Basingstoke Dialysis 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

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has changed to Good.

The service was however in breach of Regulation 12 for safe management and storage of medicines, control of substances hazardous to health and safe storage of patient records at the service.

We have not awarded this service a score for Safe.

Find out about when we will not publish a key question score and what we look at when we assess Safe.

We scored the service as 2. The evidence showed some shortfalls. The service did not always have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The service reported incidents and staff said they understood how to report concerns and described using incident reporting systems. Staff said they felt able to raise concerns and spoke positively about openness within the team. There was no clear evidence of the number of serious incidents over the previous 12 months being used to inform improvement or benchmarking.

Incident records demonstrated examples of acute deterioration and falls, and staff responded appropriately at the point of care.

Staff said they received feedback following incidents and informal discussions took place within the team. An example of multidisciplinary learning to review trends and implement sustained improvements was a quarterly falls meeting held over teams and attended by the service’s manager and falls representative. Minutes from this meeting showed examples of changes, such as the creation and introduction of a new falls risk assessment, to include a front-of-folder falls risk summary, these had not yet been implemented.

These findings demonstrated while staff understood how to report incidents and responded to events, the service did not always demonstrate how learning from safety events was consistently captured, reviewed and embedded into practice. As a result, lessons learnt were not always used to continually identify and embed good practice.

We scored the service as 3. The evidence showed the service generally worked well with people and healthcare partners to establish and maintain safe systems of care. Referral and admission processes ensured essential clinical information was received and reviewed before treatment to confirm patients' needs could be safely met. Staff worked with relevant healthcare professionals to support continuity of care within the service and following treatment. Staff monitored people throughout treatment, recognised deterioration and escalated concerns appropriately. While we identified some areas for improvement in the consistency of environmental monitoring processes, these did not significantly impact the overall effectiveness of systems to keep people safe.

There were systems and process to support safe admission and discharge which enabled staff to assess people prior to treatment. Staff described processes for receiving clinical information to ensure people were suitable for dialysis prior to treatment. Staff completed pre-treatment observations and monitored people throughout treatment using dialysis machines programmed to record observations every 20 minutes and alert staff to abnormalities.

We scored the service as 2. The evidence showed some shortfalls. The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve. They did not always protect people from abuse or ensure concerns were shared appropriately.

Leaders could not be assured people were fully protected from harm because safeguarding training was not consistently completed across the workforce and records did not demonstrate safeguarding was embedded in practice.

The service had a safeguarding policy which clearly outlined responsibilities, reporting processes and escalation pathways. Staff described how they would identify and report safeguarding concerns and told us they felt confident raising concerns. Safeguarding leads had been identified and staff understood escalation arrangements.

However, training records showed significant variation in safeguarding compliance. Safeguarding Adults training compliance ranged from 12.5% at Levels 2 and 3 to 87.5% at Level 1. Safeguarding Children training compliance ranged from 0% at Level 2 and 12.5% at Level 1 to 81.25% at Level 3. Safeguarding workshop compliance was 68.75%. These records did not provide assurance all staff had completed safeguarding training appropriate to their role.

Leaders recognised these gaps and provided evidence of an action plan to address them. The provider had experienced technical issues during the transfer of safeguarding training onto its HR-SF learning platform, which affected staff access to training. Managers and senior nurses had completed additional Level 3 safeguarding workshops and safeguarding remained a standing agenda item within governance meetings. However, despite these mitigating actions, required training had not been completed consistently across the workforce at the time of inspection.

Records also did not demonstrate how safeguarding was routinely discussed with people receiving care, how people were supported to understand and manage risks to their safety, or how safeguarding learning and outcomes were used to improve practice.

These findings meant leaders could not be assured safeguarding systems were consistently implemented or that all staff had the knowledge and competencies required to recognise, respond to and prevent potential harm.

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 was safe, supportive and enabled people to do the things mattered to them.

Staff communicated effectively with people during treatment, and observation showed staff explained care and monitored people.. Records included information about communication needs and consent. Policies required the use of interpretation services where needed.

Staff responded to individual risks such as falls and updated care following incidents. Observation showed use of safety prompts and availability of mobility aids. However, falls had increased from 15 to 17 incidents, and repeated contributory factors indicated risk management strategies were not consistently effective.

Clinical policies supported the management of deterioration, including sepsis pathways and escalation processes using structured tools. Staff demonstrated appropriate recognition and response to deterioration, including emergency escalation and resuscitation where required. Resuscitation equipment was available and records showed daily checks were completed, with required equipment and medicines present in line with national guidance.

We scored the service as 2. The evidence showed some shortfalls.

The service did not always detect and control potential risks in the care environment. They did not always ensure facilities and environmental systems supported the delivery of safe care.

Inspection findings identified environmental and governance risks that had not been effectively recognised, assessed, or mitigated. Dialysis fluids were stored in unsecured and patient-accessible areas, including corridors and clinical areas. More than 30 bottles were observed in a hallway, and additional stock was stored on a trolley within a patient treatment area. While dialysis fluids are not legally classified as medicines, they would ordinarily be expected to be stored securely and managed in a way that minimised the risk of inappropriate access or use. We did not see evidence that storage arrangements had been subject to a risk assessment where space constraints affected storage practices.

The management of hazardous substances did not consistently follow national guidance or the provider's policy. Citric acid was observed within a storeroom and isolation room. While these locations may be appropriate where access is restricted, inspection findings did not provide assurance that suitable storage controls were consistently in place. The provider's policy identified citric acid as meeting the criteria for management under the Control of Substances Hazardous to Health (COSHH) Regulations.

Environmental safety systems were not applied consistently across the service. Inspection identified variation in how products and substances were stored and managed across clinical areas, demonstrating that risk management processes were not consistently implemented.

Patient records were not consistently stored securely. Records were observed in unlocked cabinets and left unattended at nurse stations, increasing the risk of unauthorised access to confidential information and breaches of patient confidentiality.

There were examples of effective oversight within specific systems. Water safety arrangements were well managed, with records demonstrating regular monthly sampling and daily testing of dialysis water. Bacterial counts between 1 and 2 CFU/ml and endotoxin levels of approximately 0.01 remained within acceptable parameters, demonstrating effective management of this critical safety system.

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.

Staff were experienced, qualified and competent to meet the needs of the patient group. Staff completed structured induction, including competency-based training and supervised practice before working independently. Staff said they felt confident in delivering dialysis care, and inspectors observed staff following recognised clinical procedures safely.

Managers provided systems for induction, supervision and appraisal. All staff had received an annual appraisal, and staff described regular check-ins throughout the year to review performance, reflect on practice and identify development needs. Staff also said they attended regular team meetings, which supported communication, shared learning and discussion of care delivery.

Managers identified learning needs and supported staff development. Staff described access to mandatory training, competency assessments and clinical updates. MDT discussions and KPI reviews demonstrated staff responded to identified clinical risks through education and changes to care delivery.

Workforce data showed a turnover rate of 17% and sickness absence over a 12-month period, indicating some workforce movement. Staff said there were enough staff to meet people’s needs. Observation supported this, with a nurse-to-person ratio of one to four, and staff were able to respond promptly to people throughout treatment.

Managers described systems for determining staffing levels and adjusting these based on case mix. Staff said additional staff, including bank staff, were used where needed. Staff also described structured induction processes, including competency-based training, supernumerary periods of up to five months, and sign-off by experienced staff, which supported development of new staff.

However, training data showed variation in mandatory training compliance. Infection prevention and control training ranged from 0% to 87.5%, safeguarding from 12.5% to 87.5%, fire safety from 0% to 93.75%, and broader healthcare compliance from 0% to 81.25%. Some records showed missing or incomplete data entries which was attributable to new starters and system issues with training recording. Staff said they received training, including basic life support and ongoing clinical updates, and felt supported in their roles.

We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff followed infection prevention practices during care delivery. We saw staff following hand hygiene protocols, they used personal protective equipment appropriately and cleaned dialysis machines and equipment between patients. The clinical environment appeared clean and organised, and cleaning records demonstrated routine cleaning tasks were completed.

Waste management processes supported infection prevention. Policy required the segregation of clinical and non-clinical waste at the point of care, use of colour-coded and labelled bins, and the use of personal protective equipment when handling waste. These arrangements supported safe handling and disposal of waste materials.

Water quality monitoring systems were well established. Records showed regular microbiological and endotoxin testing of dialysis water systems, with results consistently within expected parameters. Bacterial counts were typically between 1 and 2 colony forming units per millilitre and endotoxin levels remained around 0.01. This demonstrated effective control of infection risks associated with dialysis treatment.

We scored the service as 2. The evidence showed some shortfalls. The service did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

There was inconsistent safe storage of medicines and treatment-related products. Some medicines and treatment-related products stored in areas where access was not consistently restricted. This included intravenous fluids and dialysis-related products stored within clinical areas and other locations accessible to people using the service and visitors. While the provider advised that some intravenous fluids were intentionally placed for emergency access and had undertaken a risk assessment, storage arrangements for medicines and treatment-related products were not consistently supported by secure access controls.

In addition, whilst temperature monitoring was in place for some medicines storage areas and records generally evidenced regular checks, this was not applied consistently to all treatment-related products. For example, dialysis fluids requiring appropriate storage conditions were stored in locations where routine temperature monitoring was not undertaken. Therefore, the provider could not demonstrate that all medicines and treatment-related products were stored in line with their storage requirements, increasing the risk of deterioration, unauthorised access, misuse or error.

Despite these concerns, staff demonstrated some good practice in medicines management. Emergency medicines, including adrenaline and intravenous fluids, were available within the resuscitation trolley alongside the equipment required for administration. Emergency medicines and equipment were subject to regular checking, and prescribing processes supported timely access to treatment required during dialysis.

The inconsistency in storage, temperature monitoring, and access controls indicated that systems intended to support the safe management of medicines were not consistently implemented in practice.

There was limited evidence of how people were involved in decisions about their medicines or treatment beyond routine clinical processes. Records did not consistently demonstrate discussion of medicines preferences, treatment options, or changes to treatment plans with people receiving care.