| Primary Author: | Sarah Humme, MSN, RN, NEA-BC |
| Co-Principal Investigators/Collaborators: | Alexia Green, RN, PhD, FAAN, Cassie M. Lane, MS, CCRP, Beatrice J. Kalisch, PhD, RN, FAAN |
| Organization | Southwest General Hospital |
Abstract
Purpose
A study was implemented to describe the amount of nursing care being missed and to describe the reasons for missed care on seven Telemetry units in the Southwest US. The identification of missed care or omission of care opportunities has the potential to improve desired outcomes of care.
Background
Ensuring quality nursing care and patient safety is a major challenge facing nursing leadership. Missed nursing care, as defined by Kalisch (2006) is any aspect of required care that is omitted (either in part or in whole) or delayed. Evidence points to the omission of nursing care as a critical problem in acute care hospitals.
Materials & Methods
A survey of telemetry nursing staff identified omissions of care and reasons for missed care. The MISSCARE Survey tool of Dr. Beatrice Kalisch (2009) was utilized to ascertain missed care and reasons for missed care.
Results
The results show a significant amount of missed care on Telemetry units of which timely medication administration (91.4%) and ambulation (82.9%) were most often reported as missed. The findings were similar to Kalisch (2011), however, the amount of missed care was lower at 59% and 76 %, respectively. Least missed were patient assessments each shift (9.9%) and bedside glucose monitoring as ordered (20.7%). The findings are consistent with the work of Kalisch (2011). The most frequent cause of missed care was inadequate labor resources (98.1%).There were no differences in missed care by unit, education, experience, shift, or full/part time status.
Conclusion
The study results support missed nursing care as a significant problem impacting patient outcomes and safety. Of concern is the finding that 91.4% of patients are not receiving medications within 30 minutes of scheduled time. The remaining failure to meet basic needs could contribute to higher fall and pressure ulcers rates which effects quality, cost, and safety. Future studies should evaluate the impact of missed care on increasing morbidity, cost, and patient satisfaction.
Bibliography
Kalisch, B. J. (2006). Missed nursing care: A qualitative study. Journal of Nursing Care Quality, 21(4), 306-13; quiz 314-5.
Kalisch, B. J., Landstrom, G., & Williams, R. A. (2009). Missed nursing care: Errors of omission. Nursing Outlook, 57(1), 3-9.
Kalisch, B. J., & Williams, R. A. (2009). Development and psychometric testing of a tool to measure missed nursing care. The Journal of Nursing Administration, 39(5), 211-219.
Kalisch, B. J., Tschannen, D., Lee, H., & Friese, C. R. (2011). Hospital variation in missed nursing care. American Journal of Medical Quality: The Official Journal of the American College of Medical Quality, DOI: 10:1177/1062860610395929
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).