Stockton Dialysis Clinic

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

Effective – 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 rated assessment for this service. This key question has been rated Good:

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We assessed 6 quality statements for this key question.

We found that patients’ needs were assessed, and their care, support and treatment reflected these needs. Leaders within the organisation, both locally and nationally, instilled a culture of improvement, which was evidenced through a comprehensive audit programme. Patients were encouraged to be actively involved in their own treatment through a shared care programme, and patients told us that they felt well supported.

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

We observed staff asking patients about allergies when administering drugs. We looked at ten sets of patient records, and saw all patient assessments had been completed fully, including good risk assessments, good consent processes and personalised care plans.

We saw evidence of referral pathways if people needed psychological support, and clear processes for assessing mental capacity and making ‘best interests’ decisions if required.

The service used the Individual Patient Performance Scores to monitor treatment efficacy.

The provider 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 were appropriately experienced and qualified and had the right skills and knowledge to meet the needs of the people who used their service. An extensive list of staff training was provided, which covered both mandatory training subjects and a range of clinical competencies to ensure that staff were appropriately skilled. We observed treatment being delivered safely and according to guidelines.

We reviewed 27 policies and saw that they had been kept up to date to reflect current best practice and national guidance.

The service engaged in shared care, encouraging patients to be as involved with their own treatment as they were able and wanted to be, which was in line with NICE Guidelines.

Definitive access rates were relatively low, with approximately 50% of patients having a fistula, which is the preferred access method according to the UK Kidney Association. The service told us that this was due to a waiting list for surgical assessment at the local Trust.

The provider 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.

Senior staff told us that they have good communication links with their NHS partners. NHS consultants and dieticians attended the clinic on a weekly basis. The clinic manager attended monthly multi-disciplinary team meetings with NHS consultants and dieticians where routine patient care was discussed. Notes from these meetings were then shared with staff at the clinic.

Where patient care needed to be escalated, there were clear processes in place. The on-call medic at the local trust could be contacted if a patient became unwell. If the situation was more urgent, we saw clear transfer out protocols using 999 services, and the patient’s admission was followed up, and the consultant informed.

All patients had a named nurse, who was responsible for that patient’s care. The named nurse reviewed monthly blood test results so was familiar with the patient’s condition and progress. Named nurses were allocated five patients to look after. Staff viewed electronic records at each attendance, so patients weren’t repeatedly asked for the same information.

Staff were regularly offered in-house training to ensure clinical skills were maintained and communication links were in place.

We saw human resources colleagues worked effectively with clinical colleagues to ensure staff were offered flexible or adapted working where applicable. Staff hours were also monitored closely to ensure staff received time back when they needed it and were not working excessive hours.

Staff told us that colleagues from the local ambulance service regularly called into the clinic to maintain links and to check the service was operating well for the clinic.

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

All patients were offered the opportunity to participate in shared care with the support of clinic staff. During our visit we observed elements of shared care, where patients were supported to be actively involved in managing their own care, for example weighing themselves, taking their own temperature and recording results. We saw documentary evidence that some patients who wished to, were supported with more advanced elements of shared care, such as priming their dialysis machine.

There were poster displays in the clinic reminding patients of the importance of infection prevention and control practices and reminding them to wash their hands and keep the dialysis access points clean.

Patients had access to dieticians if required.

The provider 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.

Patients had blood tests monthly, which were reviewed by the named nurse and discussed at the monthly multi-disciplinary meeting. The Individual Patient Performance Score data was also used to monitor outcomes.

We were told that every vascular site infection was reported and investigated as a patient safety event. We saw examples of investigation reports along with action plans and lessons learned.

Regular internal audits were conducted, which included, but were not limited to:

• Audit of Dialysis Records
• Audit of prescription delivery
• Audit of machine / Equipment logs
• Infection Control Audit
• Hand Hygiene Audit
• Vascular Access Audit

We saw three audits of prescription delivery, which all demonstrated 100% compliance. We also saw four hand hygiene audits, three of which demonstrated 100% compliance, with documented actions taken to address areas of non-compliance in the fourth.

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

The clinic had an informed consent policy in place, which outlined the process for ensuring that patients were fully informed about the risks and benefits of treatment, and that consent was appropriately documented. We reviewed ten sets of clinical records whilst on-site and observed good consent documentation.

There was a process in place for patients who lacked the mental capacity to make decisions for themselves, and this was clearly documented. We saw evidence of an appropriate mental capacity assessment in one of the clinical records we checked whilst on site.