MISSED NURSING CARE AND PATIENT OUTCOMES IN ACUTE CARE SETTINGS: DETERMINANTS, CONSEQUENCES, AND STRATEGIES FOR IMPROVEMENT

Abstract

With regard to nursing, nursing activities that are omitted, delayed or incomplete can lead to adverse health outcomes, compromise patient safety and negatively impact the experience of care. This has become an important concern in acute healthcare. This review looks at the factors that can influence the provision of missed nursing care in the acute care setting, the impact on the health and wellbeing of the patient and their family if they miss nursing care, the ways in which it is measured and the actions that can be taken to improve it. Suggested factors influencing missed care are interacting factors such as low staffing levels, high workload, patient acuity, resources, unsupportive practice environments, communication issues, and nurse-level pressures such as fatigue and burnout. Common missing activities include surveillance, mobilization, hygiene support, patient education, emotional support, documentation and care coordination. These omissions have been associated with preventable adverse events, delayed recognition of deterioration, poorer recovery, increased healthcare utilization, mortality risk, and reduced patient satisfaction. There is also variation in missed care by medical and surgical wards, EDs, ICUs and by populations with frailty, multimorbidity or high dependency. Safe staffing, skill mix, leadership support, team working, prioritization training, structured care processes, audit and feedback and a selective use of digital tools that support care processes are all strategies that can be used to reduce missed care. Need for standardized measurement, objective outcome measurement, multicenter longitudinal studies, and intervention design. Incorporating missed-care indicators into the existing quality and patient-safety surveillance may help facilitate more timely organizational actions and safer acute care.