Understanding Omissions of Care in Nursing Homes

Omissions of care, adverse events, and poor health outcomes are ongoing challenges in nursing homes, in part because of residents’ complex medical needs and challenging working conditions. However, research shows that a substantial portion of patient harms are avoidable, and that omission of care is a significant factor in many adverse events in nursing homes. These avoidable harms—for example, healthcare-acquired infections, falls, and adverse drug events—lead to additional harms, such as hospitalizations, prolonged stays, unrecognized pain, and pressure ulcers.

AIR conducted a systematic review to develop a uniform definition of omissions of care in nursing homes that is meaningful to stakeholders and can be used for research and quality improvement.

The goal of this project for the Agency for Healthcare Research and Quality (AHRQ) was to review, summarize, and synthesize existing approaches related to omissions of care in nursing homes into a single definition and to present the evidence about omissions of care in useful ways for identifying when and how they occur, which omissions lead to which consequences, how omissions can be monitored, and what strategies are effective in preventing them. The project included an environmental scan to assess the availability and utility of published and gray literature to support the development of a definition of omissions of care in nursing homes, as well as engaging technical experts and nursing home stakeholders to gain their advice and perspectives about defining omissions of care and disseminating the definition and related project findings to stakeholders.