In recent years, discharge support has been required to start early due to the shortening of hospitalization. Teamwork is essential to provide medical care with high specialty and consistent treatment for patients with various needs and combine the effort with the support. Therefore, this investigation is intended to clarify the factors which compose teamwork in discharge support.

The target of this investigation was 362 floor nurses at Okayama University Hospital and there were 244 valid respondents. The questionnaire was a set of a newly-created teamwork scale in discharge support (32 items, 7-grade evaluation) and an attribute questionnaire, which was collected by placement method after the distribution. The analysis method was exploratory factor analysis using promax rotation by principle factor analysis. Also, Cronbach coefficient α was calculated to evaluate internal consistency. Three factors were extracted from the teamwork scale in reference to scream plot, and the primary, secondary and third factors were named “individual latent capability”, “team competency” and “leader's presence” respectively. When those factors' reliability was examined by the coefficient, the primary factor was 0.942, the secondary was 0.897 and the third was 0.717. After reviewing the total scores of the teamwork scale per attribute, differences were found in job position, age, marital status and the presence or absence of attachment and trust to a current post. The teamwork scale in discharge support comprised those three factors and ensured reliability. It was suggested that attachment to work and trust relationship with co-workers influenced teamwork.

A case-cohort study was conducted to identify factors that influence oral medication errors. The cohort consisted of patients who were over 15 years old and prescribed oral medications during hospitalization in a 1,000-bed private general hospital from July 1, 2011 to June 30, 2012. The case group consisted of patients who experienced oral medication errors, and the subcohort consisted of patients who were randomly selected from the cohort. Information related to oral medication errors was collected from medical records and incident reports in order to determine the relationship between oral medication errors and each potential associated factor. Multivariate logistic regression analyses was performed with independent variables that influence was suspected and the dependent variable that was characteristic of the case group or subcohort.

The case group consisted of 203 patients and the subcohort consisted of 196 patients. Results revealed that 8 factors were associated medication errors, including storage in different locations, visual impairment, and discontinuation or resumption of a medication. The risk of a medication error increased 1.42 times with each increase in the number of medications prescribed.

In order to avoid medication errors, a system of medication storage should be considered, a pharmacist should be involved when orders from physicians are changed and coordination with pharmacists should be enhanced, and orders and prescriptions from physicians should be integrated in medical records to avoid medication errors.

In St. Marianna University School of Medicine Hospital, the discharge planning nurses of the Medical Support Center (MSC) support both inpatients and outpatients at the request from the attending doctors. The preceding study showed that there was the difference in the number of days from hospitalization to making a transfer request depending on the discharge destination. It is suggested that one of the factors for the difference is on a medical person's image of a patients' recuperation after discharge.

In this study, the effect of increase in opportunity of the participation of discharge planning nurses to ward conferences was revealed. The number of days from hospitalization to making transfer request was shortened, but the number of days from the request to discharge did not change. As a result, the length of hospital stay was reduced.

In conclusion, participation of discharge planning nurses to the ward conference is a good opportunity for ward medical persons to re-assess inpatients after admission screening and also to acquire necessary knowledge in discharge support.

We have assigned hospital ward concierges to deluxe rooms since October 2011, and have introduced various services for patients in hospital wards. At first, they were not popular with patients or staff. So, we have improved the services to decrease nurse burden and increase patient satisfaction.

At first, their main work was providing support for patients such as “Tiding up patients’ rooms”, “Talking with patients”, etc. In March 2012, the introduction of concierges had relatively little effect. The degree of recognition by nurses was 78%, the degree of commission given by nurses was 54%, the degree of recognition by patients was 80%, and the degree of utilization by patients was 60%.

We have broadened the commission given by nurses to decrease nurse burden. And we have added new work to the patients’ needs to increase patient satisfaction. We have continued to broaden the concierges’ areas of work and increase their manpower. For example, we have introduced a coffee serving service and we have modified the allocation of work to include not only nurses but also other members of staff.

By June 2013, the degree of recognition by nurses has increased to 93%, the degree of commission given by nurses has increased to 93%, and the degree of recognition by patients and the degree of utilization by patients have increased to 100%. The length of time for commission work given by nurses has also increased.

The basic plan to Promote Cancer Control Programs was revised in June 2012. Promotion of perioperative oral management had been specified. For the purpose of reduction of the perioperative complications and shortening the postoperative hospital stay, perioperative oral management fees were founded for 2012 fiscal year health care fees. Because our hospital is an acute care hospital without dentistry, we had set up cooperation program with Fukuyama dental association. We started our oral management programs in February 2014. From February 2014 to February 2015, we performed operations under general anesthesia for 105 patients, and we have implemented the program on 75 patients. The program was not implemented for 26 patients who were admitted in emergency.

The purpose of this study is to investigate the current level of Work-Life Balance (WLB) for single nurses and how working conditions are affected to WLB. This self-reported questionnaire was completed by 15,025 nurses in 49 domestic hospitals.

They showed no significant differences in “WLB demands” for single nurses and nurses with household (p＝0.558), however single nurses had a clearly lower (p＜0.001) “WLB Satisfaction”. And “Number of Day Shift”, “Working Hours of Day Shifts”, “Overtime in Day Shifts,” “Number of Night Shift,”, “Working Hours of Day Shifts”, “Overtime in Night Shifts” were much greater for single nurses (p＜0.001 for all). Both of the level of “Depression” and “Physical Fatigue” were obviously higher for single nurses (p＜0.001 for both). Compared to nurses with household, “WLB Satisfaction” of single nurses was inversely correlated with “Overtime in Day Shifts”, “Number of Night Shift”, and “Overtime in Night Shifts” (p＜0.001 for all).

Single nurses are forced to work under quite harsh working environments. Consequently, they are physically and mentally exhausted. These aspects make single nurses' potential toward WLB decrease. In keeping with the principle of WLB itself, we need to correct comprehensive policies to enhance WLB. Also, they should be implemented to reduce their burden such as increased overtime and number of night shift, and any other factors that disrupt the level of WLB.

The balanced scorecard (BSC) which was created by the executive meeting in our hospital was applied in fiscal 2013. Prior to this hospital BSC, we created BSC of the clinical trial management office in the following processes as a department BSC.

First, we created a technical skill evaluation sheet of a standard CRC business, and evaluated the technical skill of CRC. Then we carried out the SWOT analysis with the five-year action plan of clinical study and clinical trial of 2012 in mind, investigating the weak and strong points of our facility by KJ method. The BSC which defined the objective goal including an advanced quality of clinical trials and an increment of the numbers of clinical trials, an education of CRC, and a progress management of a trial was established, and was applied from fiscal 2012.

This BSC could not attain a target value in each perspective, namely the customer (patient satisfaction), the finance (newly accepted or incorporated cases, and implementation or completion rates of trials), the internal process (secretariat, CRC manual, reduction of overtime, shortening of consultation period, and holding a meeting) and the study and growth (lecture class) in fiscal 2012.

The mutual investigation of the results of CRC technical skill and the achievements of BSC clarified future objectives to be shared in the clinical trial management office.

To standardize the business and to clarify the achieved target of a clinical research coordinator (CRC), we designed the evaluation table of CRC technical skill classified by CRC works and their techniques and knowledge were self-evaluated. This evaluation table consisted of 20 CRC work skills.

The scores of the skills level for management of a trial medicine, drugs inhibited in concurrent use, deviation, coordination with related sections, Good Clinical Practice, start-up meeting, Institutional Review Board, newcomer education and English learning were lower than the average of total works in the fiscal 2012, but the scores of all works were improved in the fiscal 2013. However, the scores for management of a trial medicine were still lower than the average of total works in this year. This evaluation table clarified the present level of the CRC skill of our clinical trial management office and is a useful tool to educate a CRC on how to anticipate managerial tasks. Incorporation of the evaluated results of CRC technical skill in a balanced score card makes it possible to set up the achieved target of CRC or the qualified action plan of our clinical trial management office.