Archived: Aldeburgh Renal Unit

BBraun Avitum UK Limited provides the services at Aldeburgh renal unit. Services at the unit are commissioned by Ipswich Hospital NHS trust. Aldeburgh renal unit is one room within Aldeburgh Community Hospital. BBraun Avitum Uk LTD operate the unit as a satellite service of Ipswich Hospital NHS Trust renal unit (referred to as the hub).

Facilities at Aldeburgh renal unit include five renal dialysis stations and a water treatment room. The service provides ten haemodialysis (dialysis) sessions per day to adults aged 18 years and over Monday to Saturday, 60 sessions per week in total.

We inspected this service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 25 April 2017 along with an unannounced visit to the hospital on 5 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:

• The service held an up to date policy for the reporting of adverse patient occurrence (APO) and incidents and nursing staff were able to describe what type of incident they would report and there was evidence of investigation and learning from incidents.

• There were robust procedures around infection prevention and control of blood borne viruses, management of medicines and for patient medical records.

• Nurse staffing was better than Renal Workforce guidelines 2002, nursing staff identified and responded appropriately to risks to people who used the service and knew their responsibilities around safeguarding vulnerable adults.

• Nursing staff used policies and procedures developed from professional guidance. Dietary support and advice was available to patients from a dietitian who visited the unit weekly. Nursing staff were 100% compliant with mandatory training and the unit had an adverse incident plan and staff had practiced resuscitation and fire evacuation scenarios.

• The provider had procedures in place to enable nursing staff to support patients living with dementia or learning disability when they attended for dialysis and nursing staff provided care in line with the 6Cs of nursing - care, compassion, competence, communication, courage and commitment.

• Nursing staff were trained link nurses for anticoagulant therapy and anaemia for example. Link nurses have undertaken additional training in specialist areas to enable them to provide expert up to date knowledge to patients and colleagues.

• All the patients we spoke with during our inspection gave consistently positive feedback about nursing staff behaviour and the dialysis service and said they felt involved in decisions around their care.

• There was a strong leadership team in place at the unit and nursing staff felt management staff were visible and supportive. There were robust processes for communicating between management and nursing staff.

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

• Space between the dialysis chairs was not in line with health building note (HBN) 07-01 – satellite dialysis unit guidance. This meant patients did not have the recommended space to ensure patient privacy or allow easy access for resuscitation equipment.

• Nursing staff knew about the duty of candour regulation but were unable to describe what type of patient incident would lead to it being applied.

• The provider did not have a sepsis policy or a documented procedure for the escalation of deteriorating patients and staff had not received sepsis training.

• There was no process in place for checking patient identification before administering medications or starting dialysis. Nursing staff did this informally by greeting patients by name

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. We also issued the provider with one requirement notice that affected dialysis. Details are at the end of the report.

Heidi Smoult

Deputy Chief Inspector of Hospitals (Independent Health, Central region)