[Incident and accident reports in Tokyo Medical and Dental University Dental Hospital (FY 2001-2002)].

In 2002, the Dental Hospital of Tokyo Medical and Dental University set up a working group for risk management. This working group analyzed 225 incident and accident reports submitted to the hospital in 2001 and 2002. Each report was analyzed with regard to "type," "place," "reporter," "severity," and "cause" in order to diagnose hospital safety and prevent future incidents and accidents. The cause of incidents and accidents was analyzed using the SHEL model, where S stands for Software, H for Hardware, E for Environment, and L for Liveware. The severity of the consequence was classified into 6 levels, where level 0 = "error not applied," level 1 = "not affected," level 2 = "watch and see or additional test," level 3 = "treatment," level 4 = "aftereffect," and level 5 = "death." The incidents and accidents judged to have potentially high risk were given a score of "+H," irrespective of the level. The results of the analyses revealed that most of the incidents and accidents happened in "wards," "operation rooms," and "oral surgery clinics." This is probably because the incident and accident reporting system is well established by nurses working in these clinics. Additional analysis revealed that most of the reports were written and submitted by nurses. The frequencies of "treatment procedure," "misuse of dental instruments," "mis-prescription," "falling down" and "needlestick" related incidents and accidents were the highest and were caused mainly by L and S. There were only 3 accidents above level 4, however, less severe cases were given a score of +H due to the high potential risk involved.

[A study on the relationship between the actual situation of nursing activities, in the outpatient section of oral surgery, and medical fees].

In our outpatient oral surgery section, nurses have performed such nursing activities as guidance and consultation for outpatients. The present survey was conducted to clarify the actual situation of nursing activities, and that of claims for medical fees during fiscal year 2000, the year the claim for medical fees was started. At that time, the problems involved were examined to further improve nursing activities for outpatients. The nurses gave guidance on alimentation, oral hygiene, and breast feeding, from the nurse's record which were classified and totalled according to each disease, guidance item, and time required (less than 30 minutes or more than 30 minutes). The total numbers of patients were 172 persons and 357 cases. Major guidance items were alimentary guidance (179 cases), oral hygiene guidance (105 cases), and breast feeding guidance (73 cases). The items claimed for medical fees were two: "Athrocytosis function therapeutics" (9 cases) and "the guidance fee for the treatment of specific dental disease" (32 cases). The problems that discouraged claiming a fee for performed chargeable nursing activities are listed as 1. there are no exclusive guidance rooms, 2. insufficiency in securing staff, 3. the instructions and the requests by dentists have not been made exactly and smoothly. Thus, the problems to be considered hereafter would be 1. review and improvement in the guidance environment to an appropriate level, 2. make regulations for securing necessary staff, 3. construction of a system for exact and smooth instruction and requests, and 4. promotion to enrich the content of guidance and to make the results public.