Archived: Wells Community Hospital Trust

Mermaid Dialysis Unit is a nurse led dialysis unit operated by Wells Community Hospital Trust. Wells Community Hospital Trust is a charity. Patients attending the unit received NHS funded care commissioned by NHS England. The Mermaid Dialysis unit comprises four dialysis stations, and provides short term haemodialysis (dialysis) for adults aged 18 and over who are on holiday in the area. The service is open Monday to Saturday from April to November depending on patient bookings. Morning and afternoon dialysis sessions are provided. The service does not provide regular, long-term dialysis services.

We inspected the dialysis service using our comprehensive inspection methodology. We carried out the announced part of the inspection on 20 June 2017 along with an unannounced visit on 4 July 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.

S e r v ices 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 provider had clear criteria for ensuring that patients accepted for holiday dialysis had been appropriately screened, and were negative, for infections such as Methicillin-resistant Staphylococcus aureus (MRSA) and blood borne viruses. The provider did not have any isolation facilities.
• Staff were up to date with mandatory training, including basic life support.
• Dialysis sets were single use, to European standard (CE marked) and checked by staff to be intact and within sterility date. Staff recorded the lot number of dialyser and tubing sets used during each dialysis session. This was in line with Renal Association Haemodialysis Guidelines (2009) and meant that if there were any problems identified with consumable items, staff could contact the manufacturer and refer to the batch number.
• Staff kept detailed records of care provided. We reviewed four patient records and found that all were signed, dated and legible. Staff communicated with each patient’s home dialysis unit to make sure they had all the relevant information about the patient’s care.
• One registered nurse (RN) and one health care assistant (HCA) provided care to a maximum of four patients at any one time. This level of staffing met the nurse to patient ratio outlined within the Renal Workforce Planning Group guidance (2002) of one nurse to four patients.
• Staff referenced policies which were up to date and based on national guidance.
• Staff obtained written consent to treatment from patients before starting their first session of dialysis treatment. We reviewed four patient consent forms and found that all four were signed, dated and correctly completed.
• Feedback from patients about the service was consistently positive. An audit of patient satisfaction surveys for April to November 2016 showed positive results, with 99.6% of patients saying they would recommend the service.
• Patients were encouraged to self-manage aspects of their care if they wished to do so. Staff told us how they would be flexible to patients’ needs and preferences, for example by offering flexibility in the timing of dialysis sessions, so that patients could enjoy their holiday.
• Staff offered patients support and reassurance while they were away from home. For example, nursing staff told us they were available as a point of contact for patients outside the hours of their dialysis sessions.
• There was a clear complaints procedure, which was outlined in the complaints policy and shared with patients via a patient information leaflet. The service had not received any complaints in the reporting period January 2016 to December 2016.
• Staff were experienced in renal dialysis. The unit manager and the renal nurse both held the certificate in renal nursing.
• Nursing staff routinely monitored patient temperature pre dialysis. Nursing staff monitored patients’ blood pressure pre, during and post dialysis in order to be able to identify and respond to a deteriorating patient.

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

•  Staff had regular renal team meetings to discuss the service, but did not keep records of these meetings.
• The provider did not formally gather staff feedback.

Following this inspection, we told the provider that it should make some improvements, even though a regulation had not been breached, to help the service improve.

Heidi Smoult

Deputy Chief Inspector of Hospitals