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Archived: Sheffield Dialysis Unit

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Inspection report

Date of Inspection: 11 May 2011
Date of Publication: 2 June 2011
Inspection Report published 2 June 2011 PDF | 148.1 KB

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Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Meeting this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

How this check was done

We reviewed all the information we hold about this provider, carried out a visit on 11/05/2011, checked the provider's records, observed how people were being cared for, looked at records of people who use services, reviewed information from people who use the service, talked to staff and talked to people who use services.

Our judgement

Overall, we found that the location is meeting this outcome because consent is obtained prior to commencement of treatment and where identified an individual’s capacity to make decisions had been reviewed. However, we were concerned that we found no clear policy statement or process that outlined how a person’s ‘ongoing’ capacity to make decisions should be managed. Also, previous a capacity assessment had not been recorded. In relation to this location we recommend that the provider either expands its current policy and process statements to set out how an individual’s ongoing capacity to make decisions be managed and recorded or consider utilising the contracting NHS trust’s own mental capacity act policies and processes.

User experience

It was not possible to gain the direct views of people who use the service for this outcome.

Other evidence

The provider declared compliance with this outcome at this location at registration with CQC October 2010 and our quality and risk profile (QRP) was checked.

As part of the assessment of this location the provider submitted a ‘provider compliance assessment’ record for this outcome, which outlined how it is currently meeting each part of the outcome. The provider explained the consent forms which would capture actions and potential side effects of any treatment. Specific data protection consent was also reported as being sought from patient’s treated at the location. No direct reference was made to the Mental Capacity Act 2005 other than reference to a specific consent form for persons who would be acting on behalf of patients unable to consent for themselves.

On the site visit conducted 11 May 2011 we reviewed several completed ‘patient agreement forms’, which obtain consent prior to first commencement of dialysis at the location. The form also included a standard risks and benefits of treatment along with a section regarding advance directives. All forms we reviewed were appropriately signed and dated.

The unit manager was asked about how a person’s ongoing capacity to make decisions is managed following the initial consent. Examples were explained where patient’s had previously presented where aspects of their capacity had become limited, for example, no longer being able to retain information and interpret the detail. One example was explained where a person had been referred to the medical consultant for a mental capacity assessment. We reviewed this person’s medical notes but the actual assessment had not been recorded as required by the “Mental Capacity Act 2005 Code of Practice” (2007).

The providers own consent policy, which contained sections relating to managing a person’s capacity but this was specifically in relation to the obtaining of consent or where a person refuses to give consent and did not relate to the management of ongoing capacity. The policy does not directly refer to the provisions of the Mental Capacity Act 2005 (as amended).

We were concerned that we found no clear policy statement or process that outlined how a person’s ongoing capacity to make decisions should be managed. In relation to this location we recommend that the provider either expands its current policy and process statements to set out how an individual’s ongoing capacity to make decisions be managed and recorded or utilise the contracting NHS trust’s own mental capacity act policies and processes. This action will ensure a person’s capacity to make decisions can be effectively supported, monitored, recorded and actioned where the individual’s capacity changes during ongoing dialysis treatments.