Recio-Saucedo , et al . ( 2017 ) define delayed or unfinished care , more broadly identified as missed care , as encompassing “ all aspects of clinical , emotional or administrative nursing care that have only been partially completed , were delayed or were not completed at all ,” and point out that “ The current literature on missed care provides mounting evidence of the pervasive nature of the problem and , more importantly , the threat it poses to patient safety .” medication errors , urinary tract infections , patient falls , pressure ulcers , critical incidents , quality of care and patient readmissions .
The medical literature points to myriad factors causing inadequate quality of nursing care that may lead to patient harm , including inadequate nurse staffing levels as well as resource inadequacy . Recio-Saucedo , et al . ( 2017 ) say that “ A considerable body of evidence supports the hypothesis that lower levels of registered nurses on duty increase the likelihood of patients dying on hospital wards and the risk of many aspects of care being either delayed or left undone .”
Patient outcomes reported in the missed-care literature that have been associated with quality of care delivered , include hospital-acquired infections , mortality , falls , inadequate patient mobilization , inadequate feeding , and lack of psychological and emotional support , among other subpar outcomes .
Recio-Saucedo , et al . ( 2017 ) define delayed or unfinished care , more broadly identified as missed care , as encompassing “ all aspects of clinical , emotional or administrative nursing care that have only been partially completed , were delayed or were not completed at all ,” and point out that “ The current literature on missed care provides mounting evidence of the pervasive nature of the problem and , more importantly , the threat it poses to patient safety .”
In their review , Recio-Saucedo , et al . ( 2017 ) identified 14 studies reporting a range of outcomes related to missed care , including medication errors ; bloodstream infections ; pneumonia ; urinary tract infections ( UTIs ); nosocomial infections ; patient falls ; pressure ulcers ; patient and / or carer experience and satisfaction ratings ; patient safety ; quality of nurse delivered care ; critical incidents ; adverse events ; mortality and 30-day hospital readmissions . Most studies measured missed care with nurse or patient surveys that have been widely used in the missed-care literature , and most of the studies used nurse or patient reports to capture outcomes , with some studies using administrative data .
Recio-Saucedo , et al . ( 2017 ) found that missed care significantly decreased patient satisfaction levels . As they note , “ Overall , the evidence shows a consistent detrimental effect of rationing care on patient satisfaction .”
Binder concurs , acknowledging , “ Numerous studies that have looked at the relationship between nurse staffing and patient outcomes have found that increased nursing hours per patient day is associated with lower odds of patient mortality , lower rates of nursing-sensitive indicators ( falls and pressure ulcers ), shorter lengths of stay , and higher patient satisfaction . As someone who has had loved ones in the hospital , I know well how scary it can be when a call button is not answered .”
Binder continues , “ Leadership that is focused on addressing patient safety by default must address missed nursing care . The problem of missed nursing care cannot be separated from the overall problem of patient safety . Efforts to address events like stage three pressure ulcers or falls or medication errors all require nurses who are well-educated and fully present . There is no one specific problem associated with missed care , all the safety problems that can happen in a hospital are associated with missed care . A successful culture of safety requires adequate nurse staffing .”
Studies also identified a significant association between measures of quality of care and tasks left undone by nurses . For example , Ball , et al . used the RN4CAST survey to examine care left undone in 46 hospitals in England . Nurses were asked to report how frequently they were unable to perform any of 13 nursing activities on their last shift due to time constraints . Two measures of missed care were derived measuring the prevalence of any care being left undone , as well as the volume of care left undone . The researchers found a significant correlation between the number of items of missed care and nurses ’ perception of quality of care and nurse overall grading of patient safety on their unit / ward . Sochalski , et al . ( 2004 ) examined missed care in U . S . acute-care hospitals to determine which patient-care tasks were left undone during nurses ’ last shift due to lack of time . The results indicated an association between a poor rating of quality of care and the number of tasks left undone . Similar results were reported by Zúñiga et al . ( 2015 ) in a study of 155 Swiss nursing homes , where care providers were asked how often in the last week they could not conduct necessary care activities due to lack of time or high workload . The study found that nurses reported a better quality of care when the amount of implicit rationing of care , rehabilitation and monitoring was lower , and when fewer instances of rationing care were perceived to have occurred .
Recio-Saucedo , et al . ( 2017 ) identified six studies reporting associations between missed care , and one or more clinical outcomes , mainly medication errors ; bloodstream infections ; pneumonia ; UTIs ; nosocomial infections ; patient falls ; pressure ulcers ; critical incidents and quality of care ; and patient safety . Five of the studies found that missed care was associated with adverse outcomes , but regarding pressure ulcers , two studies ( Ausserhofer et al ., 2013 ; Thompson , 2014 ) found no significant associations between missed care and the incidence or prevalence of hospital-acquired pressure ulcers .
Ausserhofer , et al . ( 2013 ) reported an association between rationing of nursing care and higher nurse-reported levels of bloodstream infections , pneumonia and medication administration errors ; however , there were no significant effects of rationing care on the incidence of pressure ulcers and urinary tract infections . Similarly , a study across 1,291 hospitals in the U . S . conducted by Thompson ( 2014 ) found