Editorial: Fundamentals of missed care – Implications for the Editorial: Fundamentals of missed care – Implications for the perioperative environment

This Article is brought to you for free and open access by Journal of Perioperative Nursing. It has been accepted for inclusion in Journal of Perioperative Nursing by an authorized editor of Journal of Perioperative Nursing. Recommended Citation Ralph, Nicholas (2018) "Editorial: Fundamentals of missed care – Implications for the perioperative environment," Journal of Perioperative Nursing: Vol. 31 : Iss. 3 , Article 1. Available at: https://doi.org/10.26550/2209-1092.1038


ACORN
The Australian College of Perioperative Nurses (ACORN) is a registered health promotion charity that serves the patient, community and the perioperative profession to promote the prevention and control of disease.ACORN's vision is for Australian patients to receive the safest and highest quality perioperative care in the world.

Implications for the perioperative environment
Missed care is often described as an 'error of omission' and refers to nursing care that is needed but delayed, partially completed or not completed at all 1 .There is an increasing weight of evidence pointing to missed care as a widespread phenomenon that poses serious implications for patient safety.
The prevalence of missed care is reported in a review and metaanalysis of the literature, where the authors found between 55 and 98 per cent of nursing staff missed one or more cares 2 .Missed care is strongly associated with poorer patient satisfaction 3 and, more recently, has been linked to a seven per cent increase in the odds of a patient dying within 30 days of admission to hospital 4 .
In a study of 1300 hospitalised patients, Baker and Quinn 5 found a failure to provide fundamental nursing interventions such as oral care, head elevation and deep breathing resulted in an increased incidence of hospital-acquired pneumonia.A recent systematic review reported associations between missed care and medication errors, bloodstream infections, pneumonia, urinary tract infections, nosocomial infections, patient falls and pressure ulcers 6 .In the context of perioperative nursing, Duff 7 reports missed care in the perioperative environment including a frequent failure to record temperature and provide forced-air warming.
Predictors of missed care include youth (<35 years), qualification level, absenteeism within the last three months, limited professional experience and workplace type 8 .Same-day missed care events can also lead to further missed care events due to the accrual of work demands across shifts 9 .As causes of missed care are still emerging, identifying simple, cost-effective solutions for reducing missed care has proved elusive.Increasing nursing time was reported to have no effect on lowering missed care incidence in one multisite US study 10 .However, in a Korean study, increasing nursing hours lowered rates of missed care 11 .A train-thetrainer intervention reduced missed care in a North American study although the authors relied on selfreported survey data 12 .Improving the knowledge 13,14 , educational level 15,16 and research literacy 17,18 of perioperative nurses.
The Australian College of Perioperative Nurses (ACORN) is one of the leading global voices in setting standards within the perioperative environment [19][20][21][22] yet, based on the literature about missed care, it is likely that many of these standards are not met during routine care each day.Clinical standards are typically effective as the sum of their parts and rarely work when implemented as a series of missed components of care.Future standards development in the perioperative setting must account for the issue of missed care by acknowledging mechanisms and processes for assuring full implementation wherever possible.
Although solutions are still being sought, it would be naive to think the issue of missed care can be solved by introducing a single tool, another checklist or even a budgetary injection.The reality is that perioperative nurses practice in an increasingly complex environment.Issues such as missed care require an acknowledgement of this complexity by continuing to search for and communicate effective, stakeholder-informed solutions in environments where quality improvement processes are embedded, iterative, recursive and ongoing.