Unpicking the reasons for missed care

‘Stop the pressure’, ‘Harm-free care’ and ‘Sign up to safety’ are just a few examples of evidence-based national quality improvement programmes that many of us have participated in as part of our harm-reduction programmes. The past 2 years have required our primary response to be focused on the pandemic. However, as we recover and reset our quality priorities, and there is more capacity to re-engage with our professional agenda of continuous improvement, I am concentrating on what one of my non-executive colleagues has termed ‘the stubborn indices’ of pressure damage, patient falls, and safety incidents relating to nutrition.

Having spent time with colleagues reviewing the root cause of local incidents, ‘omissions in care’ is an area that warrants further exploration. A primer from the Patient Safety Network (2019), the resource hosted by the US Agency for Healthcare Research and Quality, pointed out that although there is a well-established link between nurse staffing levels and some patient outcomes such as mortality and failure to rescue, there are other patient outcomes that are less well-understood. One proposed pathway is the amount of surveillance, or ongoing assessment and reassessment of patient condition, that can be provided under a given staffing structure. A related proposed pathway is missed nursing care, which is defined as ‘a subset of the category known as error of omission’ that refers to ‘needed nursing care that is delayed, partially completed, or not completed at all’ (Patient Safety Network, 2019)