Prevalence of missed nursing care in the operating room: A scoping review

Abstract

Background: Increasing surgical complexity and limited resources contribute to missed nursing care (MNC) in the operating room, with potential impacts on patient safety. Objectives: To map the prevalence of MNC in the operating room, identify the most frequently omitted interventions, examine contributing factors and explore clinical and organisational implications. Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) guidelines. A population, concept and context (PCC) framework was used to develop the review question. Searches were performed in MEDLINE, CINAHL and DOAJ. Eligible sources included quantitative and qualitative research, mixed-methods studies, reviews and relevant grey literature. Screening, data extraction and descriptive synthesis were performed. Results: Six studies met the inclusion criteria. Two of the six were validation studies that confirmed the validity of the MISSCARE Survey-OR. Types of MNCs identified in the studies involve communication, perioperative documentation, patient surveillance and patient education. Contributing factors identified included mental fatigue, inadequate staffing, insufficient skill mix, workload, perceived competence, organisational environment and communication patterns. Conclusion: The causes of MNC in the operating room are multifactorial. Interventions should focus on staffing optimisation, skills reinforcement and improved communication and documentation processes. Further multi-centre and longitudinal studies are needed to link MNC with clinical outcomes and patient-reported outcomes.