Hospital Variation in Missed Nursing Care

Abstract

Quality of nursing care across hospitals is variable, and this variation can result in poor patient outcomes. One aspect of quality nursing care is the amount of necessary care omitted. This paper reports on the extent and type of nursing care missed and the reasons for missed care. The MISSCARE Survey was administered to nursing staff (n = 4086) who provide direct patient care in ten acute care hospitals. Missed nursing care patterns, as well as reasons for missing care (labor resources, material resources, and communication) were common across all hospitals. Job title (i.e., RN vs. NA), shift worked, absenteeism, perceived staffing adequacy, and patient workloads were significantly associated with missed care. The data from this study can inform quality improvement efforts to reduced missed nursing care and promote favorable patient outcomes.The quality of nursing care is one determinant of patient outcomes, according to the hallmark Institute of Medicine (IOM) studies that describe the status of the healthcare delivery system. 1, 2 The decision by the Centers for Medicare and Medicaid Services (CMS) to disallow reimbursement for selected adverse patient outcomes places greater accountability on healthcare providers to prevent such complications. 3 These adverse patient outcomes include pressure ulcers, hospital-acquired infections and patient falls, which are closely linked to the delivery of nursing care.The nursing care of patients in acute care hospitals is known to be variable, yet few studies have quantified these differences. When considering the IOM framework of quality care gaps, the primary policy focus has been to avoid errors of commission. 1 However, a report by the Agency for Healthcare Research & Quality (AHRQ) states that "errors of omission are more difficult to recognize than errors of commission, but likely represent a larger problem." 4 Conceptually, missed nursing care is considered an error of omission 5 and is defined as any aspect of required patient care that is omitted (either in part or whole) or significantly delayed. 6 Motivated by this knowledge gap, the purpose of this study was to identify the type and reasons for care being missed in acute care settings. This paper also explores predictors of the amount of missed nursing care including staff characteristics (i.e. gender, age, education, experience in role), work schedules (shift worked, experience in role, length of shift, weekly worked hours, absenteeism and unit type), and staffing variables (both perceived adequacy of staffing and reported number of patients cared for). The findings from this study can aid in the development of quality improvement approaches to minimize reduced care and improve patient outcomes. Previous StudiesSelected aspects of missed nursing care have been investigated previously, including the impact of failure to ambulate patients, 7-13 the assurance of providing adequate hydration and nutrition to patients following hospitalization, 14 and missed medication administration. [15][16][17] Callen ...

Understanding factors that impact on public and patient’s risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review

“…Our results found multiple missed care opportunities in the 24 hours before diagnosis of pneumonia. Numerous previous studies have reported that missed fundamental hospital care is linked to poorer patient outcomes, 17,[19][20][21][22][23][24][25] a finding that is also supported by our data.…”

“…The retrospective nature of the study prevents us from identifying the exact reasons for missed fundamental hospital care; however, reasons from other research include labor, material resources, and poor communication. 17,21 Furthermore, the ICD-9-CM codes may underestimate the actual number of NV-HAP cases because a point-prevalence observation was not conducted. Because we required CDC criteria, cases in immunocompromised patients may have been missed if cultures for pneumonia were not obtained, which is often the case.…”

“…18,19 Data from some studies support that a large amount of fundamental care is being missed in U.S. acute care hospitals. 17,[19][20][21][22][23][24][25] Furthermore, missed hospital care in both U.S. and international studies has been linked to numerous harmful outcomes for patients and increased cost for hospitals. 17 Two recent systematic reviews of these therapeutic interventions to prevent pneumonia found that the use of oral care was associated with the most evidence of benefit.…”

The Influence of Culture on Analgesic Consumption: A Retrospective Study among Malaysian Patients after Breast Cancer Surgery

“…Past studies have revealed several factors that might explain why many patients in this study did not receive any analgesic during the first four hours in the postoperative period. For instance, lack of analgesic availability at the time of patients' need and shortage of nurses are the reasons why patients do not receive the medication on time [12]. Other reasons might include the set routines of analgesic administration in the ward, and patients' attitudes.…”

“…A study by Kalisch and Tschannen et al [12] conducted in an acute care setting in 10 hospitals in the United States found that failure to administer medication on time was among the top five care elements overlooked by nurses. In Malaysian government hospitals generally, only analgesics such as morphine, pethidine, diclofenac, and paracetamol are available in the ward at any time.…”