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 .”
no significant associations of missed care with the prevalence rates of hospital-acquired pressure ulcers . Missed care had no significant direct effects for the pressure ulcer prevalence rates .
Results on further clinical outcomes were reported in a study conducted in the U . S . by Lucero , et al . ( 2010 ) in 168 acute-care hospitals . The researchers used a survey asking nurses to select from a list of seven care activities that were necessary , but left undone , due to the lack of time during their last shift worked . They concluded that unmet nursing care needs were associated with nosocomial infection and patient falls with injuries . The study by Nelson and Flynn ( 2015 ) in 63 U . S . nursing homes asked nurses to indicate which necessary activities were left undone due to the lack of time during their last shift . The authors found several missed nursing care tasks associated with a higher likelihood of residents experiencing UTIs . The tasks reported were administering medication on time ; adequate resident surveillance ; performing necessary treatments and procedures ; comforting / talking with residents ; teaching residents and / or families ; documenting nursing care ; and coordinating resident care .
A study in eight hospitals in Switzerland by Schubert et al ., ( 2008 ) found care rationing to be associated with medication errors , falls , nosocomial infections , critical incidents , and pressure ulcers . A subsequent analysis of the sample from the previous study ( 1,338 nurses and 779 patients ) sought to define a clinically meaningful rationing threshold level and found consistent reports of nosocomial infections , pressure ulcers and patient satisfaction being sensitive to rationing with negative consequences ( Schubert , et al ., 2009 ).
Is mortality associated with missed care ? Carthon , et al . ( 2015 ) found in 419 U . S . hospitals that patients treated in the hospital with the highest rationing level were 51 percent more likely to die than those in peer institutions . This study also found that a 10 percent increase in missed treatments and procedures was associated with patients more likely to experience readmissions within 30 days of hospital discharge . When the analysis was adjusted for the quality of the work environment , the effect of missing essential nursing was no longer a significant predictor of readmission , except for missing treatments and procedures , which still showed high odds for patients being readmitted to hospital within 30 days of discharge .
In their study comparing two groups of acute-care hospitals
A study in eight hospitals in Switzerland by Schubert et al ., ( 2008 ) found care rationing to be associated with medication errors , falls , nosocomial infections , critical incidents , and pressure ulcers .”
in Switzerland , Schubert , et al . ( 2012 ) reported that patients admitted to hospitals with the highest level of care rationing had a 51 percent increase in the odds of death compared to those patients hospitalized in the comparison group consisting of 71 out of 352 acute hospitals and specialized clinics in Switzerland . However , overall levels of inpatient mortality and emergency admissions were similar for both groups of hospitals .
Ambrosi , et al . ( 2016 ) conducted a secondary analysis of data collected in 12 Italian hospitals with the aim of identifying factors associated with in-hospital mortality of patients older than 65 years . They used the MISSCARE survey , where nurses and nurse aides reported the frequency of missing 24 nursing interventions during their last shift on a 5-point Likert-type scale ( 1 = never — 5 = always ). The analysis showed a statistically significant difference between the groups of patients who died or survived ( average missed care score was 51.5 percent in deceased patients and 52.6 percent in surviving patients ); however , no associations were observed between missed nursing care and inpatient mortality . After adjusting for patient and ward environment characteristics , Lucero , et al . ( 2010 ) found no evidence of an association between unmet nursing care needs and 30 days patient mortality .
Recio-Saucedo , et al . ( 2017 ) conclude that “ The evidence we reviewed indicates an association between missed care and patient outcomes , albeit tenuous in some instances . Studies provide evidence in two major categories of patient outcomes negatively affected by omissions of care : patient satisfaction and clinical outcomes . Patient satisfaction was negatively associated with missed care in four studies . Clinical outcomes affected by missed care , as reported in nine studies , included pressure ulcers , medication errors , nosocomial infections , patient falls , critical incidents , 30-day hospital readmission and mortality . Although most studies controlled for patient case mix , and hospital and nurse characteristics , differences in the context in which the studies took place ( such as hospital vs . nursing home ) or units included in the studies ( such as medical , surgical and gynecology ) create potential limitations to the generalizability of the findings .”
Increasingly , frequency of missed care is being considered as an indicator to assess the quality of nursing care , as the amount of missed care partially mediates the effects of patient-to-nurse ratios and work environment on patients recommending the hospital , according to experts .