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What impact does nursing care left undone have on patient outcomes? Review of the literature

Research output: Contribution to journalArticle

Aims and objectives: Systematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes.

Background: A considerable body of evidence support the hypothesis that lower levels of registered nurses on duty increases the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear.

Design: Systematic review

Methods: We searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses’ aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review.

Results: Fourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary-tract infections (UTIs), patient falls, pressure ulcers, critical incidents, quality of care, and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged.

Conclusions: The review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self-reported data. In order to support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care. More research that uses objective staffing and outcome measures is required.

Relevance to clinical practice: Although nurses may exercise judgements in rationing care in the face of pressure, there are nonetheless adverse consequences for patients (ranging from poor experience of care to increased risk of infection, re-admissions, and complications due to critical incidents from undetected physiological deterioration). Hospitals should pay attention to nurses’ reports of missed care and consider routine monitoring as a quality and safety indicator.
Original languageEnglish
JournalJournal of Clinical Nursing
Early online date31 Aug 2017
DOIs
StateEarly online - 31 Aug 2017

Documents

  • Re_SubmissionMissedCarePtOutcomesfinal_revised_19Aug2017_

    Rights statement: This is the peer reviewed version of the following article: Recio-Saucedo, A., Dall'Ora, C., Maruotti, A., Ball, J., Briggs, J., Meredith, P., Redfern, O. C., Kovacs, C., Prytherch, D., Smith, G. B. and Griffiths, P., What impact does nursing care left undone have on patient outcomes? Review of the literature. J Clin Nurs. Accepted Author Manuscript, which has been published in final form at doi:10.1111/jocn.14058. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

    Accepted author manuscript (Post-print), 269 KB, PDF-document

    Due to publisher’s copyright restrictions, this document is not freely available to download from this website until: 31/08/18

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