Perceptions of Uncertainty in Medical Care Among Non-medical Professionals and Nurses in Japan: A Cross-Sectional Internet-Based Preliminary Survey.

BACKGROUND: Medical care is impacted by uncertainty caused by various factors. The uncertainty that exists in medical care can cause patient distrust and lead to conflict. This study compared the tolerance of uncertainty in medical care between non-medical professionals and nurses. METHODS: We conducted a cross-sectional Internet-based survey. Participants included 2,100 individuals (600 nurses and 1,500 non-medical professionals; aged ≥ 20 years) from different parts of Japan. Of these, we excluded 70 participants who were classified as non-medical professionals but were registered nurses. Finally, we analyzed data from 2,030 participants (600 nurses and 1,430 non-medical professionals). Three registered nurses and nursing researchers developed an original questionnaire on tolerance of uncertainty in medical care. Data regarding participants' characteristics (age, sex, education level, marital status, having children, population size of the residential area, medical care usage, and occupation) were obtained. We performed a one-way analysis of variance (ANOVA) to compare the data between non-medical professionals and nurses. Additionally, we employed a multiple regression model to investigate factors related to tolerance of uncertainty in medical care scores. RESULTS: A significant portion of participants (36.7%) were aged 40-50 years (n = 745). Most were women (n = 1,210, 59.6%), and a considerable percentage were medical care users (n = 1,309, 64.5%). Non-medical professionals were less tolerant of uncertainty than nurses, and uncertainty scores were associated with medical care usage, occupation, and population size of the residential area. CONCLUSIONS: Our findings revealed variations in perceptions of uncertainty in medical care between non-medical professionals and medical care providers. To mitigate conflicts related to medical issues, medical care providers should enhance non-medical professionals' education regarding perceptions of uncertainty in medical care.

On-Campus Nursing Training During COVID-19 in Japan: A Systematic Literature Review.

During the coronavirus disease 2019 (COVID-19) pandemic, nursing education in Japan recommended the implementation of on-campus practical training as a substitute for hospital-based clinical training. This study explores nursing students' experiences with on-campus nursing training as an alternative to clinical practice by clarifying its advantages and disadvantages. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and we included 26 articles in this study. Our findings reveal both the advantages of acquiring nursing knowledge, basic skills, and membership among students. Contrastingly, many students failed to acquire skills related to patient communication and flexible nursing care. Thus, despite some strengths, on-campus training is not a complete replacement for clinical training. Although this method has benefits in emergency situations, it is desirable to consider other educational methods in preparation for future pandemics.

Comparison of physicians' and dentists' incident reports in open data from the Japan Council for Quality Health Care: a mixed-method study.

BACKGROUND: Patient safety is associated with patient outcomes. However, there is insufficient evidence of patient safety in the dental field. This study aimed to compare incidents reported by dentists and physicians, compare the type of errors made by them, and identify how dentists prevent dental errors. METHODS: A mixed-methods study was conducted using open data from the Japan Council for Quality Health Care database. A total of 6071 incident reports submitted for the period 2016-2020 were analyzed; the number of dentists' incident reports was 144, and the number of physicians' incident reports was 5927. RESULTS: The percentage of dental intern reporters was higher than that of medical intern reporters (dentists: n = 12, 8.3%; physicians: n = 180, 3.0%; p = 0.002). The percentage of reports by dentists was greater than that by physicians: wrong part of body treated (dentists: n = 26, 18.1%; physicians: n = 120, 2.0%; p < 0.001), leaving foreign matter in the body (dentists: n = 15, 10.4%; physicians: n = 182, 3.1%; p < 0.001), and accidental ingestion (dentists: n = 8, 5.6%; physicians: n = 8, 0.1%; p < 0.001), and aspiration of foreign body (dentists: n = 5, 3.4%; physicians: n = 33, 0.6%; p = 0.002). The percentage of each type of prevention method utilized was as follows: software 27.8% (n = 292), hardware (e.g., developing a new system) 2.1% (n = 22), environment (e.g., coordinating the activities of staff) 4.2% (n = 44), liveware (e.g., reviewing procedure, double checking, evaluating judgement calls made) 51.6% (n = 542), and liveware-liveware (e.g., developing adequate treatment plans, conducting appropriate postoperative evaluations, selecting appropriate equipment and adequately trained medical staff) 14.3% (n = 150). CONCLUSION: Hardware and software and environment components accounted for a small percentage of the errors made, while the components of liveware and liveware-liveware errors were larger. Human error cannot be prevented by individual efforts alone; thus, a systematic and holistic approach needs to be developed by the medical community.

Choking injuries: Associated factors and error-producing conditions among acute hospital patients in Japan.

Choking can lead to mortality and residual impairments. This study aimed to determine the factors associated with choking among acute hospital patients and examine error-producing conditions to suggest choking-prevention policies. Among 36,364 cases reported by hospital staff at an acute university hospital from 2012 to 2018 were examined using a retrospective study, 35,440 were analysis as the number of cases analysed for the study. We used descriptive statistics to present patient characteristics and conducted univariable and multivariable logistic regression analyses to identify factors associated with choking. Additionally, we conducted content analysis (root cause analysis) to examine error-producing conditions and prevention policies. Sixty-eight cases were related to choking injuries; of these, 43 patients (63.2%) were male, and 38 (55.9%) were aged 65 years and older. Choking cases had a high percent of adverse outcomes involving residual impairment or death (n = 23, 33.8%). Mental illness (adjusted odds ratio [95% confidence interval]: 3.14 [1.39-7.08]), and hospitalisation in the general wards (adjusted odds ratio [95% confidence interval]: 3.13 [1.70-5.76]) were associated with an increased probability of choking. Error production was caused by food (n = 25, 36.8%) and medical devices or supplies (n = 13, 19.1%). Almost all contributory factors were associated with inadequate checking (n = 66, 97.1%) and misperception of risk (n = 65, 95.6%). Choking poses a highly significant burden on patients, and hospital administrators should minimise the risk of choking to prevent related injuries. Hospital administrators should provide training and education to their staff and develop adequate protocols and procedures to prevent choking.

Reported Incidents Involving Non-medical Care Workers and Nursery Teachers in Hospitals in Japan: An Analysis of the Japan Council for Quality Health Care Nationwide Database.

Objective With the shortage of medical staff, the birth rate decline, and aging populations in some countries, task shifting from specific medical staff to non-medical care workers in hospitals has been implemented as a short-term solution. Incident reporting reduces preventable patient errors, improves the quality of healthcare services, and contributes to patient safety. However, research focused on the expanding roles of non-medical staff who provide direct care for patients is lacking. The present study aimed to bridge this gap by examining reported incidents involving non-medical care workers and nursery teachers in hospitals in Japan. Methodology A retrospective mixed-methods study was conducted using data published by the Japan Council for Quality Health Care. A total of 21,876 cases were reported between 2016 and 2020, and 97 out of 21,876 cases were analysed, after excluding incidents involving workers or staff other than care workers/nursery teachers. Descriptive statistics were used to examine the incidents, and textual data included in the incident reports were analysed by two registered nurses. Results The occupations of the people involved were care worker (n=80, 82.5%) and nursery teacher (n=17, 17.5%). There were two reports of worker injuries (n=2, 2.1%), which were excluded. A total of 95 cases were included in the final analysis to examine the effects on patients. Among the remaining 95 cases, there were five severe patient incidents (death, n=2, 2.1%; cerebral hemorrhage, n=3, 3.2%), and the most frequent incident was bone fracture (n=64, 67.4%). Some patients had cognitive impairment (n=29, 30.5%) and osteoporosis (n=25, 26.3%). We divided the factors related to incident occurrence into software (procedures and protocols), environment (wards and theaters), and liveware (people, including care workers, nursery teachers, and patients). Regarding the reasons for the incidents, the percentages for the three factors were as follows: education/training 34.7% (n=33), in software; patient state 4.1% (n=39), in environment; and neglect to observe 45.3% (n=43), in liveware. Conclusion Our study involved a secondary analysis of published data, and the sample size was small. However, incident reports from care workers and nursery teachers working in hospitals included serious errors. The role of non-medical care staff in hospitals is broad and diverse, and has been shifting from direct care for patients with mild illnesses to direct care for patients with severe illnesses. An efficient clinical environment that ensures quality of care and service is lacking. By focusing on patient safety outcomes, policymakers and hospital teams should consider adjusting the working environment.

Incident reports involving hospital administrative staff: analysis of data from the Japan Council for Quality Health care nationwide database.

BACKGROUND: Task shifting and task sharing in health care are rapidly becoming more common as the shortage of physicians increases. However, research has not yet examined the changing roles of hospital administrative staff. This study clarified: (1) the adverse incidents caused by hospital administrative staff, and the direct and indirect impact of these incidents on patient care; and (2) the incidents that directly involved hospital administrative staff. METHODS: This study used case report data from the Japan Council for Quality Health care collected from April 1, 2010 to March 31, 2019, including a total of 30,823 reports. In April 2020, only the 88 self-reported incidents by hospital administrative staff were downloaded, excluding incidents reported by those in medical and co-medical occupations. Data from three reports implicating pharmacists were rejected and the quantitative and textual data from the remaining 85 case reports were analyzed in terms of whether they impacted patient care directly or indirectly. RESULTS: Thirty-nine reports (45.9%) involved direct impact on patient care, while 46 (54.1%) involved indirect impact on patient care. Most incidents that directly impacted patient care involved administrative staff writing prescriptions on behalf of a doctor (n = 24, 61.5%); followed by errors related to system administration, information, and documentation (n = 7, 17.9%). Most reported errors that indirectly affected patient care were related to system administration, information, and documentation used by administrative staff (n = 22, 47.8%), or to reception (n = 9, 19.6%). Almost all errors occurred during weekdays. Most frequent incidents involved outpatients (n = 23, 27.1%), or occurred next to examination/operation rooms (n = 12, 14.1%). Further, a total of 14 cases (16.5%) involved patient misidentification. CONCLUSIONS: Incidents involving hospital administrative staff, the most common of which are medication errors from incorrect prescriptions, can lead to severe consequences for patients. Given that administrative staff now form a part of medical treatment teams, improvements in patient care may require further submission and review of incident reports involving administrative staff.