Unraveling Care Omissions

Abstract

Evidence points to the omission of required nursing care as a pervasive problem in acute care hospitals. Labor and material resource constraints, increasing patient complexity, ineffective delegation, and poor communication have been identified as contributing factors. Nurse executives should examine the degree and causes of missed care in their organizations. Action plans should be developed based on identification of issues contributing to this serious concern, thus promoting safe patient care.

An Examination of Hospital Nurse Staffing and Patient Experience with Care: Differences between Cross‐Sectional and Longitudinal Estimates

“…In Figure 1, we show that nurse staffing and skill mix may affect patients' experience, primarily through missed nursing care (Kalisch 2006;Kalisch, Landstrom, and Hinshaw 2009;Bittner et al 2011). Missed nursing care refers to the extent to which nurses fail to deliver necessary nursing care such as performing assessments; documenting patient care; performing vital signs; delivering as-needed medication; ambulating, feeding, and turning patients; responding to call bells; and performing patient education.…”

Missed Nursing Care in Hospitalized Patients

“…The omission of nursing care can lead to adverse outcomes for patients, with significant harm, especially in vulnerable patient populations (6).…”

The Relationship Between Electronic Nursing Care Reminders and Missed Nursing Care

“…One of the major negative effects of decreased labor resources on nursing practice centers on its potential to cause distractions and interruptions (Bittner, Gravlin, Hansten, & Kalisch, 2011). Pape (2002) described a distraction as anything that diverts one's attention from achieving a desired goal.…”

“…In regard to the labor resource component, a primary reason for missed care, a granular approach is needed to examine specific reasons for missed care in this component. One hypothesis is that increased patient acuity and volumes may lead to more frequent distractions and interruptions in care (Bittner et al, 2011). These distractions and interruptions may impact the RNs working memory thus contributing to an increase in missed nursing care.…”