Omissions of Care in Nursing Home Settings: A Narrative Review

Abstract

Objectives: This review aims to (1) examine existing definitions of omissions of care in the healthcare environment and associated characteristics and (2) outline adverse events that may be attributable to omissions of care among nursing home populations.

Design: Nonsystematic review. A literature search for published articles on care omissions in nursing home settings and related adverse events was performed using the databases PubMed, Web of Science, EBSCO Academic Search Premier, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) until January 2019. Articles were excluded if they were published in a language other than English or included samples that were not relevant to nursing home settings.

Settings and participants: Adult samples in nursing home settings or settings likely to include nursing homes as part of the continuum of care.

Measures: Articles must provide a definition of missed or omitted care relevant to nursing home settings or include adverse events that can be attributed to care omissions.

Results: From a total of 2155 articles retrieved, 34 were retained for thematic synthesis. Key themes included broad agreement that any delay or failure of care is an omission; diverse views on including consideration of risks or occurrence of adverse events within the definition; diverse approaches to including components of care delivery systems in the definition; recognition that care in nursing homes includes both clinical and psychosocial care; and awareness that insufficient or inadequate resources to meet care demands can cause omissions. For research on adverse events attributable to omissions, 327 of 8385 articles were included for review. Nineteen adverse events were identified and omissions contributing to their incidence are highlighted.

Conclusions/implications: Definitions of omissions of care for nursing homes vary in scope and level of detail. Substantial evidence connects omissions of care with an array of adverse events in nursing home populations.

Keywords: Medical errors; adverse events; missed care; preventable harms; psychosocial care; unmet need.