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

Abstract

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. MethodologyA 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. ResultsThe 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. ConclusionOur 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.

Critical Incident Reports Related to Ventilator Use: Analysis of the Japan Quality Council National Database

“…Third, the staff and hospital administrators experience complex feelings and barriers to reporting incidents, the risk of litigation issues, which makes it difficult to collect incident reports and hospital information. Incident reporting research has focused on nurses, physicians, and pharmacologists, but there are few studies focusing on other hospital staff, including hospital administrative staff, 42 nursery teachers, and care-certified staff 23 . Fourth, this is a cross-sectional study; thus, we cannot investigate the causal relationship between the improvement of complicated specifications of ventilators and the actual prevention of errors.…”

“…Incident reporting research has focused on nurses, physicians, and pharmacologists, but there are few studies focusing on other hospital staff, including hospital administrative staff, 42 nursery teachers, and care-certified staff. 23 Fourth, this is a cross-sectional study; thus, we cannot investigate the causal relationship between the improvement of complicated specifications of ventilators and the actual prevention of errors. Because this study was based on the data collected by the JCQHC, it cannot be said whether these codes improved or if the accidents were preventable.…”

“…Two research nurses were involved: one with experience as a patient safety manager and the other, a qualified clinical engineering technologist, with surgical nurse experience. Both had experience in mixed-methods research and content analysis 23 . The researchers independently read the incident reports several times and the reasons for errors coded according to the Mattox report 13 and the SHELL model 24 .…”

“…Both had experience in mixed-methods research and content analysis. 23 The researchers independently read the incident reports several times and the reasons for errors coded according to the Mattox report 13 and the SHELL model. 24 The SHELL model consists of 4 domains: software (procedure, protocol, and training), hardware (machines and medical instruments), environment (operating theater, wards, and consultation room), liveware (human factors: doctors, nurses, and other health care professionals, or patients), liveware-liveware (human factors: people surrounding the person, people who were with the person).…”