Missed Nursing Care (MISSCARE) Survey

OVERVIEW

The MISSCARE Survey identifies and addresses components of missed nursing care to improve patient safety.

• Systematically identifies omissions in nursing care using a validated survey
• Improves patient outcomes and hospital compliance with safety regulations

BACKGROUND

In nursing, acts of omission, where essential care is missed or delayed, pose a significant risk to patient outcomes. Historically, studies have explored how nurse staffing levels and education affect care quality, yet there remains a gap in understanding exactly what care is being omitted. Missed care often goes unnoticed, risking patient safety through complications like pressure ulcers or falls that are preventable with proper care. Regulatory changes, such as those from the Center for Medicare and Medicaid Services, emphasize the importance of preventing such complications. Although smaller studies have focused on specific areas, such as patient nutrition or ambulation, comprehensive research on missed nursing care is limited. Existing staffing models and organizational systems often fail to adapt to fluctuations in patient needs, revealing a critical need for improved strategies to reduce missed care and enhance patient safety in hospitals.

INNOVATION

The Missed Nursing Care (MISSCARE) Survey, a novel instrument is designed to systematically identify which nursing care tasks are frequently missed and the reasons behind these omissions. By using factor analysis, the survey highlights areas most commonly neglected, such as patient ambulation, medication effectiveness assessments, and timely patient education. Technical advancements of this approach include its ability to quantify missed care and pinpoint causal factors like labor shortages, poor communication, and inadequate material resources. 

The real-world applications are significant: this tool enables hospital administrators and nursing leaders to pinpoint specific interventions, optimize nursing workflows, and prioritize resource allocation to areas of most need. Ultimately, its use can reduce the incidence of patient safety events and improve compliance with healthcare regulations, directly impacting the quality and cost-effectiveness of patient care in acute care settings.

ADDITIONAL INFORMATION

LICENSING INFORMATION:

© 2019, The Regents of the University of Michigan

Beatrice Kalisch, School of Nursing

These materials are available under a Creative Commons Attribution-NonCommercial 4.0 International License CC BY-NC.

Adaptations are permitted as long as you attribute this original work and copyright statement.

REFERENCES:

Kalisch, B., Landstrom, G., & Williams, R.  (2009).  Missed nursing care: Errors of omission.  ScienceDirect, 57(1), 3-9.  https://www.sciencedirect.com/science/article/abs/pii/S0029655408001462?casa_token=U0NrmiY_rdQAAAAA:Ife-TCVSCO-TNCRSD_ApedUpc6EG-sC7rexevn4Zb6MAwkY2Dh5ip_RVJg_S2JhMiDg4zsHy-6w

Kalisch, B., & Williams, R.  (2009).  Development and Psychometric Testing of a Tool to Measure Missed Nursing Care.  JONA: The Journal of Nursing Administration, 39(5), 211-219.  https://journals.lww.com/jonajournal/abstract/2009/05000/development_and_psychometric_testing_of_a_tool_to.4.aspx

Dabney, B., Kalisch, B., & Clark, M.  (2019).  A revised MISSCARE survey: Results from pilot testing.  ScienceDirect, 50.  https://www.sciencedirect.com/science/article/abs/pii/S0897189719304963?casa_token=iyEhjGmUwoAAAAAA:xR4gXXVCrGsNnYYNG1e5jpy1XObBHIxHs9hUgYq_UBJyIH3FxAuPoW-n_efs46Nh02Z3fwvMYzQ