Yeovil Renal Unit

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

Patients received individual assessments, based on the risks to their health and safety from individual co-morbidities, but there were significant shortfalls in documenting the risk to patients with certain co-morbidities within care plans. Therefore, they did not always manage or monitor people’s safety. This was a breach of the regulation: Safe care and treatment of the Health and Social Care Act. However, we were told all co-morbidities were discussed in regular team meetings and renal clinics.

The service had an appropriate number of staff who received the right amount of training and support to undertake their roles. Staff communicated well with patients, so they understood their care and treatment. There were good links between services, and we saw evidence of regular communication with the local NHS trust. When patients were too unwell to continue treatment at the unit, they were transferred to hospital.

Staff understood how to protect people from abuse and managed infection risks well. There was a good incident reporting culture, and learning from incidents was shared.

The environment was clean, tidy and well-maintained, and the equipment was regularly serviced.

This service scored 62 (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 3. The evidence showed a good standard. The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

There was a good safety culture. Staff followed the incident reporting policy to record incidents. We saw that 6 incidents had been recorded in the last 5 months. A review of the 2 most recent incidents showed evidence of investigation by senior staff, as well as actions taken and lessons learned within the team. Staff told us learning from incidents was shared during daily team huddles.

Learning from a recent incident was also shared with patients by means of a patient safety bulletin in the waiting room.

We scored the service as 1. The evidence showed significant shortfalls in documenting the risk to patients with certain co-morbidities. Therefore, the service did not always manage or monitor people’s safety. However, they worked well with healthcare partners to ensure there was continuity of care, including when people moved between services.

Patients were involved in their risk assessments when they started using the service. Individual care plans were created for each patient, but they did not consider some important co-morbidities. We saw care plans that covered risks such as sepsis, diabetes, falls and pressure injuries. However, we found patients who were at risk from heart disease, depression, foot health and smoking for which no care plans were present. We were told of a patient who had suffered a choking incident, where the risk to the patient had been addressed, but nothing had been documented in their care plan so there was a risk not all staff would be aware. The clinic manager explained to us the implementation of care plans was ongoing and acknowledged there was work to do to make them more holistic. Patient co-morbidities were also discussed in team meetings and renal clinics. We were told monitoring cardiovascular health was a key part of the holistic management provided by the patient’s renal consultant and evidenced through multidisciplinary team (MDT) meetings and core medical notes.

We saw evidence of good communication between services. Staff told us they were able to contact the on-call consultant at the local NHS trust for advice if they were concerned about a patient. Electronic recording meant the consultant could immediately access and review patient observations.

A clinical governance meeting was held monthly, with representatives from the dialysis unit and NHS trust, including a dietitian and members of the transplantation team.

Blood samples were taken to the NHS trust monthly. We saw evidence of a patient being transferred back to the trust for dialysis when they became too unwell to continue treatment at the satellite unit.

There was a policy which covered the temporary and permanent admission of patients from the trust and from other units, ensuring all essential information about the patient was received.

We scored the service as 3. The evidence showed a good standard. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Although there were no recent safeguarding referrals to discuss, staff knew how to make a safeguarding referral and who to inform if they had concerns. They had completed level 2 training in safeguarding for adults and children. Senior managers had completed level 3 training. As well as a safeguarding manual, there was a safeguarding contact details poster. This displayed details of the safeguarding lead and deputy, the Freedom to Speak Up guardian and other useful contacts.

We scored the service as 3. The evidence showed a good standard. The service worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Patients were involved in their risk assessments when they started using the service.

Diabetic patients had their blood sugar measured pre and post-dialysis as-per national guidance, and non-diabetic patients also had their blood sugar levels measured if staff thought there was a problem, or if patients told staff they felt unwell.

Patients were informed of their monthly blood test results, and if any changes were needed to their treatment.

Staff enabled patients to provide feedback on the service they received via a patient feedback box and annual patient surveys.

We scored the service as 3. The evidence showed a good standard. The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment was safe, spacious and fit for purpose. The unit housed 12 treatment stations and 1 isolation room on a ground floor unit. Work was underway to expand the unit to the first floor, which would increase the capacity to 24.

The unit was clean and tidy throughout. The toilet door in the treatment area was sticking on the floor, meaning that it was very difficult to close. When we mentioned this to staff, we were told this had already been raised with the Estates department.

All areas were locked for security purposes. The stock room was air conditioned for safe storage of dialysis solutions and saline. The water treatment system was monitored daily. The technician’s room contained 3 spare units, one of which was solely for the purpose of treating patients who potentially had blood-borne viruses. Chemicals that could be hazardous to health were assessed and stored in a locked cupboard, in line with the control of substances hazardous to health (COSHH) guidelines. The temperature of the fridge containing blood samples was checked daily. There was a secure storage room for paper records.

Each treatment bay contained a glucose monitoring kit. However, we noticed that dates had not been written on any of the 4 test pots to indicate when they had been opened. This meant that staff would not know when the test kits would expire. When we mentioned this to staff, the test kits were discarded and replaced.

Emergency resuscitation equipment and medicines were kept securely and log sheets showed these were checked daily. Equipment was safety tested and calibrated. The medicines cupboard and fridge were locked, and the temperature of the fridge checked daily.

The dialysis machines were serviced annually. If a machine broke down, we were told a technician would be available either the same day or the next day. We saw a machine log for reported issues. We saw that monthly first aid stock checks, and monthly equipment checklists were completed.

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service ran 3 dialysis sessions a day, 6 days a week. There was at least 1 member of staff for every 4 patients, with 2 registered nurses on each shift. Nurses were assisted by dialysis assistants and healthcare assistants. Staff we spoke with said they felt this was adequate to keep people safe. The staffing rota indicated the service was consistently well staffed.

Staff recruitment files were checked and found to contain proof of identification, Disclosure and Barring Service (DBS) checks, references and employment history.

People told us they felt staff were friendly, helpful and approachable.

We saw an example of the clinical skills assessment record covering the training requirements in the first year of the nursing role. This brought together theoretical and practical elements of the role, and opportunities for learning and reflection between the staff member and the preceptor.

There was a qualification matrix which laid out the mandatory training modules necessary for each staff group. Data we reviewed showed compliance with mandatory training was 96% against the service target of 90%.

Staff received annual appraisals. This provided staff the opportunity to discuss individual goals and targets with the clinic manager, and to determine what support was needed in the coming year.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection, and controlled the risk of it spreading.

The waiting room, toilets and treatment area were all visibly clean. All equipment we checked had clean indicator stickers, and the chairs in the waiting room had wipe-down covers.

Each treatment bay contained a sharps bin, handwashing sink, wall-mounted soap dispenser, hand gel, clinical and non-clinical waste bins. Patients told us that the unit was clean and tidy. We saw evidence of monthly cleaning audits.

The dialysis machines and beds were cleaned between patients.

We saw posters in the waiting room detailing the infection prevention and control risk assessment for the renovation work, which identified risks and how these risks were mitigated.

Staff were bare below the elbow, and we witnessed good hand hygiene practices as well as the use of personal protective equipment. Hand hygiene audits were undertaken monthly, and any issues with non-compliance were raised in staff safety meetings.

Staff told us they received sepsis training. Patients were not routinely screened for sepsis, but staff were able to recognise sepsis symptoms and escalate through the unit’s sepsis risk assessment pathway.

The unit had an isolation policy, which covered assessment, roles and responsibilities, and nursing arrangements.

We scored the service as 3. The evidence showed a good standard. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff followed good practice in medicines management. Medicines stored in cupboards and fridges were locked. Patient notes contained details of current medications, as well as blood and swab results. Staff told us these were discussed with the renal consultant at monthly multidisciplinary team (MDT) meetings. Any changes to medicines were relayed to the patient and the notes updated accordingly.

The diabetes management policy contained clear instructions for the immediate treatment of hypoglycaemia, which is when the blood sugar (glucose) level drops too low. This can be serious if left untreated. In severe cases, the policy involved calling for an ambulance and administering intravenous dextrose (a simple sugar that is identical to glucose). Although national guidance states that intramuscular glucagon (a hormone that helps regulate blood sugar levels) should also be available in case intravenous access is not possible, the Fresenius Country Medical Director UK Ireland explained this guidance had been purposefully adapted to better reflect the circumstances of the outpatient setting.