North Devon Satellite Dialysis Unit

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

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.

At our last assessment this key question was not inspected. At this assessment we rated this key question as good.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. Peoples needs were assessed however care plans were not always holistic and did not include patient comorbidities.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls.The service did not always make sure people’s care and treatment were effective. Care plan templates did not support staff to identify all patient risks. The service was aware of this issue and were taking steps to ensure patients had holistic care plans.

Patients who used services said staff were, “brilliant and nothing is too much trouble for them”. If they had any issues they were happy to talk to the staff members to address these.

We observed staff communicating with people in a person centred approach.

Staff completed risk assessment upon admission and there was a policy to follow that included screening requirements, medicines, healthcare requirements and resuscitation status.

Patient’s care was discussed at the regular multidisciplinary meeting which included input from the local NHS consultant, dietician and the unit staff.

We scored the service as 3. The evidence showed a good standard.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 had access to Fresenius policies which included information about best practice guidance and standards.

Staff gave people clear information about their 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. One patient said they were provided with a card with the dietitians contact details and were told to get in touch with them if and when required.

We scored the service as 3. The evidence showed a good standard.The service worked well across teams and services to support people. The service coordinated with the local NHS Trust to ensure patients were reviewed in a timely manner. The service held regular multidisciplinary team meetings and had regular governance meetings with the local Trust

Staff shared information about patients at effective handover meetings within the team. There was a daily safety huddle for staff to share this information.

The teams had effective working relationships with each other and other specialist teams. One staff member told us, “It’s a really good team where we help each other”.

Consultants saw patients at the unit as well as at the local NHS Trust.

We scored the service as 3. The evidence showed a good standard.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, reduce their future needs for care and support.

Patients had access to a dietitian. Patients said they had been able to access this service. We saw posters on the wall giving information to patients on support services such as mental health support and kidney care UK as well as patient support groups and information on diet for renal patients. Patients had access to an exercise bike tailored for dialysis patients should they choose to exercise whilst they were on dialysis.

Patients whose health and wellbeing was deteriorating were discussed at the multidisciplinary meeting and conversations were documented about whether they should be moved to being treated at the local NHS trust.

We saw the unit discussed shared care, which enable patients to participate in some or all of their care. 3 patients wanted to commence home dialysis and the unit was supporting them in this decision.

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

We scored the service as 3. The evidence showed a good standard. 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 Fresenisus locations.

Patients were monitored in accordance with best practice guidelines. The unit monitored patient outcomes on a monthly basis via 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.

Staff reported monthly to the local NHS Trust on a number of performance indicator metrics for the unit.

We scored the service as 3. The evidence showed a good standard.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 that all patients had consented to receive dialysis.

Patients had choice over the amount of time they received dialysis. Patients’ time on the dialysis machines was prescribed by the local NHS consultant. Patients who wished to end dialysis time early, had the risks explained to them and staff completed an early termination form. Having less dialysis time than prescribed for a patient could be dangerous which is why the unit followed procedures to document this activity, if it was what a patient with capacity wished.