From the Department of Public Health and Pediatrics, University of Torino, Torino.
Department of Translational Medicine, University of Piemonte Orientale, Novara.
J Patient Saf. 2021 Dec 1;17(8):e1840-e1845. doi: 10.1097/PTS.0000000000000643.
The aim of the study was to describe omitted or delayed nursing care (i.e., missed nursing care [MNC]) in a sample of Italian nursing homes (NHs).
Nurses from 50 NHs located in Northern Italy selected the 20 most dependent residents in their care and reported instances of MNC for three to five consecutive shifts. They described the type of MNC, its cause(s), management, recurrence, and severity of possible consequences for the resident. Information on the residents and the NH was also collected. The instances of MNC were classified as potentially avoidable/preventable or not.
Overall, 266 (85.3%) of 312 nurses participated and 1000 residents were observed during 381 shifts (164 mornings, 164 afternoons, and 53 nights); 101 (38%) nurses reported 223 instances of MNC among 175 residents (17.5%). Ninety-seven omissions and 109 delays occurred during the day shift (56 omissions were delegated to the next shift). The most frequent MNC was drug administration (n = 71, 34.5%). In 24 (44.4%) of 54 instances of delayed drug administration, the delay was less than 30 minutes. Nurses rated approximately 20% of MNC (n = 41) as highly severe because of the discomfort caused to the resident, the clinical impact, or the repetitiveness of the situation. Nurses ascribed almost half of MNC (n = 100, 48.5%) to inadequate staffing, and they categorized 26 (11.6%) instances of MNC as unavoidable.
The number of nurse-reported instances of MNC we reported was much lower than that previously collected with available instruments. Most MNC did not impact the comfort and safety of residents. A certain proportion of MNC was unavoidable.
本研究旨在描述意大利养老院（NH）样本中遗漏或延迟的护理（即，护理缺失[MNC]）。
意大利北部 50 家 NH 的护士选择了他们护理的 20 名最依赖的居民，并连续三个到五个班次报告 MNC 情况。他们描述了 MNC 的类型、原因、管理、复发以及对居民可能产生的严重后果。还收集了居民和 NH 的信息。MNC 的情况被归类为潜在可避免/可预防或不可避免。
共有 266 名（85.3%）护士参与，1000 名居民在 381 个班次（164 个早晨，164 个下午，53 个晚上）中接受了观察；101 名（38%）护士在 175 名居民中报告了 223 例 MNC（17.5%）。白天班次（56 次委托给下一班次）发生了 97 次遗漏和 109 次延迟。最常见的 MNC 是药物管理（n = 71，34.5%）。在 54 次延迟药物管理的情况下，有 24 次（44.4%）延迟不到 30 分钟。护士将大约 20%的 MNC（n = 41）评为高度严重，因为这给居民带来了不适、临床影响或情况的重复性。护士将近一半的 MNC（n = 100，48.5%）归因于人员配备不足，并将 26 次（11.6%）MNC 归类为不可避免。
我们报告的护士报告的 MNC 次数远远低于以前使用现有工具收集的次数。大多数 MNC 没有影响居民的舒适和安全。一定比例的 MNC 是不可避免的。
