Archived: Poole Dialysis Unit

Fresenius Medical Care UK (FMC), an independent healthcare provider, operates Poole dialysis unit. Dorset County Hospital NHS Trust contracts the unit to provide renal dialysis to NHS patients. There are 22 stations (comprised of 12 stations in the general area; two 4-station bays with glass partitions which can be used for cohorting purposes; and two side rooms which can be used for isolation purposes), for providing haemodialysis for stable patients with end stage renal disease/failure.We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 4 May 2017, along with an unannounced visit to the hospital on 15 May 2017.To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led? Where we have a legal duty to do so we rate services’ performance against each key question as outstanding, good, requires improvement or inadequate.Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we do not rate

We regulate dialysis services but we do not currently have a legal duty to rate them. We highlight good practice and issues that service providers need to improve and take regulatory action as necessary.

We found the following areas of good practice:

• There were processes in place to control and prevent the risk of infection. All areas of the unit appeared clean, tidy and well maintained; they were free from clutter and provided a safe environment for patients, visitors and staff to move around freely.
• We saw evidence that staff monitored water quality for bacteria monthly
• We saw there were appropriate processes in place to support those patients with blood borne viruses (BBV). Staff received a comprehensive induction and had good access to corporate training courses. Nurses were supported to complete external renal nurse training.
• Staff completed a detailed competency assessment when they started work at the unit and were reassessed annually.
• Staff participated in annual appraisals and all staff reported in the last staff survey that they understood their roles and responsibilities.
• Staff were well supported by the clinic manager.
• The Fresenius service had developed a Nephrocare standard for good dialysis care based upon standards of best practice.
• All patients we asked reported the staff were caring and respectful.
• Staff coordinated care safely and effectively with the NHS trust consultants and dietitian.
• The service performed regular staff and patient surveys and responded to feedback.

However, we also found the following issues that the service provider needs to improve:

• We did not see consistency of practice for positive identification of the patients attending for their dialysis.
• There were a number of reported patient falls but we did not see dedicated falls risk assessments completed and reviewed for all patients.
• Staff did not always follow the Fresenius corporate policy for infection prevention and control to ensure the clean field was maintained.
• There was no policy in place for staff to follow when a patient shows symptoms of sepsis.
• The service did not have or maintain a Workforce Race Equality Standard (WRES) action plan or publish data with regards to monitoring staff equality.

Following this inspection, we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve.

Details are at the end of the report.

Professor Edward Baker

Chief Inspector of Hospitals