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Section 8. Medical science
As a whole, according to the results of the research:
1. Estimation of activity efficiency of 684 home nursing nurses in 96 rural medical centers of 5 regions of the Republic has been introduced and enabled:
- To increase the quality of dyspanserization of local population, consequently raised patients detection and the number of hospitalized ones. So, the number of patients reffered to the hospitals from medical centers elevated from 53.1 % to 58.5 %.
- To minimize the number of patients treated in the departments of emergency care during the period of 9 month, 2013 - 9 month, 2014 from 12.8 % to 11.6 % in the correlation to the general number of treated patients in the hospitals also, the number of calls to first-aid to 4 %, this certifies the proper prophylaxis work timely reveal and planned treatment of the patients in rural medical centers included into the experiment
- To lower the number of patients reffered to labour medical examination during 9 month, 2013 - 9 month, 2014 to 5 %, and the number of sick leaves given to the patients in this period to 12.9 %.
2. Recommendations on estimation mechanisms in rural medical centers proved by Introductions of ministry of Health of the Republic of Uzbekistan on January 5th 2015 hae been worked out and are being introduced in 319 RMC of 18 regions of the Republic.
Conclusion:
- The system of self — estimation of therapeutic — prophylactic institutions (TPI) can be used for any type level of Healthcare institutions, as it gives the opportunity to motivate
the process of medical help administration, to receive objective marks based on the facts and it is directed to increase in formativeness of the institutions of Healthcare on existing problems, demanding the solutions.
- The estimation of experts requires disciplinary skills, so the experts team has to include specialists of all main directions for determination of exact problems requiring improvement.
- For the successful process of accreditation and taking categories, the personnel have to study and adopt the changes of the management of their institution into the standards and indicators of accreditation.
- The introduction of scientifically proved model of RMC accreditation into practical Healthcare provides the improvement of medical help quality without any exive directions foe state level, it means, it can be applideternal investment and resources.
- Standards and indicators of accreditation worked out for the management system of medical help quality in primary healthcare unit can be sugested to be used in the system of financial support of medical workers.
- Scientifically proved organizing model of accreditation of primary healthcare units enables to determine prioritive directions for state level, it means, it can be applied for accreditation of other medical institutions of the Republic of Uzbekistan.
- Taking into account the system structure formed in republic healthcare, evaluation of Completeness and quality of medical help administration in RMCs can be suggested as intermediate stage before introducing of accreditation in the republic.
References:
1. About measures on further strengthening of reforms system of Healthcare. - Resolution of the President of Republic of Uzbekistan of November 28th, 2011. - № 1652.
2. Temporary principles order of legalization of GPs.//Healthcare of Uzbekistan. - Tashkent, 2006. - № 2. - Р. 4-5.
3. Grebenyuk I. V Legalization in the field of Healthcare.//Chef Nurse. - 2000. - № 3. - Р. 155-158.
4. Larin A. B., Tyukov Yu. A. Development of law standards of legalization in healthcare.//Economy and management matters for director in healthcare. - M., 2008. - № 1. - Р. 5-10.
5. About measures on fur the development of the order of legalization in medical activity. Resolution of the Cabinet of the Republic of Uzbekistan of April 3rd, 2008. - № 61.
6. Kochorova L. V. Actual matters of legalization and accreditation of psychiatric services and perspectives of their development in St.Petersburg.//Russia psychiatric journal. - 2001. - № 1. - Р. 61-63.
7. Minn L. State accreditation of healthcare institutions in France.//Russia psychiatric journal. - 2001. - № 3. - Р. 57-60.
Yusupaliev Bakhodir Kahramonovich, Tashkent institute of doctor's post-graduate education, Assistant of department of public health care E-mail: yusupaliev.b@gov.uz
Evaluation of patronage nurse at rural medical centre
Abstract: The system of evaluation quality and effectiveness of medical care must functionate constantly, that allows to get operatively the necessary information for control. By that the main factor of turning from quality evaluation and effectiveness to their increase is education and constantly improvement knowledge and skills
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Evaluation of patronage nurse at rural medical centre
of personnel. The disciplinary measuresor punishments are extreme measures and little effective means of improvement quality for medical care.
Keywords: medical care, patronage, nurse, rural medical centre.
Actuality. The quality of medical care is totality of many features, proving correlation of taken care with patient’s (population) expectations, modern level of medical science and Technology. In 1980 Avedin Donabedian suggested the next determination: “The quality of medical care is defined with use medical science and technology with the highest benefit for human health, by that without risk increase so the level of quality is the degree of achievement for the above mentioned balance of benefit and risk”.
The quality is many — sided problem and, includes adequacy, accessibility, succession and continuity, effectiveness, resultants, safety, timeliness, satisfaction in requirements and expectations, process and results’ stability, constant perfection and improvement [1]. As it is knows, for evaluation of quality (result) the standards and indicator are necessary.
The quality of medical services are: care, treatment, services, being concentrated on patient, practicing by every employee, the level of safety, effectiveness and timeless, those, determine possibility of expected results, and corresponds to modern professional achievements of medicine [2].
The quality control is based, first of all, on results evaluation indices. If they are out of range for the results’ standards, it will be necessary to make out why it was happened, firstly, to analyses the observation of technology standards, and, then, if it is necessary, to control resources’ standards [3].
For all components the standards are made, as, both evaluation and control can be done only with the comparison of standards. By the present we have necessary legislative base, structure, human and material resources, in order to work out the necessary standards at all levels.
The system of evaluation quality and effectiveness of medical care must functionate constantly, that allows to get operatively the necessary information for control. By that the main factor of turning from quality evaluation and effectiveness to their increase is education and constantly improvement knowledge and skills of personnel. The disciplinary measuresor punishments are extreme measures and little effective means of improvement quality for medical care [4].
Purpose of the investigation: Improving of evaluation of patronage nurse at rural medical centre.
Materials and methods: In order to introduce as an experiment, The system of rating evaluation for quality work of patronage medical nurses, and rural medical centers (RMC), in Bostanlik, Uzbekistan, Shahrizabs, Khiva, and Djambay regions of the Republic of Uzbekistan, the temporary regulation was worked out.
The experiment covered 684 patronage nurses, who worked in 96 RMC. From being involved 96 RMC in experiment, 52 % were located on the territory with developed infrastructure, 30 % were in mountain place, 18 % were in steppe zone.
From general number, being involved in experiment 65 % have radius of service to 10 km., 31 % were from 10 to 20 km., 4 % were over 20 km.
Results and discussions. The effectiveness, evaluation of activity for patronage medical nurses was carried out by 9 main directions and 30 indices:
- Indices, determining the volume of performing work in diseases prophylaxy among attaches population (study medical and social state of house keeping (patronage), visiting young families, patronage alone old persons, being in need of care, and, invalids; covering.
Examination of adult population; taking measures on observation infectiousfoci; depending on incubation period of infectious diseases; fluorography examination of population from risk groups).
- Indices, determining volume of carrying out work in prophylaxy of diseases among women of fertile age, pregnant and parturient (visiting pregnant at home (patronage); covering with prophylactic examination of fertile aged woman; patronage of parturient (for 42 days after childbirth).
- Indices, determining volume of carrying out work among children (patronage children under 1 year old at home; patronage children — invalids at home; covering with prophylactic examination children at the age from 1 to 18 years).
- Indicates, determining volume of carrying out work by evaluation and monitoring of physical development children (monitoring of physical development children under 1 year old, from 1 to 3 years old, from 3 to 5 years old, from 5 to 14 years old, from 14 to 18 years old).
- Indices, determining volume of carrying out work in prophylaxy of diseases among children (monitoring of rickets prophylaxy among children under 1 year old, monitoring of breast feeding children under 1 year old).
- Indices, determining volume of carrying about work in vaccination among children (covering with vaccination children of 2 years old, providing control after complications and reactions after vaccination).
- Indices, determining volume of therapeutic work (providing coming patients with chronic diseases system carry out therapeutic measures at home by physician’s administration).
- Indices, determining quality of taking medical documentation (passport of family, diary of patronage medical sister, ambulatory cards of patients).
- Qualitative indices, negatively influencing on total effectiveness indices activity of patronage medical nurses (negative points minusing from total evaluation).
- To register pregnant women in late terms (after 12 weeks of pregnancy) spread infections morbidity on attached territory (untimely observation), presence of cases of maternity mortality, cases of infant’s mortality (under 1 year old).
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Section 8. Medical science
By the evaluation results once a month the special report form was worked out.
The points on indices, determining quality of taking medical documentation, and, also on quality indices, negatively influencing on total indices for effectiveness evaluation of patronage medical nurses (negative points, minusing from total evaluation indices) were made by general practitioner and senior medical nurse in RMC.
The calculation of rating points for effectiveness evaluation activity of patronage medical nurse was carried out according to specially worked out system of points counting.
According to given system the maximum points’, that can be accumulated, is 100 points. In such case the patronage medical sister having to 100 % carries out her functional duties.
In the case of having point in range from 85 to 100 % the functional duties are carried out effectively; from 72 to 85 % is good; from 55 to 72 % is satisfactory, less than 55 % is unsatisfactory.
At the beginning of taken experiment (April 2014) the rating evaluation effectiveness activity of patronage medical nurses showed, that from 684 patronage medical nurses only 16 gathered more than 85 points, and, their activity was evaluated as effective.
In October 2014 the taken secondary rating evaluation showed, that number of effectively working patronage medical nurses, were 67. Together with it, the number of patronage medical nurses, working “good" (rating point was from 72 to 85 %) also was increased in 1.5 times, the number
of unsatisfactory working patronage medical nurses reduced from 14.4 % to 10.6 %.
Conclusion
Introduction of rating system evaluation effectiveness activity of patronage medical nurses allowed:
- To determine clearly functional duties, being responsible patronage medical nurses, and, also, to organize their daily work on planning base.
- To work out control mechanism after activity of patronage medical nurses from the side of general practitioner and senior medical nurse of RMC.
- To increase effectiveness of work for patronage medical nurses.
- To simulate RMC to do their daily work on planning base.
- To improve quality of dispensary system for population, accordingly, to increase revealing of patients and number of hospitalizing patients in inpatient departments.
- To reduce number of patients, being undergone to treatment, in departments of urgent medical care, for the period from 9 months 2013 to 9 month of 2014, from 12.8 % to 11.6 % in relation to general number of having treatment in hospitals, and, also number of carrying out calls of ambulance to 4.6 % witness on planning treatment of patients in RMC, being involved in experiment.
- To reduce number of patients, being directed to examination of labour medical evaluation for from 9 month 2013 to 9 month 2014 to 5 %, and also, number of sick leaves to 12.9 %.
References:
1. Control quality of primary medical sanitation care in Uzbekistan: WHO (documents of World Health Organization). -Copenhagen, 2009. - Р. 94.
2. Control quality in public health: licensing, standardization, clinical and economic analysis: Scientific practical conference. - M., 2005. - w. 11. - Р. 108-150.
3. Mihaylova Y. V. Quality of medical care and its components.//Medical newspaper. - 2005. - Р. 6.
4. Vardosanidze S. L., Lihota A. I. Control quality of medical diagnosis process with use medical standards (minutes). Economy of public health. - 2000. - Р. 10-13.
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