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Inspection Summary


Overall summary & rating

Updated 1 September 2017

Broadgreen Dialysis unit is operated by Fresenius Medical Care Renal Services Ltd. The unit has 22 dialysis stations. The service provides dialysis services for people over the age of 18, and does not provide treatment for children.

Patients were referred to the unit via the Royal Liverpool and Broadgreen University Hospital Trust.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 June 2017, along with an unannounced visit to the unit on 26 June 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? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.

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

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.

Services we do not rate

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

We found the following issues that the service provider needs to improve:

  • We observed some of the privacy screens were being stored on the main ward and would be difficult to access due to being stored behind a dialysis chair and equipment.
  • There were no call bells available for patients to use if they required assistance or emergency. This did not comply with the health building note (HBN) 07-02 main renal unit.
  • One of the nursing stations was located facing away from the main ward. This meant that staff using the station would not be able to view patients whilst receiving care. The computer screen also faced a dialysis chair, which could pose a data confidentiality issue.
  • Several of the dialysis machines had been reported to have media data port faults. This meant that staff were required to input data into the dialysis machine manually. This increased the risk of data being inputted incorrectly and had not been risk assessed.
  • We found that emergency equipment was not consistently checked daily as we found six omissions throughout the month of May 2017.
  • We found that fridge temperatures were not consistently recorded to ensure they were all within normal ranges. We found six omissions throughout the month of May 2017.
  • We observed 13 prescription charts and found from May to June 2017 there were seven occasions where signatures were missing to indicate whether medication had been given.
  • We looked at 13 patient records and found there were omissions in recordings
  • The service does not have a policy or provide training for nursing staff with regards to identification or process for sepsis management
  • Not all staff competency files were fully completed and up to date.
  • From the 10 patients we spoke with, seven told us that their clinic appointment did not start on time.
  • Not all risks associated with the unit had been risk assessed. For example, there was no risk assessment completed for there not being any call bells for the patients to summon help in an emergency.
  • We did not see any evidence that patient concerns raised from the 2016 patient survey had been suitably addressed.

However, we found the following areas of good practice:

  • Mandatory training was made available to all staff to enable them to provide safe care and treatment to patients.
  • We observed cleaning logs were kept for the weekly disinfecting of the dialysis machines.
  • All areas of the unit were tidy and well maintained; they were free from clutter and provided a safe environment for patients, visitors and staff to move around freely.
  • The service had developed a Nephrocare standard for good dialysis care based upon standards of best practice.
  • All patients we asked reported the staff were caring and respectful.
  • Every patient had an individualised treatment prescription to ensure effective dialysis treatment.
  • Parking facilities were available for patients, and we saw there were free dedicated spaces outside the unit and transport was arranged for those who needed it.
  • Patients were supported to have holidays away from the unit.
  • There was no waiting list for treatment. This meant that there were no patients waiting to start treatment.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements. We also issued the provider with a requirement notice. Details are at the end of the report.

Ellen Armistead

Deputy Chief Inspector of Hospitals

Inspection areas

Safe

Updated 1 September 2017

We do not currently have a legal duty to rate dialysis services

We found the following issues that the service provider needs to improve:

  • There were no call bells available for patients to use if they required assistance. This did not comply with the health building note (HBN) 07-02 main renal unit – which states one emergency call button (with an audible and visual alarm) per station should be provided.
  • Several of the dialysis machines had been reported to have media data port faults. This meant that staff were required to input data into the dialysis machine manually. This increased the risk of data being inputted incorrectly and had not been risk assessed.
  • One of the nursing stations was located facing away from the main ward. This meant that staff using the station would not be able to view patients whilst receiving care. The computer screen also faced a dialysis chair, which could pose a data confidentiality issue.
  • We observed 13 prescription charts and found from May to June 2017 there were seven occasions where signatures were missing to indicate whether medication had been given.
  • We looked at 13 patient records and found that in six records there were omissions in the recording of pre and post patient temperatures. We also found two patients had been recorded as needing pressure relieving equipment and monthly review but this had not happened. We also found two records where midway observations had not been completed for four days in June 2017.
  • The service does not have a policy or provide training for nursing staff with regards to identification or process for sepsis management. This was not in line with the NICE guideline (NG51) for recognition, diagnosis, or early management of sepsis. (Sepsis is a life-threatening illness caused by the body’s response to an infection).

However, we also found the following areas of good practice:

  • We saw there was an electronic incident reporting system that captured details regarding clinical, non-clinical and treatment variance incidents that occurred on the unit.
  • Mandatory training was made available to all staff to enable them to provide safe care and treatment to patients. Some of the training was completed through e-learning which staff could access at a time to best suit their needs.
  • We reviewed that weekly disinfecting of the dialysis machines took place. We reviewed the cleaning logs and found for May and June 2017 the logs were completed, signed, and dated.
  • All areas of the unit were tidy and well maintained; they were free from clutter and provided a safe environment for patients, visitors and staff to move around freely.
  • Patients used nominated dialysis machines to aid tracking and traceability.

Effective

Updated 1 September 2017

We found the following areas of good practice:

  • Information about the outcomes of patients’ care and treatment was collected and monitored by the service to ensure good quality care outcomes were achieved for each patient.
  • The service had developed a Nephrocare standard for good dialysis care based upon standards of best practice.
  • 100% of patients were receiving Hi Flux dialysis. This is considered a better form of dialysis for patients.

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

  • The service did not have or maintain a Workforce Race Equality Standard (WRES) action plan or publish data with regards to monitoring staff equality.
  • Not all competency files were fully completed and up to date. We found five competency files where the peer review sections of their annual reassessment had not been completed, and in one file, medication competencies had not been completed or annually reassessed since 2015.

Caring

Updated 1 September 2017

We found the following areas of good practice:

  • We observed that nurses had close working relationships with their patients. Interactions were positive, friendly and professional.
  • All patients we asked reported the staff were caring and respectful.
  • In the reception area, we observed there were many thank you cards from patients expressing their gratitude to the care and treatment from the staff team.
  • Patients told us that the nursing staff checked on them regularly during their treatment to ensure they were well.

Responsive

Updated 1 September 2017

We found the following areas of good practice:

  • Every patient had an individualised treatment prescription to ensure effective dialysis treatment.
  • Parking facilities were available for patients, and we saw there were dedicated spaces outside the unit and transport was arranged for those who needed it.
  • Patients were supported to have holidays away from the unit
  • Patient information was provided in English, however could be obtained in other formats if required
  • There was no waiting list for treatment. This meant that there were no patients waiting to start treatment.

Well-led

Updated 1 September 2017

We found the following issues that the service provider needs to improve: areas of good practice:

  • Not all risks associated with the unit had been risk assessed. For example, there was no risk assessment completed for there not being any call bells for the patients to summon help in an emergency.

  • We did not see any evidence that patient concerns raised from the 2016 patient survey had been suitably addressed. For example, patients informed us that the dialysis chairs were uncomfortable yet this had been highlighted in the 2016 survey.
  • We found there was no management oversight to ensure all daily checks completed by the staff had been completed.
  • Quality assurance meetings regarding patient outcomes were not being held consistently on a monthly basis.

However, we found the following areas of good practice:

  • We saw there was a clear clinical governance strategy policy that set out the strategic aims of the service. The aims included continuous improvement in patient care and promote evidence based clinically effective care.
  • There was a clear leadership structure from unit level to senior management level.
  • All staff we spoke with reported they had a good relationship with their managers.
  • We observed that managers were visible and approachable on the unit and provided support to staff as required.

Checks on specific services

Dialysis Services

Updated 1 September 2017

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