for other purposes. To avoid injury and the occurrence of dangerous situations, the nurse must comply with the following requirements: do not leave switched on and operating equipment unattended; do not allow persons who have not undergone appropriate training to work with medical equipment; work only on serviceable medical equipment and serviceable tools; constantly monitor the expiration date of the drugs used; observe the rules of electrical safety and fire safety; do not perform work that is not part of your duties. Sterilize medical instruments only in specialized rooms (treatment room). When working with medical equipment, observe safety measures: do not connect to the electrical network and do not disconnect devices from it with wet and damp hands; do not violate the sequence of turning on and off the equipment, do not violate technological processes; strictly follow the instructions for using electrical appliances available in the medical office; do not leave unattended devices, quartz lamps, ovens, etc., turned on in the medical office;
Each student is required to undergo a safety briefing at the clinical base of the department, before starting training and conducting practical classes. Conducting practical classes at the clinical bases of the department, in the departments of the surgical profile. Safety instructions for working in the surgical department. File description: Added: 04/20/2016 Downloads: 1603 File status: available File public: Yes File uploaded: raulLAN44. Standard instructions for labor protection for personnel of operating units (approved. Job description of the nurse of the surgical department: This job description was developed and approved by them; - internal rules work schedule; — rules and regulations of labor protection, safety and fire protection; — 1st and 2nd surgical departments. Standard safety instructions for working in sterilization rooms (Approved by the Ministry of Health of the USSR on 14.10. Each student is required to undergo a safety briefing in the hospital. Before starting work in the hospital department, it is necessary to change clothes.
An instruction on labor protection for an obstetrician is urgently needed. To work in the gynecological department (hereinafter referred to as the "department"). Surgical instruments used in various HEALTH AND SAFETY INSTRUCTION Nursing post of the surgical department, Contents. Repeated briefing on labor protection should be carried out at least in time when working in the surgical department, in maternity, etc. Participates in surgical operations, provides members of the surgical team with the necessary tools, materials, equipment. Complies with internal regulations, fire safety and safety regulations.
This job description defines official duties, rights and responsibility (head of the department, deputy chief physician). Safety and fire safety rules at the workplace and in the department. Basic requirements, orders, instructions for infectious safety and prevention of nosocomial infections in a surgical hospital. Instructions for students on safety precautions when working in medical institutions in 2. Before starting work in the hospital department, you must change clothes. Dress code: medical gown, surgical suit, medical cap. All newly hired workers must undergo an introductory briefing on labor protection. The results are recorded in the entry log. My 422039-05 (technics for the collection and transport of surgical and biomaterials in microbiological laboratories) institutions). Instructions GBUZ SO *&SOKB N*.
The head of the department is obliged to develop safety instructions for each type of equipment, which must be approved by the administration of the health facility and agreed with the trade union committee.
Standard instruction on labor protection for staff of departments, labor protection for a ward nurse (reception-quarantine. The job description of a nurse (nurse) is a local act in which the activities of the department to which it is attached (surgical, radiological Compliance with safety regulations when working with equipment 9. Infections of the skin and subcutaneous tissue - only for obstetric and surgical hospitals, neonatal pathology departments. .Provide a safe environment for the patient in the hospital.
To protect yourself from injuries to your hands in the process of opening the ampoule, you must first file the ampoule with a nail file and then break off its nose with your fingers protected with gauze or cotton. Know the ways of evacuation in case of fire, the procedure for emergency situations, be able to use a powder fire extinguisher if necessary. During work, the nurse must observe the rules of personal hygiene, the requirements of the labor protection instructions for the school nurse, and be careful with medications. Occupational safety requirements at the end of the work of a nurse. Disconnect all electrical equipment from the electrical network.
Ventilate the medical office. Tidy up your workspace. Take off your overalls and hide them in the designated place. Tightly close the window, transom. Close the medical and treatment room with a key.
reachpriority.weebly.com
I.V.SHATKIN
Appendix No. 21
to the order of the Ministry
health care of the USSR
dated 23.09.1981 N 1000
www.zakonprost.ru
Organization of the work of the surgical department and the surgical room of the polyclinic
In our country health care organized according to the territorial principle, however, with the development of insurance and private medicine, this principle, especially in relation to planned care, begins to change.
Organizations of surgical care
Feldsher-obstetric station - provides emergency first aid, carries out the prevention of diseases and injuries to residents of one or more rural settlements.
The district hospital provides emergency and urgent medical care for acute surgical diseases and injuries, carries out work on their prevention, manages the work of feldsher-obstetric stations located in this area of the district.
District hospital - provides surgical care to all patients with acute surgical diseases and trauma, conducts planned treatment of the most common surgical diseases (hernia, gastric ulcer, cholecystitis, etc.)
The regional hospital - in addition to the volume of care provided in district hospitals, provides specialized surgical care: urological, traumatological, oncological, etc.
City hospitals provide emergency and planned surgical care to residents of city districts.
Surgical departments of medical universities - in addition to providing surgical care, they conduct the scientific development of certain sections of surgery.
Scientific research institutes, in accordance with their profile, provide special surgical care, carry out the scientific development of surgical problems.
Inpatient surgical care is provided in three types of surgical departments: general, specialized and highly specialized (centers).
General surgical departments are organized as part of district and city hospitals. They provide the main types of qualified inpatient surgical care to a large part of the country's population. Various diseases are treated here, among which more than 50% are acute surgical pathologies and 20-40% are injuries and diseases of the musculoskeletal system.
Specialized departments are opened in regional and city hospitals and serve from 50 thousand to 3 million people. They are intended to provide patients with surgical care in the relevant specialty. The organization of specialized departments is based on similar principles that contribute to the concentration of patients on a certain basis:
* · for a disease of one organ system - departments of vascular surgery, lung surgery, proctological, urological, etc.;
* By nosological forms, taking into account localization - burn departments, surgery for genitourinary and osteoarticular tuberculosis, etc.;
* by sections of surgical pathology - oncological departments, emergency surgery, purulent surgery, etc.;
* by the peculiarities of the methods of operations - plastic surgery;
* by age characteristics — pediatric surgery.
General surgical departments are opened, as a rule, for 60 beds or more, specialized departments for 25-40 beds. A significant part of city and regional hospitals are clinical, as surgical clinics of medical institutes operate on their basis. Surgical beds are also available in special clinics of medical institutes that are not part of the city network, in research institutes subordinate to ministries and departments, and in institutes of the Russian Academy of Medical Sciences.
Organization of emergency and urgent surgical care. In cities, it is carried out according to the scheme: emergency medical care (health center or clinic) - surgical hospital. In the countryside: feldsher-obstetric station, district hospital - surgical department of the district hospital. Surgical departments have round-the-clock duty of surgeons, anesthesiologists and operating nurses to provide emergency surgical care.
ORGANIZATION OF THE WORK OF THE SURGICAL DEPARTMENT
Departments of the surgical profile should be located in the same building with the emergency room, the operating unit, the intensive care unit and the intensive care unit, since they are functionally dependent on each other. Ward departments are organized for 60 or more beds. According to SNiP (Building Norms and Rules, 1971), departments in new hospitals are planned from two impassable sections, which are separated by halls. The section should have 30 beds. The ward section provides for: a post for a nurse on duty (4 m 2), a treatment room (18 m 2), a dressing room (22 m 2), a dining room (with at least 50% of the number of beds), a room for sorting and temporary storage of dirty linen , cleaning items (15 m 2), bathroom (12 m 2), enema (8 m 2), restroom (men's, women's, for staff). Along with this, the department needs: the head's office (12 m 2), the staff's room (10 m 2 for each doctor, in addition to one additional 4 m 2), the head nurse's room (10 m 2), the hostess (10 m 2). The clinics provide offices for professors, associate professors, assistants and study rooms for 10-12 people.
Chamber - the main place of stay of the patient in a medical institution. In the wards of the surgical department, 7 m 2 is allocated per bed. Most of the wards in the section are planned for 4 beds, 2 - two-bed wards, 2 - one-bed wards. The optimal number of beds in the ward is 3. Before entering the ward, a gateway is planned, which is provided as a small front room, where there are built-in individual wardrobes for patients and an entrance to the toilet, with a washbasin, bath or shower. The rooms are equipped with beds of a metal structure, to which a transfusion stand and a skeletal traction device can be attached. Most beds should be functional. The interior of the room is complemented by a bedside table, a common table, chairs, and a waste paper basket. The temperature in the room should be at 20°C. Optimum air humidity is 50-60%, air mobility is about 0.15 m/s. Chambers should be well lit by natural light, windows should not be oriented to the north. The ratio of the area of windows and the floor should be 1:6. Provides general and local electric lighting. Each bed has a nurse call system.
The post of the ward sister is placed in the corridor so as to ensure good review chambers. The post is located in the center of the section. It is equipped with cabinets for storing medicines, tools, care items and documentation (lists of medical appointments, handovers, etc.).
When placing patients, it is necessary to take into account the characteristics of the contingent, so clean and purulent departments should be allocated. This will make the treatment more effective, and most importantly, prevent complications.
Surgical departments should be provided with forced ventilation, and separate rooms with supply and exhaust ventilation or conditioned air. The premises of surgical departments are subject to wet cleaning, using disinfectants, twice a day: in the morning after the patients wake up and in the evening before bedtime. Once a month, it is necessary to carry out general cleaning, with wet disinfection of mattresses and pillows. Air samples should be taken monthly for bacteriological examination.
The organization of work of medical personnel is regulated by the “Model internal regulations”, on the basis of which rules are drawn up for various institutions, depending on their purpose. Each surgical department has a daily routine, which is aimed at creating rational working conditions for medical personnel and optimal conditions for the recovery of patients.
Special requirements are imposed on the personnel of the surgical department: the human qualities of the personnel are no less important than their qualities as specialists. It is necessary to impeccably fulfill the principles of medical deontology and ethics. Deontology (Greek: deon - due, logos - teaching) - a set of ethical and organizational norms for the fulfillment by health workers of their professional duties. The main elements of deontology are aimed at creating a special psychological climate in the surgical department. The main function of the psychological climate in a surgical facility is to create conditions for the speedy, high-quality and reliable recovery of patients. Two main goals follow from this:
* Minimize the effect of factors slowing down and qualitatively worsening the process of patients' recovery;
* Maximize the extent to which patients perceive a healthier lifestyle.
WORK ORGANIZATION
SURGICAL DEPARTMENT OF THE POLYCLINIC
The polyclinic provides reception of patients with surgical diseases and treatment of those who do not need inpatient treatment. Most patients visit the department repeatedly for dressings and medical procedures.
The surgical department of the polyclinic should be located, if there is no elevator, on the first or second floor. This facilitates visits by patients with diseases of the lower extremities and the delivery of stretcher patients. With one working surgeon, the department should include: a doctor's office, a dressing room, an operating room, a sterilization room, and material rooms. With a large number of working surgeons, the operating room, sterilization room, material room can be shared, but the office and dressing room should be separate for each doctor. The surgeon's office should have a table, 2 stools, a couch for examining patients, which is best placed behind a screen, a negatoscope, etc.
The walls must be smooth and in all rooms at least two meters high must be painted with oil paint, the walls of the operating room must be covered with tiles. All rooms in the surgical department must have wash basins. Premises of the surgical room must be especially carefully protected from pollution. The contingent of patients changing during the reception, the delivery of patients in clothes contaminated after injuries contributes to the introduction of dirt into the surgical room. Therefore, it is necessary to frequently wipe the floors of offices and dressing rooms with a wet method, using antiseptic liquids that are devoid of an unpleasant odor. Wet current cleaning of the premises (floor, walls) should be carried out after each appointment. At the end of the day's work, the office is completely cleaned.
The work of a surgeon in a clinic is significantly different from the work of a surgeon in a hospital. Unlike a hospital surgeon, an outpatient surgeon has significantly less time for each patient and often lacks the ability to accurately distribute his work hours, especially where there is no separate trauma room. Appeal of patients for emergency surgical care (dislocations, fractures, injuries) requires stopping the current appointment and providing first aid to the victim, however, this does not relieve the surgeon from providing assistance to all other patients scheduled for an appointment.
The surgeon participates in consultations with doctors of other specialties, resolves issues of planned and emergency hospitalization of patients, issues of working capacity, employment. In addition to medical, advisory work, a polyclinic surgeon conducts a medical examination of certain groups of patients (varicose veins, thrombophlebitis, osteomyelitis, hernia, after surgery for gastric ulcers, etc., as well as disabled WWII), participates in preventive work at the site, in work of engineering and medical teams. The polyclinic surgeon maintains contact with the hospital, where he sends patients, and also provides aftercare after discharge from the hospital. In some cases of emergency surgery, the doctor has to visit patients at home, where, in the absence of additional research methods, he is obliged to make the correct diagnosis and decide on the tactics of further treatment of the patient. An error in diagnosis and delay in providing the necessary assistance can lead to fatal consequences. To carry out this work, the surgeon must be the organizer of the medical and surgical process, implementing the principle of N.I. Pirogov on the importance of organization in medicine and surgery in particular.
The nature of the work of the surgical office requires that all personnel are well aware of their duties and master the methods of their work. The nurse of the surgical room should be knowledgeable in the field of asepsis and antisepsis, comply with her requirements in work and monitor compliance with them by other employees and patients, help the doctor in organizing the reception of patients. The nurse of the surgical department should be trained in the rules of cleaning, washing instruments, and the technique of preparing material for sterilization. She must skillfully help the doctor and nurse during certain manipulations (help with undressing, dressing, etc.). Be aware of the danger of violating the rules of asepsis (be able to open bottles with sterile linen, supply a sterilizer with instruments, a basin for washing hands, etc.).
When conducting a lesson in the surgical office of the polyclinic, students, together with the surgeon working in the office, receive primary and secondary patients, participate in their examination, get acquainted with the rules for filling out medical documents (outpatient card, dispensary card, coupons and referrals) and selecting patients for hospitalization. The most interesting and thematic patients are dealt with in more detail with the teacher. In the course of admission, students get acquainted with the procedure for issuing and extending sick leave.
Thus, in the classroom in the clinic, students get acquainted with the contingent of patients that they do not see in the hospital, and also consolidate practical skills (bandaging, immobilization, injections, etc.).
ORDER of the Ministry of Health of the USSR dated September 23, 1981 N 1000 (as amended on December 22, 1989) “ON MEASURES TO IMPROVE THE ORGANIZATION OF WORK OF OUTPATIENT AND POLYCLINIC INSTITUTIONS”
Annex N 20
1. Surgical, otolaryngological, ophthalmological and neurological departments (offices) are organized as part of the city polyclinic.
2. The head of the department (office) is a specialist who has received special training in the relevant specialty.
3. Control over the work of the department (office) is carried out by the management of the polyclinic.
4. Doctors of departments (offices) work in contact with doctors - specialists of a different profile and, first of all, with general practitioners - district (territorial and shop medical districts).
5. Doctors of departments (offices) in their work are guided by this regulation, orders, instructions and instructions of the Ministry of Health of the USSR and current legislation.
6. The main tasks of departments (offices) are to carry out disease prevention measures, early detection of patients and their effective treatment in a polyclinic and at home according to their profile.
7. In accordance with these tasks, doctors of departments (offices) carry out:
- regular outpatient appointments according to the schedule approved by the administration of the polyclinic;
- dynamic observation and active treatment of patients until their recovery, remission or hospitalization;
- control over the timeliness of the implementation of diagnostic and therapeutic procedures by patients under supervision in this department (office);
- timely referral of patients, if indicated, to VTEK;
- consultations of patients in the directions of other doctors - specialists, incl. at home;
- timely identification of persons subject to medical examination according to the profile of this department (office), and taking them for dynamic observation;
– conducting an examination of temporary disability with the issuance of sick leave in accordance with applicable law;
— carrying out sanitary-educational work and hygienic education of the population.
8. The department (office) has the necessary space for placement, in accordance with sanitary and hygienic standards and requirements, as well as medical equipment, tools and inventory.
Head of the Main Department
medical and preventive care
I.V.SHATKIN
Appendix No. 21
to the order of the Ministry
health care of the USSR
dated 23.09.1981 N 1000
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