Results of a questionnaire survey regarding the current status of near-miss/incident/accident reporting in the Saiseikai Clinical Laboratory and efforts to increase the number of reports

Currently, there have been many reports that activating incident and accident reporting activities are important initiative for improving medical safety in clinical scene. However, there are few reports on the number of incidents and accidents that occur in association with the work of clinical labo...

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Published inJapanese Journal of Medical Technology Vol. 74; no. 1; pp. 147 - 153
Main Authors TOMITA, Ayako, MOMOTA, Hiroshi, SEKIYA, Koichi
Format Journal Article
LanguageJapanese
Published Japanese Association of Medical Technologists 25.01.2025
一般社団法人 日本臨床衛生検査技師会
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ISSN0915-8669
2188-5346
DOI10.14932/jamt.24-24

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Abstract Currently, there have been many reports that activating incident and accident reporting activities are important initiative for improving medical safety in clinical scene. However, there are few reports on the number of incidents and accidents that occur in association with the work of clinical laboratory technicians in Japan and overseas. Therefore, we conducted a questionnaire survey on the incident and accident reporting activities at 76 nationwide Saiseikai medical facilities that have clinical laboratories, as well as facilitating activities to increase reporting and the action process against the incidents/accidents. We received responses from 71 (93%) out of 76 facilities. The maximum total number of near misses/incidents/accidents reported was 536, and the minimum was 0. The maximum number of cases reported per technician was 32.3. Many activities were made to increase the number of reports, including promotional activities of reporting, sharing report content, establishing a system for easy reporting, and setting targets for the number of reports. The most common action process against the incident/accident report were: alerting related department staff, changing procedures/work manuals, improving the work environment related to the incident, alerting those who carried out the incident, and revision of educational instruction related to the incident. A positive correlation was found between the number of incident reports and the number of near misses. Although there was no relationship between activities to increase the number of reports and the number of reports, association was found between the number of incident report and the number of actions against incident report. It was thought that improvement actions against incident report had a positive impact on clinical practice and led to an increase in the number of incident reports.
AbstractList Currently, there have been many reports that activating incident and accident reporting activities are important initiative for improving medical safety in clinical scene. However, there are few reports on the number of incidents and accidents that occur in association with the work of clinical laboratory technicians in Japan and overseas. Therefore, we conducted a questionnaire survey on the incident and accident reporting activities at 76 nationwide Saiseikai medical facilities that have clinical laboratories, as well as facilitating activities to increase reporting and the action process against the incidents/accidents. We received responses from 71 (93%) out of 76 facilities. The maximum total number of near misses/incidents/accidents reported was 536, and the minimum was 0. The maximum number of cases reported per technician was 32.3. Many activities were made to increase the number of reports, including promotional activities of reporting, sharing report content, establishing a system for easy reporting, and setting targets for the number of reports. The most common action process against the incident/accident report were: alerting related department staff, changing procedures/work manuals, improving the work environment related to the incident, alerting those who carried out the incident, and revision of educational instruction related to the incident. A positive correlation was found between the number of incident reports and the number of near misses. Although there was no relationship between activities to increase the number of reports and the number of reports, association was found between the number of incident report and the number of actions against incident report. It was thought that improvement actions against incident report had a positive impact on clinical practice and led to an increase in the number of incident reports.
Currently, there have been many reports that activating incident and accident reporting activities are important initiative for improving medical safety in clinical scene. However, there are few reports on the number of incidents and accidents that occur in association with the work of clinical laboratory technicians in Japan and overseas. Therefore, we conducted a questionnaire survey on the incident and accident reporting activities at 76 nationwide Saiseikai medical facilities that have clinical laboratories, as well as facilitating activities to increase reporting and the action process against the incidents/accidents. We received responses from 71 (93%) out of 76 facilities. The maximum total number of near misses/incidents/accidents reported was 536, and the minimum was 0. The maximum number of cases reported per technician was 32.3. Many activities were made to increase the number of reports, including promotional activities of reporting, sharing report content, establishing a system for easy reporting, and setting targets for the number of reports. The most common action process against the incident/accident report were: alerting related department staff, changing procedures/work manuals, improving the work environment related to the incident, alerting those who carried out the incident, and revision of educational instruction related to the incident. A positive correlation was found between the number of incident reports and the number of near misses. Although there was no relationship between activities to increase the number of reports and the number of reports, association was found between the number of incident report and the number of actions against incident report. It was thought that improvement actions against incident report had a positive impact on clinical practice and led to an increase in the number of incident reports. 近年,臨床現場においてインシデント報告活動の活性化は,医療の安全性向上に重要であることが多く報告されている。しかし,国内外において臨床検査技師の業務に関連して発生するインシデント,アクシデント件数についての報告はほとんどなされていないのが現状である。そこで,全国の臨床検査室を保有する済生会医療施設での実態をアンケート調査し報告数を把握するとともに,報告を増やす取り組みや報告後の改善対策の取り組みについて調査を行った。76施設中71施設から回答を得た。ヒヤリ・ハット/インシデント/アクシデント合計報告数の最大値は536件,最小値は0件であった。検査技師一人あたりの報告数最大値は32.3件であった。報告数を増やす取り組みとして,報告の重要性の意識づけや報告内容の共有,報告しやすい環境整備,報告数の目標値設定などが行われていた。報告後の取り組みは,関連部門スタッフへの注意喚起,インシデント事例に関する手順書・作業書の変更や作業環境の調整,インシデント実施者への注意,インシデント事例に関する教育内容の見直しの順に多かった。インシデントとヒヤリ・ハット報告数に正の相関を認めた。報告数を増やす取り組みと報告数の増加には関連性がみられなかったものの,インシデント報告後の改善対策項目数と報告数の増加には関連性を認めた。報告後の改善活動の取り組みによる現場への良い影響が報告数の増加につながっていると考えられる。
Author TOMITA, Ayako
MOMOTA, Hiroshi
SEKIYA, Koichi
Author_FL 百田 浩志
富田 文子
関谷 晃一
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  fullname: TOMITA, Ayako
  organization: Department of Clinical Laboratory, Saiseikai Kumamoto Hospital
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  organization: Department of Clinical Laboratory, Saiseikai Karatsu Hospital
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  fullname: SEKIYA, Koichi
  organization: Department of Clinical Laboratory, Saiseikai Kawaguchi Hospital
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References 2) 齋藤 大造,他:テキストマイニングを用いた臨床検査部門におけるインシデント・アクシデントレポートの分析.生物資料分析,2018; 41: 236–242.
4) H. W. ハインリッヒ,他,総合安全工学研究所(訳):ハインリッヒ産業災害防止論.468,海文堂出版,東京,1982.
1) 大庭 明子:インシデント報告を活用した医療安全活動.週刊医学界新聞(看護号),2024; 第3555号.医学書院,https://www.igaku-shoin.co.jp/paper/archive/y2024/3555_02(2024年3月28日アクセス)
3) 有吉 彩,他:検査室における再発インシデントの特徴.医学検査,2019; 68: 7–12.
References_xml – reference: 3) 有吉 彩,他:検査室における再発インシデントの特徴.医学検査,2019; 68: 7–12.
– reference: 4) H. W. ハインリッヒ,他,総合安全工学研究所(訳):ハインリッヒ産業災害防止論.468,海文堂出版,東京,1982.
– reference: 1) 大庭 明子:インシデント報告を活用した医療安全活動.週刊医学界新聞(看護号),2024; 第3555号.医学書院,https://www.igaku-shoin.co.jp/paper/archive/y2024/3555_02(2024年3月28日アクセス)
– reference: 2) 齋藤 大造,他:テキストマイニングを用いた臨床検査部門におけるインシデント・アクシデントレポートの分析.生物資料分析,2018; 41: 236–242.
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SubjectTerms clinical laboratory
incident and accident reporting activities
initiatives to increase incident reporting
medical safety
response after incident report
インシデント報告を増やす取り組み
インシデント報告後の対応
ヒヤリ・ハット/インシデント/アクシデント報告
医療安全
臨床検査室
Title Results of a questionnaire survey regarding the current status of near-miss/incident/accident reporting in the Saiseikai Clinical Laboratory and efforts to increase the number of reports
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