If the situation that is developing in many Japanese hospitals is not yet a national emergency, it soon will be. The frequency with which medication errors and other medical accidents are occurring has many people legitimately concerned about undergoing a hospital stay. Those fears can only be heightened by the news that, on average, some patients in every large hospital in the Tokyo metropolitan area receive the wrong medication on an almost daily basis. The mistakes occur most often on the first day of hospitalization — and nurses commit most of the errors.
This is not to single out these often overworked hospital staff members. There is plenty of blame to go around. Details of the medication mixups are contained in a report just released on a one-month survey of 11 major Tokyo hospitals conducted early this year by the Japan Nursing Association. In that brief period, the survey found, there were 257 instances of patients receiving the wrong drugs, usually because of a nurse’s error. Fortunately, no deaths or permanent injuries ensued.
Nevertheless, harm could have resulted in almost 40 percent of the cases, and a few patients did have to extend their hospital stays. Not everyone is that lucky, as reports of deaths, brain damage and other serious injuries resulting from treatment errors make clear. Too often, the victims are infants or the elderly, the most vulnerable members of society.
The seriousness of the problem is underlined by another, more detailed study released in the spring by the medical-affairs branch of the All Japan Prefectural and Municipal Workers’ Union. This survey turned up the shocking statistic that 62.7 percent out of 5,277 nurses at public and private clinics and hospitals in the Tokyo metropolitan area had filed reports of accidents or mistakes in the previous 12 months. The union specifically blamed the large number of reports on a shortage of nurses. Nearly half the nurses responding said they were “too busy” to follow safety manuals in detail.
The media, medical workers’ unions and others have repeatedly raised the issue of Japan’s shortage of nurses in recent months, yet measures to alleviate the situation have been insufficient. Apparently acting in response to public concern, the Education Ministry surveyed 79 hospitals affiliated with national, municipal and private universities during the summer and learned that, while only 16 percent of the nurses acknowledged having made errors in patient medication, 68 percent of them reported having come close to doing so.
There is reason to doubt that the results of nursing errors, or more serious mistakes by physicians, are always so benign. On the contrary, medical mistakes may be one cause of preventable death in this country. Doubts are increased by learning that only 10 percent of department heads in hospitals nationwide reported medical accidents to the Health and Welfare Ministry in fiscal 1998, the latest year for which such statistics are available. While a survey found that a total of 1,981 such blunders had occurred, only 80 were reported to the ministry.
Yet a leading private hospital in Osaka announced earlier this year that its own internal investigation had turned up evidence of an astonishing 770 instances of medical errors or malpractice between November 1997 and this February, along with an additional 408 potential mistakes that were caught in time by doctors or nurses. Even more incredible, considering the 80 instances reported by department heads to the health ministry in 1998, the Osaka hospital reported an average of 70 instances a month. Many involved errors in drug administration or other aspects of nursing care.
Surveys of all kinds are the preferred way of attacking many social problems in this country, partly because they are a reasonably reliable means of ferreting out details that people otherwise are often unwilling to disclose voluntarily. Yet, while surveys may reveal alarming conditions in many Japanese hospitals, they fail to provide solutions or even call for remedies. It has to be emphasized that the matter of too few nurses is only one part of the problem, albeit a key one. Among nurses who responded to the Education Ministry investigation, 91 percent said instructions from doctors about patient medication sometimes were unclear.
What is being done to improve the situation? The nursing shortage and the problems stemming from this have been subjects of great concern for some time. The Health and Welfare Ministry proposed a new system to prevent hospital medication errors last March, and in June it announced plans for three new rules to curb rising medical malpractice. The directors of state-run university hospitals have proposed assigning a risk manager in each department. Yet serious errors continue to occur, some as recently as this month.
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