Order 222 of May 31, 1996. The order on endoscopy is new. Regulations on the nurse of the department, department, endoscopy room

1. Conversation with the patient
3. Preparation for the study
4. Hand washing
6. Conducting research

A.A.KARPEEV

perforation of a hollow organ;

Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV

www.laparoscopy.ru

Order of the Ministry of Health and Medical Industry of the Russian Federation dated May 31, 1996 N 222 “On improving the endoscopy service in healthcare institutions of the Russian Federation” (with amendments and additions)

Order of the Ministry of Health and Medical Industry of the Russian Federation of May 31, 1996 N 222
“On improving endoscopy services in healthcare institutions of the Russian Federation”

With changes and additions from:

Currently, endoscopy has become quite widespread both in the diagnosis and treatment of various diseases. A new direction has appeared in medical practice - surgical endoscopy, which makes it possible to achieve a pronounced economic effect while maintaining the therapeutic result by significantly reducing the length of hospitalization and the cost of treating patients.

The advantages of endoscopic methods ensure the rapid development of this service in the Russian Federation.

Over the past 5 years, the number of endoscopy departments and rooms in medical institutions has increased by 1.7 times, and their equipment with endoscopic equipment has increased by 2.5 times.

From 1991 to 1995, the number of endoscopists increased 1.4 times; 35% of specialists have qualification categories (1991 - 20%).

The scope of performed research and treatment procedures is constantly expanding. Compared to 1991, their number increased by 1.5 and 2 times, respectively. In 1995, 142.7 thousand operations were performed using endoscopic technology.

In a number of areas of the country, a 24-hour emergency endoscopic care service has been created, which can significantly improve indicators in emergency surgery, traumatology and gynecology. Computer programs have been developed and are being actively implemented to evaluate the results of endoscopic studies.

At the same time, there are serious shortcomings and unresolved problems in organizing the activities of the endoscopy service.

Only 38.5 percent of hospitals in rural areas, 21.7 percent of dispensaries (including 8 percent for tuberculosis), and 3.6 percent of outpatient clinics have endoscopy units.

Only 17 percent of the total number of endoscopy specialists work in health care institutions located in rural areas.

In the staffing structure of endoscopists, there is a high proportion of part-time doctors from other specialties.

The capabilities of endoscopy are underutilized due to the unclear organization of work of existing departments, the slow introduction into practice of new forms of management and labor organization of medical personnel, the scattering of specialists involved in endoscopy among other specialized services, and the lack of highly effective endoscopic diagnostic and treatment programs and algorithms.

In some cases, expensive endoscopic equipment is used extremely irrationally due to poor training of specialists, especially in surgical endoscopy, and lack of proper continuity in work with doctors of other specialties. The load on one endoscope with fiber optics is 2 times lower than the standard.

Certain difficulties in organizing the service are due to the lack of the necessary regulatory framework, recommendations for optimizing the structure and staffing, and the range of studies in endoscopy units of various capacities.

The quality of endoscopic equipment produced by domestic enterprises does not fully meet modern technical requirements.

In order to improve the organization of the endoscopy service and increase the efficiency of its work, the rapid introduction of new diagnostic and therapeutic methods, including surgical endoscopy, as well as improving personnel training and technical equipment of departments with modern endoscopic equipment

1. Regulations on the chief freelance specialist in endoscopy of the Ministry of Health and Medical Industry of the Russian Federation and health authorities of the constituent entities of the Russian Federation (Appendix 1).

2. Regulations on the department, unit, endoscopy room (Appendix 2).

3. Regulations on the head of the department, department, endoscopy room (Appendix 3).

4. Regulations on the endoscopist of the department, department, endoscopy room (Appendix 4).

5. Regulations on the head nurse of the department, endoscopy department (Appendix 5).

6. Regulations on the nurse of the department, department, endoscopy room (Appendix 6).

7. Estimated time standards for endoscopic examinations, therapeutic and diagnostic procedures, operations (Appendix 7).

8. Instructions for the use of estimated time standards for endoscopic examinations (Appendix 8).

9. Instructions for the development of estimated time standards when introducing new equipment or new types of research and treatment (Appendix 9).

10. Qualification characteristics of the endoscopist (Appendix 10).

12. Methodology for calculating prices for endoscopic examinations (Appendix 12).

13. Journal of registration of studies performed in the department, department, endoscopy room - form N 157/u-96 (Appendix 13).

14. Instructions for filling out the Register of studies performed in the department, unit, endoscopy room - form N 157/u-96 (Appendix 14).

15. Addition to the list of forms of primary medical documentation (Appendix 15).

1. To the Ministers of Health of the republics within the Russian Federation, heads of health authorities and institutions of territories, regions, autonomous entities, the cities of Moscow and St. Petersburg:

1.1. During 1996, develop and implement the necessary measures to form a unified endoscopy service in the territory, including diagnostic, therapeutic and surgical endoscopy, taking into account the profile of medical institutions and local conditions.

1.2. When planning a network of endoscopy units, pay special attention to their organization in primary care institutions, including rural healthcare.

1.3. Appoint the main freelance endoscopy specialists and organize their work in accordance with the regulations approved by this order.

1.4. Involve departments of research institutes, educational universities and postgraduate educational institutions in organizational, methodological and advisory work on endoscopy.

1.5. Organize the work of departments, departments, endoscopy rooms in accordance with this order.

1.6. Establish the number of personnel in departments, departments and endoscopy rooms in accordance with the volume of work based on the estimated time standards for endoscopic examinations.

1.7. Take the necessary measures to maximize the use of endoscopic equipment with fiber optics, ensuring the load on the device is at least 700 studies per year.

1.8. Provide regular training to medical doctors on current issues of endoscopy.

2. The Department of Organization of Medical Care to the Population (A.A. Karpeev) to provide organizational and methodological assistance to health authorities on the organization and functioning of endoscopy services in the territories of the Russian Federation.

3. The Department of Educational Institutions (Volodin N.N.) to supplement the training programs for training specialists in endoscopy in educational institutions of postgraduate training, taking into account the introduction into practice of modern equipment and new research methods.

4. The Department of Scientific Institutions (O.E. Nifantiev) to continue work on creating new endoscopic equipment that meets modern technical requirements.

5. Rectors of institutes for advanced training of doctors must ensure in full the applications of health care institutions for the training of endoscopists in accordance with the approved standard programs.

6. Consider the order of the Ministry of Health of the USSR N 1164 of December 10, 1976 “On the organization of endoscopy departments (rooms) in medical institutions”, appendices NN 8, 9 to the order of the Ministry of Health of the USSR N 590 of April 25, 1986, to be considered invalid for institutions of the system of the Ministry of Health and Medical Industry of Russia. “On measures to further improve the prevention, early diagnosis and treatment of malignant neoplasms” and order of the USSR Ministry of Health N 134 of February 23, 1988 “On approval of estimated time standards for endoscopic examinations and therapeutic and diagnostic procedures.”

By order of the USSR Ministry of Health of April 25, 1986 N 590, order of the USSR Ministry of Health of December 10, 1976 N 1164 was declared invalid

7. Entrust control over the execution of the order to Deputy Minister A.N. Demenkov.

222 order endoscopy

MINISTRY OF HEALTH AND MEDICAL INDUSTRY OF THE RUSSIAN FEDERATION
ORDER of May 31, 1996 N 222
ON IMPROVING ENDOSCOPY SERVICE IN HEALTH CARE INSTITUTIONS OF THE RUSSIAN FEDERATION

INSTRUCTIONS FOR DEVELOPING ESTIMATED TIME STANDARDS FOR IMPLEMENTING NEW EQUIPMENT OR NEW TYPES OF RESEARCH AND TREATMENT

When introducing new diagnostic methods and technical means for their implementation, which are based on different research methodology and technology, new content of medical staff’s work, the absence of estimated time standards approved by the Ministry of Health and Medical Industry of Russia, they can be developed on the spot and agreed upon with the trade union committee in those institutions where they are being introduced new techniques. The development of new calculation standards includes taking time measurements of the actual time spent on individual elements of labor, processing this data (according to the methodology outlined below), and calculating the time spent on the study as a whole. Before timing, a list of technological operations (main and additional) for each method is compiled. For these purposes, it is recommended to use the methodology applied in compiling a universal list of labor elements for technological operations. In this case, it is possible to use the “List” itself. “, adapting each technological operation to the technology of a specific new diagnostic or treatment method.

Timing is carried out using sheets of timing measurements, which consistently set out the names of technological operations and the time of their implementation. Processing the results of timing measurements includes calculating the average time spent, determining the actual and expert repeatability coefficient for each technological operation and the estimated time to complete the study under study.

UNIVERSAL LIST OF LABOR ELEMENTS FOR TECHNOLOGICAL OPERATIONS, RECOMMENDED WHEN DEVELOPING ESTIMATED TIME STANDARDS

1. Conversation with the patient
2. Study of medical documentation
3. Preparation for the study
4. Hand washing
5. Consultation with your doctor
6. Conducting research
7. Advice and recommendations for the patient
8. Consultation with the manager. department
9. Processing of the apparatus and instruments
10. Registration of honey. documentation
11. Registration of biopsy material
12. Entry in the log book

The average time spent on an individual technological operation is determined as the arithmetic average of all measurements. The actual repeatability factor of technological operations in each study is calculated using the formula:

where K is the actual repeatability coefficient of the technological operation; P is the number of timed studies using a specific research method in which this technological operation took place; N is the total number of the same timed studies. The expert coefficient of repeatability of a technological operation is determined by the most qualified doctor - an endoscopist who knows this technique, based on the existing experience in using the method and professional understanding of the proper repeatability of the technological operation. The estimated time for each technological operation is determined by multiplying the average actual time spent on a given timing operation by the expert coefficient of its repeatability. The estimated time to complete the study as a whole is determined separately for the doctor and the nurse as the sum of the estimated time to complete all technological operations using this method. After approval by the order of the head of the medical institution, it is the estimated time limit for performing this type of research in this institution. To ensure the reliability of local time standards and their correspondence to the true time spent, not dependent on random causes, the number of studies subject to time measurements should be as large as possible, but not less than 20 - 25.

It is possible to develop local time standards only when the personnel of the department, department, office have mastered the methods well enough, when they have developed a certain automatism and professional stereotypes in performing diagnostic and therapeutic manipulations. Before this, research is carried out in the order of mastering new methods, within the time spent on other types of activities.

Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV

QUALIFICATIONS OF AN ENDOSCOPIST DOCTOR

The level of an endoscopist is determined taking into account the volume and quality of the work performed, the availability of theoretical training in the field of basic and related specialties, and the regularity of training in specialized educational institutions that have a special certificate. The assessment of the practical training of an endoscopist is carried out under the guidance of the endoscopic unit and the institution at the specialist’s place of work. The general opinion is reflected in the performance characteristics from the place of work. Theoretical knowledge and compliance of practical skills with the current level of endoscopy development are assessed during certification cycles conducted by endoscopy departments.

In accordance with the requirements of the specialty, the endoscopist must know, be able to, and master:

prospects for the development of endoscopy;

fundamentals of healthcare legislation and policy documents defining the activities of healthcare authorities and institutions in the field of endoscopy;

general issues of organizing planned and emergency endoscopic care in the country for adults and children, ways to improve endoscopic services;

organization of medical care in military field conditions during mass casualties and disasters;

etiology and ways of spreading highly infectious diseases and their prevention;

work of an endoscopist in the conditions of insurance medicine;

topographic anatomy of the bronchopulmonary apparatus, digestive tract, abdominal and pelvic organs, anatomical and physiological features of childhood;

the causes of pathological processes that an endoscopist usually encounters;

diagnostic and therapeutic capabilities of various endoscopic methods;

indications and contraindications for diagnostic, therapeutic and surgical esophagogastroduodenoscopy, colonoscopy, laparoscopy, bronchoscopy;

methods of processing, disinfection and sterilization of endoscopes and instruments;

principles, techniques and methods of pain relief in endoscopy;

clinical symptoms of major surgical and therapeutic diseases;

principles of examination and preparation of patients for endoscopic methods of examination and management of patients after examinations;

equipment for endoscopy rooms and operating rooms, safety precautions when working with equipment;

design and principle of operation of endoscopic equipment and auxiliary instruments used in various endoscopic studies.

collect anamnesis and compare the information obtained with the data of the available medical documentation for the patient in order to select the desired type of endoscopic examination;

independently carry out simple examination methods: digital examination of the rectum in case of bleeding, palpation of the abdomen, percussion and auscultation of the abdomen and lungs;

identify the patient’s allergic predisposition to anesthetics in order to correctly determine the type of anesthesia under which endoscopic examination will be performed;

determine indications and contraindications for performing a particular endoscopic examination; — teach the patient how to behave correctly during an endoscopic examination;

choose the optimal type and type of endoscope (rigid, flexible, with end, end-side or just side optics) depending on the nature of the planned endoscopy;

master the methods of local infiltration anesthesia, local anesthesia of the pharyngeal ring and tracheobronchial tree;

knowledge of biopsy methods and the ability to perform them is required;

knowledge of medical documentation and research protocols;

ability to compile a report on the work done and analyze endoscopic activities.

3. Special knowledge and skills:
A specialist endoscopist must know prevention, clinical presentation and treatment, be able to diagnose and provide the necessary assistance for the following conditions:

intraorgan or intra-abdominal bleeding that occurred during an endoscopic examination;

perforation of a hollow organ;

acute cardiac and respiratory failure;

arrest of breathing and cardiac activity.

A specialist endoscopist must know:

clinic, diagnosis, prevention and principles of treatment of major lung diseases (acute and chronic bronchitis, bronchial asthma, acute and chronic pneumonia, lung cancer, benign lung tumors, disseminated lung diseases);

clinic, diagnosis, prevention and treatment of major diseases of the gastrointestinal tract (esophagitis, gastritis, ulcerative lesions of the stomach and duodenum, cancer and benign tumors of the stomach, duodenum and colon, diseases of the operated stomach, chronic colitis, hepatitis and liver cirrhosis, pancreatitis and cholecystitis, tumors of the hepato-pancreatoduodenal zone, acute appendicitis);

master the technique of esophagogastroduodenoscopy, colonoscopy, bronchoscopy, laparoscopy, using all techniques for a detailed examination of the mucous membrane of the esophagus, stomach, duodenum during esophagogastroduodenoscopy, all parts of the colon and terminal ileum during colonoscopy;

tracheobronchial tree, up to the bronchi of the 5th order - during bronchoscopy, serous integument, as well as the abdominal organs of the abdominal cavity - during laparoscopy;

visually clearly determine the anatomical boundaries of physiological narrowings and sections of the organs being studied;

correctly assess the responses of the sphincter apparatus of the organs being studied in response to the introduction of an endoscope and air;

under conditions of artificial lighting and some magnification, it is correct to distinguish macroscopic signs of the normal structure of the mucous, serous integuments and parenchymal organs from pathological manifestations in them;

perform targeted biopsy from pathological foci of the mucous membranes of the serous integument and abdominal organs;

orient and fix the biopsy material for histological examination;

correctly make smears - prints for cytological examination;

remove and take ascitic fluid, effusion from the abdominal cavity for cytological examination and culture;

based on the identified microscopic signs of changes in the mucous, serous covers or tissues of parenchymal organs, determine the nosological form of the disease;

clinic, diagnosis, prevention and treatment of major diseases of the pelvic organs (benign and malignant tumors of the uterus and appendages, inflammatory diseases of the appendages, ectopic pregnancy).

4. Research and manipulation:

bronchofibroscopy and rigid bronchoscopy;

targeted biopsy from mucous membranes, serous tissues and abdominal organs;

removal of foreign bodies from the tracheobronchial tree, upper gastrointestinal tract and colon during endoscopic examination;

local hemostasis during esophagogastroduodenoscopy;

endoscopic removal of benign tumors from the esophagus and stomach; - expansion and dissection of scar and postoperative narrowing of the esophagus;

papillosphincterotomy and virsungotomy and removal of stones from the ducts;

installation of a feeding tube;

drainage of the abdominal cavity, gall bladder, retroperitoneal space;

removal of pelvic organs during laparoscopy according to indications;

removal of abdominal organs during laparoscopy according to indications;

removal of retroperitoneal organs under endoscopic control according to indications.

Depending on the level of knowledge, as well as on the basis of work experience, quantity, quality and type of diagnostic tests and therapeutic interventions performed, the certification commission decides on assigning the appropriate qualification category to the endoscopist.

Head of the Department of Organization of Medical Care to the Population
A.A.KARPEEV

www.laparoscopy.ru

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The organizational and staffing structure of the endoscopy department is regulated by Appendix No. 2 of the order of the Ministry of Health of the Ministry of Health of the Russian Federation No. 222 dated May 31, 1996.

The preamble of Order No. 222 of May 31, 1996, “On improving the endoscopy service and healthcare institutions of the Russian Federation,” clearly states the advantages of endoscopy and its role in clinical medicine.

In Appendix No. 2 of this order, all organizational aspects are briefly summarized. Thus, clause 7 states that “the equipment of a department, department, office is carried out in accordance with the level and profile of the medical institution”, and in clause 8 - “the staff of medical and technical personnel is established in accordance with the recommended staffing standards, carried out or the planned amount of work and, depending on local conditions, based on the estimated time standards for conducting various studies.” The phrase “depending on local conditions” can be interpreted quite broadly, both in favor of endoscopy and against it.

In the canceled appendices No. 8 and 9 of the order of the USSR Ministry of Health No. 590 of 1986 “On measures to further improve the prevention, early diagnosis and treatment of malignant neoplasms,” the issues of equipment and composition of the endoscopy department were covered in detail and the ratio of the rates of middle and junior staff in relation to to the staff of an endoscopist. Also, staffing standards for medical personnel in the endoscopy department (office) of a medical institution were established and the time frame for all endoscopic examinations was regulated, both in minutes and in conventional units.

All subsequent orders, having canceled the effect of Appendices No. 8 and 9 of Order No. 590, created a certain confusion in the organization of the endoscopic service, allowing health care organizers to freely interpret the number of staff rates for endoscopic services, especially in the number of rates for middle and junior staff. This concerns, first of all, Order No. 134 of the USSR Ministry of Health dated February 23, 1988 “On approval of estimated time standards for endoscopic examinations and therapeutic and diagnostic procedures,” as well as the currently valid Order No. 222 of the Ministry of Health of the Ministry of Health of the Russian Federation dated May 31. 96 “On improving the endoscopy service in healthcare institutions of the Russian Federation.”

222 order on endoscopy new

Endoscopic service in Russia began to emerge in the 70s of the 20th century. At the first stages, it was represented by scattered diagnostic rooms at large medical clinics and research centers. In those years, completely unsuitable premises were allocated for endoscopy rooms, since the presence of the latter was not provided for when designing the buildings. In most health care facilities, to this day, the premises of endoscopy rooms and departments do not meet sanitary and epidemiological standards.

The personnel potential of endoscopy was initially formed by part-time workers, often surgeons and therapists.

The first documents regulating the work of the new direction in medicine were: order of the USSR Ministry of Health No. 1164 dated December 10, 1976 “On the organization of endoscopic departments (rooms) in medical institutions”, appendices No. 8, 9 to the order of the USSR Ministry of Health No. 590 dated 25 April 1986 “On measures to further improve the prevention, early diagnosis and treatment of malignant neoplasms” and order of the USSR Ministry of Health No. 134 of February 23, 1988 “On approval of estimated time standards for endoscopic examinations and therapeutic and diagnostic procedures.” At that time, few people realized that these first steps in the development of endoscopy would entail titanic shifts in the entire medical industry.

On the one hand, the information content of visual observation, as experience accumulated, radically changed scientific views on the etiology, pathogenesis, and pathological anatomy of diseases, which, in turn, entailed a complete revision of the methodological aspects of diagnosis and treatment of most of the most common diseases. On the other hand, thanks to scientific and technological progress in the 90s, endoscopy began to leave the diagnostic sphere and displace traditional surgery, radically changing and improving the very technique of surgical interventions. As it seemed to us then, a new section called “minimally invasive surgery” was emerging in surgery. Today we can confidently state the fact that then a whole era of modern surgery called “endoscopic surgery” was born. In parallel with the practical priority, the geography expanded. Endoscopic methods of diagnosis and treatment spread more and more widely to regional treatment and preventive institutions.

The understanding began to come that endoscopy is an independent direction in medicine, it is advisable to organize separate endoscopic departments in medical institutions, and train endoscopists from surgeons. It is at this time that issues of organization and regulations for the work of this service are raised. On May 31, 1996, the Ministry of Health of the Russian Federation issues order No. 222 “On improving the endoscopy service in healthcare institutions of the Russian Federation.” The order emphasizes that due to shortcomings in the organization of work of existing endoscopic units, the slow introduction into practice of new forms of management and organization of work of medical personnel, the scattering of specialists involved in endoscopy among other specialized services, the lack of highly effective endoscopic diagnostic and treatment programs and algorithms, This medical area is not receiving proper development. The order reflected the provisions on the chief freelance specialist; about the department, division, endoscopy room; about the head, endoscopist, senior nurse, nurse of the endoscopy department. Calculated time standards for endoscopic examinations, therapeutic and diagnostic procedures, and operations were also introduced; an approximate list of the minimum volume of endoscopic examinations for medical institutions is recommended; a methodology for calculating prices for endoscopic examinations, primary medical documentation and processing of endoscopes has been approved. The order had a lot of shortcomings, however, at that stage of the development of endoscopy, its publication ensured further progress in the development of endoscopy.

Over the past 20 years, endoscopy has undergone revolutionary changes in both qualitative and quantitative aspects. Modern digital video endoscope systems provide high-precision images with varying degrees of magnification and color gamut. It became possible to perform endoscopic microscopy. Endoscopic surgery is present in almost all branches of medicine. But there are still a lot of unresolved issues that, directly or indirectly, hinder the development of endoscopy in our country.

The first open question is logistics and financing. Unfortunately, the years of perestroika caused enormous damage to the country's healthcare system in general and endoscopy in particular. Enterprises involved in the production of domestic fiber endoscopes were bankrupt and liquidated, and foreign analogues turned out to be prohibitively expensive both in terms of acquisition and in terms of operation and repair. In this regard, compared to the West, where the share of modern digital endoscopes is 96%, in the Russian Federation it does not exceed 39%. In such a huge country as Russia, there are 31,237 units of endoscopic equipment, of which 16,842 gastroscopes, 6,061 colonoscopes, 5,618 bronchoscopes, 2,531 duodenoscopes and 185 ultrasound endoscopes. Most of them have been repaired several times and have long been technically obsolete. According to the Ministry of Health of the Russian Federation, wear and tear of the endoscope fleet is 67%. There are no regulations on the use of endoscopic technology in our country. In recent years, thanks to stricter sanitary requirements, old models of “non-submersible” endoscopes have begun to be withdrawn from practice. But even this has not been done everywhere. The monopoly of foreign manufacturers on the repair of endoscopes allows tens, or even hundreds of times, to exceed the real cost of eliminating technical faults. Until domestic production of endoscopic equipment is established in the country, these abuses will continue to occur.

The same monopoly system is thriving in the market for high-level endoscope disinfectants. When entering into technical support contracts, endoscope manufacturers reserve the right to recommend, and indeed dictate, the chemistries suitable for their devices. Of course, there are no domestic analogues on this list. If the recommendations are not followed, manufacturers will remove the warranty from endoscopes.

Another exorbitant cost is the purchase of endoscopic instruments. According to the new sanitary rules SP 3.1.3263-15, only sterile instruments are allowed for use in endoscopy, regardless of sterile or non-sterile examination. If you carefully study the catalogs of endoscopic instruments for fiber-fiber devices, then almost all of them are disposable and are not subject to subsequent sterilization. No medical institution in Russia can afford such luxury. Most often, either a disposable instrument is used as a reusable one and subjected to various methods of sterilization, or they are limited to high-level disinfection, turning a blind eye to sanitary requirements. Positive dynamics in the last two years have begun to be observed in import substitution, unfortunately, so far only for certain types of endoscopic instruments. But even these first steps are very encouraging.

The second, pressing issue in the organization of endoscopy is the attraction and training of personnel. There are about 6 thousand endoscopists and the same number of endoscopic nurses in the Russian Federation. New requirements for admission to primary specialization in endoscopy require that the specialist have a certificate in surgery. This is completely justified, since even the most technically basic endoscopic examination is accompanied by penetration into the patient’s internal organs, carries the risk of damage to organs and tissues, is fraught with the development of various complications and, accordingly, should be equated to the level of complexity and risks of surgical intervention. Over the past 15 years, the increase in operational activity in endoscopy has been more than 400%. No other area of modern medicine is developing as rapidly as endoscopy. This is one of the main ways to modernize healthcare in the Russian Federation. However, most medical universities still do not provide endoscopy courses to students. This is a huge gap at the current stage of development of medicine. Endoscopy has won the right to be taught as a separate course, along with radiology, radiation diagnostics, etc.

For many years, the issue of remuneration for endoscopists and nursing staff in endoscopy departments and the issue of providing this category of workers with a preferential pension remained open. A big drawback of the still valid order of the Ministry of Health of the Russian Federation No. 222 of May 31, 1996 is the absence of a clearly stated provision in it that endoscopy is a surgical profile, endoscopists enjoy all the benefits, like surgeons. This gap has widely allowed pension fund workers to interpret endoscopists' rights "at their own discretion." Plus, a lot of organizational mistakes in past years made locally by chief doctors did not allow many specialists in this field to take advantage of preferential pensions. In judicial practice, many contradictions and disagreements have accumulated on these issues, which also need to be taken into account and prevented in the future. The most typical organizational errors that did not allow endoscopic personnel to take advantage of the preferential pension:

1. According to the order of the Ministry of Health of the Russian Federation No. 222 dated May 31, 1996, the endoscopy room or department is a structural unit of a medical institution with direct subordination to the chief physician or his deputy for medical work. Often, the chief physicians of clinics assigned the endoscopic department to the structure of the clinic with direct subordination to the deputy chief physician for the clinic. On the one hand, this created convenience for examinations of outpatients, excluding their flow to the hospital, and on the other hand, it deprived endoscopists of the status of an inpatient doctor, which affected the level of wages and gave rise to the refusal to provide a preferential pension. If you look at it more broadly, the nature of the work of the staff of the endoscopy department in the clinic and in the hospital is no different, so this should not in any way affect the provision of preferential pensions to employees.

2. Heads of endoscopy departments, by order of the Ministry of Health of the Russian Federation No. 222 of May 31, 1996, are not exempt; they are required to perform the same number of manipulations as a resident doctor. However, the pension fund does not take this into account and the heads of departments refuse to provide a preferential pension.

3. Order of the Ministry of Health of the Russian Federation No. 222 of May 31, 1996 provides for maintaining a log of endoscopic manipulations. When assigning preferential pensions to endoscopists, the pension fund often requests a so-called operating log, which is not provided in endoscopy departments. Its absence becomes the basis for refusal to receive a preferential pension for endoscopists.

In recent years, the sanitary and epidemiological requirements for the work of the endoscopic department in medical institutions have also increased. The new sanitary and epidemiological rules SP 3.1.3263-15 “Prevention of infectious diseases during endoscopic interventions” differentiated endoscopic interventions into sterile and non-sterile, radically changing the requirements for the processing of endoscopes, their instruments, equipment and premises. The processing process itself, maintaining a lot of additional documentation (up to 7 journals per office) require additional time expenditure from middle and junior medical personnel, not provided for by Order of the Ministry of Health of the Russian Federation No. 222 of May 31, 1996. In this regard, many contradictions arose in the organizational issues of the endoscopy department. Let's list some of them.

1. According to SP 3.1.3263-15, only the process of processing one endoscope, taking into account the use of the most expensive and fast-acting agents, takes a nurse 47 minutes, instead of 17 minutes by order of the Ministry of Health of the Russian Federation No. 222 of May 31, 1996. This makes compliance with the old operating time standards for the endoscopy department impossible.

2. All actions related to the processing of endoscopes, instruments, the workplace, the operation of bactericidal lamps, oxygen supply devices, testing the quality of cleaning, etc. the nurse records in the appropriate journals. This is also not provided for by Order of the Ministry of Health of the Russian Federation No. 222 dated May 31, 1996 and forces you to waste additional time.

3. The universal list of labor elements for technological operations, recommended when developing estimated time standards for an endoscopist, has also expanded. Additional time is spent on drawing up a contract for the provision of services and the patient’s informed consent, registering data in digital format, and printing photos and videos of the study.

In connection with the above, there is an urgent need to revise the universal list of labor elements in endoscopy and the estimated time standards. This will undoubtedly improve the quality of endoscopy-related medical care.

A separate issue is the organization and development of combined types of research in endoscopic departments: X-ray endoscopy, ultrasound endoscopy, confocal endoscopy, etc., which require additional material resources, attraction and training of qualified personnel, and again, increased time costs.

All these questions are even more painful for endoscopy in pediatrics. Thinner children's endoscopes are distinguished, on the one hand, by their high cost, and on the other, by increased fragility. Endoscopic manipulations in children themselves require anesthesia, which significantly increases their cost. That is why this type of endoscopy has not yet received proper distribution. But it is children who often experience emergency situations requiring endoscopic intervention.

From our analysis, we can identify the following main directions in solving the problems of further development of endoscopy:

1. Improving the regulatory framework in endoscopy. Order of the Ministry of Health of the Russian Federation dated May 31, 1996 No. 222 “On improving the endoscopy service in healthcare institutions of the Russian Federation” is long outdated and does not meet modern requirements. There is an urgent need to develop and implement a new “Procedure for providing endoscopic care to adults and children in the Russian Federation,” taking into account all of the above contradictions.

2. Implementation of the import substitution program in endoscopy. Creation of domestic endoscopic equipment complexes with subsequent service support, reusable endoscopic instruments, detergents and disinfectants.

3. Optimization of personnel policy. A clear definition of endoscopy as a surgical specialty, with the provision of providing employees with all relevant benefits, including on the basis of the Federal Law of December 17, 2001 No. 173 (as amended on December 31, 2002) Art. 28 clause 11 “On labor pensions in the Russian Federation” and Russian Government Decree No. 781 of October 29, 2002. . Isolation of endoscopy as a separate direction in the course of teaching to students of medical universities.

www.science-education.ru

ORDER of May 31, 1996 N 222 ON IMPROVING ENDOSCOPY SERVICE IN HEALTH CARE INSTITUTIONS OF THE RUSSIAN FEDERATION

The development of endoscopic technology in recent decades, based on the use of fiber optics, has significantly expanded the use of minimally invasive instrumental research methods in medical practice. Currently, endoscopy has become quite widespread both in the diagnosis and treatment of various diseases. A new direction has appeared in medical practice - surgical endoscopy, which makes it possible to achieve a pronounced economic effect while maintaining the therapeutic result by significantly reducing the length of hospitalization and the cost of treating patients.

The advantages of endoscopic methods ensure the rapid development of this service in the Russian Federation. Over the past 5 years, the number of endoscopy departments and rooms in medical institutions has increased by 1.7 times, and their equipment with endoscopic equipment has increased by 2.5 times. From 1991 to 1995, the number of endoscopists increased 1.4 times; 35% of specialists have qualification categories (1991 - 20%). The scope of performed research and treatment procedures is constantly expanding. Compared to 1991, their number increased by 1.5 and 2 times, respectively. In 1995, 142.7 thousand operations were performed using endoscopic technology. In a number of areas of the country, a 24-hour emergency endoscopic care service has been created, which can significantly improve indicators in emergency surgery, traumatology and gynecology. Computer programs have been developed and are being actively implemented to evaluate the results of endoscopic studies.

At the same time, there are serious shortcomings and unresolved problems in organizing the activities of the endoscopy service. Only 38.5 percent of hospitals in rural areas, 21.7 percent of dispensaries (including 8 percent for tuberculosis), and 3.6 percent of outpatient clinics have endoscopy units. Only 17 percent of the total number of endoscopy specialists work in health care facilities located in rural areas. In the staffing structure of endoscopists, there is a high proportion of part-time doctors from other specialties. The capabilities of endoscopy are underutilized due to the unclear organization of work of existing departments, the slow introduction into practice of new forms of management and labor organization of medical personnel, the scattering of specialists involved in endoscopy among other specialized services, and the lack of highly effective endoscopic diagnostic and treatment programs and algorithms. In some cases, expensive endoscopic equipment is used extremely irrationally due to poor training of specialists, especially in surgical endoscopy, and lack of proper continuity in work with doctors of other specialties. The load on one endoscope with fiber optics is 2 times lower than the standard. Certain difficulties in organizing the service are due to the lack of the necessary regulatory framework, recommendations for optimizing the structure and staffing, and the range of studies in endoscopy units of various capacities. The quality of endoscopic equipment produced by domestic enterprises does not fully meet modern technical requirements

In order to improve the organization of the endoscopy service and increase the efficiency of its work, the rapid introduction of new diagnostic and treatment methods, including surgical endoscopy, as well as improving personnel training and technical equipment of departments with modern endoscopic equipment, I affirm:

2. Regulations on the department, department, endoscopy room (Appendix 2).

3. Regulations on the head of the department, department, endoscopy room (Appendix 3).

4. Regulations on the doctor - endoscopist of the department, department, endoscopy room (Appendix 4).

5. Regulations on the head nurse of the department, endoscopy department (Appendix 5).

6. Regulations on the nurse of the department, department, endoscopy room (Appendix 6).

7. Estimated time standards for endoscopic examinations, therapeutic and diagnostic procedures, operations (Appendix 7).

8. Instructions for the use of estimated time standards for endoscopic examinations (Appendix 8).

9. Instructions for the development of estimated time standards for the introduction of new equipment or new types of research and treatment (Appendix 9).

10. Qualification characteristics of the endoscopist (Appendix 10).

12. Methodology for calculating prices for endoscopic examinations (Appendix 12).

13. Journal of registration of studies performed in the department, department, endoscopy room - form N 157/u-96 (Appendix 13).

14. Instructions for filling out the Register of studies performed in the department, unit, endoscopy room - form N 157/u-96 (Appendix 14).

15. Addition to the list of forms of primary medical documentation (Appendix 15).

1.2. When planning a network of endoscopy units, pay special attention to their organization in primary care institutions, including rural healthcare.

1.3. Appoint the main freelance endoscopy specialists and organize work in accordance with the Regulations approved by this Order.

1.4. Involve departments of scientific research institutes, educational universities and postgraduate educational institutions in organizational, methodological and advisory work on endoscopy.

1.5. Organize the work of departments, departments, endoscopy rooms in accordance with this Order.

1.6. Establish the number of personnel in departments, departments and endoscopy rooms in accordance with the volume of work based on the estimated time standards for endoscopic examinations.

1.7. Take the necessary measures to maximize the use of endoscopic equipment with fiber optics, ensuring the load on the device is at least 700 studies per year.

1.8. Provide regular training to medical doctors on current issues of endoscopy.

4. The Department of Scientific Institutions (O.E. Nifantiev) to continue work on creating new endoscopic equipment that meets modern technical requirements.

6. Consider as invalid for institutions of the Russian Ministry of Health and Medical Industry Order of the USSR Ministry of Health N 1164 of December 10, 1976 “On the organization of endoscopy departments (rooms) in medical institutions”, appendices N 8, 9 to Order of the USSR Ministry of Health N 590 of April 25, 1986 “On measures to further improve the prevention, early diagnosis and treatment of malignant neoplasms” and Order of the USSR Ministry of Health No. 134 of February 23, 1988 “On approval of estimated time standards for endoscopic examinations and therapeutic and diagnostic procedures.”

7. Entrust control over the execution of the Order to Deputy Minister A.N. Demenkov.

Minister of Health and Medical Industry of the Russian Federation A.D. TSAREGORODTSEV

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