Perception of causes of omissions in the assessment of patients with chestpain

There is growing evidence that errors and omissions often occur in the nurs ing assessment and care of patients. As yet, the impact of audit has been i nsufficient to correct these deficiencies, possibly because audit does not primarily focus on the causes of deficiencies. The purpose of this study wa s to examine the perceived causes of omissions in the assessment of patient s with chest pain and to compare these with omissions detected in an audit of the assessment records. The type of attributions nurses used to explain the causes of the omissions was also investigated. Following an audit of th e assessment records of patients with chest pain, 88 nurses were invited to answer a 51-item questionnaire relating to the types of omissions which oc curred in the assessment of patients with chest pain. The results showed a marked discrepancy between the frequency of reported omissions and those fo und in the assessment records. The most common causes of omissions reported by the nurses were patients' condition, work overload, lack of time, poor assessment documentation, not realizing that the assessment had not been fu lly carried out and different nurses being involved in the assessment of pa tients. Nurses overwhelmingly attributed the causes of omissions to externa l or environmental factors rather than internal ones such as lack of knowle dge or fatigue, which have implications for the types of strategies that mi ght be used to improve care.