The purpose of this study is to investigate the factors that influence patient safety awareness of midwives and to obtain fundamental data for midwifery postgraduate education on patient safety. We conducted a quantitative cross-sectional survey by self-reported questionnaire in 1005 full-time midwives working in 68 hospitals in Kanto Area, Japan. The questionnaire included the professional autonomy in midwifery, the Japanese Burnout Scale, awareness of patient safety and demographic characteristics. The survey response rate was 74.8% (n=752) and the valid response rate was 59.5% (n=598). The multiple regression analysis indicated that the factor affecting awareness of patient safety of midwives were participation in patient safety training, tocology training, years of experience as midwife, clinical practice, independent judgment, emotional exhaustion and reduced personal accomplishment. The results of the study suggested that carrier support, improved work environment and psychological support to raise the awareness in patient safety of midwifery is needed.

Nation-wide trends of fatal adverse events which caused patient's deaths or severe disabilities and numbers of in-hospital reports concerning adverse events or near misses have not been determined sufficiently. This study aimed to determine the progression of hospitals that have experienced fatal adverse events, progression of number of reported adverse events or near misses, and relationships between those progressions and the improvements of hospital system such as the assignment of patient safety managers, hospital accreditation or other factors of relevance.

Mail surveys were conducted on all member hospitals of All Japan Hospital Association in 2004, 2011, 2014 and 2015. The questionnaires included questions about the characteristics of hospitals, the experience of fatal adverse events in the immediate last three years and the annual number of reported adverse events or near misses. The progression of data from 2011 to 2015 was analyzed, and the data in 2004 is shown here as reference.

Recovery rates of each year ranged from 18% to 28%. From 2011 to 2015, the hospitals which experienced fatal adverse events were increased (23%, 29%, p=0.02), and the median number of in-hospital reports per bed tended to increase (2.7 cases, 3.3 cases). The hospital accreditation and the assignment of full-time patient safety manager were associated with the increase. When calibrated to the function of hospitals, the size of hospitals, the hospital accreditation status and the assignment of patient safety managers, we found the year of survey was correlated not with the experience of fatal adverse events but with the number of in-hospital reports.

The increase in hospitals that experienced fatal adverse events may be the result of improved detection capability for fatal adverse events by improving hospital system. The increase in number of reports may be the result of improvements in hospital system and other activities that were not grasped in our study.

This study aimed to develop a Patient-Reported Quality of Life scale to measure perceived quality of life outcomes brought about by nursing interventions.

To obtain the data necessary to develop the scale, we recruited subjects from patients who had been hospitalized for two days or longer, and were prepared to be discharged on a set date. Questionnaires were distributed to 1,225 patients, and 1,193 responses were obtained. For statistical analyses, we used the data of 820 patients who responded to all of the survey items. In reference to previous studies, we prepared the NQOL scale items：4 items for the domain of “Health,” 7 items for the domain of “Life,” and 4 items for the domain of “Existence.” We performed exploratory factor analysis (EFA) to assess content validity and confirmatory factor analysis (CFA) to examine construct validity. To assess the reliability of the scale, we examined the internal consistency using the reliability coefficient omega. Before evaluating the validity and reliability of the scale, polychoric correlation coefficients were calculated to omit redundant items. Next, we performed EFA to eliminate all the items with loadings of 0.30 or higher on multiple factors, and interpreted the factors. The fit of the extracted model to the data was examined through CFA based on structural equation modeling.

Results indicated that the three-second-order-factor model comprising 2 items for “Health,” 4 items for “Life” and 2 items for “Existence” as first-order factors and NQOL as second-order factor had adequate fit. The reliability coefficient omega was also within a statistically appropriate range.

In the Discussion section, we evaluated the construct validity of the NQOL scale through cross validation and discussed the need to elucidate factors that can influence NQOL.

This study attempts to clarify aspects of student experiences in collaborative practice by conceptualizing and analyzing subjective phenomena during interprofessional education at University A. A text mining analysis was conducted on assigned reports in 2013. With a focus on the phrase “other professions,” which was the most frequently used phrase in the reports, trends in the use of expressions were revealed through a quantitative analysis of emergence patterns. An investigation of the term associations in the reports showed that one aspect of the students' training experience was the ability to envision the process of dealing with other professions, leading to an increased awareness of one's own profession；and changes to one's concept of medical care teams composed of people from different professions.

This paper attempts to visualize and share the patients' information by using the “Check Board” to prevent fallings.

First, the report of falling incidents was checked and reviewed of the nurse-attitude survey from July 2011 was conducted before the start of the use of the check board in March 2012. With this review, the Check Board was constructed for the preventive management of falling, with list of information on each hospitalized patient regarding required assistant level (level of independency), excretion care and methods, frequency of injection and tubing, and bed fence information. The members of the staff reviewed the board daily and shared the information. The incidence rate, situation of the fall, contributing factor as well as the nurse-attitude after the introduction of the board were investigated.

Falling reduced to thirteen incidents from twenty-two, and the falling rate per day improved significantly from 7.5/thousand people to 2.7/thousand people compared to the survey taken between 2011 and 2012 (p<0.01). Incidents at toilet use showed an improvement from fourteen to eight (p<0.05). Nurses' attitudes for the patients' care (such as variance of patient daily condition) showed improvement in the attitude survey taken after the implementation of the board.

By sharing the information of all patients by using “Check board”, it is possible to say that the goal of reducing the number of fall incidents was achieved.

The purpose of this study is to clarify about family nursing practice and nurse's recognition of practice for transfer of the terminal cancer patients from a general ward to a home care setting. As a result, the contents of family nursing practice included “Communication with family and reporting about the home care settings,” and “Listening to patients' family about transfer to a home care setting, adjustment to the conflicting family member.” The contents of nurses' recognition about family support included “Cooperating with the member of various job types with family members for transfer to a home care setting,” and “Respecting the individuality of the family and regarding a family as a unit.”

As family support for transfer to a home care setting, the nurses recognized the patient's hopes, but did not nominate action to this as part of family nursing practice. Transferring terminal patients into home care revealed to have extra difficulties since we were not only dealing with the patients' wishes but that of the family members and nurses. Nurses did recognize that when one of the family members suffer from a cancer and is transferred to a home care setting has affects on the whole family, but they lacked the viewpoint in nursing care regarding the relationship among family members.

This study places nurses in a community medicine cooperation office in hospitals, aiming to strengthen the cooperation system between the hospitals and welfare nursing facilities for the elderly.

We placed full-time nurses in medium-sized cooperative hospitals responsible for providing a plurality of care in the elderly welfare facilities of the region (hereafter referred to as “nursing homes” ). Although the regional medical cooperation office had been staffed by full-time social workers, as patients discharged from hospitals in states requiring medical procedures increased, there was a need to allocate nurses in the office to provide full-time discharge support. A full-time nurse with visiting-nurse experience working in a ward that had accepted many of the nursing home residents in collaboration with the appointed hospital was appointed to this position.

The appointed full-time nurse extracted issues regarding cooperation through meetings with nursing homes. In addition, the reality of the facility care was confirmed by actual visits to the nursing homes. It was revealed that medical procedures were conducted according to nursing-home nurses' working hour because there were no night-time nurses. There is no placement policy of the night-time nurses in nursing homes, and there was a discrepancy in the medical assistance method of patients between hospitals and nursing homes. To solve the deviation of the hospitals and nursing homes, a full-time nurse regularly provided a course of treatment and nursing information to nursing-home nurses, and nursing homes helped to allow preparation for proper re-admission. In addition, a full-time nurse, to strengthen the hospital system, launched a discharge support nurses association aimed at development of nurses with knowledge on patients' life in nursing homes. Appointment of a full-time nurse to regional medical cooperation scheme proved to be effective.

Decreasing the length of stay in stroke rehabilitation hospitals is of utmost importance as is quickly admitting rehabilitation and performing the most efficient rehabilitation possible；rehabilitation programs must be refined to be as effective as possible.

We emphasized the importance of strengthening of the uninvolved lower limb and have administered stand-up and sit-down exercises 400-600 times for approximately 2 hours per day. In occupational therapy, exercises were also done mainly for increasing the uninvolved lower limb's power. ROM exercise of the paralyzed upper limb was performed by the patients' own uninvolved hand. Swallowing exercise was not performed since it is supposed to have little effective evidence. Most of the patients spent more than four hours in the rehabilitation room.

Our rehabilitation ward began in August 2014, and treated 254 patients in 18 months. The outcome was compared with the national study of stroke rehabilitation (9,041 cases). Although there was no difference in FIM scores at admission (74.4 in our case and 71.1 in national group), a difference appeared in FIM scores at discharge (94.6 in our cases and 88.3 in national group). Length of stay was 45.0 days in our cases, but 81.3 days for the national group. 80.3% in our cases and 66.3% in national group were discharged to their own home.

Our study showed that the length of stay can be shortened with 400-600 stand-up and sit-down exercises, strengthening of the lower extremities, and omission of swallowing exercise.

Since 2015, with the introduction of Patient Flow Management (PFM), we have been conducting a prehospital interview as part of the program in effort to construct course projection from hospitalization to discharge. We analyzed and compared the patients and their family members on this program to those that are not by conducting semi-structured interview and clarified the issues surrounding their predicament. Results showed that prehospital interviews were useful in that it provided an image of a hospitalized life to patients, showed that patients understood the context of their treatment including choices of surgery/discontinuation of treatment and medications, and provided insight into what patients and their family members were being anxious and confused of with the life after discharge.

The responsibility of ward rounds aid provided by assistants at the physicians' offices (referred to as “doctor aids [DAs]” at this hospital) at the Funabashi Municipal Medical Center includes not only making records of the hospital round details, but also maintaining records of changes in admission instructions, treatment and examination details, and conference details. However, the quality of the content entered by different DAs varies because the characteristics of the disease being handled and details of treatment given at the time of hospital rounds are different in each hospital department. Therefore, to ensure quality of tasks, we established an educational system for rounds assistance in the form of ladder check evaluations for new assistants (DAs responsible for assisting in making records of the rounds for the first time). According to our system, teams of two persons (new DA and DA responsible for rounds) conduct rounds as a part of on-the-job training (OJT), and after a fixed period, the DA responsible for rounds conducts ladder check evaluation of the new DA. The evaluation is conducted in three steps, and as per the comprehensive evaluation criteria, the new DA is considered capable of working independently and ready for rounds upon receiving a passing mark (i.e., scoring more than 50% in each item). Implementation of ladder check evaluations for tasks was found to be useful as it allows the new DAs to understand the level they have attained and objectively view their progress. Physicians expect DAs to be involved with a larger variety of tasks while ensuring high quality.

The core role of the medical doctor's clerk (DC) in Nanpuh Hospital is to support doctors with outpatient care and to record medical certificates on behalf of doctors. In meeting the demands from the clinical site, DC's overtime increased as the requests from doctors grew. Therefore, to improve work efficiency, we had assigned DC into the busy period during the outpatient care, and granted responsibility as the person in charge of recording medical information into database. As a result, we could introduce the DC system into other new departments. In addition, in 2015, the number of medical certificate recording was increased by 7%, discharge summary recording was increased by 73%, thus, could shorten overtime by 21% from the preceding fiscal year.

Furthermore, we constructed a doctor support system that focused on the data analysis, clinical study and foreign language. We found those supports were helpful for the doctors, and it was more than we imagined. With variety of the DC's roles in acute care hospital, reduction of the doctor's burden, and contribution to the development of the hospital is expected.

We received the first examination of the third-party evaluation by Japan Council for Evaluation of Postgraduate Clinical Training (JCEP) on March 29, 2012. We improved the items where further considerations were required in the first examination to pass the update examination (February 27, 2014). In this paper, we report our actions and outcomes.

First, we summarized the items that were deemed to require examination into a table and reviewed the results after the first examination. We could classify these items into four challenges although items pointed out were different, they nevertheless indicated contents that were same as the result of the review.

We constructed improvements to four challenges sequentially and received examination again. We received the 4 years authorization along with a report which appreciated our activities；(1) the director shows the leadership, (2) the hospital created a better training program and a better clinical training environment, and (3) all staffs in the hospital teach junior residents as clinical training leaders. However, the new items were indicated to make our hospital grow further as a clinical training hospital of higher quality.

We were able to see the clinical training environment objectively and clarify both the strength and the weakness of our hospital by receiving the third-party evaluations of JCEP twice. We think that we can improve the quality of the clinical training by improving on our weakness and by strengthening our strong points. We wish to continuously work on the creation of better postgraduate clinical training environment by utilizing a third-party evaluation.

This study was conducted to examine the acquisition of immunity to measles, rubella, mumps, and varicella by outpatient staff of multiple professions, as well as challenges for building a vaccination program.

The subjects were 428 outpatient staff. Questionnaires regarding history of infection and history of antibody testing for measles, rubella, mumps, and varicella and history of vaccinations were administered, and IgG antibody titers for measles, rubella, mumps, and varicella were measured by enzyme-linked fluorescent assay.

Antibody-positive subjects included 395 for measles, 372 for rubella, 400 for mumps, and 404 for varicella. The antibody titer results showed 308 subjects with “antibodies for all four diseases” and 120 subjects with “antibody-negative/indeterminate results for any of the four diseases”. The proportion of subjects who answered, “I will not get vaccinated if I test negative for antibodies in these blood sampling results” was significantly higher among “antibodies for all four diseases” than “antibody-negative/indeterminate results for any of the four diseases” groups (p = 0.012).

The results suggested that future challenges for building a vaccination program included, “Developing a vaccination program to allow both medical staff and non-medical staff to undergo antibody testing and vaccination”, “Carefully explaining the vaccinations required by each individual undergoing vaccination according to their antibody test results in order to link these results to vaccination behavior”.

In August 2008, Juntendo University Hospital began an antibacterial drug use notification system targeting broad-spectrum antimicrobial agents. In 2012, the addition of operations of a hospital ward pharmacy was newly established, ensuring the hospital ward time of pharmacists, and a system to promote prompt submission of notifications to the physician was provided. At this time, whether improvement in the notification rate by the hospital ward operations would effect change in antibacterial use density (AUD) was examined, by considering notification rate and AUD before and after the start of hospital ward operations. As a result, notification rate significantly increased to an average of 93.1% after the start of the hospital ward operations compared to an average of 55.8% before the start of operations. The AUD of Quinolones was decrease and Carbapenems was increase. The addition of operations of a hospital ward pharmacy has been shown to be useful for improving the notification rate. A pharmacist does not stay at AUD evaluation for achievement of last antibacterial medicine use. To ensure proper use of these medications, pharmacist intervention should be considered for each individual patient.