Application of the MISSCARE scale in an Oncology Service: a contribution to patient safety

Rabin, Eliane Goldberg; Silva, Camila Neves da; Souza, Aline Brenner de; Lora, Priscila Schmidt; Viegas, Karin

doi:10.1590/S1980-220X2018025403513

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Original Article • Rev. esc. enferm. USP 53 • 2019 • https://doi.org/10.1590/S1980-220X2018025403513 copy

Application of the MISSCARE scale in an Oncology Service: a contribution to patient safety

Aplicação da escala MISSCARE em um Serviço de Oncologia: uma contribuição à segurança do paciente

Aplicación de la escala MISSCARE en un Servicio de Oncología: una contribución a la seguridad del paciente

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To investigate the prevalence of and reasons for missed nursing care in oncology units.

Method:

A cross-sectional study was conducted at inpatient oncology units at a private hospital. Eighty-three professionals from the nursing team took part. The MISSCARE instrument and a sociodemographic questionnaire were administered. Simple descriptive statistics were used for analyses. Pearson's chi-square test was used to detect associations between variables.

Results:

The care tasks missed most frequently were assisting with toileting needs within 5 minutes of a request (57.8%), ambulation 3 times per day or as ordered (44.6%), and turning patients every 2 hours (36.1%). The main reasons for missed care were related to communication: tension or communication breakdowns within the nursing team, and the caregiver responsible off unit or unavailable (both 66.2%).

Conclusions:

there is a need to develop nursing interventions that neutralize and/or reduce the negative results of this missed care in order to improve the quality of care provided to cancer patients.

DESCRIPTORS
Oncology Service, Hospital; Nursing Care; Oncology Nursing; Quality of Health Care; Patient Safety

Variables	Dimensions^* * p = Pearson's chi-square.
Variables	Dimension 1	Dimension 2	Dimension 3	Dimension 4
Role	0.354	0.178	0.010	0.255
Academic qualifications	0.284	0.399	0.018	0.683
Experience	0.603	0.082	0.046	0.058
Time (years) in role	0.986	0.557	0.255	0.342

Missed care items by dimension		Mean±Standard deviation^* * Scores: 1 (always missed), 2 (frequently missed), 3 (occasionally missed), 4 (rarely missed), or 5 (never missed).
Dimension 1
	Full documentation of all necessary data	4.43±0.802
	IV/central line site care and assessments according to hospital policy	4.55±0.740
	Monitoring fluid balance – Intake/output	4.54±0.804
	Vital signs assessed as ordered	4.39±0.857
	Focused reassessments according to patient condition	4.45±0.932
	Hand washing	4.63±0.729
	Capillary glucose monitoring	4.71±0.676
	Patient assessments performed each shift	4.65±0.760
	Total for Dimension 1	4.54±0.11
Dimension 2
	Assess effectiveness of medications	4.15±0.918
	PRN medication requests acted on within 15 minutes	3.87±0.872
	Medications administered within 30 minutes before or after scheduled time	3.82±0.818
	Assist with toileting needs within 5 minutes of request	3.29±0.896
	Response to patient call within 5 minutes	3.94±0.807
	Emotional support to patient and/or family	4.32±0.887
	Total for Dimension 2	3.90±0.35
Dimension 3
	Ambulation 3 times per day or as ordered	3.52±1.146
	Turning patient every 2 hours	3.72±0.850
	Mouth care	3.98±0.875
	Feeding patient when the food is still warm	3.88±0.807
	Patient bathing/skin care	4.35±0.807
	Setting up meals for patients who feed themselves	4.34±0.789
	Skin/wound care	4.27±0.876
	Total for Dimension 3	4.01±0.32
Dimension 4
	Patient teaching about procedures, tests, and other diagnostic studies	3.87±0.991
	Attend interdisciplinary care conference whenever held	3.84±1.160
	Patient discharge planning and teaching	4.41±0.785
	Total for Dimension 4	4.04±0.32

Items		Mean±Standard deviation^* * Scores: 1 (significant reason), 2 (moderate reason), 3 (minor reason), or 4 (not a reason for missed care).
Communication
	Unbalanced patient assignment per professional	2.60±0.923
	Inadequate hand-off from previous shift or sending unit	2.29±0.931
	Other professionals did not provide the care needed (e.g. physiotherapist did not ambulate patient)	2.64±1.089
	Lack of back up support from team members	2.73±1.159
	Tension or communication breakdowns with other ancillary/support departments	2.66±1.003
	Tension or communication breakdowns within the nursing team	2.81±1.064
	Tension or communication breakdowns with the medical staff	2.60±1.047
	Nursing assistant did not communicate that care was not done	2.42±1.049
	Caregiver responsible off unit or unavailable	2.77±1.086
	Total for dimension	2.61±0.17
Labor resources
	Inadequate number of staff	1.75±0.986
	Urgent patient situations	1.69±0.882
	Unexpected rise in patient volume and/or activity in the unit	1.57±0.858
	Inadequate number of care personnel (e.g. nursing assistants, technicians, unit secretaries etc.)	1.76±0.892
	Heavy admission and discharge activity	2.57±1.073
	Total for dimension	1.87±0.40
Material resources
	Medications were not available when needed	2.13±0.985
	Supplies/equipment not available when needed	2.65±1.109
	Supplies/equipment not functioning properly when needed	2.60±1.136
	Total for dimension	2.46±0.29

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Eliane Goldberg Rabin, Rua Sarmento Leite, 245/401 90050170 – Porto Alegre, RS, Brazil elianer@ufcspa.edu.br