Abstract P861: The Perception of Missed Nursing Care in Patients With Acute Stroke

Abstract

Background: “ Missed nursing care” is a unique type of error known as medical underuse. These errors of omission are related to events, such as patient falls, nosocomial infections, and pressure injuries, associated with increased stroke mortality and morbidity. This study aimed to measure the phenomena of missed care in patients with stroke from the perspective of staff RNs working on a stroke unit and neuro intensive care unit at a Comprehensive Stroke Center. Methods: A Missed Care Survey was developed. Building on the work by Kalisch, the new Missed Care Survey focused entirely on nurse-sensitive measures and related evidence-based bundle steps. Two versions of the 25- question ordinal survey were developed, differing only in how the responses were worded. One asked how often care was missed [never missed (5), rarely missed (4), occasionally missed (3), frequently missed (2), always missed (1)]. and the other how frequently care was completed [always completed (5),usually completed (4), etc.).Descriptive statistics were used to evaluate results. Staff volunteered to take the survey during an annual stroke review class, rating their perception of care over the last 30-days. The IRB determined that the human subject regulation did not apply. Results: Completion rate was 93% (n=140). Differences between the two surveys were minimal with the overall summary score being the same (4.1; range 3.5-4.5). Individual scores ranged from 2.6 to 5. Items most frequently described as never missed included timely administration of pre-operative antibiotics and use of barrier precautions with central venous access device insertion. Care most missed included bathing and peri-care (with/without indwelling catheter), mobility, incentive spirometry, and the prevention of loops in urinary drainage catheter tubing. There were minor changes in rankings between the two survey versions. Conclusions: Scores reflect that known interventions to prevent iatrogenic complications are frequently or occasionally missed (or only usually and occasionally completed). Next steps include validation with real time observations. When missed care is not addressed, it can become routine, known as normalization of deviance, negatively impacting patient outcomes and the quality of care.