Shoichi Maeda

Patient safety education at Japanese nursing schools: results of a nationwide survey.

BackgroundPatient safety education is becoming of worldwide interest and concern in the field of healthcare, particularly in the field of nursing. However, as elsewhere, little is known about the extent to which nursing schools have adopted patient safety education into their curricula. We conducted a nationwide survey to characterize patient safety education at nursing schools in Japan.ResultsResponse rate was 43% overall. Ninety percent of nursing schools have integrated the topic of patient safety education into their curricula. However, 30% reported devoting less than five hours to the topic. All schools use lecture based teaching methods while few used others, such as role playing. Topics related to medical error theory are widely taught, e.g. human factors and theories & models (Swiss Cheese Model, Heinrichs Law) while relatively few schools cover practical topics related to error analysis such as root cause analysis.ConclusionsMost nursing schools in Japan cover the topic of patient safety, but the number of hours devoted is modest and teaching methods are suboptimal. Even so, national inclusion of patient safety education is a worthy, achievable goal.

Attitudes toward autopsy in unexpected death: a nationwide survey of physicians and risk managers in Japanese teaching hospitals.

Context Autopsy is a useful tool for understanding the manner and cause of death in unexpected patient death. The information about the opinions of physicians and risk managers in Japan regarding autopsy is limited. Objective To describe and evaluate the opinions of physicians and risk managers at Japanese teaching hospitals regarding forensic autopsy. Design, setting and participants Cross-sectional study of all residency programme directors and risk managers completing a survey in January 2009. Specific clinical scenarios where autopsy would be essential to determine whether medical error occurred and whether medical care contributed to the death of the patient were presented. Respondents gave their opinion regarding the necessity of autopsy and their beliefs about if they would actually recommend it. Results Of 1113 eligible physicians and 1113 eligible chief risk management officers, 466 physicians (41.9%) and 599 risk managers (53.8%) responded. The majority of physicians and risk managers reported they would recommend an autopsy in cases of unclear medical error or unclear cause and effect relationship of medical care and patient death; however, 10% or more of physicians and 25% or more of risk managers (depending on the situation) reported that they would not recommend an autopsy. Risk managers were less likely than physicians to recommend and believe that autopsy was necessary. Conclusions The majority of physicians and risk managers in Japan would recommend autopsy and believe in its necessity in cases of unexpected patient death.

Doctor as criminal: reporting of patient deaths to the police and criminal prosecution of healthcare providers in Japan

BackgroundIn Japan, medical error leading to patient death is often handled through the criminal rather than civil justice system. However, the number of cases handled through the criminal system and how this has changed in recent years has not previously been described. Our aim was to determine the trend in reports of patient death to the police and the trend in the resulting prosecution of healthcare providers for medical error leading to patient death from 1998 to 2008.MethodsWe collected data regarding the number of police reports of patient death made by physicians, next-of-kin, and other sources between 1998 and 2008. We also collected data regarding the number of resulting criminal prosecutions of healthcare providers between 1998 and 2008. Reporting and prosecution trends were analyzed using annual linear regression models.ResultsReports: The number physician reports of patient deaths to the police increased significantly during the study period (slope 18.68, R2 = 0.78, P < 0.001) while reports made by next-of-kin and others did not. Mean annual reporting rates by group were physicians 130.1 (± 70.1), next-of-kin 29.3 (± 12.5), and others 10.4 (± 6.0). Prosecutions: The number of resulting criminal prosecutions increased significantly during the study period (slope 9.21, R2 = 0.83, P < 0.001). The mean annual prosecution rate was 61.0 (± 33.6).ConclusionsThe reporting of patient deaths to the police by physicians increased significantly from 1998 to 2008 while those made by next-of-kin and others did not. The resulting criminal prosecutions of healthcare providers increased significantly during the same time period. The reasons for these increases are unclear and should be the focus of future research.

Why are autopsy rates low in Japan? Views of ordinary citizens and doctors in the case of unexpected patient death and medical error

This article examines what could account for the low autopsy rate in Japan based on the findings from an anonymous, self-administered, structured questionnaire that was given to a sample population of the general public and physicians in Japan. The general public and physicians indicated that autopsy may not be carried out because: (1) conducting an autopsy might result in the accusation that patient death was caused by a medical error even when there was no error (50.4% vs. 13.1%, respectively), (2) suggesting an autopsy makes the families suspicious of a medical error even when there was none (61.0% vs. 19.1%, respectively), (3) families do not want the body to be damaged by autopsy (81.6% vs. 87.3%, respectively), and (4) families do not want to make the patient suffer any more in addition to what he/she has already endured (61.8% vs. 87.1%, respectively).

Attitudes toward clinical autopsy in unexpected patient deaths in Japan: a nation-wide survey of the general public and physicians

Context Autopsy is a useful tool for understanding the cause and manner of unexpected patient death. However, the attitudes of the general public and physicians in Japan about clinical autopsy are limited. Objective To describe the beliefs of the general public about whether autopsy should be performed and ascertain if they would actually request one given specific clinical situations where patient death occurred with the additional variable of medical error. To compare these attitudes with previously obtained attitudes of physicians practising at Japanese teaching hospitals. Design, setting and participants We conducted a cross-sectional study of the general public. We sent standardised questionnaires in 2010 to a randomly selected non-physician adult population using a survey company for participant selection. Respondents gave their opinions about the necessity of autopsy and how they might act given various clinical scenarios of patient death. We compared these results with those of a previous survey of Japanese physicians conducted in 2009. Results Of the 2300 eligible general adult population, 1575 (68.5%) responded. The majority of the general public indicated they believed an autopsy was necessary. However, in cases of unclear medical error or unclear cause and effect relationship of medical care and patient death, the general public were much less likely to indicate they would actually request an autopsy than were physicians (p<0.0001). Currently in Japan the debate about the role autopsy should play in the case of error related to death is underway. The results from this study will be important in informing related decisions.

Reuse of cardiac organs in transplantation: an ethical analysis

BackgroundThis paper examines the ethical aspects of organ transplant surgery in which a donor heart is transplanted from a first recipient, following determination of death by neurologic criteria, to a second recipient. Retransplantation in this sense differs from that in which one recipient undergoes repeat heart transplantation of a newly donated organ, and is thus referred to here as “reuse cardiac organ transplantation.”MethodsMedical, legal, and ethical analysis, with a main focus on ethical analysis.ResultsFrom the medical perspective, it is critical to ensure the quality and safety of reused organs, but we lack sufficient empirical data pertaining to medical risk. From the legal perspective, a comparative examination of laws in the United States and Japan affirms no illegality, but legal scholars disagree on the appropriate analysis of the issues, including whether or not property rights apply to transplanted organs. Ethical arguments supporting the reuse of organs include the analogous nature of donation to gifts, the value of donations as inheritance property, and the public property theory as it pertains to organs. Meanwhile, ethical arguments such as those that address organ recycling and identity issues challenge organ reuse.ConclusionWe conclude that organ reuse is not only ethically permissible, but even ethically desirable. Furthermore, we suggest changes to be implemented in the informed consent process prior to organ transplantation. The organ transplant community worldwide should engage in wider and deeper discussions, in hopes that such efforts will lead to the timely preparation of guidelines to implement reuse cardiac organ transplantation as well as reuse transplantation of other organs such as kidney and liver.

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.