Rules for visiting the intensive care unit. New patients have arrived. Nyuta Federmesser, President of the Vera Hospice Fund

Image copyright Ria Novosti Image caption Doctors explain the ban on visiting children in intensive care by the danger of infections

The Ministry of Health of Russia had to again to remind that the law obliges doctors to allow relatives to visit patients in medical institutions including in intensive care.

The ministry's press secretary, Oleg Salagai, recalled that the ministry sent a corresponding letter to the regions last year.

"If there are violations, you need to contact the insurance company that issued the policy to you, the health authorities of the region, the control authorities," - wrote press secretary on Facebook.

This is how he reacted to the petition, which requires the Ministry of Health to publish not a "letter of request", but a decree that does not allow free interpretations. To date, a petition demanding to oblige hospitals not to prevent visiting loved ones in intensive care has collected more than 200,000 signatures.

The petition notes that patients, especially sick children, need psychological support, which they are deprived of due to the rules of medical institutions. The most popular comments on the petition describe cases in which sick children were deprived of communication with their parents.

Section 51 of Law 323 states that one of the parents or legal representative has the right to be with the child "when medical care in stationary conditions during the entire treatment period.

Patients and employees of charitable organizations that help children say that in Russia it is really difficult to get into intensive care with a child, not to mention adults. At the same time, the situation in the regions is much worse than in Moscow.

Usually, doctors explain the ban by the fact that parents can bring the infection or become infected themselves, in some cases they interfere with treatment and distract medical staff.

There are not enough psychologists who could work with parents and children. Patients often refer to Western experience, where relatives are not forbidden to visit patients - except when the patient is receiving emergency care.

The BBC Russian service turned to experts and asked them to comment on how the law is being implemented locally, obliging parents to let their children into intensive care.

Nyuta Federmesser, President of the Vera Hospice Fund

Wherever parents are not allowed, there is a violation of federal law. The law on the health of citizens spelled out the right of the child to be with his parents in the hospital.

All internal regulations are fiction and the will of the chief doctors in the field. Sanitary standards are often violated by employees more than by parents, as employees, for example, go outside to smoke in the same shoes they work in, and parents obediently bring a shift.

In hospital departments, it is nosocomial infection that is terrible, which is carried by dirty rags for cleaning, the lack of a culture of proper washing hands, gowns in which the medical staff moves from ward to ward, and disposable gloves that cease to be disposable after the nurse has moved to the next patient in the same gloves.

Many nurses say they wear gloves to protect themselves from hepatitis, not to protect the patient.

Parents are the most interested in quality care people. And they are the first aid to the staff in the case when children cry when it is time for dinner, washing or changing clothes. Parents must strictly observe only one rule - to leave the resuscitation ward at the first request of the staff in the event of resuscitation or serious manipulations requiring the participation of two or more physicians.

Inadequate behavior of parents, which is often referred to by the heads of intensive care units, when they do not let the mother see the child, is the result of separation from children.

Alexander Rabukhin, anesthesiologist with US experience

In the US, there is no such profession as a resuscitator. Severe patients are treated by a specialized doctor. If this surgical patient- then in surgery, if therapeutic - then in therapy, and so on. That is, there is no separate specialty "resuscitation", there are only blocks intensive care- ICU so-called.

AT certain time please can [visit]. Relatives come in, order pizza in unison, watch TV, eat pizza, wave to the hardware patient and leave. There is no such problem [prohibition on visits], because the attitude towards this is generally easier there, and doctors go without white coats. A sick person is also a person, and relatives are people, therefore human relations.

In Russia, a sick person is a person who has lost all rights in general. From the time you got to the hospital, the babysitter decides everything.

As for unsanitary conditions, to be honest, I have never seen any homeless people come to visit there.

And this applies not only to resuscitation, you just try to go to the hospital. It is much easier to get to any defense facility. In our country, 50% of the able-bodied population works in security, in my opinion. They need to protect something.

Now, if I, a doctor, come to some other hospital on business, if a pass is not ordered for me, I cannot get through. And in order to order a pass, you need to get inside, and so on, the circle is closed. It’s good at least they let you into the grocery store without a pass, but you say resuscitation.

State Duma Deputy Nikolai Gerasimenko submitted a bill to parliament that would allow relatives and legal representatives to visit patients in intensive care units. Today, the legislation allows people to visit sick relatives, but the decision on this is made by the management of the medical institution. There is no direct reference in current legal documents to the fact that hospitals are obliged to provide the possibility of visiting patients in intensive care in any situation, even if the doctor did not give such permission.

In May 2016, the Ministry of Health published a letter with recommendations and conditions under which relatives can get into the patient's ward. According to these rules,

when visiting intensive care units and intensive care units, relatives should not have signs of acute infectious diseases (elevated temperature, manifestations respiratory infection, diarrhea). In addition, before visiting, the medical staff should have a brief conversation with relatives and prepare them psychologically for what they will see in the department.

Also, before visiting the ward, a close person of the patient must remove outerwear, put on shoe covers, a bathrobe, a mask, a hat and wash your hands thoroughly.

However, this document still transfers the final decision on the admission of a relative to the authority of the leadership of the medical institution. Gerasimenko notes that today access to patients in most cases is a goodwill gesture of the chief physician. This, in his opinion, causes backlash in society and reduces the effectiveness of treatment. In an explanatory note to the bill, the parliamentarian referred to the experience of many foreign countries where relatives and representatives of the patient can freely be with him in intensive care.

The State Duma deputy also noted that, according to the Russian Ministry of Health, the access of relatives to patients in intensive care units is not organized in all medical organizations. “So, for example, in Primorsky Krai, only 10 out of 27 children's intensive care units and intensive care units have access to patients,” says Gerasimenko. But the access of parents to young patients in intensive care is just one of the priorities in domestic clinics.

Recall that in February 2014, Russians began to complain that in most medical institutions, parents are not always allowed into the intensive care unit with their children, explaining that they can harm the child. The Vera Foundation sent a letter to the president, in which he spoke about the tragedy of those mothers who are forced to wait at the door of intensive care until they are allowed to see their child for at least five minutes. Later, the Ministry of Health reported that Russian law does not prohibit parents from being next to the child in the intensive care unit. The agency required hospitals to accept necessary measures on the organization of visits by relatives of children in the departments of anesthesiology and resuscitation.

The medical community is divided over whether it is worth letting the patient's relatives into the intensive care unit.

Some doctors believe that every intensive care patient would like to be able to see their loved ones, and relatives are afraid not so much of what exactly happened to their loved ones as of the unknown.

Once outside the doors of the intensive care unit, they will make sure that the doctors are doing everything necessary. Other health workers say that not all relatives can adequately perceive the condition of a loved one and the ban on visiting the intensive care unit thus saves them from shock.

Director of the HSE Institute of Health Larisa Popovich is sure that it is impossible to oblige relatives to go to intensive care, no matter what. “I believe that this cannot be an obligation, because only doctors can really determine how safe it will be to visit relatives intensive care unit”, she told Gazeta.Ru.

Popovich added that Russia has stricter requirements for the sanitary and epidemic regime in hospitals than in many other countries. “If abroad are used very powerful antibiotics, then we still prefer to observe sterility. Therefore, the possibility of visiting the rehabilitation department is determined only on the basis of the current conditions of sanitary and epidemic support in the hospital and the patient’s condition,” the expert noted.

Larisa Popovich emphasized that such things very much depend on national characteristics organization of the healthcare system. "Let's say

the absence in Russia of a disinfection system at the entrance to the hospital significantly limits the possibility of admitting relatives to the hospital in principle. In Israel, for example, you can even enter the operating room from the street in ordinary clothes.

I myself observed how, during a neurosurgical operation, a man in a jacket stood and spoke on the phone. But they have a very serious system of antibiotic therapy. Why do we need it with you? Everyone has their own technologies for dealing with postoperative complications, ”she said.

To the question of Gazeta.Ru, is there enough Russian hospitals infrastructure is developed so that relatives stay in the intensive care unit for a long time, Popovich replied that no one is going to arrange hotel rooms in the intensive care unit. “This is about a short visit and about psychological support, for which it is not required to be in the ward all the time. In the United States, relatives are also expelled in the event of certain situations - they are far from long period are in the wards,” said the director of the HSE Institute of Public Health.

The lawyer of the "Society for the Protection of Patients' Rights" Anna Oreshkova agreed with the arguments of the author of the bill. “Relatives need to be allowed into intensive care, because it benefits everyone. However, in such a specialized department there are no conditions for organizing the flow of relatives: there are serious equipment and patients in critical conditions. Under this law it is necessary to work out certain conditions”, the lawyer told Gazeta.Ru.

. “It is the right of every patient to be visited by relatives and friends, including in intensive care,” the newspaper quoted Oleg Salagay, director of the Department of Public Health and Communications of the Ministry of Health of the Russian Federation, as commenting on Facebook on an online petition sent to the Minister of Health of the Russian Federation with a request to allow visit patients in intensive care.

The official said that a corresponding letter from the Ministry of Health of Russia with a request to ensure the implementation of this provision of the law was sent to the regions last year.

The intensive care unit contains patients with serious illnesses and injuries, as well as patients after complex operations and anesthesia.

Russian doctors - unlike many foreign colleagues- most often, relatives are forbidden to visit relatives in intensive care, explaining this by the possibility of introducing an infection.

In these cases, Oleg Salagay advises "to contact the insurance company that issued the policy to you, the health authorities of the region, the control authorities."

The petition on the Internet (author - Olga Rybkovskaya, Omsk) has already collected more than 100 thousand signatures. We present the text of the document in full, since any of us may find ourselves in similar situation:

"AT this moment in Russia there is no official law prohibiting visits to relatives in intensive care. Moreover, Article 55 of the Family Code refers to the unconditional right of parents and other relatives to freely communicate with children, and Federal Law No. 323 “On the basics of protecting the health of citizens in Russian Federation» the right to stay of parents with children during treatment in medical organizations is prescribed.

Despite this, the decision to admit or not admit relatives to the intensive care unit is still made at the level of the head physician or head of the department, and in 99% of cases this decision is not made in favor of relatives and patients. In the overwhelming majority of cases, visits are banned, and the basis for it is some kind of "sanitary standards", which immediately disappear when we are talking, for example, about a paid ward or a paid clinic.

Any sane person should understand that a sick child, who is in intensive care, and especially a sick child, like no one else, needs the psychological support of loved ones. There is great amount examples where only one presence is nearby loved one contributed to recovery, gave strength and was an invaluable psychological help.

Proceeding from the protection of the rights of the patient and, first of all, from elementary humanistic principles, we demand to abolish this medieval, cruel and senseless practice of isolating seriously ill patients from relatives. In all civilized countries there is no such practice. Moreover, in resuscitation wards, comfortable conditions for round-the-clock stay of relatives of seriously ill patients there.

We demand that the Ministry of Health of the Russian Federation, using the experience of developed countries, develop an official document for everyone without exception medical institutions, providing unhindered and round-the-clock access for parents and other relatives to intensive care. This document must be interpreted unambiguously (without options) and have absolute priority over all local rules and prohibitions. It is also necessary to provide conditions for the stay of relatives with patients - this does not require large investments, it is enough to put a chair in the ward.

We are well aware that resuscitation is special place, which must be observed certain rules behavior and sanitation. There is no need to invent anything here - there is the experience of European countries that can be taken and used.

We believe that while such a practice of ignoring the elementary human relationship to people in medical institutions will continue, Russia has no right to be considered a civilized country.”

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5 comments → “Is it possible to visit patients in intensive care?”

Anonymous


I had a husband in intensive care on March 18, 2016, I asked him to visit me chief physician refused that it was not supposed to. And asked to call an intensive care vehicle from Novosibirsk, the doctor answered me that he was not transportable, I myself will contact the city by phone. He also had a heart attack, the therapist wrote. They say he turned in late, but since December he has been knocking on the thresholds and what he got. And the outpatient card immediately disappeared

“Medical staff should not wipe drool…”
The country is undergoing a health care reform, directly aimed at its destruction. For some reason, many consider themselves so competent that they give themselves the right to interfere in the work of a well-functioning mechanism. As a rule, this leads to a violation of its work, and not to benefit. We all want to do a lot, BUT FROM CHILDHOOD we are taught that we can’t do a lot. Let's allow anyone who is curious to get into transformer boxes, visit prisons and morgues. Not funny? So, in our country, many hospitals differ from cinematic ones, and even more so from real foreign hospitals. 1. We don’t have enough separate rooms in intensive care units, we don’t even have enough pajamas. You will be pleased if your relative is naked, broken, not in best form an unfamiliar uncle will stare, who will then spread confidential information about your relative, collecting it from his subjective feelings and scraps of phrases from the staff. Are you ready to see for yourself the unpleasant footage of resuscitation of seriously ill patients nearby?2. as a result of the reform, the intensity of work of intensive care personnel has increased, and there is such a thing as medical triage. Medical staff cannot wipe their saliva, straighten linen and be distracted by your unprofessional requests. because defiantly wiping your grandmother’s drool (you’ll run to complain after visiting) will miss someone’s life (and then your relative’s turn will come) tumble into a burn patient. am I exaggerating? your flu will easily kill the nearby exhausted old man (but what do you care, you just have a runny nose!) 4. patients with pneumonia and tuberculosis, hepatitis and swine flu often lie in intensive care units. Are you ready to bring it all home after a night with your beloved relative?

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

LETTER

[On sending a letter "On the rules for visiting patients' relatives in intensive care units (reanimation)" and the form of a memo for visitors]

In pursuance of paragraph 2 of the list of instructions of the President of the Russian Federation V.V. a letter "On the rules for visiting relatives of patients in intensive care units (reanimation)" and the Form of memo for visitors, which they must familiarize themselves with before visiting their relative in the intensive care unit (ICU), for strict execution.

I.N.Kagramanyan

Application. On the rules for visiting relatives of patients in intensive care units and intensive care units

Application

Visits by relatives of patients in intensive care units and intensive care units are permitted under the following conditions:

1. Relatives should not have signs of acute infectious diseases (fever, manifestations of a respiratory infection, diarrhea). Medical certificates of the absence of diseases are not required.

2. Before visiting the medical staff, it is necessary to have a short conversation with relatives to explain the need to inform the doctor about the presence of any infectious diseases, to prepare psychologically for what the visitor will see in the department.

3. Before visiting the department, the visitor must remove outer clothing, put on shoe covers, a bathrobe, a mask, a hat, and wash their hands thoroughly. Mobile phone and other electronic devices must be turned off.

4. Visitors in a state of alcoholic (drug) intoxication are not allowed to enter the department.

5. The visitor undertakes to observe silence, not to impede the provision of medical care to other patients, to follow the instructions of medical personnel, and not to touch medical devices.

6. Children under the age of 14 are not allowed to visit patients.

7. No more than two visitors are allowed to be in the room at the same time.

8. Visits to relatives are not allowed during invasive manipulations in the ward (tracheal intubation, vascular catheterization, dressings, etc.), cardiopulmonary resuscitation.

9. Relatives may assist medical personnel in caring for the patient and maintaining cleanliness in the ward only at their own request and after detailed instructions.

10. In accordance with Federal Law N 323-FZ, medical personnel should ensure the protection of the rights of all patients in the intensive care unit (protection personal information, compliance with the protective regime, the provision of timely assistance).

Recommended form for visitors to read before visiting their relative in the intensive care unit (ICU)

Dear visitor!

Your relative is in our office in serious condition, we give him all needed help. Before visiting a relative, please read this leaflet carefully. All the requirements that we impose on visitors to our department are dictated solely by concern for the safety and comfort of patients in the department.

1. Your relative is sick, his body is now particularly susceptible to infection. Therefore, if you have any signs of contagious diseases (runny nose, cough, sore throat, malaise, fever, rash, intestinal disorders) do not enter the department - it is extremely dangerous for your relative and other patients in the department. Tell the medical staff if you have any medical conditions so they can decide if they pose a threat to your family member.

2. Before visiting the ICU, you must take off your outer clothing, put on shoe covers, a dressing gown, a mask, a hat, and wash your hands thoroughly.

3. Visitors who are under the influence of alcohol (drugs) are not allowed in the ICU.

4. No more than 2 relatives can be in the ICU at the same time, children under 14 years old are not allowed to visit the ICU.

5. Silence should be observed in the department, do not take mobile and electronic devices with you (or turn them off), do not touch devices and medical equipment, communicate with your relative quietly, do not disturb protective regime department, do not approach or talk with other ICU patients, strictly follow the instructions of medical personnel, and do not interfere with the provision of medical care to other patients.

6. You should leave the ICU if you need to perform invasive procedures in the ward. You will be asked to do so by health professionals.

7. Visitors who are not direct relatives of the patient are allowed in the ICU only if accompanied by a close relative (father, mother, wife, husband, adult children).

Familiarized with the memo. I undertake to comply with the requirements specified in it.

Name _______________ Signature _______________

Relationship with the patient (underline) father mother son daughter husband wife other _______

The date _________



Electronic text of the document
prepared by Kodeks JSC and verified against:
distribution file

(approved by the order of the chief physician of the GBUZ "City Clinical Hospital No. 52 DZM" dated July 23, 2018 No. 659)

Visits from relatives legal representatives) patients of resuscitation and intensive care units of GBUZ "City Clinical Hospital No. 52 DZM" are installed in the mode: around the clock, under the following conditions.

1. Visitors should not have signs of acute infectious diseases (fever, manifestations of a respiratory infection, diarrhea). Medical certificates of the absence of diseases are not required.
2. Before visiting, medical staff should have a brief conversation with visitors to explain the need to inform the doctor about the presence of any infectious diseases, to prepare for what the visitor will see in the ICU.


3. Before visiting the ICU, the visitor must remove outer clothing, put on shoe covers, a dressing gown, a mask, a hat, wash their hands thoroughly, treat antiseptic preparation hands. Mobile phone and other electronic devices must be switched off or put into “airplane mode”. It is forbidden to take photos and videos in order to respect the rights of patients to maintain medical secrecy and protect personal data.


4. Visitors in a state of alcoholic (drug) intoxication are not allowed in the ICU.


5. The visitor undertakes to maintain silence, to protect the peace of not only his relative/relative, but also the peace of other patients nearby in the intensive care unit, not to impede the provision of medical care to other patients, follow the instructions of the medical staff, and not touch medical devices.


6. Children under the age of 14 are not allowed to visit patients.


7. No more than 2 visitors are allowed in the room at the same time!


8. A visit is not allowed during diagnostic and treatment activities in the ward and any invasive manipulations (tracheal intubation, vascular catheterization, dressings, etc.), cardiopulmonary resuscitation. Treat with understanding!


9. In accordance with the provisions federal law dated November 21, 2011 No. 323-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation", medical personnel should ensure the protection of the rights of all patients in ICUs (protection of personal information, compliance with the medical and protective regimen, provision of timely medical care)


10. Information about the health status of the patient in the ICU is provided from 15 to 17 hours physician and/or department head. Doctors on duty at other times, information about the state of health is not provided. Please be understanding! Information about the patient’s health status is not provided by phone (Article 13 of the Federal Law of November 21, 2011 No. 323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation”)


11. In pursuance of Article 6 of the Federal Law of November 21, 2011 No. 323 FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation", the provisions of the Order of the USSR Ministry of Health of November 16, 1987 No. 1204 "On the medical and protective regime in medical institutions", in order to creation favorable conditions for effective treatment providing the necessary psychological environment and rational patient care, proper organization and indispensable strict observance medical and protective regimen, the regimen of the day of patients, compliance with the right of patients to healthy sleep, exclusion of all moments that violate peace and quiet, respect for the rights of other patients who are in the same intensive care room with your relative, restrictive measures may be applied in the institution for visits to patients in the intensive care unit:
    - during quiet hours and at night from 22:00 to 07:00.
    - in the morning and evening for the purpose of holding sanitization patients, morning (evening) toilet, medical staff cleaning beds and changing linen, hygiene procedures.
    It is not recommended to visit patients during these hours. Please be understanding.