title: Poor systems and staffing problems led to poor patient outcomes.
abstract: The office of the Health Service Ombudsman regularly publishes reports of complaints investigated by its assessors. The cases presented here relate to failures of nursing care: some of the problems were found to be the result of inadequate staffing and training, others were due to poor documentation, lack of staff accountability and inadequate organisation.
authors.forename: Ann
authors.initials: A
authors.lastname: Abraham
mesh_terms: D006801:Humans; D009739:Nursing Services / Q000592:standards* / Q000600:supply & distribution; D009740:Nursing Staff / Q000600:supply & distribution*; D005791:Patient Care / Q000592:standards*; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D011787:Quality of Health Care