Care left undone in patients with chronic respiratory diseases admitted to medical wards: an observational study

Background: Chronic respiratory diseases are among the most common causes of mortality and comorbidity in the world. In the medical wards there are often inpatients with complex conditions, who cannot be admitted to a specialized unit due to their complex clinical and nursing needs. Nurses in this context play an important role and are responsible for the surveillance and prevention of complications in these inpatients. Aims: To describe the frequency and patterns of care left undone in medical wards in Italy. Methodology: Data were extracted from the RN4CAST@IT study, a larger cross-sectional observational study conducted in 2015, involving nurses, through convenience sampling of 40 hospitals. For this analysis we considered nurses involved (n=2082) in medical wards or similar. We surveyed which activities, from a list of 13, were necessary but left undone because of lack of time during the last shift worked. Results: The most frequent care left undone activity was ‘oral hygiene’ (47.6%), ‘frequent mobilisation of bedridden patient’ (47.3%), ‘comforting and talking with patients’ (45.8%), ‘information and education’ (45.1%). Conclusion: Care left undone is an error of omission that has a negative impact on patient outcomes. Omitting basic care, such as ‘oral hygiene’, leads to an increase of the workload for nurses and negative clinical outcomes in frail patients admitted to medical wards, especially when patients are affected by chronic respiratory diseases.