The missed care in Nursing Homes: a pilot study

Abstract

To date missed care have been described mostly in hospitals and data on nursing homes (NH) are missing. To describe missed care in NH residents identifying their perceived impact and seriousness. A pilot study was conducted in 10 Piedmont NHs. For each omitted or delayed care on 20 residents observed for 3 consecutive days, the nurses provided information on the type of care, and information on the residents and on the organization were collected. Twenty-three nurses reported 57 missed care for 44/200 residents (22%; median 5 for each NH, range 0-13). Twenty-five missed/omitted care on 20 residents were considered of medium/high severity: 14 (56%) involved drug therapies and 5 (20%) the monitoring of vital signs. The level of severity derived from the distress caused to the resident, the risk of deterioration of residents'conditions and the repeated omissions on the same resident. Of the 32 missed care on 25 residents, judged of limited impact, the more frequent were dressing changes (12, 37.5%), and drugs administration (10, 31.3%). The most frequent reasons for delay/omission were unplanned events (16, 28.1%), shortage of nurses (12, 21.1%), and residents' clinical conditions (9, 15.7%). Missed care occur also in NHs. If staff shortage play a key role among potentially modifiable factors, a sizeable number of omission is associated to unlikely forseeable or avoidable events.