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

Abstract

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.

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Identifiers

ORCID for Alejandra Recio Saucedo: orcid.org/0000-0003-2823-4573

ORCID for Chiara Dall'ora: orcid.org/0000-0002-6858-3535

ORCID for Jane Ball: orcid.org/0000-0002-8655-2994

ORCID for Peter Griffiths: orcid.org/0000-0003-2439-2857

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