Japan Council Research Articles

The trend of medication errors due to different length working as a nurse: Utilization of published data from the Japan Council for Quality Health Care

The trend of medication errors due to different length working as a nurse: Utilization of published data from the Japan Council for Quality Health Care

The approach to make better clinical training environment by utilizing third-party evaluation of Japan Council for Evaluation of Postgraduate Clinical Training

The approach to make better clinical training environment by utilizing third-party evaluation of Japan Council for Evaluation of Postgraduate Clinical Training

No fault compensation in perinatal medicine in Japan-from results for 8 years.

No fault compensation in perinatal medicine has been established to provide aid to patients in the event of disability due to a medical accident during delivery and to strive to resolve disputes quickly that contributes to reduce medical malpractice suit in the field of perinatal medicine. Furthermore, this system is aimed to establish a mechanism that achieves higher quality of obstetric care by analyzing the causes of accidents. This system is operated by Japan Council for Quality Health Care and 99.9% of childbirth facilities in Japan registered with this compensation system. Compensation system has two major functions including compensation and cause analysis and recurrence prevention based on cases. Compensation eligibility is reviewed in the Review Committee at the organization in Japan Council for Quality Health Care and currently 1,717 cases are judged as eligible cases out of 2,250 since 2009. The cause of each eligible case is analyzed in the Cause Analysis Committee one by one. The Cause Analysis Committee has 7 independent subcommittee and each subcommittee members are consistent of obstetricians, neonatologists, pediatricians, midwives and lawyers. Original cause analysis report is sent to childbirth facility and patient's family. Questionnaire survey demonstrated that 73% of childbirth facilities and 65% of patient family were satisfied with the cause analysis report. The number of medical lawsuit in obstetrics and gynecology is significantly decreased compared to those in all medical departments since the compensation system was introduced suggesting that these cause analysis reports may contribute the decrease in medical lawsuits. The major purpose of the Recurrence Prevention Committee is striving to prevent future cases of cerebral palsy and to improve the quality of obstetric care. To accomplish the purpose, the committee routinely collect information from individual cases and analyze quantitatively and epidemiologically. Furthermore the committee choose subject from cases to discuss for future prevention and provide wide public disclosure of the information with recommendation. The committee issued 6 reports until now and these reports have been distributed to childbirth facilities, perinatal medicine-related scientific society and administrative agencies.

A Life with Light, Statistics and Differintegrals

In this issue we also continue our custom of inviting the winner of the JCNIR Award to contribute an overview of his or her research interests in near infrared (NIR) spectroscopy. Dr Jun Uozumi is the winner of 2016 JCNIR award. The award is made annually by the Japan Council for Near Infrared Spectroscopy (JCNIRS) on the basis of the contribution of an individual to NIR research in Japan and the whole Asian continent. The award ceremony will be held on 1 December 2016 at the 5th Asian NIR Symposium (joint event with the 32nd Japanese NIR Forum) in Kagoshima city, Japan.

ISQUA16-1278THE DIFFERENCES OF STRENGTHS BETWEEN SUBGROUPS OF ACUTE CARE HOSPITALS IN ACCREDITATION SURVEY RESULT IN JAPAN:

Japan Council for Quality Health Care (JQ) is a third-party organization conducting hospital accreditation in Japan based on their accreditation scheme. It has 6 accreditation standards based on hospital type, and two of them are for acute care hospitals. One is hospital type 1 referring small- to mid-sized hospitals (smaller hospitals) and the other is hospital type 2: core hospitals supporting local healthcare in a relatively broad area (larger hospitals). The evaluation is made to each Small Item using 4 levels, which are “S (excellent)”, “A (applicable)”, “B (achievement of a certain level)” and …

中心静脈カテーテル留置術の安全確保─CVC研修会の試み─

中心静脈カテーテル留置術（CVC）の医療安全を確保する目的で，2009年から日本医療機能評価機構の枠組みを使ったCVC研修会を開始した．研修会は年4回開催され，医師20名が朝9時から17時まで休みなく講義，ハンズオン，小グループ討論などを経験する．技術面ではエコーガイド下穿刺，PICCなどのハンズオンと，管理面ではCVCに関する医療安全の講義と小グループ討論を重視している．研修会終了6カ月後のフォローアップアンケートによれば，多くの研修参加者が自院のCVCの安全管理に寄与していることがわかった．

Activities of the Japan Council of Organ Transplantation Related Academic Societies (J COTRAS) and new strategies to reduce burden on organ procurement hospitals in Japan

Activities of the Japan Council of Organ Transplantation Related Academic Societies (J COTRAS) and new strategies to reduce burden on organ procurement hospitals in Japan

Severe fetal acidemia in cases of clinical chorioamnionitis in which the infant later developed cerebral palsy.

BackgroundThe umbilical arterial pH (UApH) in cases of clinically apparent chorioamnionitis (CAM) in which the infant later develop severe cerebral palsy (CP) has not yet been fully investigated. The objective of this study was to determine the UApH in CAM cases in which the infant later develop severe CP.MethodsA review was conducted unti1 April 2014 among 324 infants with CP diagnosed to be caused by antenatal and/or intrapartum conditions, as determined by the Japan Council for Quality Health Care. Eighty-six infants born at over 34 weeks of gestation with an abnormal FHR pattern during labor were selected. The subjects were divided into the following two groups: cases with (Group I, n = 19) and those without (Group II, n = 67) clinical CAM. Severe fetal acidemia was defined as a pH of less than 7.0.ResultsThe frequency of severe acidemia in Groups 1 and II was 26.3 and 74.6 %, respectively. In addition, the frequency of severe acidemia was significantly less in Group I (odds ratio (OR) 0.12, 95 % confidence interval (CI) 0.03–0.53) than in Group II, while the frequency of fetal tachycardia was greater in Group I (OR 7.61, 95 % CI 1.82–31.7) than in Group II, after adjusting for confounding effects.ConclusionsThe frequency of severe acidemia was lower in the cases of clinical CAM in which the infant later developed severe cerebral palsy than in the cases without clinical CAM. The relation of fetal tachycardia to CP with clinical CAM, but not to acidemia, should be reevaluated in such cases.

Umbilical arterial pH in patients with cerebral palsy

BackgroundUmbilical arterial pH (UApH) in severe cerebral palsy (CP) is not fully understood. AimsThis work aims to determine the relationship between fetal acidemia and clinical features of severe CP. Study designA retrospective study design is used. SubjectsA review was conducted unti1 April 2013 among 218 infants with CP diagnosed to be caused by antenatal and/or intrapartum conditions determined by the Japan Council for Quality Health Care. After excluding patients in whom the causes of CP were thought to be due to events after delivery, 168 infants born at over 34weeks of gestation that both Apgar score and UApH were measured were selected. Outcome measuresSevere fetal acidemia was defined as a pH of less than 7.0. ResultsSix major factors were found to be associated with CP: placental abruption (A, n=42), traumatic delivery with an abnormal FHR pattern (B, n=29), an abnormal FHR pattern during labor (C, n=27), chorioamnionitis with an abnormal FHR pattern (D, n=17), an abnormal FHR pattern before labor (E, n=14), and cord prolapse (F, n=10). The UApH was less than 7.0 in 114 cases (67.9%) and more than 7.20 in 20 cases (11.9%). The UApH values were lowest in group A (median 6.7, 6.43–6.99) and highest in group E (7.18, 6.92–7.45). The distribution of the UApH values was significantly different in these groups. ConclusionPlacental abruption was a factor most associated with low pH. Even among the infants with severe CP, over 10% of patients exhibited a non-acidemic status at birth.

電気メス，レーザー等を用いた手術に関連するインシデントについて

In an effort to improve the safety of surgery, we investigated the incidents related to surgery using a laser or an electric scalpel, not to mention other equipment.The subjects included in this study were 86 cases who experienced incidents related to their surgery that we found in the reports of the Japan Council for Quality Health Care. We searched for a breakdown of the medical equipment used and the influence on the patient, and analyzed the causes of the incidents to determine whether new recommendations might reduce the risk of incidents. The breakdown of the medical equipment included 61 electric scalpels, 11 light sources, 7 radio wave cautery devices, 5 lasers, and 2 supersonic wave coagulation incision devices. The incidents were 46 burns, including 18 with no adverse outcomes, 8 cases with a foreign body left after surgery, 6 cases of damage to a proximal organ, 3 cases with perforations and 5 other incidents. The causes were 33 errors in the use of the equipment, 20 malfunctions and/or damage to the equipment, 17 cases of sudden ignition, 9 cases in conjunction with the use of a counter electrode plate, and 7 other causes. Many incidents were related to the use of a heat source apparatus, such as an electric scalpel or laser. Because most incidents were due to a lack of knowledge and recognition, taking countermeasures including increased education may be able to prevent the majority of incidents. Medical workers can reduce incidents by recognizing the risks, increasing their knowledge about the devices and sharing countermeasures as a team.

Fundamental Factors Related to Continuing Education in Family Nursing in Japan: A Mixed Methods Approach

In medical settings in Japan, where 25% of the total population is aged ≥65 years, an emphasis has been placed on homecare. Accordingly, nurses face the urgent task of interacting effectively with patients’ families, who are in a position to provide care for patients, in addition to the patients themselves. The aim of the present study was to obtain suggestions for continuing education that promote the practical family nursing ability of generalist nurses at medical facilities in Japan. A mixed methods approach was used to survey continuing education in family nursing in Japan. At 1,000 facilities accredited by the Japan Council for Quality Health Care, the implementation of lecture-style, in-house group training and its fundamental characteristics were explored through a questionnaire survey and interviews. Facilities with many hospital beds and personnel in charge of education conducted lecture-style, in-house group training on family nursing. The following four fundamental characteristics were identified: (1) an organizational culture of “the family as the target of nursing”; (2) the belief that “the patient lives at home”; (3) experience of “being useful to the family”; and (4) structures for “intersection of learning and teaching”. In summary, the study suggests the need to allocate personnel in charge of continuing education and, where this may be difficult, as in small- and medium-sized facilities, to adopt guidelines on continuing education through on-the-job training using the four fundamental characteristics identified in this study.

P319 Minds Project As Guideline Clearinghouse - Evaluation Of Clinical Practice Guidelines Developed In Japan

BackgroundMINDS (Medical Information Network Distribution Service) is a consignment project for MHLW (Ministry of Health, Labour and Welfare) managed by Japan Council for Quality Health Care. MINDS has been disseminating...

Heterogeneous effect of a per diem prospective payment system on hospitals' volume and quality

BackgroundThe original version of the inpatient prospective payment system is based on a fixed payment for an episode of treating a patient with a given diagnosis. However, specialised hospitals, as well as countries with historical differences in hospital reimbursement, require a modification with per diem prospective payments. MethodsThis paper provides theoretical and empirical analysis of hospitals' volume, proxied by average length of stay, and hospitals' quality, proxied by planned readmission rate, under different reimbursement systems. We demonstrate hospitals' heterogeneity in the response to the change from the fee-for-service (FFS) to a per diem prospective payment system with a length-of-stay dependent step-down rate (SDR): hospitals with shorter (longer) average length of stay under FFS have longer (shorter) average length of stay under SDR. We show that for FFS hospitals with longer average length of stay, the planned readmission rate increases under SDR. FindingsWe use a recently released administrative database for 684 Japanese hospitals in 2007–11 (Ministry of Health, Labor, and Welfare), with most hospitals changing the financial method from FFS to SDR during this period. The data are supplemented with financial variables (Ministry of Internal Affairs), accreditation information (Japan Council for Quality Health Care), and hospital characteristics (Handbook of Hospitals). The empirical analysis is conducted for each major diagnostic category. The results of the estimations with dynamic panel data provide empirical support for the predictions of our theoretical model. InterpretationThe results suggest that SDR contributes to differential hospitals' response to a per diem prospective payment system and might lead to insufficient cost containment. The findings are relevant not only for country-level (Japan, Germany), but also for medical-specialty-level generalisations. Indeed, prospective per diem payments are currently employed in Medicare's psychiatric hospitals, skilled nursing facilities, hospices, and in Medicaid's psychiatric inpatient facilities. FundingDAS received funding from Belk College of Business Dean's grant for 2012–13.

Labor induction by transcervical balloon catheter and cerebral palsy associated with umbilical cord prolapse

The aim of this study was to determine whether the use of transcervical balloon catheter (TCBC) for induction of labor (IOL) is a risk factor for cerebral palsy (CP) associated with umbilical cord prolapse (UCP-CP) in singleton pregnancies with cephalic presentation. Among all 102 infants with CP who were preliminarily determined as caused by antenatal and/or intrapartum hypoxemia by the Japan Council for Quality Health Care until April 2012, all 56 infants who met all of the following criteria were studied: cephalic singleton pregnancy, reassuring fetal status on electronic cardiotocogram at time of admission to obstetric facilities for labor pains, ruptured fetal membranes, and/or IOL, and hypoxic-ischemic encephalopathy at birth. Clinical backgrounds were compared between six infants with UCP-CP and the remaining 50 infants with CP not associated with UCP (non-UCP-CP). Frequencies of IOL (83% [5/6] vs 32% [16/50], P = 0.0236), use of TCBC (67% [4/6] vs 10% [5/50], P = 0.0044), and amniotomy (67% [4/6] vs 24% [12/50], P = 0.0494) were significantly higher in the UCP-CP than the non-UCP-CP group. Only TCBC was a risk factor significantly associated with UCP-CP after logistic regression analysis, yielding an odds ratio of 18.0 (95% confidence interval, 2.6-124; P = 0.003). Saline volumes of 80-150 mL were used for TCBC inflation in the four UCP-CP patients. Use of TCBC with a saline volume ≥ 80 mL was a significant risk factor for UCP-CP; however, the absolute risk of UCP-CP was estimated to be very low, approximately one in 7875 TCBC users.

Clinical features of abruptio placentae as a prominent cause of cerebral palsy

BackgroundAlthough abruptio placentae causes hypoxia in the infant and thus leading to cerebral palsy (CP), its incidence and clinical features at a nationwide level have not been demonstrated. AimsTo determine the proportion of abruptio placentae among antenatal and intrapartum causative factors leading to cerebral palsy (CP) and clinical features of such abruptio placentae. Study designA review was conducted in 107 infants with CP in whom CP was determined to be due to antenatal and or intrapartum hypoxic conditions by the Japan Council for Quality Health Care until April 2012. ResultsAbruptio placenta was responsible for 28 (26%) of the 107 CP infants, and was the single leading causative factor of CP. Of these 28 women, 22 (79%) exhibited non-reassuring fetal status on admission to obstetric facilities at 36.2±2.6weeks of gestation and had neonates with umbilical cord arterial blood pH (base excess) of 6.728±0.164 (−25±5.4mmol/L). In these 22 women, strong abdominal pain and/or profuse vaginal bleeding occurred 159±99min prior to admission to an obstetric facility, and the interval until delivery after admission was 47±31min. Hypertension or isolated proteinuria preceded clinical events in one (4.5%) and five (23%) of these 22 women, respectively. ConclusionsAbruptio placentae was responsible for CP in one quarter of all cases determined to be due to antenatal and/or intrapartum hypoxic conditions in Japan. New strategies to shorten the interval until admission to an obstetric facility after onset of symptoms are urgently needed.

An Introduction to Myself and My Current Research Interests

Currently, I work as an Associate Professor at the University of the Ryukyus in the field of virology. After graduating from high school, I entered college at the Tokyo University of Science. During my fourth year, I began a research project in the area of cell biology where I studied differentiation of neuronal cells (PC12 cells) [1]. During this period, I learned about prion diseases such as bovine spongiform encephalopathy (BSE), Creutzfeldt-Jakob disease (CJD) and scrapie. I subsequently entered an MS program and then a PhD program at the University of Tokyo (Department of Molecular Immunology, School of Agricultural and Life Sciences) to study prion proteins. In the laboratory, I performed research on “the functions of cellular prion protein in copper homeostasis and anti-oxidative defense” [2,3]. As a result of this research I received an award from the Japanese Society for Host Defense Research in 2006 and an award from the Japanese Society of Veterinary Science in 2009. After I moved to Osaka University, I began to perform research on near-infrared (NIR) spectroscopy as a postdoctoral scientist [4]. As a result of my NIR studies, I received the 2006 Award for best poster from the Forum of Near-Infrared Spectroscopy in Japan for our study entitled, “Bio-monitor of prion infections by nearinfrared spectroscopy”. In 2006 I received the Venture business award from Osaka University for our study entitled, “Non-invasive diagnosis of infectious diseases by near-infrared spectroscopy”. I was also a recipient of the 2011 NIR Advance Award from the Japan Council for Near Infrared Spectroscopy for our project entitled, “Development of clinical laboratory test using NIR spectroscopy”. After moving from Osaka University to the University of the Ryukyus, I set up a bio safety level 2 (BSL-2) animal facility in my laboratory. I recently started a new research project on gas plasma sterilization of pathogens such as viruses and prions [5]. Related to this research, I received the 1st Nanointerface Innovative Award for our study entitled, “Interactions between N2 gas plasma and viruses in nanoscale”, from the Committee of Frontier Science of Interactions between Plasmas and Nanointerfaces in 2011.

Quantitative analysis of hospital management using the data from the Japan Council for Quality Health Care

Quantitative analysis of hospital management using the data from the Japan Council for Quality Health Care

Incidents within community pharmacies across Japan: An analysis of the newly launched incident collecting project among community pharmacies and a comparison of causes between hospital pharmacies and community pharmacies

In April 2009, Japan Council for Quality Health Care (JCQHC) launched the Project to Collect Incidents within Community Pharmacies, a national project of self-and-voluntary reporting of incidents among community pharmacies. While there have been several studies and projects to collect and analyze incident reports among a set number of community pharmacies across the globe, it is still rare for an incident collecting project to exist at a national level. This paper introduces the new project in Japan. A retrospective analysis of community pharmacy participation across the country and cause of reported incidents based on the data released by JCQHC. Among the total number of reported incidents (1,460 cases), the most frequently reported incidents were related to the task of filling out prescriptions (92.0%). The most frequently answered cause of the incident was due to a “failure to check thoroughly” with 1,293 (96.3) out of 1,343 reported cases of incidents from community pharmacies. In a comparison of incidents reported between hospital pharmacies and community hospitals, both types of pharmacies reported a “failure to check thoroughly” as the leading cause of incidents. In hospital pharmacies, however, only 3,265 (84.7%) cases out of 3,857 were reported with “failure to check thoroughly” as the cause of incident. The rates between hospital pharmacy and community pharmacy for this cause differed significantly ( P < 0.05). As the main cause of incidents was due to “the failure to check thoroughly”, the need for confirmation systems within community pharmacies has become ever more evident.

薬剤師の病棟薬剤関連業務に関する医療従事者への意識調査

The report of the Japan Council for Quality Health Care in 2009 shows that 26.4% of medical incidents were related to medication. In Japan, not pharmacists but ward nursing staff are mostly responsible for pharmacy tasks at present, and the involvement of pharmacists in such tasks is expected to improve medical security.Recently, the concept of ‘skill mix’, meaning bringing together the skills of various healthcare professionals in hospital medical teams, has been attracting attention. In order to clarify the expectations and needs of the professionals involved, we conducted a survey of 175 nurses, 29 pharmacists and 50 doctors. The collection rates of the completed survey from the nurses, pharmacists and doctors were 74.3%, 93.1% and 94% respectively.Many nurses were concerned about their knowledge of drugs, and they also felt that their performance of pharmacy tasks negatively affected the nursing services they provided. Nurses and doctors hoped that pharmacists could be present in wards and participate in pharmacy tasks. In particular, nurses hoped that they would carry out the mixing of injection drugs, preparation of premixed injection drugs and preparation of oral medicines. They also tended to want pharmacists to carry out pharmacy tasks which required neither close communication with patients nor special knowledge of diseases. However, nurses who worked with pharmacists constantly in the ward wanted them to participate in many kinds of pharmacy task which required close communication with patients.

Information Center for Performing Arts and Entertainment's (ed.), Performing Art's White Paper 1997, Geidankyo (Japan Council of Performers' Organizations), 1997

Information Center for Performing Arts and Entertainment's (ed.), Performing Art's White Paper 1997, Geidankyo (Japan Council of Performers' Organizations), 1997