Nurse Richard – The Wax Wizard

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.
This is the first assessment of this service. This key question has been rated as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

Care and treatment was delivered in line with national guidance and best practice. Staff had the necessary skills, training and experience to provide effective care to patients. Patients and their parents were given information to enable them to give informed consent to their care.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.

Staff completed a comprehensive assessment of each patient in a timely manner. The provider completed an assessment at the beginning of each patient’s visit to the service. This included identifying the presenting complaint; the person’s medical history, potential infections or other risks; and their preferences regarding treatment. The provider explained the treatment process as part of the assessment, and gave the patient information to enable them to give informed consent.

The provider used an online system for booking appointments and recording notes of each procedure. This was completed with the patient throughout the assessment. Following the procedure the provider recorded a summary of the process, the tools used, the outcome, and if there had been any conditions identified that needed further action or follow up. For example, if the patient was advised to visit their GP or if the use of ear sprays was recommended. When necessary, pictures of the inside of the ear were attached to the record.

The care records contained the necessary information, and were easy to navigate. However, the system logged the record against the person who booked the appointment, which may not be the person who received treatment. For example, if a parent booked an appointment for their child – the record would be in the name of the parent, not the child who was the patient. The correct name of the person who was being treated was included in the record. The provider was aware of this anomaly and knew where to find information, and ensured it was recorded correctly. However, this may not always be the case if the provider employed more staff in the future.

We plan and deliver people’s care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

Staff followed up-to-date policies to plan and deliver high quality care according to best practice and national guidance. The provider had detailed policies on the use of microsuction and irrigation. This included the initial assessment of the patient, the procedure for removal of ear wax and objects, and aftercare. The policy was clear regarding what it should be used for and when the procedure should be stopped. The policies followed national and recognised guidance, including from the National Institute of Clinical and Healthcare Excellence (NICE). The provider said that endoscopes were more accurate, as they give a clearer view inside the ear, but acknowledged that there was currently no national standard about the use of endoscopes in treatment.

Staff were experienced, qualified and had the right skills and knowledge to meet the needs of patients. The provider had experience and training in the removal of ear wax through both microsuction and irrigation, and in using an endoscope to assist the process. The provider was part of a national group that was looking at standards for training in this area of audiology. The provider networked with other professionals who worked in this area, including ear, nose and throat (ENT) specialists, and shared information and advice.

We work effectively across teams and services to support people, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

If there were problems that needed immediate or further attention, the provider advised the patient and their parents to attend their GP or occasionally the emergency department. If a patient needed to be seen by an Ear, Nose and Throat (ENT) specialist, they would be referred by their GP. The provider wrote a supporting letter, with information about their findings, photographs if necessary, and advice for further investigation and treatment where appropriate.

The provider had a standard template letter for GP referrals, which ensured they contained key information, and which additional information about the patient’s condition was added.

We support people to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

The production of ear wax is normal and healthy. However, for some people it can build up and cause problems such as hearing loss, or be a sign of other problems such as infection. There may be limited actions a person can take to stop the problematic build-up of ear wax. However, the provider advised patients and their parents about what may help (such as ear sprays and oils), and what may make the problem worse (such as inserting cotton buds into the ear canal, and putting one’s head under water). The provider gave some patients ear sprays, which may help to reduce the build-up of wax, and how frequently they needed to have it removed.

The provider had a website with information about ear wax and treatments, including videos of the process.

The provider was a registered nurse and non-medical prescriber, although they did not prescribe medicines in the service. The provider did not provide treatments other than for ear wax removal. However, if a patient told them about other concerns (for example they were feeling dizzy) the provider may carry out a basic assessment (such as taking their blood pressure) and advise them or their parents to seek medical attention.

The provider told us that the outcome of the treatment was usually immediate and obvious, as the patient could see that the wax or object had been removed from their ears. The provider monitored repeat visits, but these were due to the future build-up of wax, and not related to the quality of the treatment. Patients were asked for verbal feedback at the time of treatment, and to review the service afterwards. Online reviews of the service online were positive.

Managers used information from the audits to improve care and treatment. For example, an adult patient had become unwell during a procedure and then disclosed a medical condition. The provider had added an additional question to their initial assessment of patients to capture this.

The provider monitored the number of referrals they had made when patients had a medical condition that needed further treatment.

We tell people about their rights around consent and respect these when we deliver person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. As part of the assessment process, the provider explained to patients and their parents what the treatment involved, potential risks, and the success of the outcome. The provider clearly recorded consent in patients’ records. The provider had a good understanding of capacity and was clear that patients were only consenting to the decision at hand, which was the removal of ear wax. Children attended appointments with a parent or guardian. The provider ensured that their parents understood what they were consenting to, and worked with the child as much as possible depending on their age and level of understanding.

The provider used an endoscope (tiny camera) that looked inside the ear whilst the wax was removed. This was shown on a monitor in front of the patient, so that they could see what was happening throughout the procedure. This enabled them to see wax or other build up in their ear, and to then see it being removed. They could also see how clear the ear canal was at the end of the procedure. The provider would discuss with the parents whether they wished to have the monitor on or not, if this may be confusing or distressing for the child.

The provider had an online channel where he showed photos and videos of ear wax and other objects being removed. These did not identify individuals and only showed the view inside the ear canal. Patients and their parents were made aware of this and could choose not to consent to this being displayed.