Nurse staffing, missed care, quality of care and adverse events: A cross-sectional study.

AIM: This study aimed to illustrate the relationship between nurse staffing and missed care, and how missed care affects quality of care and adverse events in Thai hospitals. BACKGROUND: Quality and safety are major priorities for health care system. Nurse staffing and missed care are associated with low quality of care and adverse events. However, examination of this relationship is limited in Thailand. METHODS: This cross-sectional study collected data from 1188 nurses in five university hospitals across Thailand. The participants completed questionnaires that assessed the patient-to-nurse ratio, adequacy of staffing, missed care, quality of care and adverse events. Logistic regression models were used to estimate associations. RESULTS: Higher patient-to-nurse ratio, poor staffing and lack of resource adequacy were significantly associated with higher odds of reporting missed care. Higher nurse-reported missed care was significantly associated with higher odds of adverse events and poor quality of care. CONCLUSIONS: Poor nurse staffing was associated with missed care, and missed care was associated with adverse events and lower quality of care in Thai university hospitals. IMPLICATIONS FOR NURSING MANAGEMENT: Improving nurse staffing and assuring adequate resources are recommended to reduce missed care and adverse events and increase quality of care.

Comparison of oral versus intravenous ramosetron in prevention of acute cisplatin-induced emesis: a randomized controlled trial.

OBJECTIVE: To compare the antiemetic efficacy of a single oral versus intravenous (i.v.) ramosetron, a new class of selective 5-HT3 receptor antagonists, in gynecologic cancer patients receiving high-dose cisplatin. METHOD: Between February 2003 and July 2003, 109 patients with gynecologic cancer scheduled to receive single agent cisplatin chemotherapy at a dose of 75 mg/m2 were randomized to receive either 0.2 mg oral (51 cases) or 0.3 mg i.v. (58 cases) ramosetron 1 h and 30 min respectively before chemotherapy. Patients were evaluated for 24 h after chemotherapy. The number of nausea and vomiting including adverse events were recorded every 6 h. RESULTS: 51 and 58 patients received oral and i.v. ramosetron respectively. Both groups were similar regarding age, performance status, body mass index and diagnosis of gynecologic cancer. 95 per cent of cases were cervical cancer. Antiemetic effect was significantly higher in the oral group when compared with the i.v. group during the first 6 hours and during the period of 18 to 24 hours after administration of cisplatin chemotherapy. Overall in 24 h, patients receiving oral ramosetron experienced no emesis slightly higher than that of the i.v. group (55% and 36% respectively, p = 0.05). Adverse events were mild and transient and were not significantly different in both groups, except tiredness which was more frequent in the i.v. group. CONCLUSION: Oral ramosetron at a dosage of 0.2 mg is as effective as 0.3 mg of intravenous ramosetron in prevention of acute emesis in patients receiving 75 mg/m2 of cisplatin chemotherapy.