64 - Evaluation of the Misscare OR Survey and Nursing Sensitive Outcomes
Description: Problem/PurposeThe MISSCARE OR Survey is a recently developed instrument that identifies missed nursing care in the perioperative setting. Literature Little research has focused on the link between OR nursing care and outcomes. This study provides insight into missed care and opportunities for improvement. Research Questions What are 1) the underlying factor groupings of missed OR nursing care, 2) the reasons for which care is missed, and 3) the association with nursing-sensitive outcomes (NSO) (falls, decubitus, CLABSI, CAUTI). Conceptual Framework The Missed Nursing Care Model (Kalisch, 2015) was derived from Donabedian's quality model. Methodology/Data Analysis A cross-sectional design was used to collect data using an anonymous, self-reported Qualtrix survey. The survey included questions to gauge how frequent care was missed as well as to scale the listed reasons for which care was missed. Factor analysis with varimax rotation uncovered underlying factor groupings of the missed care variables. The same was done for the reasons for missed care variables. Results A total of 258 OR nurses completed the survey. The missed care questions grouped as follows: Intra-/Post-operative Care (variance explained: 32%), Pre-operative Care (variance explained: 30%). The questions on the reasons for missed care grouped as follows: Team Dynamics (variance explained: 31.6%), Logistics and Supplies (variance explained: 25.6%). The items most often missed were: Other activities are suspended during the surgical time-out (mean: 3.747), Isolation precautions are implemented for infectious diseases (mean: 4.1), and Abnormal lab work is reported. (mean: 4.1). The items least often missed: Count discrepancies communicated to the surgeon, (mean: 4.8), Patient is transferred without harm to and from the OR table, (mean: 4.8) and Patient is properly grounded when electrosurgical cautery is used. (mean: 4.8). On average, care was self-reported to be rarely or never missed, in comparison with the inpatient nursing responses. The three most frequently responded reasons for missed care were: Other departments did not properly prepare the patient for surgery, (mean: 2.4), Unexpected changes in a planned surgical procedure (mean: 2.2), and Urgent patient situations (e.g. a patient's condition worsening)(mean: 2.2). There is no association between the factor groupings and the NSOs. Conclusion This initial study provides insight into items missed in the perioperative setting but factors did not correlate with the NSOs in the previous work in an inpatient setting by Kalisch et al. This is the first study evaluating missed OR care in a health system. Findings indicate this topic warrants the development of a tool capturing OR nursing-sensitive outcomes. Implications This study stresses the importance of the key moments immediately prior to opening supplies for a procedure. Improvements may be addressed by focusing on team dynamics and logistics for needed supplies.