Percutaneous endoscopic gastrostomy (PEG) is a common procedure for placing a feeding tube in the stomach to provide fluids and nutrition to patients who have difficulty in swallowing or in taking enough noutrishment through the mouth. Thought the procedure is simple and easy, PEG is not without its risks. The reported complication ratio is not low-, -between 5.7% and 33.3%. This is probably because the patients are lacking in reserves of physical faculties.The present study was conducted to work out measures to reduc the incidence of PEG complications by reviewing the complications cases treated in our hospital.From March 1997 to December 2005, we performed PEG on 110 patients, of which 11 patients (9.6%) had complications. In some cases, we inadvertently perforated the colon. From our experience, we have learned that it is not safe to perform PEG with the aid of radiography alone on cases in which the intervention of the transverse colon between stomach and abdominal wall was suspected by CT scan, and concluded PEG should be done using gastrography of the transverse colon, to guide the placement of a feeding tube in the stomach. In view of the systemic condition of the patients, we thought it necessary to take safety measures by all possible means.
Percutaneous endoscopic gastrostomy ; Complications Specific to Antepartum or Postpartum ; Stomach ; Management ; Prevention

　　The employee turnover rate of nurses at our hospital has been higher than the national average. To stabilize the nursing workforce and to decrease the employee turnover rate, we participated in promotion of the 2012 Work Life Balance (WLB) Program organized by the Japanese Nursing Association. In this study, we examined the work-life-study balance (WLSB), adding the activity of “study” to WLB, by evaluating the three activities over a 2-year period. Members tasked with promoting and addressing the issues of WLSB consisted of those in the operation improvement team, Partnership Nursing System (PNS) team, and labor management team. A committee supervised the progress of each team, conducted an index surveillance and a satisfaction survey, and observed changes among nurses who were complaining. A WLSB training course was held for leaders among the staff members. As a result of the PDCA (plan-do-check-act) management cycle being run every 2 months, we achieved the objectives to improve operations and the rate of fulfilling a &ldqup;no overtime day” was improved from 0% to 70-80%. In addition, a &ldqup;birthday day off” and a long vacation were taken systematically, the rate of taking paid vacation improved because of the introduction of paid half-days off, and trainees on the WLSB training course appeared to change, now finding their work worthwhile and enjoyable. The PNS was also introduced. Staff members realized that these results of actions taken were successful, and a positive work climate has been created. The actions taken likely created a comfortable work environment for nurses and accelerated the rate of feeling settled in the workplace by decreasing factors creating dissatisfaction and increasing levels of satisfaction.

A recovery rehabilitation ward is a ward where aggressive rehabilitation is provided to enable patients to return to their former level of activities of daily living (ADL). Our hospital is actively engaged in rehabilitation medicine as provided by various therapists including physical, occupational, and speech-language-hearing therapists and nurses on the ward. So, management of the patient's schedule and information sharing among members of this multidisciplinary team can be a challenge. We therefore introduced a patient schedule that provides an overview of the management plans for all patients, a rehabilitation schedule board that helps with confirming each patient's schedule and is kept in the bedside cabinet, and the ADL panel where information on ADL status and target is recorded.As a result of using the patient schedule, it became easy to make adjustments in rehabilitation duration for the patient and to reduce the stress from overscheduling.Using the rehabilitation schedule board has enabled us to now check the schedule at the bedside, and the patients can plan activities cognizant of their daily routine.Using the ADL panel allows nurses and therapists to share ADL information and also allows the patients to confirm their present status and targets.Information sharing is vital in rehabilitation medicine multidisciplinary teams on recovery rehabilitation wards where the various roles affect the patient, and using the patient schedule, rehabilitation schedule board, and ADL panel is useful for achieving this.