Care quality and safety in long-term aged care settings: A systematic review and narrative analysis of missed care measurements.
Xinxia Wang, John Rihari-Thomas, Kasia Bail and 2 others
PMID 39092879WHAT IT FOUND
There is no established gold standard for measuring missed care in long-term aged care.
Most tools rely on staff self-report, and evidence is too weak to recommend one.
Key findings
01The review included 24 publications and found two main ways of measuring missed care in long-term aged care: adjusted standard scales and study-specific approaches.
02The adjusted BERNCA-NH and MISSCARE approaches asked caregivers to self-report missed care, using recall periods of the past seven working days or the most recent shift.
03The only wholly objective approach used was observation, and it found care or communication was absent in 38% to 41% of morning care occasions.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a review of measurement instruments, not a test of an intervention, so it cannot show that a missed-care measure improves patient safety. Most included studies were cross-sectional, and the review included only 24 publications. Many measurement tools relied on staff self-report, which can understate omissions because of fear of punishment or normalised missed care. The only wholly objective approach was observation, and observed staff may behave differently because they are being watched. Several included studies had unclear sampling, low or unreported response rates, or incomplete psychometric testing. The review could not fully apply COSMIN instrument review guidelines because included publications lacked psychometric detail.
Declared interests
The authors declared no conflicts of interest, and the research received no specific grant from any public, commercial, or not-for-profit funding agency.
The easy way to misread this
Do not read the reported missed care rates as precise or comparable across facilities. Most instruments used staff self-report, and the review found no gold standard to confirm accuracy.