Marches Ambulance Service

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• 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 is the first assessment for this newly registered service. service. This key question has been rated good.

We looked for evidence that people and communities had the best possible outcomes because their needs were assessed. We checked that people’s care, support and treatment reflected these needs and any protected equality characteristics, ensuring people were at the centre of their care. We also looked for evidence that leaders instilled a culture of improvement, where understanding current outcomes and exploring best practice was part of their everyday work. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

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 made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

We looked at 4 patient records; all included a comprehensive and timely health assessment of the patient. This included a record of their observations in addition to social information such as their address, contact number and next of kin. Care records detailed treatment provided. All patient records were reviewed by the event team manager and the doctor to ensure effective treatment was provided.

The patients record reviews also included a review by the medicines[SH1] [AH2] management team to check appropriateness of medicines management.

In addition to direct clinical supervision, the ambulance service had clear clinical guidance available through the electronic record system. The medical director could also access the patients records remotely to provide advice when needed.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff worked to national guidance and evidence-based practice which included both National Institute of Clinical Excellence (NICE) and Joint Royal Colleges Ambulance Liaison Committee (JRCALC) to deliver care and treatment. Staff had access to up-to-date policies and procedures for both children and adults which met patient’s needs. Leaders monitored staff performance to ensure they were working in line with evidence-based practice.

Systems and processes supported evidence-based care and practice in line with national standards. Managers audited staff compliance against evidence-based practice to identify if patients received required care and treatment or if any staff learning or development was required.

The event team included and had access to a paramedic and a doctor to meet the needs of patients who may require a medical review, treatment and if transfer to hospital was appropriate

Training for staff included the Mental Capacity Act 2005. This was to ensure staff were aware additional support and measures must be organised to meet patients’ rights and ensure reasonable adjustments were made.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff worked well across multidisciplinary teams to support patients. Records showed staff communicated effectively both with other staff, staff in other services the patient and those close to them.

Patients’ records reviewed showed ambulance crews had contacted the hospitals accident and emergency department to make them aware they were on route and included information about the patient. Ambulance crews also completed a written record for the hospital accident and emergency department staff. We saw patient Information was shared appropriately between teams and services to ensure continuity of care.

The event team manager reviewed patient records to ensure information was checked and shared in line with evidence-based practice.

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

Staff encouraged and supported patients to make healthier choices to promote their health and wellbeing. We saw how staff had signposted patients to drug and alcohol services or to their GP. Health promotion materials were also available. with contact details for helplines and organisations to support ongoing health promotion.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

There was a clear approach to monitoring, auditing and benchmarking the quality of the service and the outcomes for people receiving care and treatment. Patients’ care and treatment were routinely monitored to ensure patients received safe and effective care and when identified improvements made.

Staff used recognised tools to monitor patients, for example the National Early Warning score (which identifies patient deterioration) and conscious level This assisted in helping staff assess when timely escalation to hospital was required and was a key element of patient safety and improving patient outcomes.

The service monitored its performance. The service reviewed: time at scene, treatment time, time to transport, the number of patients seen and discharged whilst at the event, patients who declined transfer to hospital, patients transported from events, level of need when transferred to hospital staff and checks on medicines to ensure no medication errors. Information was shared within clinical governance meetings.

Outcomes were positive, consistent, and meet clinical expectations. Managers completed audits to monitor and improve upon outcomes.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

There were systems and processes in place to ensure staff understood relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005 and the Children’s Acts 1989 and 2004 and other relevant national standards and guidance.

Staff recorded when they had asked patients for their consent for treatment. If they did not have capacity to consent staff recorded this and appropriate actions were undertaken. When people lacked mental capacity staff ensured that best interest decisions were made in accordance with legislation and guidance recognising the importance of the person’s wishes, feelings, culture and history. Event team managers reviewed all patient records to check care and treatment, and consent was recorded.

The service had highly experienced staff who promoted practice that avoided the need for restraint. Managers confirmed if restraint was necessary, it would only be used in a safe, proportionate and monitored way.