Errors of Omission in Nursing Care

Would it surprise you to know that a review of 42 studies showed that 55% to 98% of nurses surveyed said they “missed one or more items of required care”?¹

Maybe it shouldn’t be a surprise: Other studies show that low nurse staffing levels were significantly associated with higher reports of missed care,² or errors of omission. And most hospitals are hurting for nurses. In fact, nursing shortages at the national level are projected until 2037.³

Let’s take a look at the multiple causes of patient safety concerns and steps you can take to prevent the risk of missed nursing care.

What factors reduce patient safety in nursing?

In addition to inadequate staffing levels, contributors to patient safety concerns include:

• Increased nurse workload
• Poor work environment
• Limited staff experience, education or competency
• Lack of material resources
• Poor communication
• Poor care transitions
• Limited skills mix of staff on the unit
• Lack of teamwork⁴

“You may have nurses fresh out of nursing school who have no experience in the ICU taking care of three patients on ventilators,” says Christine Dean, MSN, RN, Medline medical science liaison. “You may have to cut corners and you’re going to have to sacrifice certain aspects of care because there’s no other option.”

What are the effects of errors of omission?

All of these factors can lead to dangerous consequences:

• Infections, increased length of stay, readmissions and even death⁵
• Complications such as pressure injuries, falls and ventilator-associated pneumonia
• Decreased patient satisfaction
• Decreased employee satisfaction⁶

How can you reverse the trend while coping with staffing issues?

Strategies for preventing errors of omission

“The nursing discipline is vital to quality healthcare,” says Donna Matocha, DNP, MSN, RN, CNRN, VA-BC, Medline senior manager, clinical resources. “It’s no wonder the shortage has created a problem. But I want to make it clear that nursing is not the problem. It’s a complex problem.”

1. Standardize nursing care processes and products

Do you have clinical guidelines that were developed with frontline nurse input? Are the guidelines easy to access and follow? This will help increase engagement and promote consistent facility best practices in care across all staff.

Are your nurses going to the stock room multiple times to gather items for changing a central line dressing or inserting a Foley catheter? Try a bundled approach.

Product bundles:

• Provide all necessary items for a particular procedure or treatment in one package. This reduces the likelihood of forgetting critical components and steps.
• Encourage standardized practices by providing a consistent set of supplies for specific procedures
• Save time during preparation and procedures
• Enhance patient safety by including items designed to help with infection control measures
• Simplify training and orientation by providing a visual guide to the required supplies

“Bundles make it easier to complete all the steps in a given procedure,” Dean says. “For example, if a nurse forgets to prep a patient’s skin before changing a dressing, the doors to infection are open. With a bundle, the skin prep is included.”

The nursing discipline is vital to quality healthcare. It’s no wonder the shortage has created a problem. But I want to make it clear that nursing is not the problem. It’s a complex problem.

Donna Matocha

DNP, MSN, RN, CNRN, VA-BC, Medline Senior Manager, Clinical Resources

2. Institute multidisciplinary rounds

These rounds—conducted at least once a day—play a significant role in preventing omissions of care in nursing by promoting effective communication, collaboration and comprehensive patient management. Nurses can ask questions, provide insights and updates, and be prepared for each patient’s plan for the day.

Multidisciplinary rounds:

• Promote a comprehensive patient assessment. Experts in different disciplines share their knowledge and insights, which help identify potential care needs that might be overlooked if only one discipline is involved.
• Enable better information sharing. Nurses can provide crucial insights about patients’ daily care routines, vital signs, medication administration and any observations about changes in condition.
• Support early identification of issues. Nurses may notice subtle changes in a patient’s condition that other team members might miss. For example, is a pressure injury starting to form? By participating in rounds, nurses can raise concerns early, leading to prompt interventions and preventing complications.
• Provide skill sharing and training. Nurses can share their expertise with other team members and learn from them as well. This knowledge exchange helps prevent omissions due to lack of knowledge or experience.
• Contribute to continuity of care. Nurses have a clearer understanding of the patient’s overall care journey. This reduces the risk of fragmented or disjointed interventions.

3. Streamline onboarding and training of new nurses

The best way to onboard new nurses? Assess what they know and don’t know—before they start.

• Provide pre-employment materials. Give new nurses materials such as policies and procedures, employee handbooks and information about the healthcare facility’s culture and mission. These materials can help familiarize them with the healthcare facility and its expectations.
• Provide orientation materials. Help nurses get started with orientation materials such as a handbook or a virtual tour of the facility.
• Offer virtual onboarding sessions. These meetings can provide an opportunity for nurses to ask questions and connect with other staff members.
• Connect new nurses with a mentor: Are there experienced nurses who can provide guidance? If they’re stretched too thin, consider pairing new hires with veteran certified nursing assistants as a start.
• Provide access to online training modules. Give new nurses access to online training modules related to pressure injury, CLABSI prevention, CAUTI prevention, hand hygiene and other topics. These modules can be completed before the nurse’s first day on the job. You’ll want your educational offerings to be easy to implement and designed to meet the varying learning preferences of a multigenerational workforce.

If it’s not possible to provide online training, consider partnering with your medical supplier. Some companies offer free remote learning opportunities, and many of the courses count for continuing education credit.

“When new nurses are able to complete some educational training before their first day, it gives them more time for specific orientation,” Matocha says.

4. Implement flexible scheduling for nurses

Consider using variable staffing grids that can be adjusted daily or weekly based on patient census and acuity. This allows for better allocation of nurses to areas with the greatest need.

Are you able to offer part-time schedules? Job sharing? Compressed workweeks or rotating shifts? How about float pools?

Your medical supply partner wants to make nurses’ lives easier.

Christine Dean

MSN, RN, Medline Medical Science Liaison

These groups of experienced nurses are available to step in and provide support during periods of high patient volumes, staffing shortages or unexpected absences.

Float pools:

• Fill immediate staffing needs. Float pool nurses are ready to be deployed to units experiencing staffing shortages or unexpected increases in patient volume. This rapid response helps prevent situations where patient care might be compromised due to insufficient staffing.
• Support continuity of care. These nurses are usually experienced and familiar with various clinical areas. This expertise allows them to step in seamlessly and provide care without compromising patient safety or quality.
• Help reduce burnout. When regular nursing staff are consistently stretched thin due to high patient loads, it can lead to increased stress and burnout. Float pool nurses can help alleviate this burden, giving regular staff an opportunity to recharge and reducing the risk of errors due to fatigue.

When implementing flexible scheduling options, remember to maintain transparency, ensure fairness across the team and consider the impact on patient care.

5. Provide cross-training for nurses

You need nurses to be more versatile and adaptable, especially during staffing shortages. Here’s how you can effectively implement cross-training programs:

• Identify target clinical areas where cross-training would be most beneficial based on patient acuity, staffing needs and the skill sets of existing nurses.
• Develop training and education plans for each target area. These plans should outline the learning objectives, required competencies, training duration and evaluation methods.
• Assign experienced nurses as mentors to guide cross-training nurses through the learning process. This hands-on approach ensures practical learning and allows for immediate feedback.
• Increase clinical experience by allowing cross-training nurses to spend time in target clinical areas, observing and participating in patient care activities under the supervision of experienced nurses. Gradually increase their responsibilities as their skills improve.
• Develop clear competency criteria that cross-training nurses must meet before working independently in new clinical areas. This assessment ensures that they can provide safe and effective care.

6. Team up with your medical supply partner

In addition to providing essential medical equipment and supplies, your medical supplier may offer resources to help reduce omissions of care.

You and your facility can benefit from:

• Assessments: Your supply partner gathers insights on your facility’s clinical practice and product utilization, uncovering gaps and opportunities to build on your successes. A well-performed discovery assessment delivers measurable results, which can be turned into action-based recommendations. You and your partner collaborate to ensure a seamless rollout by onboarding caregivers with proper protocols, targeted education programs and comprehensive product in-servicing.
• Education and training: Your staff receives training and education on the proper use of equipment and supplies. In addition, clinicians check in with you on a regular basis to help keep caregivers engaged and motivated through a variety of touch points, such as expert-led webinars, downloadable posters and in-person or virtual training.
• Customized solutions: You and your partner collaborate on customized supply plans, such as bundles, based on your facility’s specific needs and patient population. This tailored approach provides you and your nurses with what you need to provide high-quality patient care.

“Your medical supply partner wants to make nurses’ lives easier,” Dean says.

Key takeaway

Nursing shortages have contributed to “preventable harm due to omitted care or treatment.”¹ You can address errors of omission by standardizing nursing processes and products, instituting multidisciplinary rounds, streamlining onboarding and training of nurses, implementing flexible scheduling, providing cross-training for nurses and collaborating with your medical supply partner.