Frequent Interruptions Most Common Cause of Lapsed Nursing Care in Neonatal ICUs
Researchers examining nursing care lapses in neonatal intensive care units (NICUs), including missed rounds, found that the most commonly cited reasons were frequent interruptions and urgent situations involving other patients.The lapses themselves were wide-ranging, including oral care for ventilated infants, educating and involving parents in care, and oral feedings. The least common lapses were hand hygiene, safety and physical assessment, and medication administration.
The study, first published online Nov. 27, 2014 in the Journal of Advanced Nursing, achieved significant national attention for calling attention to nursing care quality in NICUs.
The team was led by Heather Tubbs-Cooley, PhD, RN, a faculty member in Research in Patient Services with a secondary appointment with the James M. Anderson Center for Health Systems Excellence. The study focused on the frequency of nurse-reported missed care, and nurses' reports of factors contributing to missed care on their last shift worked. While previous studies highlighted the frequency of missed nursing care in adult settings, there was little or no such data on incidents in NICUs.
Using a cross-sectional web-based survey, researchers took a random sample of certified neonatal ICU nurses in seven states. Descriptive statistics constituted the primary analytic approach. The team concluded that system factors might have contributed to missed care. The most frequent reasons nurses cited were: frequent interruptions (73 percent), urgent patient situations (66 percent) and an unexpected rise in patient volume and/or acuity on the unit (61 percent).
Approximately half of respondents reported that an inadequate number of nurses and missing equipment/supplies were reasons for missed care.
Tubbs-Cooley and colleagues are analyzing data from a separate longitudinal study in one NICU to examine relationships between nurse workload, specific instances of missed care, and the occurrence of adverse events.
