Standards for the provision of medical care in a hospital. On approval of the standard of emergency medical care for hypertension. Medical services for the treatment of a disease, condition and treatment control

Dear colleagues!

In accordance with the Federal Law of December 25, 2018 No. 489-FZ “On Amendments to Article 40 federal law“On Compulsory Health Insurance in Russian Federation” and the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” on Clinical Recommendations”, clinical recommendations are currently defined as a document containing structured information based on scientific evidence on prevention, diagnosis, treatment and rehabilitation.

This Federal Law defines a transitional period until December 31, 2021, necessary for the revision and approval of clinical recommendations in accordance with the norms introduced by the bill. The approved clinical guidelines will contain parameters that reflect the correct choice of diagnostic and treatment methods based on the principles of evidence-based medicine. The application of clinical recommendations will allow medical workers to determine the tactics of managing a patient with a specific nosology at all stages of care. medical care.

Clinical guidelines will be used as the basis for developing other documents regulating the process of providing medical care, including standards and procedures for providing medical care, as well as criteria for assessing the quality of medical care. Thus, at the end of the transition period, a complete system management of the quality of medical care, based on clinical recommendations, taking into account the best world practices.

The Ministry of Health of the Russian Federation issued a number of orders regulating the work on the development of clinical guidelines:

1. Order of the Ministry of Health of Russia dated February 28, 2019 No. 101n "On approval of the criteria for the formation of a list of diseases, conditions (groups of diseases, conditions) for which clinical recommendations are developed." Currently, this list is posted on the website of the Ministry of Health of the Russian Federation https://www.rosminzdrav.ru/poleznye-resursy/nauchno-prakticheskiy-sovet;
2. Order of the Ministry of Health of Russia dated February 28, 2019 No. 102n “On Approval of the Regulations on the Scientific and Practical Council of the Ministry of Health of the Russian Federation”;
3. Order of the Ministry of Health of Russia dated February 28, 2019 No. 103n “On approval of the procedure and timing for the development of clinical recommendations, their revision, standard form clinical recommendations and requirements for their structure, composition and scientific validity of the information included in clinical recommendations”;
4. Order of the Ministry of Health of Russia dated February 28, 2019 No. 104n "On approval of the procedure and terms for the approval and approval of clinical recommendations, the criteria for the scientific and practical council to decide on the approval, rejection or referral for revision of clinical recommendations or the decision to revise them."

According to the order of the Ministry of Health of Russia dated February 28, 2019 No. 103n “Medical professional non-profit organizations develop draft clinical recommendations and organize their public discussion, including with the participation of scientific organizations, educational organizations higher education, medical organizations, medical professional non-profit organizations, their associations (unions) specified in Part 5 of Article 76 of Federal Law N 323-FZ, as well as by posting on the Internet information and telecommunication network.

According to the order of the Ministry of Health of Russia No. 102n dated February 28, 2019, after the development of clinical recommendations, they will be further considered by the Scientific and Practical Council of the Ministry of Health of Russia and approved, rejected or sent for revision in accordance with the terms and criteria regulated by the order of the Ministry of Health of Russia 104n.

With a positive decision of the Scientific and Practical Council of the Ministry of Health of Russia, clinical recommendations are approved by professional non-profit organizations.

In connection with the above, we would like to inform you that the Union of Pediatricians of Russia, a medical professional non-profit organization, has begun developing clinical guidelines for diseases, conditions (groups of diseases, conditions) included in the List for which clinical guidelines should be developed/updated. .

We also inform you that the formation of working groups will be carried out in cooperation with medical professional non-profit organizations in the relevant fields and will include, among other things, specialists providing medical care to patients of the adult age category.

The Union of Pediatricians of Russia widely involves professional communities, as well as scientific, educational organizations and the public.

President of the Union of Pediatricians of Russia,
Chief freelance pediatric specialist in preventive medicine of the Ministry of Health of Russia,
acad. RAS L.S. Namazova-Baranova

Honorary President of the Union of Pediatricians of Russia,
Chief freelance specialist pediatrician of the Ministry of Health of Russia,
acad. RAS A.A. Baranov

• Vaccination of Haemophilus influenzae type b in children
• Vaccination of diseases caused by the human papillomavirus
• Vaccination of pneumococcal infection in children
• Vaccination of rotavirus infection in children
• Very long chain fatty acid acyl-CoA dehydrogenase deficiency in children
• Immunoprophylaxis of meningococcal infection in children

Just a couple of weeks ago, the Faculty of Medical Law introduced readers and subscribers to the list of newly introduced standards of medical care in the article “The Ministry of Health approved new standards of medical care for the use of psychoactive substances” (publication dated July 13, 2016). And here again, the Ministry of Health of Russia "released" a number of other standards of medical care that regulate the rules for providing medical care for extremely serious diseases.

Thus, in July 2016, the following 20 new standards for emergency medical care were approved. Note that not all of these standards are the first of their kind. So, earlier, for some diseases, standards have already been adopted that have become invalid since the adoption of new standards of medical care.

So, in July 2016, the following standards of medical care were adopted, the scope of which had previously been regulated:

• The standard of emergency medical care for bradycardia (approved by the Order of the Ministry of Health of Russia dated July 05, 2016 No. 453n) - comes into force on August 02, 2016. From that moment, the Standard for Emergency Medical Care for Bradyarrhythmias, approved by the Order of the Ministry of Health of Russia dated 07.07.2013 No. 359n, became invalid.
• The standard of emergency medical care for sudden cardiac death (approved by the Order of the Ministry of Health of Russia dated July 5, 2016 No. 454n) - comes into force on July 29, 2016. From that moment, the Standard for emergency medical care for sudden cardiac death, approved by the Order of the Ministry of Health of Russia dated December 20, 2012 No. 1113n, became invalid.
• The standard of emergency medical care for cardiogenic shock (approved by the Order of the Ministry of Health of Russia dated July 05, 2016 No. 455n) - comes into force on July 31, 2016. From that moment, the Standard for emergency medical care for cardiogenic shock, approved by the Order of the Ministry of Health of Russia dated December 24, 2012 No. 1432n, became invalid.
• The standard of emergency medical care for acute coronary syndrome without ST segment elevation (approved by the Order of the Ministry of Health of Russia dated July 05, 2016 No. 456n) - comes into force on July 30, 2016. From this date, the Standard for Emergency Medical Care for Acute Coronary Syndrome without ST Elevation, approved by the Order of the Ministry of Health of Russia dated December 24, 2012 No. 1387n, became invalid.
• The standard of emergency medical care for acute transmural myocardial infarction (approved by the Order of the Ministry of Health of Russia dated July 5, 2016 No. 457n) - comes into force on August 06, 2016. From that moment, the Standard for Emergency Medical Care for Acute Coronary Syndrome with ST-segment Elevation, approved by the Order of the Ministry of Health of Russia dated December 24, 2012 No. 1383n, became invalid.
• The standard of emergency medical care for acute respiratory failure (approved by the Order of the Ministry of Health of Russia dated 05.07.2016 No. 458n) - comes into force on August 06, 2016. From the same date, the Standard for Emergency Medical Care for Acute Respiratory Failure, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1080n, became invalid.
• The standard for emergency medical care for pneumonia (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 459n) - comes into force on July 29, 2016. From this date, the Standard for Emergency Medical Care for Pneumonia, approved by the Order of the Ministry of Health of Russia dated December 24, 2012 No. 1437n, became invalid.
• The standard of emergency medical care for heart failure (approved by the Order of the Ministry of Health of Russia dated 05.07.2016 No. 460n) - comes into force on July 20, 2016. From that moment, the Standard for emergency medical care for heart failure, approved by the Order of the Ministry of Health of Russia dated December 20, 2012 No. 1283n, became invalid.
• The standard of emergency medical care for fainting (syncope) and collapse (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 461n) - comes into force on August 05, 2016. From this date, the Standard for emergency medical care for fainting, approved by Order of the Ministry of Health of Russia dated December 24, 2012 No. 1398n, became invalid.
• The standard of emergency medical care for tachycardia and tachyarrhythmias (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 464n) - comes into force on August 05, 2016. From the same date, the Standard for emergency medical care for tachyarrhythmias, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1284n, became invalid.
• The standard of emergency medical care for acute cerebrovascular accident (approved by Order of the Ministry of Health of Russia dated July 5, 2016 No. 466n) - comes into force on July 29, 2016. From this date, the Standard for Emergency Medical Care for Stroke, approved by the Order of the Ministry of Health of Russia dated December 20, 2012 No. 1282n, became invalid.
• The standard of emergency medical care for convulsions, epilepsy, epileptic status (approved by Order of the Ministry of Health of Russia dated 07/05/2016 No. 468n) - comes into force on 07/29/2016. since that date, he has lost the Standard for emergency medical care for convulsions, approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1082n.
• Standard for emergency medical care for asthmatic status (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 469n) - comes into force on July 31, 2016. From that moment, the Standard for emergency medical care for status asthmaticus, approved by Order of the Ministry of Health of Russia dated 12.20.2012 No. 1087n, has become invalid .
• The standard of emergency medical care for hypertension (approved by the Order of the Ministry of Health of Russia dated 07/05/2016 No. 470n) - comes into force on July 31, 2016. From this date, the Standard for emergency medical care for diseases characterized by high blood pressure, approved by the Order of the Ministry of Health of Russia dated December 20, 2012 No. 1513n, became invalid.
• The standard of emergency medical care for somnolence, stupor, unspecified coma (approved by Order of the Ministry of Health of Russia dated 05.07.2016 No. 471n) - comes into force on July 29, 2016. From this date, the Standard for emergency medical care for unspecified coma, approved by the Order of the Ministry of Health of Russia dated December 20, 2012 No. 1431n, became invalid.

The following standards are fundamentally new:

• The standard of emergency medical care for meningitis (approved by the Order of the Ministry of Health of Russia dated July 5, 2016 No. 462n) - comes into force on July 29, 2016.
• The standard of emergency medical care for acute headache (approved by the Order of the Ministry of Health of Russia dated July 5, 2016 No. 463n) - comes into force on July 31, 2016.
• The standard of emergency medical care for severe myasthenia gravis (approved by the Order of the Ministry of Health of Russia dated July 5, 2016 No. 465n) - comes into force on August 05, 2016.
• The standard of emergency medical care for bleeding from the upper respiratory tract (pulmonary bleeding) (approved by Order of the Ministry of Health of Russia dated 07/05/2016 No. 467n) - comes into force on July 31, 2016.
• The standard of emergency medical care for inflammatory polyneuropathy (approved by the Order of the Ministry of Health of Russia dated July 05, 2016 No. 472n) - comes into force on August 06, 2016.

The Faculty of Medical Law recalls that the standards of medical care are developed in accordance with the nomenclature of medical services and include average indicators of the frequency of provision and frequency of use:

• medical services;
• medicinal products registered in the Russian Federation (indicating average doses) in accordance with the instructions for use of the medicinal product and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization;
• medical devices implanted in the human body;
• blood components;
• types of therapeutic nutrition, including specialized therapeutic nutrition products;
• otherwise based on the characteristics of the disease (condition).

At the same time, all standards of medical care differ from each other and reflect the specifics of a particular disease.

More detailed content of the above standards can be found on the website of the Faculty of Medical Law in the "" section.

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ORDER

In accordance with Article 37 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2015, N 10, Art. 1425)

I order:

1. Approve the standard of emergency medical care for hypertension according to the appendix.

2. Recognize invalid the order of the Ministry of Health of the Russian Federation dated December 24, 2012 N 1513n "On approval of the standard for emergency medical care for diseases characterized by high blood pressure" (registered by the Ministry of Justice of the Russian Federation on February 27, 2013, registration N 27355).

Minister
V.I. Skvortsova

Registered
at the Ministry of Justice
Russian Federation

registration N 42897

Application. Hypertension Ambulance Standard

Application
to order
Ministry of Health
Russian Federation
dated July 5, 2016 N 470n

Floor: any

Phase: acute condition

Stage: any

Complications: regardless of complications

Type of medical care: ambulance, including specialized ambulance, medical care

Conditions for the provision of medical care: outside the medical organization

Form of medical assistance: emergency, urgent

Average treatment time (number of days): 1

________________ * International Statistical Classification of Diseases and Related Health Problems, X revision.
Nosological units
		Essential (primary) hypertension
		Hypertensive heart disease (hypertensive heart disease predominantly affecting the heart)
		Hypertensive (hypertonic) disease with a primary lesion of the kidneys
		Hypertensive (hypertonic) disease with a primary lesion of the heart and kidneys
		Secondary hypertension
		Hypertensive encephalopathy

1. Medical services for the diagnosis of a disease, condition

1.1. Appointment (examination, consultation) with a specialist doctor
Medical service code
________________ The probability of providing medical services or prescribing drugs for medical use (medical devices) included in the standard of care, which can take values ​​from 0 to 1, where 1 means that this event is carried out by 100% of patients corresponding to this model, and the numbers are less than 1 - the percentage of patients specified in the standard of care with relevant medical indications.
	Examination by an ambulance doctor
	Examination by an ambulance paramedic

1.3. Instrumental research methods
Medical service code	Name of medical service	Average delivery frequency	Average rate of application frequency
	Decoding, description and interpretation of electrocardiographic data
	Registration of an electrocardiogram

2. Medical services for the treatment of a disease, condition and treatment control

2.7. Methods of prevention, treatment and medical rehabilitation
Medical service code	Name of medical service	Average delivery frequency	Average rate of application frequency
	Intramuscular administration of drugs
	Inhalation administration of drugs and oxygen
	Catheterization of cubital and other peripheral veins
	Intravenous administration of drugs
	medical evacuation

3. List of medicinal products for medical use registered in the territory of the Russian Federation, indicating the average daily and course doses

	Anatomy therapeutic chemical classification	Name of the medicinal product**	The average frequency indicator provides leniya	Units
________________ ** International non-proprietary or chemical name of the medicinal product, and in cases of their absence - the trade name of the medicinal product. *** Average daily dose. **** Average course dose.
	Saline solutions
		Sodium chloride
	Electrolyte solutions
		Magnesium sulfate
	organic nitrates
		Nitroglycerine
	Imidazoline receptor agonists
		Clonidine
		Moxonidine
	Alpha- blockers
		Urapidil
	Sulfonamides
		Furosemide
	Selective beta blockers
	Derivatives of dihydropyridine
		Nifedipine
	ACE inhibitors
		Captopril
	benzodiazepine derivatives
		Diazepam
	medical gases
		Oxygen

Notes:

1. Medicinal products for medical use registered in the territory of the Russian Federation are prescribed in accordance with the instructions for use of the medicinal product for medical use and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization, as well as taking into account the method of administration and use medicinal product.

2. The prescription and use of medicinal products for medical use, medical devices and specialized medical nutrition products that are not included in the standard of medical care are allowed if there are medical indications(intolerance, for health reasons) by decision of the medical commission (part 5 of article 37 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" (Collected Legislation of the Russian Federation, 2011, N 48, art. .6724; 2015, N 10, article 1425)).

Electronic text of the document
prepared by Kodeks JSC and verified against:
Official Internet portal
legal information
www.pravo.gov.ru, 20.07.2016,
N 0001201607200004

Order of the Ministry of Health and social development RF dated April 16, 2012 N 366n
"On Approval of the Procedure for Providing Pediatric Care"

Approved Order providing pediatric care. It applies to all healthcare organizations.

Assistance is provided in the form of primary health care, emergency and specialized medical care. In this case, different conditions are possible.

The first - outside the medical organization (at the place where the ambulance brigade was called, as well as in the vehicle during medical evacuation).

The second is on an outpatient basis (in conditions that do not provide for round-the-clock medical supervision and treatment).

The third - in a day hospital (in conditions that provide for observation and treatment in the daytime, but not around the clock).

The fourth - stationary (in conditions that provide round-the-clock monitoring and treatment).

The rules for organizing the activities of a district pediatrician's office, a children's polyclinic (department), a consultative and diagnostic center for children, and a pediatric department are given. For each of these structures, recommended staff standards medical staff and equipment standards.

In accordance with Article 37 of the Federal Law of November 21, 2011 No. 323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, No. 48, Art. 6724; 2015, No. 10, Art. 1425 ) I order:

1. Approve the standard of emergency medical care for hypertension according to.

2. Recognize invalid the order of the Ministry of Health of the Russian Federation dated December 24, 2012 No. 1513n “On approval of the standard for emergency medical care for diseases characterized by high blood pressure” (registered by the Ministry of Justice of the Russian Federation on February 27, 2013, registration No. 27355).

Minister

IN AND. Skvortsova

Standard
first aid for hypertension

Age category: adults Gender: any Phase: acute condition Stage: any Complications: regardless of complications Type of medical care: ambulance, including specialized ambulance, medical care Conditions for providing medical care: outside a medical organization Form of medical care: emergency, emergency Average treatment time (number of days): 1
ICBC code
Nosological units
	I10	Essential (primary) hypertension
	I11	Hypertensive heart disease (hypertensive heart disease predominantly affecting the heart)
	I12	Hypertensive (hypertonic) disease with a primary lesion of the kidneys
	I13	Hypertensive (hypertonic) disease with a primary lesion of the heart and kidneys
	I15	Secondary hypertension
	I67.4	Hypertensive encephalopathy

1. Medical services for the diagnosis of a disease, condition

1.1. Appointment (examination, consultation) with a specialist doctor
The code medical services
B01.044.001	Examination by an ambulance doctor	0,5	1
В01.044.002	Examination by an ambulance paramedic	0,5	1
1.2. Laboratory methods research
1.3. Instrumental research methods
The code medical services	Name of medical service	Average delivery frequency	Average rate of application frequency
А05.10.004	Decoding, description and interpretation of electrocardiographic data	0,9	1
A05.10.006	Registration of an electrocardiogram	0,9	1
1.4. Other research methods

2. Medical services for the treatment of a disease, condition and treatment control

2.1. Reception (examination, consultation) and supervision of a specialist doctor
2.2. Patient monitoring and care medical workers with secondary vocational education
2.3. Laboratory research methods
2.4. Instrumental research methods
2.5. Other research methods
2.6. Surgical, endoscopic, endovascular and other methods of treatment requiring anesthesia and/or resuscitation support
2.7. Methods of prevention, treatment and medical rehabilitation
The code medical services	Name of medical service	Average delivery frequency	Average rate of application frequency
A11.02.002	Intramuscular administration of drugs	0,1	1
A11.09.007	Inhalation administration of drugs and oxygen	0,3	1
A11.12.002	Catheterization of cubital and other peripheral veins	0,5	1
A11.12.003	Intravenous administration of drugs	0,5	2
А23.30.042	medical evacuation	0,5	1

3. List of medicinal products for medical use registered in the territory of the Russian Federation, indicating the average daily and course doses

The code	Anatomical-therapeutic-chemical classification	Name of the medicinal product	Average delivery frequency	Units	SSD	SKD
B05CB	Saline solutions		0,5
		Sodium chloride		ml	200	200
	Electrolyte solutions		0,1
		Magnesium sulfate		mg	2500	2500
	organic nitrates		0,3
		Nitroglycerine		mg	10	10
C02AC	Agonists imidazoline receptors		0,6
		Clonidine		mg	0,1	0,1
		Moxonidine		mg	0,4	0,4
C02CA	Alpha blockers		0,1
		Urapidil		mg	50	50
C03CA	Sulfonamides		0,25
		Furosemide		mg	40	40
C07AB	Selective beta-blockers		0,05
		Esmolol		mg	10	10
C08CA	Derivatives of dihydropyridine		0,05
		Nifedipine		mg	10	10
C09AA	ACE inhibitors		0,2
		Captopril		mg	50	50
N05BA	benzodiazepine derivatives		0,2
		Diazepam		mg	20	20
V03AN	medical gases		0,3
		Oxygen		l	120	120

*(1) - International Statistical Classification of Diseases and Related Health Problems, X revision

*(2) - The probability of providing medical services or prescribing drugs for medical use (medical devices) included in the standard of care, which can take values ​​from 0 to 1, where 1 means that this event is carried out by 100% of patients corresponding to this model, and numbers less than 1 - the percentage of patients indicated in the standard of care with relevant medical indications.

*(3) - international non-proprietary or chemical name of the medicinal product, and in cases of their absence - the trade name of the medicinal product

*(4) - average daily dose

*(5) - average course dose

Notes:

1. Medicinal products for medical use registered in the territory of the Russian Federation are prescribed in accordance with the instructions for use of the medicinal product for medical use and the pharmacotherapeutic group according to the anatomical-therapeutic-chemical classification recommended by the World Health Organization, as well as taking into account the method of administration and use medicinal product.

2. The prescription and use of medicinal products for medical use, medical devices and specialized medical nutrition products that are not included in the standard of medical care are allowed if there are medical indications (individual intolerance, according to vital indications) by decision of the medical commission (part 5 of article 37 of the Federal Law No. 323-FZ of November 21, 2011 “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, No. 48, Art. 6724; 2015, No. 10, Art. 1425)).

Document overview

A new standard of medical care has been approved, which defines the basic requirements for the diagnosis and treatment of patients with hypertension. The standard is recommended for use in the provision of emergency medical care (including specialized).

The standard of emergency medical care for diseases characterized by high blood pressure is no longer valid.