Managing gaps in the continuity of nursing care to enhance patient safety

Gaps in the continuity of patient care increase the risk of preventable adverse events. This paper reports findings from the first Australian study to explore the role and expertise of nurses in identifying and managing gaps. Aim: To describe the processes nurses used to (i) identify potentially harmful gaps in the continuity of patient care and (ii) manage the gaps identified as a key aspect of safe care. Method: The study used a qualitative exploratory descriptive approach. Data were collected from a purposeful sample of seventy one registered nurses from emergency department, critical care, perioperative, rehabilitation and transitional care, and neurosciences settings in Australia and analysed using content and thematic analysis strategies. Results: The identification and management of gaps were based on nurses’ knowledge and experience of: where gaps occur; the types of gaps that occur; the things that happen, go wrong and are overlooked; the clinical environment; available equipment; and correct processes and procedures. The gaps identified included failure to recognise and respond to the deteriorating patient, inattention to the ‘simple things’, the practice of cutting corners, and lapses in critical thinking. Three deliberative processes were used to manage the gaps identified: nursing surveillance, teamwork and communication. These, in turn, were augmented by the non-deliberative processes of serendipity and ‘chance’. Conclusion: The study deepens understanding of how nurses contribute to creating safety through the use of effective nursing strategies for identifying and managing gaps in hospital settings.