A descriptive study of nurse-reported missed care in neonatal intensive care units

• Published in: Journal of advanced nursing Vol. 71; no. 4; pp. 813 - 824
• Main Authors: Tubbs-Cooley, Heather L., Pickler, Rita H., Younger, Janet B., Mark, Barbara A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.04.2015; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Intensive care; Intensive Care Units, Neonatal - statistics & numerical data; Intensive Care, Neonatal - statistics & numerical data; Male; Medical Errors - statistics & numerical data; Middle Aged; missed nursing care; Neonatal care; neonatal intensive care; Nurse patient relationships; Nurse's Role; Nursing; Nursing care; Nursing Staff, Hospital; outcomes; Patient Safety - statistics & numerical data; quality; Quality of Health Care - statistics & numerical data; Random number sampling; Risk Management - statistics & numerical data; safety; Self Report; Shift work; United States; Young Adult; United States; United States > US; missed nursing care; nursing; neonatal intensive care; outcomes; safety; quality
• ISSN: 0309-2402; 1365-2648
• DOI: 10.1111/jan.12578

Aims The aims of this study are to describe: (1) the frequency of nurse‐reported missed care in neonatal intensive care units; and (2) nurses’ reports of factors contributing to missed care on their last shift worked. Background Missed nursing care, or necessary care that is not delivered, is increasingly cited as a contributor to adverse patient outcomes. Previous studies highlight the frequency of missed nursing care in adult settings; the occurrence of missed nursing care in neonatal intensive care units is unknown. Design A descriptive analysis of neonatal nurses’ self‐reports of missed care using data collected through a cross‐sectional web‐based survey. Methods A random sample of certified neonatal intensive care nurses in seven states was invited to participate in the survey in April 2012. Data were collected from nurses who provide direct patient care in a neonatal intensive care unit (n = 230). Descriptive statistics constituted the primary analytic approach. Results Nurses reported missing a range of patient care activities on their last shift worked. Nurses most frequently missed rounds, oral care for ventilated infants, educating and involving parents in care and oral feedings. Hand hygiene, safety and physical assessment and medication administration were missed least often. The most common reasons for missed care included frequent interruptions, urgent patient situations and an unexpected rise in patient volume and/or acuity on the unit. Conclusion We find that basic nursing care in the neonatal intensive care unit is missed and that system factors may contribute to missed care in this setting.