Archived: Yeovil Renal Unit

Yeovil Renal Unit is operated by B. Braun Avitum UK Limited. The service has 13 dialysis stations for patients and offers two shifts of daily sessions between 6.30am and 6.30pm. The service also offers three evening shifts on Mondays, Wednesdays and Fridays (from 6.30pm to 11pm). The service is open six days a week and operates 180 sessions for a current caseload of 55 patients. The unit has capacity for 65 patients. Facilities include a main unit with12 dialysis stations, divided into three bays, and one isolation room with dialysis station. There was a manager and clerical office, consultant’s office, rear service corridor, and patient toilet.

The medical care is covered by three NHS hospitals (Dorchester, Southmead and Exeter). The patients from Southmead and Exeter have their blood results reviewed monthly at a continuous quality improvement meeting and patients from Dorchester are reviewed in the unit. The dietetic cover is provided by a dietician who visits the unit twice weekly as agreed through a service level agreement with Somerset Commissioning Group.

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.

The service is a nurse led unit and is supported by the renal unit at Dorchester Hospital in Dorset.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 19 June 2017 and further unannounced inspection on 29 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?

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 when they are provided as a 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 areas of improvement that were required:

• Staff were not fully compliant with mandatory training in line with corporate policy.

• Nurses did not check patients’ identity prior to commencing haemodialysis treatment.

• There was no policy or guidance available to staff about the early recognition or management of sepsis. Staff had received no specific training for the early identification of sepsis and management (infection) in line with national guidance (NHS England, 2015).

• Patients’ records were not securely stored on the unit during dialysis.

• There was no awareness of and evidence of compliance with the Workforce Race Equality Standard (WRES) which became mandatory in April 2015.

• Patients felt that it was difficult to have a private conversation on the unit.

• There was not an effective process to monitor how local service risks were identified, mitigated and acted upon.

• Some chairs in the unit were visibly damaged and many patients found them to be uncomfortable.

• Due to a lack of permanent unit manager prior to the inspection, unit staff were not having regular meetings, and some staff had not had an annual appraisal in the preceding 12 months.

However, we found the following areas of good practice:

• Evidence based practice and the Renal Association guidelines were used to develop how care and treatment was delivered. All policies and procedures were based on national guidance and updated when required to reflect change to national guidance and then distributed to staff. Patient outcomes were monitored in line with best practice guidelines.

• There was a good incident reporting culture and the staff were aware of the procedure to follow when reporting an incident or an adverse patient incident. Staff followed company policy with regards to infection, prevention and control.

• The unit had clear processes to ensure regular servicing and maintenance of equipment, and there were policies and procedures to follow in case of a failure in the water supply or power failure. Staff were aware of their roles and responsibilities to maintain the service in the event of a major incident.

• There was good multidisciplinary working and strong communication links with the lead consultant and the local NHS trust.

• There were effective processes for gaining informed consent, which was sought and documented prior to treatment.

• Staff understood the impact of the treatment on patient’s emotional wellbeing and actively supported patients.

• Services were planned and delivered to meet individual patient needs and improve their quality of life.

• There was a system to monitor and deal with complaints. There had been no formal complaints at the unit in the year prior to our inspection.

• Staff felt valued and supported in their roles and reported a positive working culture.

• There was a replacement programme for the dialysis machines, in line with the Renal Association guidelines.

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, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notices. Details are at the end of the report.

Edward Baker

Chief Inspector of Hospitals

South Region