Archived: Boston Dialysis Unit

Boston Dialysis Unit is operated by Fresenius Medical Care Renal Services Limited. The site is situated on a business park and was opened for this service in 2005 and a refurbishment took place in 2015. The facility has 12 dialysis stations and provides haemodialysis services six days a week. Facilities include a consulting room, isolation room, nurses office and patient kitchen.

Dialysis units offer services, which replicate the functions of the kidneys for patients with advanced chronic kidney disease. Dialysis is used to provide artificial replacement for lost kidney function. At the time of inspection these services were commissioned by a local NHS trust.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 April 2017 along with an unannounced visit to the unit on 2 May 2017.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate dialysis services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• The unit was visibly clean with evidence of thorough infection control practices.

• Equipment was serviced and fit for purpose.

• Staff knew how to report incidents and treatment variances.

• Staff demonstrated a good understanding of their responsibilities around safeguarding.

• All staff were up to date with mandatory training.

• Medicines were administered in line with national guidelines.

• Staff carried out structured patient risk assessments throughout dialysis treatment.

• Staff followed evidence based treatment and best practice guidance

• All staff had received a recent appraisal.

• The service monitored closely patient outcomes and reported these to the commissioning trust.

• The commissioning trust submitted Boston Dialysis Unit figures to the Renal Registry.

• Staff received training on the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards as part of their induction training.

• All patients received regular multidisciplinary reviews.

• Information sharing between the NHS trust and Boston Dialysis Unit was seamless.

• Staff demonstrated compassion to both patients and family members.

• Patients were treated with privacy and dignity.

• Where possible patient’s wishes were considered on dialysis appointment.

• Transport services were provided by Fresenius drivers located at the unit.

• Patients were involved in decisions around their care.

• The service received low levels of complaints. Those that were received were resolved appropriately and in a timely way.

• There was a company vision, strategy and values, which most staff were aware of and shared.

• Locally staff were well supported by the clinic manager.

• The service performed regular staff and patient surveys and responded to feedback.

However, we also found the following issues that the service provider needs to improve.

• Some risks were not reported or monitored appropriately due to the two tier incident reporting system.

• Action plans developed in conjunction with a staff survey were not completed in a timely fashion.

• Although no errors had occurred in relation to patient identification there was no formal process to follow.

• Currently no guidelines were in place for staff to follow when monitoring and identifying patients at risk of developing sepsis.

Following this inspection, we told the provider that it should make improvements, even though a regulation had not been breached, to help the service improve. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals

Central Region