In June 2010, Kochi prefectural Hata Kenmin hospital introduced a regional network system called the“Shimanto network”which utilizes information technology to share electronic medical records among in-network facilities. This network allows the existing“Liaison Critical pathways for apoplexy”and“Hospital-clinic liaison Critical pathways for apoplexy”that have been used in the Hata area of Kochi prefecture to be shared online. In the past year, the network has been operating smoothly, accounting for 247 cases using“Liaison Critical pathways for apoplexy”.“Hospital-clinic liaison Critical pathways for apoplexy”were applied to 148 cases and 227 pathway sheets were issued during one year of operation.
Now that problems related to paper-based pathway sheets have been resolved, critical pathways are readily available for a variety of professionals to view. Supplementary information can be added, visibility and readability of the sheets have improved, and real time information sharing for all participants is now possible.
If a patient at our hospital must be moved to a different medical facility, the patient's electronic medical record and network pathway sheets are immediately made available to the staff of the new facility, thus enabling more extensive information sharing.
This study aims to find useful methods of medication therapy management (MTM) of outpatient chemotherapy within Saga region. In this study, the ‘Portfolio’ was developed from the data of questionnaire survey among 26 hospital pharmacists and 69 community pharmacists. ‘Portfolio’ indicated the difference from the hospital pharmacist and community pharmacist on three failure factors of MTM；‘knowledge of pharmacist’, ‘man power’, and ‘information of patient’. Five of MTM duties need ‘man power’ and ‘information of patient’ among the hospital pharmacists. By contrast, among community pharmacists, six of MTM duties needed ‘information of patient’.
Based on the above, we made a ‘medication therapy path-sheet’ of regional pharmacist for outpatient cancer chemotherapy. This sheet can be used for monitoring side effects, dosage of medicine and drug interaction to pharmacist, which may be used as support for the seamless MTM.
This survey investigated the methods to promote support for hospital discharge using 253 nursing staff members (abbr. ward staff) in the general ward of an acute hospital (response rate：84.6%). Multiple regression analysis showed that discharge support assessment was related to patients' long-term care insurance certification (abbr. LTC certification), understanding of their health care problems, and the length of ward work of the responders (abbr. ward length). The ward length was positively correlated to hearing ability regarding patients' anxiety, guidance to their post-discharge lives, and setting hospital discharge as a goal. The ward staff who were responsible for setting a goal for discharge were significantly less likely to identify a family structure or the LTC certification of patients, to ask about their request for post-discharged lives, and to give advice on their recuperation. It was suggested that the capability of doing something might not lead to practice.
It is important that the ward staff gather patients' information considering their post-discharge lives and give them proper advice on their recuperation. In this regard, the ward staff needs to have a view point of continuing nursing care. For the promotion of hospital discharge support, the ward staff should not set a goal simply for patients' discharge.
In order to respond to the rapidly growing social requirements on medical transparency, quality assurance and safety guarantee, Evidence Based Medicine (/Management） must be incorporated to cope with both efficiency and quality of medicine.
The All Japan Hospital Association (AJHA) aims to gain all the aforementioned goals, specifically the standardization of healthcare, by conducting quality assessment based on clinical indicators (2002), DPC data based analysis (MEDI-TARGET) (2006), and International Quality Indicator Project (IQIP) (2006).
In 2010, based on our ongoing operation of clinical outcome evaluation and DPC data analysis, we were granted the Promotion Project on Healthcare Quality Evaluation and Public Reporting by the Ministry of Health, Labour and Welfare. 27 hospitals participated in the project.
As a result, we have established (1) a public reporting system of hospital data with disease severity and specialty, and (2) a standardized method for development, introduction and public reporting of patient satisfaction and recommendation of hospitals.
Future agendas are (1) construction of a sustainable mode of operation, (2) reliability assurance of collected data, and (3) training of field staff.
Hospitals are managed in close association with governmental health policy. For this reason, unlike commercial enterprises, hospitals may be managed without being exposed to high economic risks. However, to maintain and advance a hospital as an organization, organizational activities like the ones required of commercial enterprises are needed. In this sense, a hospital's financial data will reflect its management as is the case with commercial enterprises. Before arguing about such data, the authors assumed that there might be factors within the qualitative information of hospitals that may have crucial impacts on hospital management. Based on this assumption, the authors conducted a study to explore if such factors could be revealed through numerical analysis of the data collected by the Japan Council for Quality Health Care (JCQHC) and to clarify the involvement of qualitative information in hospital management. Analysis was conducted of “hospital management policy” and “hospital environments” based on the assumption that these factors might affect hospital management. The data collected by the JCQHC were used for this study. Covariance structure analysis was attempted. In overall evaluation of the analysis models, high degrees of model fitness were revealed (GFI＝0.958, AGFI＝0.941, CFI＝0.865, RMSEA＝0.044). The results of this study suggest that hospital management policy and hospital environments are factors affecting the management of hospitals.
Minced foods and paste foods are often served to people who are unable to eat ordinary food due to difficulty in chewing or swallowing, or who have impaired physical strength. However, such foods are not appealing to the eye and are thus not appetizing. Eating is a joy of life, and enjoying the taste of food is fundamental for QOL.
“iEat?,” a support food for recovery of eating function, was therefore developed. The appearance and flavor are the same as ordinary foods, but “iEat?” can be mashed by the tongue and readily dissolved. We supplied “iEat?” for 3 days to patients who had been ingesting conventional minced or mashed foods, and compared their appetite, impression, and amount of intake with those for the conventional foods. Cost effectiveness was also compared between “iEat?” and minced foods prepared at the hospital in terms of working hours and costs.
“iEat?” was as safely ingested as “minced foods” by patients with difficulty of mastication. Significant difference was not observed in the food intake before and after intake of “iEat?”. Mean satisfaction level of “iEat?” was significantly higher than the conventional foods. “iEat?” needed little time for preparation and working hours were shorter, but was more expensive than the conventional foods.
Although “iEat?” is more expensive, it looks delicious and allows patients the “joy of eating.” It would be worth serving since patient QOL is enhanced compared with the conventional foods.
In Nagara medical center, one pharmacist has been allocated to oversee pharmaceutical care at neonatal intensive care unit (NICU)/ growing care unit (GCU) from April 2008 after Items of Pharmaceutical Care were established in the center. The overseeing pharmacist was given charge of the NICU/GCU and checked every dosage of drug to all affected infants administered with therapeutic medicine in NICU/GCU. This pharmacist allotted an average of 2 hours a day on pharmaceutical care at NICU/GCU during her regular work hours. The analysis of the result of the survey which included the number of inquiries from doctors or nurses to the pharmacist and pharmaceutical interventions undergone by the pharmacist in the NICU/GCU revealed that the majority of the inquiries consisted of dosage checks, intravenous line check and planning, evidence confirmation and selection of drugs, therapeutic drug monitoring, and provision of information including characteristics of products. The questionnaire survey using doctors and nurses indicated a strong need for dosage check, injection drug composition advice and check, instruction of dosage and administration to patients' family at patient discharge. Also, the number of drug-related incidents in NICU/GCU decreased since the beginning of the pharmaceutical care.
Pharmaceutical care that could be provided by pharmacists and needed by other medical staff at NICU/GCU was revealed in this study. Furthermore, it was suggested that active involvement of pharmacist can lead to better safety management at NICU/GCU.