Archived: St Anne's - Emsworth

St. Anne’s Dialysis Unit, Emsworth is operated by West London Hospitals Holiday Dialysis Trust. The service has three dialysis stations and one isolation room. The unit was nurse-led and staffed by one registered nurse and two part time healthcare assistants. The service provides dialysis for one session per day with three appointment slots available for patients requiring temporary dialysis away from base while on holiday.

We inspected this service using our comprehensive inspection methodology on 7 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.

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 good practice:

• Clinical areas were visibly clean and there were established processes in place for the cleaning and maintenance of equipment.
• There were clear criteria for admission to minimise the risks of patients with more complex needs being treated at the service.
• There were clear processes in place for ensuring that patients accepted for holiday dialysis had been appropriately screened for infections such as Methicillin-resistant Staphylococcus aureus (MRSA) and blood borne viruses.
• Staff were up to date with mandatory training, including basic life support, and safeguarding adults training.
• Dialysis sets were single use and CE marked and checked by staff to be intact and within sterility date. This was in line with Renal Association Haemodialysis Guidelines (2009).
• Staff kept detailed records of care. We reviewed four patient records and found that all were signed, dated and legible.
• There was one registered nurse for three patients.
• Staff communicated with each patient’s local dialysis unit to make sure they had all the relevant information about the patient’s care, whilst adhering to data protection requirements.
• Staff obtained written consent to treatment from patients before starting their first session of dialysis treatment. We reviewed four patient consent forms and found that all were signed, dated and correctly completed.
• Feedback from patients about the service was consistently positive. An audit of patient satisfaction surveys for 2016 showed positive results, with 98% of patients saying the overall care at was good or excellent.
• Staff offered patients support and reassurance while they were away from home, and the onsite self-catering holiday apartments provided the patients with comfortable relaxing surroundings.
• We observed staff treating patients with respect, courtesy and care, and patients were included in discussion about their normal observations. There was a calm and friendly atmosphere at the unit.
• There was a complaints policy which was shared with the patients and the service had not received any complaints from April 2016 to March 2017.
• The unit was purpose built to provide accommodation and dialysis to enable patients to have a holiday without compromising their dialysis.
• The nurse manager felt supported by the board of trustees, and the staff told us the nurse manager was very approachable.
• The staff offered the patients an opportunity to give feedback following their dialysis, and the patient survey results demonstrated high levels of patient satisfaction.

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

• There was no local incident policy in place, and recorded incidents were not fully investigated, which meant opportunities for learning were missed.
• The service did not have a policy, or provide staff training, for identification of sepsis or its 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).
• The service did not have an early warning score system in place to support staff in recognising the deteriorating patient.
• There was a basic local medicines management policy in place. Medicines were brought to the unit by patients for their own personal use during dialysis. The medicines were not always labelled with the patients’ unique personal identifier, creating the potential for incorrect administration.
• The staff did not demonstrate a good understanding of the duty of candour and when it should be implemented.
• Staff did not receive training in child safeguarding.
• The registered nurse manager reviewed the local policies and standard operating procedures, but it was not clear to us if all policies were based on national guidance and therefore we were not assured that staff were fully up to date with current practice.
• There was no evidence of effective monitoring of the quality of the service provided, for example, staff did not undertake local audits to identify areas for improving practice.
• The board of trustees did not request any quality reports from the registered manager, which meant there was a lack of oversight of the quality of the service provision.
• There were no robust risk management procedures in place and a lack of risk assessment and review.

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 a warning notice to be compliant by 7 January 2018. Details are at the end of the report.

Professor Sir Edward Baker

Chief Inspector of Hospitals