RELATIONSHIP BETWEEN MISSED CARE AND URINARY TRACT INFECTIONS IN NURSING HOMES
Rationale/Conceptual Basis/Background: A majority of adverse events, including urinary tract infections (UTI), occurring in nursing homes are likely preventable and are attributed to substandard treatment, inadequate monitoring, or delay or failure to provide necessary care. Necessary but uncompleted nursing care activities, commonly labeled care left undone or missed care, is an indicator of impaired nursing processes and poor care quality.
Methods: A secondary data analysis was conducted including survey data from 340 RNs from 63 nursing homes, which was merged with CMS outcome data extracted from the federal dataset Nursing Home Compare (NHC). A total of 12 categories of missed care and a metric of total missed care were measured with reliable and valid survey items used in previously published research conducted in U.S. and international settings. Descriptive statistics for missed care were examined in the nurse-level data set prior to aggregation to the nursing home level. Following examination of bivariate correlations, unadjusted and adjusted regression models were estimated to determine predictors of UTI prevalence among nursing home residents.
Results: A total of 48.2% of nurse respondents reported that they had missed at least one necessary care activity by leaving it undone during their last shift. Seven of the 12 categories of missed care, as well as a measure of total missed care, were significant predictors of UTI. Nursing system factors such as measures of practice environment, staffing levels and reported nurse workload did not significantly predict UTI in adjusted models.
Implications: Missed nursing care may be an operant mechanism and metric that links substandard nursing care and adverse outcomes in nursing homes. Nursing home administrators should consider assessing the frequency and types of missed care in their facility in order to adequately evaluate the quality of the care provided to their residents. In order to improve resident outcomes, further research is needed to identify the predictors of missed care. With this understanding, strategies can be developed and implemented that supports the necessary processes of care and reduces missed nursing care in the nursing home environment.