paliatiuri mzrunvelobis erovnuli programa

1. saqarTvelos parlamenti janmrTelobis dacvisa da socialur sakiTxTa komiteti 2006 wlis 15 dekemberi paliatiuri mzrunvelobis erovnuli programa fRss shf sponsorebi

2. პალიატიური მზრუნველობის ეროვნული კოორდინატორის მიერ 2006 წლის მანძილზე გაწეული სამუშაო

5. paliatiuri mzrunvelobis saWiroebis mqone pacientTa umetes nawils aqvs simsivnis diagnozi, Tumca maT Soris arian pirebi filtvebis, gulis, nervuli sistemis sxvadasxva qronikuli paTologiebiT, alchaimeris da parkinsonis daavadebiT, dializze myofni, SidsiT Sepyrobilni _ anu isini, romelTa gankurnebac mocemul etapze SeuZlebelia,

6. magram SesaZlebelia (da aucilebeli) im diskomfortTan da tkivilTan brZola, romelic wamyvani Civili xdeba maTi sicocxlis bolo periodSi.

7. ZiriTadi strategia: • tkivilis marTva (dayuCeba); • simptomebis kontroli.

10. ra aris tkivili? tkivili warmoadgens fsiqo-emociur fenomens, romelic asaxavs organizmze mavne faqtorTa damazianebel da potenciurad saSiS zemoqmedebas

11. ra aris tkivili? tkivili subieqturi fenomenia, gulisxmobs sxeulis romelime nawilSi usiamovno gancdas, rasac Tan axlavs emocia.

12. Qqronikuli tkivili jandacvis im problemebs miekuTvneba romlebic bolomde Seufasebelia Tanamedrove samyaroSi • igi mniSvnelovan zegavlenas axdens avadmyofebis cxovrebis xarisxze • MmiCneulia, rom qronikuli tkivili –es TavisTavad daavadebaa.

13. @vizualur-analogiuriskala 1 2 3 4 5 6 7 8 9 10

14. janmo-s eqspertTa modeli tkivilis marTvisaTvis Zlieri tkivili (7-10) bali. Zlieri ipioidebi: morfini, fentalini. saSualo (4-6 bali) tkivilisas: susti opioidebi; kodeini, tramadoli, dihidrokdeini. samsafexuriani modeli susti tkivilisas: (1-3 bali) araopioidebi; paracetamoli, asaA, ibuprofeni

15. ori opioidi morfini kodeini Setanilia aucilebel mrdikamentTa sanimuSo siaSi ( MODEL LIST)

17. imisTvis, rom damatebiT vakontroloT tkivilis sxva epizodebi, pacienti unda iqnes ozrunvelyofili im opioidis e.w. “gamaTavisuflebeli” “saWiroebis dros” misaRebi doziT ( as needed ). yoveli gamaTavisuflebeli doza unda iyos 24 saaTiani regularuli dozis 10-20% da unda ganmeordes enteraluri miRebis SemTxvevaSi TiTo saaTis SualediT, kanqveS an intramuskularuli ineqciis SemTxvevaSi yovel 30 wuTSi, xolo intravenurad yovel 10-15 wuTSi.

18. Tu tkivili 24 saaTis Semdeg arakontrolebadia (ar dayuCda), unda gaizardos regularulad misaRebi dRiuri doza wina dRes “saWiroebis dros” miRebuli dozebis jamiT. Tu tkivili msubuqi an saSualo intensivobisaa, savaraudoa dRiuri dozis gazrda 25-50%-iT, Zlieri, arakontrolebadi tkivilisas ki 50-100%-iT.

19. saaTobrivad analgeziuri saSualebebis daniSvna sasurvelia drois garkveuli intervalebiT. e.i. TandaTanobiT unda gaizardos pacientis komfortuli mdgomareobis miRwevamde. morigi doza sasurveli mieces winamdebare dozis srul ganeitralebamde – am gziT SesaZlebelia tkivilis gayuCeba xangrZlivi drois ganmavlobaSi.

20. individuri midgoma ar arsebobs opioiduri preparatebis standartuli dozebi. “sworad SerCeul dozad” iTvleba is, romelic iZleva pacientis tkivilis Semsubuqebas. magaliTad, peroralurad misaRebi morfinis dozebi meryeobs sul mcire 5 mg-dan 1000 mg-mde 4 saaTSi erTxel.

21. analgeziuri efeqtis identurobis cxrili ekvianalgeziu-ri dozirebis sqema gamoyenebul unda iqnas, rogorc orientiri

22. xarjTefeqturoba rogorc swrafad xsnadi ise nela xsnadi morfinis generiuli formebis Rirebuleba sazogadod, SesaZlebelia gautoldes acetilsalicilis mJavas tabletebis Rirebulebas maSin rodesac transdermuli fentanilis ekvivalenturi dozis Rirebuleba gacilebiT ufro metia.

23. opioiduri preparatebis SedarebiTi Rirebuleba

24. wamlebis xelmisawvdomoba (nebadarTuloba)

25. paliatiuri mzrunveloba binaze ahk `sworad SerCeuli~ medikamenti - `sworad SerCeuli~ doziT – ”sworad SerCeul” drois monakveTSi.

26. paliatiuri mzrunveloba opioiduri preparatebis peroraluri gziT daniSvna iZleva tkivilis efeqtur Semsubuqebas pacientTa umravlesobaSi da martivia marTvis TvalsazrisiTac.

27. paliatiuri mzrunveloba didma klinikurma gamocdileba aCvena, rom fsiqologiuri damokidebuleba ar yalibdeba kiboTi daavadebul pacientebSi imis gamo, rom avadmyofTa aRniSnuli kategoria opioidur preparatebs Rebulobs tkivilis Semsubuqebis mizniT. es dasturdeba rogorc bavSvebSi, aseve mozrdilebSic.

28. INCB-is 2001 wlis monacemebiT evropaSi morfinis danaxarjis 88% modioda dasavleT evropis qveynebze;

31. narkotikuli saSualebebis avadmyofisaTvis daniSvna, misi raobis, erTjeradi da sadReRamiso dozis gansazRvra an dozis Secvla xorcieldeba komisiuri wesiT, risTvisac poliklinikis direqtoris, xolo iq, sadac poliklinika ganyofilebis saxiT Sedis saavadmyofos struqturaSi, saavadmyofos direqtoris brZanebiT iqmneba komisia Semdegi SemadgenlobiT: poliklinikis direqtoris moadgile samkurnalo dargSi (poliklinikuri ganyofilebis gamge) an poliklinikis ganyofilebis gamge (komisiis Tavmjdomare), ubnis eqimi da onkologi (araonkologiuri daavadebebisas komisiis SemadgenlobaSi Sedis mkurnali eqimi avadmyofis daavadebis profilis mixedviT).

32. qalaqsa da raionul centrSi macxovrebeli kontigentisaTvis erTi receptis blankze erTjeradad SeiZleba gamoiweros narkotikuli saSualebebis araumetes sami an oTxi dRis (policiis SenobaSi ganTavsebuli afTiaqidan narkotikuli saSualebebis gacemis dReebis gaTvalisqinebiT), xolo soflad macxovrebeli kontigentisaTvis _ araumetes xuTi dRis maragisa.

33. tkivilis dayuCebis moTxovna es adamianis erT -erTi mTavari da xelSeuxebeli uflebaa gaerTianebuli erebis organizaciis adamianTa uflebaTa saerTaSoriso deklaracia (1948).

34. tkivilis dayuCebis moTxovna es - uflebaa, radganac tkivili aris kurnebadi (dayuCebadi). arsebobs barierebi tkivilis efeqturad marTvis gzaze, rac Txoulobs gadaudebel, globalur gadawyvetas.

36. janmo 2000 wels gvTavazobs narkotikebisa da fsiqotropuli wamlebis Sefasebis gaidlains saTauriT ,,mivaRwioT balanss opioidebis kontrolis nacionalur politikaSi”. am gaidlainis III danarTi warmoadgens mis Sejamebas, sadac mocemulia rekomendaciebi qveynebis xelmZRvanelobis mimarT tkivilisa da narkotikebis politikis warmarTvis Taobaze.

37. (2003)24 rekomendacia evrosabWos wevr-qveynebSi paliatiuri mzrunvelobis organizaciis Taobaze mowonebulia evrosabWos ministrTa komitetis mier 2003 wlis 12 noembers wevri-qveynebis ministris moadgileebis Sexvedraze

38. III Tavi _ politika da organizacia $5. kanonmdeblobam unda moaxdinos opioidebisa da sxva wamlebis gamoSvebis formisa da dozebis gansazRvra - maTi samedicino gamoyenebisaTvis. normativTa sirTulem ziani ar unda miayenos maT xelmisawvdomobas da efeqtur moxmarebas. qveynebma saWiroebis SemTxvevaSi unda moaxdinon kanonmdeblobis Secvla am mimarTebiT.

40. - sazogadoebisjandacvis sistemis kanonmdeblobis Secvla _ jandacvis muSakebispreparatebis (eqimebi, eqTnebi,nebadarTulobis farmacevtebi), gaumjobesebis mizniT _ sxvapirebis(gansakuTrebiT (jandac. sferos opioiduri politikis preparatebis wammarTveli mimarT) pirebi, administra- preparatebis torebi,daniSnulebis, prepartTa ganawilebis, gavrcelebis,gavrcelebis maregula- damarTvis cieblebi). G gaumjobe- seba erovnuli da saxelmwifo politikis gamokveTa kiboTi gapirobebuli tkivilis Semsubuqebis saWiroebebze tkivilisSemsubuqebis programebis gaxorcielebis safuZvlebi g a n a T l e b a w a m a l T a d a S v e b a d o b a s a m T a v r o b o p o l i t i k a

41. saqarTveloSi paliatiuri mzrunvelobis ganviTarebis erovnuli koordinatoris ofisi saerTaSoriso eqspertebis rekomendaciaTa gaTvaliswinebiT axorcielebs Semdeg gegmas:

42. politikis sakiTxebi: • paliatiuri mzrunvelobis CarTva saqarTvelos jandacvis erovnul programaSi; • 2. swrafad xsnadi (dauyovnebeli moqmedebis) da nela xsnadi (neli moqmedebis) tabletirebuli morfinis (generiuli formebis) xelmisawvdomobis uzrunvelyofa, misi racionaluri daniSvnis da gamoweris wesebis gamartivebis xelSewyoba

43. II. ganaTleba • paliatiuri mzrunvelobis CarTva samedicino skolebis saswavlo programebSi; • paliatiuri mzrunvelobis subkomponentad gamoyofa saeqimo specialobaTa nusxaSi da Sesabamisi saswavlo (daxelovnebis) programis implementacia; • kanonmdeblebis, samedicino personalis, socialuri muSakebis, moxaliseebis, pacientebisa da maTi ojaxis wevrebis informaciiT momarageba.

44. III. dafinanseba: • uwyveti da mzardi sabiujeto (saxelmwifo) dafinansebis uzrunvelyofa, maT Soris saqarTvelos regionebSi paliatiuri mzrunvelobis axali samsaxurebis (gundebis) dafinansebis saSualebaTa moZieba regionuli biujetidan; • 2. saerTaSoriso da adgilobrivi donorebisagan xelSewyobis moZieba: • - paliatiuri mzrunvelobis erovnuli programis dawyebisaTvis; • - kibos kontrolis momavali erovnuli programis ganviTarebis xelSewyobisaTvis.

45. aRniSnuli gegmis realizaciisTvis Seqmnilia samuSao jgufi Semdegi SemadgenlobiT: l. juReli – ministris moadgile, m. jebaSvili da o. ToiZe – saqarTvelos parlamentis wevrebi, v. surgulaZe - socialuri dazRvevis erTiani saxelmwifo fondis generaluri direqtoris moadgile, m. javaSvili – bioeTikis erovnuli sabWos Tavmjdomare, d. korZaia – paliatiuri mzrunvelobis erovnuli koordinatori, r RvamiCava – kavSir “onkoprevenciis centris” direqtori, m. Savdia – onkologiis nacionaluri centris TanamSromeli,

46. T. ruxaZe – asociacia “humanistTa kavSiris” paliatiuri mzrunvelobis programis koordinatori, • n. gongaZe – saerTaSoriso farmakolog-eqsperti, T. kvirkvelia – jandacvis saministros ganyofilebis gamge, • xavanskaia – “humanistTa kavSiris” wevri, • n. natroSvili – saerTaSoriso humanitarul fond “SOCO”-s jandacviTi da socialuri programebis xelmZRvaneli, • k. oCigava – jandacvis saministros iuridiuli departamentis ufrosis moadgile.

47. samuSao jgufis koordinacia saqarTvelos parlamenti jandacvisa da socialur sakiTxTa komitetis mxridan davalebuli aqvs baton o. ToiZes. CamoTvlili RonisZiebebi xorcieldeba paliatiuri mzrunvelobis erovnuli koordinatoris ofisis dafinansebiT, moZiebuli grantebiT, SemowirulobebiT. RonisZiebaTa patronaJs axorcielebs qalbatoni sandra rulovsi.

48. gmadlobT yuradRebisaTvis