Gloucester Royal Hospital Renal Units

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 service was previously inspected and rated under a previous provider but has not yet been rated under the new provider.

At this inspection we rated Effective as Good.

We looked for evidence people and communities had the best possible outcomes with their needs assessed. The service worked well across teams and services to support people. There was input from the local trust and there was dietetic support for the people who used service. The service monitored people’s care and treatment to continuously improve it.

Blood results and other key performance indicators were regularly monitored and discussed to optimise patient outcomes. This showed patients were receiving effective treatment. Consent was actively sought and checked on an annual basis.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service discussed people’s health, care, wellbeing and communication needs with them which meant care and treatment was effective. Patients, we spoke to felt included in their own care.

People said staff were kind and compassionate and felt staff understood their individual needs. The service had up-to-date care plans for people and staff were aware of individual care needs.

We observed staff communicating with patients in a way they could understand. Communication needs were documented in patient care records and translation services (both online and in person) were accessible though the host trust.

The process for allocating patients to a particular unit involved consultant prescriptions, risk assessments, and initial suitability checks. If a patient was found unsuitable after arrival, the units worked together to reallocate them, prioritising patient safety and minimising disruption. Additionally, patients may be relocated to a more appropriate setting not only after arrival but at any time as their clinical condition circumstances may change.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to people.

Staff gave people clear information about the care and treatment needed to support both their physical and mental health. Specialist support from dietitians was available for all patients as per national guidance. Dietitians from the referring trust attended the service to see patients, assess dietary needs and provide advice and guidance on renal diets. Patients said they could get the advice they needed. Dietitians also attended multi-disciplinary team (MDT) reviews with the dialysis nurses and consultants.

Registered managers reviewed key performance indicators (KPIs) monthly and analysed trends in hospital admissions, shortened dialysis sessions, and transport issues. On Severn, data suggested flow during dialysis could be improved, so actions taken included increasing needle sizes and pump speeds to improve Individual Patient Performance Scores (IPPS) and patient outcomes.

Patients said they could mostly get the treatment slots they requested. The units were able to flex appointments to work with patients to help support them to attend the required number of dialysis sessions. Where a patient did not attend, the units were able to work together to offer an additional session at a time to suit the patient.

People who used services had access to food and drinks whilst undergoing their treatment. The nurses provided patients with tea, sandwiches and fruit. Some people choose to bring their own food into the unit to eat during the session. Patients told us the sandwiches were a nice touch and there was a selection of fillings plus sandwiches to meet special dietary requirements such as gluten free.

The service employed practice development nurses who supported all three units. They produced bitesize training sessions in response to changes in best practice guidance or safety alerts. They also oversaw and updated policies when new or improved guidance was published.

The service worked well across teams and services to support people. The service coordinated with the local trust to ensure patients were reviewed in a timely manner. The service held regular multidisciplinary meetings and had regular governance meetings with the local trust.

Patients saw their consultant at the renal units, but staff explained it was difficult to record which consultants saw which patient when as the visits were sporadic and a nurse could not always shadow the doctor on their rounds. On Cotswold unit, the registered manager had begun work on a spreadsheet to support nurses to document when face to face consultant reviews had taken place. There were written and electronic records showing regular quality assurance meetings were taking place and staff felt the face-to-face review documentation was the missing piece of assurance.

Arrangements for link nurses to support patients with other conditions such as diabetes were supported by the local trust. Staff could also link to dedicated dementia and learning disabilities nurses and gave an example of an autistic patient who was supported by dedicated staff from the trust to successfully undergo their treatment.

The service supported people to manage their health and wellbeing, and to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Patients had access to a dietitian. Patients we spoke with said they had been able to access this service. We saw posters on the wall giving information to patients on fluid management and food labels to help them choose the right foods for their condition. Staff involved relatives to help patient manage fluids if they could not do so on their own.

We saw discussions at multidisciplinary meetings included patients whose health and wellbeing was deteriorating and observed conversations about whether they should be moved to being treated on the inpatient unit on ward 7b. The service did not routinely dialyse out-patients on ward 7b, however, if a patient was deteriorating or required additional support an admission could be considered or best interest meeting to ensure the patients' needs were being met.

The website provided a range of useful information for patients receiving dialysis which included advice on staying healthy, avoiding infections and recipes and nutrition.

External organisations also attended the units regularly to give practical advice as well as lifestyle. For example, support with grants and benefits.

The service monitored people’s care and treatment to continuously improve it.

The service uploaded patient information to a data base, which allowed the service to benchmark patients’ clinical outcomes against other Diaverum locations.

Patients were monitored in accordance with best practice guidelines. The unit monitored patient outcomes monthly, through the multidisciplinary quality meeting. These outcomes consisted of blood results, vital signs, target weights and nutritional status, as per a pre-defined schedule by the lead consultant. These were used to optimise individual patient treatments.

The service also monitored shortened dialysis times and did not attend rates to ensure there were no barriers preventing patients from accessing services.

The service reported monthly to the local trust on a number of key performance indicator metrics.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment. We reviewed patient records and saw all patients had consented to receive dialysis.

The service had policies detailing the consent process. Consent was reviewed annually for all patients.

Consent was obtained on entry and annually but may be revisited if a patient became non-concordant or experienced cognitive decline. If a patient withdrew consent, consultants were immediately involved so discussion around next steps, including respect forms (do not attempt resuscitation) could begin.