Bath Kidney Care Centre

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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 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.

At our last assessment we rated this key question good. At this assessment the rating has remained good. 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.

The service had clear criteria, in collaboration with the local NHS renal service, to determine which patients were suitable to receive dialysis at the centre.

Staff completed individualised care plans for all patients. These included dialysis specific care and other care needs such as mobility, communication, skin integrity and family/work/social needs. Care plan documents showed the plans were developed in collaboration with the patient and our conversations with patients confirmed this.

The service carried out monthly audits on the completeness of patient records, including care plans. Information provided by the service showed that the most recent audits demonstrated all patient records were completed accurately and amended as required. Our review of care plans and the patient records audits demonstrated staff carried out monthly reviews of patient care plans.

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.

Patients received care, treatment and support that was evidence-based and in line with good practice standards. The service used policies and procedures developed by their provider Fresenius Medical Care. Most of these reflected current national guidance and recommendations. The exceptions to this were the incident policy which did not reflect the national patient safety incident response framework and the safeguarding policy which did not reflect the national recommendation that all registered healthcare staff should complete level 3 adult safeguarding training.

Staff also followed policies and procedures for some clinical tasks set by the NHS trust who had overall responsibility of the clinical management of the patients. The service followed national guidance about shared care. This is where dialysis service support patients to learn and develop the skills and competencies to be able to transfer to home dialysis. This process was coordinated by the NHS trust, and the centre supported the process of supporting patients and their family members in developing the competencies to transfer to home dialysis.

Review of patient records showed staff used nationally recognised tools to assess and monitor patient risks.

Audits completed by the service monitored staff compliance with polices such as medicine management and infection prevention and control. This ensured staff were following evidence based national guidance as detailed in the provider’s policies and procedures.

However, the service did not meet the national recommendations that 80% of patients receiving dialysis should receive it through an arteriovenous fistula/graft rather than through a line. Approximately half of the patients receiving dialysis at the centre had dialysis through arteriovenous fistulas or grafts. National kidney guidelines emphasise promoting fistula/graft access where clinically appropriate. Vascular access rates were influenced by factors such as local patient case mix, comorbidities, and the availability and capacity of surgical vascular access services within the local NHS Trust. These external factors significantly affect the timelines of access creation and were outside the direct control of Bath Kidney Care Centre. The service continued to encourage arteriovenous access and worked closely with the local NHS surgical team to support referrals, pre operative assessment, and follow up.

The service worked well across teams and services to support people.

Staff worked collaboratively with the local NHS trust. The service was commissioned to provide renal dialysis to NHS patients. All patients who received dialysis were under the care of a named renal consultant at the local NHS trust. Staff described good working relationships with the NHS trust, which included the dietetic service and use of trust policies and protocols. The service had worked with the trust to trail dialysis protocols which were now being implemented across several services.

Multidisciplinary meetings including the centre staff and the NHS consultant were held monthly to discuss and plan patients’ dialysis treatment. The manager spoke about how the service worked effectively with the NHS trust’s renal coordinator to accommodate new patients.

The service had effective working relationships with a national dialysis support group. Representatives from the dialysis support group described how welcoming the service was to them and how they appreciated their input and feedback.

The service worked collaboratively with the wider Fresenius Medical Care service. This included sourcing other dialysis units for patients to attend while on holiday and accommodating dialysis for patients on holiday in the Bath Kidney Care Centre.

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 supported people to live healthier lives. The service had relevant information promoting healthy lifestyles and support in patient areas. Posters were displayed in patient waiting areas giving advice about how to access information about healthier lifestyles.

Staff provided education and guidance to patients about their renal conditions and how to optimise their health. Discussion with patients confirmed staff spoke with them about how to best look after their renal health.

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.

The service participated in national audits. Patient dialysis outcomes were reported to the national renal registry in line with national standards. However the data was included with other data for the NHS trust, so it was not possible to review the outcome data for patients receiving dialysis at Bath Kidney Care Centre.

All patients were reviewed at least every month by the consultant from the NHS trust. The monthly review included review of vascular access, infections, medicines and anaemia (low red blood cell count) management. The electronic patient record system provided easy oversight for clinicians about the effectiveness of patient dialysis. The system was a ‘live system.’ This meant up-to-date and current information was uploaded and where patient data was outside of accepted parameters, this was highlighted and could be escalated for review by the clinician.

Dialysis prescriptions were reviewed in accordance with monthly blood test results and in conversation with patients and staff. There were processes to ensure electronic patient records and patients were updated. If staff had concerns about patients, they could contact the renal consultant or on call renal registrar by phone or email. Staff told us this worked well, and they felt supported by medical staff working for the NHS trust.

All patients were discussed in regular meetings in the NHS trust to ensure optimal treatment for patients was monitored and maintained. If there were any concerns raised from these meetings, this was shared with the staff at Bath Kidney Care Centre.

The service had agreed set key performance indicators to review the effectiveness of dialysis treatment provided at the service. This data was shared with the NHS trust and reviewed at regular intervals to monitor the effectiveness of treatment and identify any areas for improvement.

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

Staff took all practical steps to enable patients to make their own decisions. Staff demonstrated in conversation a good understanding about the need for consent from patients and their roles and responsibilities under the mental capacity act.

Records showed that patients gave their consent for dialysis treatment. This was confirmed in conversations with patients. At the time of the inspection there were no patients who had impaired capacity to make informed decisions. However, staff knew the steps they needed to take to assess patient capacity and to ensure treatment decisions were made in the best interest of the individual patient.